Interprofessional education and the basic sciences: Rationale and outcomes.

PubMed

Thistlethwaite, Jill E

2015-01-01

Interprofessional education (IPE) aims to improve patient outcomes and the quality of care. Interprofessional learning outcomes and interprofessional competencies are now included in many countries' health and social care professions' accreditation standards. While IPE may take place at any time in health professions curricula it tends to focus on professionalism and clinical topics rather than basic science activities. However generic interprofessional competencies could be included in basic science courses that are offered to at least two different professional groups. In developing interprofessional activities at the preclinical level, it is important to define explicit interprofessional learning outcomes plus the content and process of the learning. Interprofessional education must involve interactive learning processes and integration of theory and practice. This paper provides examples of IPE in anatomy and makes recommendations for course development and evaluation. © 2015 American Association of Anatomists.

Research Strategies To Improve the Outcome of Secondary Special Education Programs for Mildly Handicapped Students: System Support Strategies.

ERIC Educational Resources Information Center

Edgar, Eugene; Vadasy, Patricia F.

This paper proposes system supports to improve the post-school status of mildly disabled special education students and recommends that such supports be a focus of research supported by the federal Office of Special Education and Rehabilitation Services. Each service is discussed in terms of its rationale, possible content, process measures,…

The Big Crunch: A Hybrid Solution to Earth and Space Science Instruction for Elementary Education Majors

ERIC Educational Resources Information Center

Cervato, Cinzia; Kerton, Charles; Peer, Andrea; Hassall, Lesya; Schmidt, Allan

2013-01-01

We describe the rationale and process for the development of a new hybrid Earth and Space Science course for elementary education majors. A five-step course design model, applicable to both online and traditional courses, is presented. Assessment of the course outcomes after two semesters indicates that the intensive time invested in the…

Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care.

PubMed

Blijleven, Vincent; Koelemeijer, Kitty; Wetzels, Marijntje; Jaspers, Monique

2017-10-05

Health care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow unintendedly imposed by electronic health record systems (EHRs). Although workarounds may seem favorable at first sight, they are generally suboptimal and may jeopardize patient safety, effectiveness of care, and efficiency of care. Research into the scope and impact of EHR workarounds on patient care processes is scarce. This paper provides insight into the effects of EHR workarounds on organizational workflows and outcomes of care services by identifying EHR workarounds and determining their rationales, scope, and impact on health care providers' workflows, patient safety, effectiveness of care, and efficiency of care. Knowing the rationale of a workaround provides valuable clues about the source of origin of each workaround and how each workaround could most effectively be resolved. Knowing the scope and impact a workaround has on EHR-related safety, effectiveness, and efficiency provides insight into how to address related concerns. Direct observations and follow-up semistructured interviews with 31 physicians, 13 nurses, and 3 clerks and qualitative bottom-up coding techniques was used to identify, analyze, and classify EHR workarounds. The research was conducted within 3 specialties and settings at a large university hospital. Rationales were associated with work system components (persons, technology and tools, tasks, organization, and physical environment) of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to reveal their source of origin as well as to determine the scope and the impact of each EHR workaround from a structure-process-outcome perspective. A total of 15 rationales for EHR workarounds were identified of which 5 were associated with persons, 4 with technology and tools, 4 with the organization, and 2 with the tasks. Three of these 15 rationales for EHR workarounds have not been identified in prior research: data migration policy, enforced data entry, and task interference. EHR workaround rationales associated with different SEIPS work system components demand a different approach to be resolved. Persons-related workarounds may most effectively be resolved through personal training, organization-related workarounds through reviewing organizational policy and regulations, tasks-related workarounds through process redesign, and technology- and tools-related workarounds through EHR redesign efforts. Furthermore, insights gained from knowing a workaround's degree of influence as well as impact on patient safety, effectiveness of care, and efficiency of care can inform design and redesign of EHRs to further align EHR design with work contexts, subsequently leading to better organization and (safe) provision of care. In doing so, a research team in collaboration with all stakeholders could use the SEIPS framework to reflect on the current and potential future configurations of the work system to prevent unfavorable workarounds from occurring and how a redesign of the EHR would impact interactions between the work system components. ©Vincent Blijleven, Kitty Koelemeijer, Marijntje Wetzels, Monique Jaspers. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 05.10.2017.

Four nurse entrepreneurs: what motivated them to start their own businesses.

PubMed

Roggenkamp, S D; White, K R

1998-01-01

In an environment of change, innovators or entrepreneurs emerge to develop new methods and processes of delivering health care in a way that lowers the overall costs of care while improving outcomes. This qualitative study looks at the factors that motivate nurse entrepreneurs as well as the characteristics of nurse entrepreneurs and their business ventures. The rationale for health care managers to capitalize on nurse entrepreneurship is discussed as an effective method of strategic adaptation.

Evaluation of nursing practice: process and critique.

PubMed

Braunstein, M S

1998-01-01

This article describes the difficulties in conducting clinical trials to evaluate nursing practice models. Suggestions are offered for strengthening the process. A clinical trial of a nursing practice model based on a synthesis of Aristotelian theory with Rogers' science is described. The rationale for decisions regarding the research procedures used in presented. Methodological limitations of the study design and the specifications of the practice model are examined. It is concluded that clear specification of theoretical relationships within a practice model and clear identification of key intervening variables will enable researchers to better connect the treatment with the outcome.

Measuring Student Performance: Assessment in the Social Studies. Theme Issue.

ERIC Educational Resources Information Center

Kiernan, Henry, Ed.; Pyne, John, Ed.

1993-01-01

The four articles in this theme issue provide an overview of assessment in the social studies and the rationale behind the movement for a more authentic assessment of learning outcomes. In the first article, "Thinking as an Unnatural Act," William T. Daly offers a clear rationale for social studies teachers to re-examine the methods of assessing…

Telework rationale and implementation for people with disabilities: considerations for employer policymaking.

PubMed

Moon, Nathan W; Linden, Maureen A; Bricout, John C; Baker, Paul M A

2014-01-01

Telework has been promoted as a viable workplace accommodation for people with disabilities since the 1990s, when information and communication technologies (ICT) had developed sufficiently to facilitate its widespread adoption. This initial research and accompanying policy recommendations were prescriptive in nature and frequently aimed at employers. This article adds to existing policy models for facilitating successful telework outcomes for people with disabilities. Drawing upon two studies by the Rehabilitation Engineering Research Center on Workplace Accommodations, we expound on employee-side considerations in the implementation of telework. Our policy model utilizes established typologies for policy evaluation to develop a process model that considers rationales and implementation factors for telework among people with physical disabilities. Telework may be used as an accommodation for disability, but employee rationales for telework are more complex, involving work-life balance, strategies for pain and fatigue not formally recognized as disability, and expediency in travel and transportation. Implementation of telework as a component of workplace operations is similarly multifaceted, involving non-technology accommodations to realize job restructuring left incomplete by telework. Our model grounds new empirical research in this area. We also renew our call for additional research on effective telework practices for people with disabilities.

Building capacity in nursing: creating a leadership institute.

PubMed

Simpson, Beverley; Skelton-Green, Judith; Scott, Julia J; O'Brien-Pallas, Linda

2002-01-01

The authors describe the development of the Dorothy M. Wylie Nursing Leadership Institute, an innovative partnership of the Nursing Effectiveness, Outcomes and Utilization Research Unit at the University of Toronto site and nurse consultants with expertise in organizational and human resource development. The context for the initiative, needs and rationale, supporting literature and the coalition-building and planning activities are outlined. The program and its conceptual underpinnings, creation of a learning community, participant profiles, evaluation processes and future plans are described.

Reference-dependent risk sensitivity as rational inference.

PubMed

Denrell, Jerker C

2015-07-01

Existing explanations of reference-dependent risk sensitivity attribute it to cognitive imperfections and heuristic choice processes. This article shows that behavior consistent with an S-shaped value function could be an implication of rational inferences about the expected values of alternatives. Theoretically, I demonstrate that even a risk-neutral Bayesian decision maker, who is uncertain about the reliability of observations, should use variability in observed outcomes as a predictor of low expected value for outcomes above a reference level, and as a predictor of high expected value for outcomes below a reference level. Empirically, I show that combining past outcomes using an S-shaped value function leads to accurate predictions about future values. The theory also offers a rationale for why risk sensitivity consistent with an inverse S-shaped value function should occur in experiments on decisions from experience with binary payoff distributions. (c) 2015 APA, all rights reserved).

Interprofessional Education and the Basic Sciences: Rationale and Outcomes

ERIC Educational Resources Information Center

Thistlethwaite, Jill E.

2015-01-01

Interprofessional education (IPE) aims to improve patient outcomes and the quality of care. Interprofessional learning outcomes and interprofessional competencies are now included in many countries' health and social care professions' accreditation standards. While IPE may take place at any time in health professions curricula it tends to focus on…

Evaluating the Rationale for Affirmative Action in College Admissions: Direct and Indirect Relationships between Campus Diversity and Gains in Understanding Diverse Groups

ERIC Educational Resources Information Center

Pike, Gary R.; Kuh, George D.; Gonyea, Robert M.

2007-01-01

Affirmative action in college admissions is based on the premise that a diverse student body contributes to interactions among students from different backgrounds, which are in turn positively related to desirable outcomes of college. This study evaluates the merits of this rationale for affirmative action by examining the direct and indirect…

Process and Outcome of Fecal Microbiota Transplants in Patients With Recurrent Clostridium difficile Infection: A Prospective Study.

PubMed

Walton, Janice; Burns, Denise; Gaehle, Kay E

The incidence of Clostridium difficile infection is on the rise worldwide, causing high mortality rates and costing patients, hospitals, and insurance companies millions of dollars annually. Fecal microbiota transplants successfully treat recurrent C. difficile infections unresponsive to standard pharmacologic treatment such as flagyl, vancomycin, or rifaximin. Evidence in the literature provided the foundation for the development and refinement of this fecal microbiota transplant protocol. During the initial phase of the project, the protocol included patient selection criteria, donor screening/selection, infection control, fecal processing and delivery, and patient pre and postprocedure education. This article highlights the second phase of prospective testing of a nurse-driven protocol to implement fecal microbiota transplantation in patients with recurrent C. difficile infection. All stages of the protocol are explained as well as rationale for component parts to achieve successful patient outcomes when the protocol is carefully followed.

Getting to Outcomes: An Evaluation Capacity Building Example of Rationale, Science, and Practice

ERIC Educational Resources Information Center

Wandersman, Abraham

2014-01-01

The Labin et al. logic model describes the why, how, what, and potential outcomes of evaluation capacity building (ECB). Getting To Outcomes offers a frame and empirical results for operationalizing the ECB logic model of Labin et al. and for deepening the science and practice of ECB.

The ‘grey’ assessment practice of IA screening: Prevalence, influence and applied rationale

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bidstrup, Morten, E-mail: Bidstrup@plan.aau.dk

Research focusing on the practices surrounding screening in Impact Assessment (IA) is limited. Yet, it has been found that development proposals sometimes are adjusted through an informal dialog with IA practitioners prior to or during screening. Such practice is often referred to as ‘grey IA’ in Denmark. This article explores the prevalence, influence and applied rationale of grey IA. Through a questionnaire, data was collected from 121 IA practitioners working within the fields of environmental impact assessment and strategic environmental assessment. It was found that grey IA is a common practice, which influences the outcomes of formal screening procedures throughmore » consideration of impacts on neighbours and spatial zones of protection. Grey IA is to some extent motivated by the opportunity to save the resources required for full-scale IA, but an additional ‘green’ rationale also exists. Grey IA may influence the effectiveness of IA systems, but further research is needed before any conclusions can be made. - Highlights: • Screening procedures may function as an informal, ‘grey’ assessment. • Grey assessment is common and influences formal screening outcomes. • Grey assessment is motivated by an opportunity to cut IA costs. • Yet, an environmental, ‘green’ rationale for grey assessment also exists.« less

Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review.

PubMed

Sandborgh, Maria; Dean, Elizabeth; Denison, Eva; Elvén, Maria; Fritz, Johanna; Wågert, Petra von Heideken; Moberg, Johan; Overmeer, Thomas; Snöljung, Åsa; Johansson, Ann-Christin; Söderlund, Anne

2018-06-21

In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicine content and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

Rationale, design and methodology of a trial evaluating three strategies designed to improve sedation quality in intensive care units (DESIST study).

PubMed

Walsh, Timothy S; Kydonaki, Kalliopi; Antonelli, Jean; Stephen, Jacqueline; Lee, Robert J; Everingham, Kirsty; Hanley, Janet; Uutelo, Kimmo; Peltola, Petra; Weir, Christopher J

2016-03-04

To describe the rationale, design and methodology for a trial of three novel interventions developed to improve sedation-analgesia quality in adult intensive care units (ICUs). 8 clusters, each a Scottish ICU. All mechanically ventilated sedated patients were potentially eligible for inclusion in data analysis. Cluster randomised design in 8 ICUs, with ICUs randomised after 45 weeks baseline data collection to implement one of four intervention combinations: a web-based educational programme (2 ICUs); education plus regular sedation quality feedback using process control charts (2 ICUs); education plus a novel sedation monitoring technology (2 ICUs); or all three interventions. ICUs measured sedation-analgesia quality, relevant drug use and clinical outcomes, during a 45-week preintervention and 45-week postintervention period separated by an 8-week implementation period. The intended sample size was >100 patients per site per study period. The primary outcome was the proportion of 12 h care periods with optimum sedation-analgesia, defined as the absence of agitation, unnecessary deep sedation, poor relaxation and poor ventilator synchronisation. Secondary outcomes were proportions of care periods with each of these four components of optimum sedation and rates of sedation-related adverse events. Sedative and analgesic drug use, and ICU and hospital outcomes were also measured. Multilevel generalised linear regression mixed models will explore the effects of each intervention taking clustering into account, and adjusting for age, gender and APACHE II score. Sedation-analgesia quality outcomes will be explored at ICU level and individual patient level. A process evaluation using mixed methods including quantitative description of intervention implementation, focus groups and direct observation will provide explanatory information regarding any effects observed. The DESIST study uses a novel design to provide system-level evaluation of three contrasting complex interventions on sedation-analgesia quality. Recruitment is complete and analysis ongoing. NCT01634451. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Recent advances in botulinum neurotoxin inhibitor development.

PubMed

Kiris, Erkan; Burnett, James C; Kane, Christopher D; Bavari, Sina

2014-01-01

Botulinum neurotoxins (BoNTs) are endopeptidases that target motor neurons and block acetylcholine neurotransmitter release. This action results in the muscle paralysis that defines the disease botulism. To date, there are no FDA-approved therapeutics to treat BoNT-mediated paralysis after intoxication of the motor neuron. Importantly, the rationale for pursuing treatments to counter these toxins is driven by their potential misuse. Current drug discovery efforts have mainly focused on small molecules, peptides, and peptidomimetics that can directly and competitively inhibit BoNT light chain proteolytic activity. Although this is a rational approach, direct inhibition of the Zn(2+) metalloprotease activity has been elusive as demonstrated by the dearth of candidates undergoing clinical evaluation. Therefore, broadening the scope of viable targets beyond that of active site protease inhibitors represents an additional strategy that could move the field closer to the clinic. Here we review the rationale, and discuss the outcomes of earlier approaches and highlight potential new targets for BoNT inhibition. These include BoNT uptake and processing inhibitors, enzymatic inhibitors, and modulators of neuronal processes associated with toxin clearance, neurotransmitter potentiation, and other pathways geared towards neuronal recovery and repair.

Molecularly targeted therapies for malignant glioma: rationale for combinatorial strategies

PubMed Central

Thaker, Nikhil G; Pollack, Ian F

2010-01-01

Median survival of patients with malignant glioma (MG) from time of diagnosis is approximately 1 year, despite surgery, irradiation and conventional chemotherapy. Improving patient outcome relies on our ability to develop more effective therapies that are directed against the unique molecular aberrations within a patient’s tumor. Such molecularly targeted therapies may provide novel treatments that are more effective than conventional chemotherapeutics. Recently developed therapeutic strategies have focused on targeting several core glioma signaling pathways, including pathways mediated by growth-factors, PI3K/Akt/PTEN/mTOR, Ras/Raf/MEK/MAPK and other vital pathways. However, given the molecular diversity, heterogeneity and diverging and converging signaling pathways associated with MG, it is unlikely that any single agent will have efficacy in more than a subset of tumors. Overcoming these therapeutic barriers will require multiple agents that can simultaneously inhibit these processes, providing a rationale for combination therapies. This review summarizes the currently implemented single-agent and combination molecularly targeted therapies for MG. PMID:19951140

Structure, Citizenship, and Professionalism: Exploring Rationale Development as Part of Graduate Education in Social Studies

ERIC Educational Resources Information Center

Hawley, Todd S.; Pifel, A. Robert; Jordan, Adam W.

2012-01-01

This article details an interpretive, qualitative interview study that explored rationales developed by seven social studies graduate students, all experienced teachers, at a large Midwestern university. Interviews revealed three common themes regarding the influence of the rationale development process. The three themes were: providing structure,…

Rationale for Using Social Media to Collect Patient-Reported Outcomes in Patients with Celiac Disease.

PubMed

Park, Kt; Harris, Merissa; Khavari, Nasim; Khosla, Chaitan

2014-02-01

Patients with celiac disease (CD) are increasingly interconnected through social media, exchanging patient experiences and health-tracking information between individuals through various web-based platforms. Social media represents potentially unique communication interface between gastroenterologists and active social media users - especially young adults and adolescents with celiac disease-regarding adherence to the strict gluten-free diet, gastrointestinal symptoms, and meaningful discussion about disease management. Yet, various social media platforms may be underutilized for research purposes to collect patient-reported outcomes data. In this commentary, we summarize the scientific rationale and potential for future growth of social media in patient-reported outcomes research, focusing on college freshmen with celiac disease as a case study and provide overview of the methodological approach. Finally, we discuss how social media may impact patient care in the future through increasing mobile technology use.

Development of a publicly available, comprehensive database of fiber and health outcomes: rationale and methods

USDA-ARS?s Scientific Manuscript database

Background: Dietary fiber is a broad category of compounds historically defined as partially or completely indigestible plant-based carbohydrates and lignin with, more recently, the additional criteria that fibers incorporated into foods as additives should demonstrate functional human health outcom...

Innovative Training in Pediatrics, General Psychiatry, and Child Psychiatry: Background, Outcomes, and Experiences

ERIC Educational Resources Information Center

Gleason, Mary Margaret; Fritz, Gregory K.

2009-01-01

Objectives: The authors describe the history, rationale, and outcomes of combined training programs in pediatrics, psychiatry, and child psychiatry ("triple board"), including narrative feedback from graduates and reflections upon the important components of the program. Methods: This article reviews the background and experiences of triple board…

A preliminary report of music-based training for adult cochlear implant users: Rationales and development.

PubMed

Gfeller, Kate; Guthe, Emily; Driscoll, Virginia; Brown, Carolyn J

2015-09-01

This paper provides a preliminary report of a music-based training program for adult cochlear implant (CI) recipients. Included in this report are descriptions of the rationale for music-based training, factors influencing program development, and the resulting program components. Prior studies describing experience-based plasticity in response to music training, auditory training for persons with hearing impairment, and music training for CI recipients were reviewed. These sources revealed rationales for using music to enhance speech, factors associated with successful auditory training, relevant aspects of electric hearing and music perception, and extant evidence regarding limitations and advantages associated with parameters for music training with CI users. This informed the development of a computer-based music training program designed specifically for adult CI users. Principles and parameters for perceptual training of music, such as stimulus choice, rehabilitation approach, and motivational concerns were developed in relation to the unique auditory characteristics of adults with electric hearing. An outline of the resulting program components and the outcome measures for evaluating program effectiveness are presented. Music training can enhance the perceptual accuracy of music, but is also hypothesized to enhance several features of speech with similar processing requirements as music (e.g., pitch and timbre). However, additional evaluation of specific training parameters and the impact of music-based training on speech perception of CI users is required.

A preliminary report of music-based training for adult cochlear implant users: rationales and development

PubMed Central

Gfeller, Kate; Guthe, Emily; Driscoll, Virginia; Brown, Carolyn J.

2015-01-01

Objective This paper provides a preliminary report of a music-based training program for adult cochlear implant (CI) recipients. Included in this report are descriptions of the rationale for music-based training, factors influencing program development, and the resulting program components. Methods Prior studies describing experience-based plasticity in response to music training, auditory training for persons with hearing impairment, and music training for cochlear implant recipients were reviewed. These sources revealed rationales for using music to enhance speech, factors associated with successful auditory training, relevant aspects of electric hearing and music perception, and extant evidence regarding limitations and advantages associated with parameters for music training with CI users. This information formed the development of a computer-based music training program designed specifically for adult CI users. Results Principles and parameters for perceptual training of music, such as stimulus choice, rehabilitation approach, and motivational concerns were developed in relation to the unique auditory characteristics of adults with electric hearing. An outline of the resulting program components and the outcome measures for evaluating program effectiveness are presented. Conclusions Music training can enhance the perceptual accuracy of music, but is also hypothesized to enhance several features of speech with similar processing requirements as music (e.g., pitch and timbre). However, additional evaluation of specific training parameters and the impact of music-based training on speech perception of CI users are required. PMID:26561884

Core outcome sets for research and clinical practice.

PubMed

Chiarotto, Alessandro; Ostelo, Raymond W; Turk, Dennis C; Buchbinder, Rachelle; Boers, Maarten

This masterclass introduces the topic of core outcome sets, describing rationale and methods for developing them, and providing some examples that are relevant for clinical research and practice. A core outcome set is a minimum consensus-based set of outcomes that should be measured and reported in all clinical trials for a specific health condition and/or intervention. Issues surrounding outcome assessment, such as selective reporting and inconsistency across studies, can be addressed by the development of a core set. As suggested by key initiatives in this field (i.e. OMERACT and COMET), the development requires achieving consensus on: (1) core outcome domains and (2) core outcome measurement instruments. Different methods can be used to reach consensus, including: literature systematic reviews to inform the process, qualitative research with clinicians and patients, group discussions (e.g. nominal group technique), and structured surveys (e.g. Delphi technique). Various stakeholders should be involved in the process, with particular attention to patients. Several COSs have been developed for musculoskeletal conditions including a longstanding one for low back pain, IMMPACT recommendations on outcomes for chronic pain, and OMERACT COSs for hip, knee and hand osteoarthritis. There is a lack of COSs for neurological, geriatric, cardio-respiratory and pediatric conditions, therefore, future research could determine the value of developing COSs for these conditions. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Sustaining and Improving Study Abroad Experiences Through Comparative Evaluation.

PubMed

Johanson, Linda S

Researchers have related participation in study abroad experiences to many positive outcomes for nursing students; however, educators are faced with the task of not only developing meaningful study abroad opportunities but sustaining and improving them as well. Educators can evaluate repeat study abroad programs by comparing experiences, looking for trends, and conjecturing rationales. To illustrate this process, an example of a study abroad opportunity that has been repeated over 11 years is presented. The first six years have been compared to the most recent five years, revealing three categories of change for evaluation and the resulting course improvements.

A Rationale for Music Training to Enhance Executive Functions in Parkinson's Disease: An Overview of the Problem.

PubMed

Lesiuk, Teresa; Bugos, Jennifer A; Murakami, Brea

2018-04-22

Music listening interventions such as Rhythmic Auditory Stimulation can improve mobility, balance, and gait in Parkinson’s Disease (PD). Yet, the impact of music training on executive functions is not yet known. Deficits in executive functions (e.g., attention, processing speed) in patients with PD result in gait interference, deficits in emotional processing, loss of functional capacity (e.g., intellectual activity, social participation), and reduced quality of life. The model of temporal prediction and timing suggests two networks collectively contribute to movement generation and execution: the basal ganglia-thalamocortical network (BGTC) and the cerebellar-thalamocortical network (CTC). Due to decreases in dopamine responsible for the disruption of the BGTC network in adults with PD, it is hypothesized that rhythmic auditory cues assist patients through recruiting an alternate network, the CTC, which extends to the supplementary motor areas (SMA) and the frontal cortices. In piano training, fine motor finger movements activate the cerebellum and SMA, thereby exercising the CTC network. We hypothesize that exercising the CTC network through music training will contribute to enhanced executive functions. Previous research suggested that music training enhances cognitive performance (i.e., working memory and processing speed) in healthy adults and adults with cognitive impairments. This review and rationale provides support for the use of music training to enhance cognitive outcomes in patients with Parkinson’s Disease (PD).

The Long-Term Oxygen Treatment Trial for Chronic Obstructive Pulmonary Disease: Rationale, Design, and Lessons Learned.

PubMed

Yusen, Roger D; Criner, Gerard J; Sternberg, Alice L; Au, David H; Fuhlbrigge, Anne L; Albert, Richard K; Casaburi, Richard; Stoller, James K; Harrington, Kathleen F; Cooper, J Allen D; Diaz, Philip; Gay, Steven; Kanner, Richard; MacIntyre, Neil; Martinez, Fernando J; Piantadosi, Steven; Sciurba, Frank; Shade, David; Stibolt, Thomas; Tonascia, James; Wise, Robert; Bailey, William C

2018-01-01

The Long-Term Oxygen Treatment Trial demonstrated that long-term supplemental oxygen did not reduce time to hospital admission or death for patients who have stable chronic obstructive pulmonary disease and resting and/or exercise-induced moderate oxyhemoglobin desaturation, nor did it provide benefit for any other outcome measured in the trial. Nine months after initiation of patient screening, after randomization of 34 patients to treatment, a trial design amendment broadened the eligible population, expanded the primary outcome, and reduced the goal sample size. Within a few years, the protocol underwent minor modifications, and a second trial design amendment lowered the required sample size because of lower than expected treatment group crossover rates. After 5.5 years of recruitment, the trial met its amended sample size goal, and 1 year later, it achieved its follow-up goal. The process of publishing the trial results brought renewed scrutiny of the study design and the amendments. This article expands on the previously published design and methods information, provides the rationale for the amendments, and gives insight into the investigators' decisions about trial conduct. The story of the Long-Term Oxygen Treatment Trial may assist investigators in future trials, especially those that seek to assess the efficacy and safety of long-term oxygen therapy. Clinical trial registered with clinicaltrials.gov (NCT00692198).

Diabetes Prevention for Latino Youth: Unraveling the Intervention "Black Box".

PubMed

Shaibi, Gabriel Q; Konopken, Yolanda P; Nagle-Williams, Allison; McClain, Darya D; Castro, Felipe Gonzalez; Keller, Colleen S

2015-11-01

The translation of research findings into sustainable health promotion and disease prevention programs in community settings remains a challenge. This report describes the process of substantiating a community-developed diabetes prevention program for Latino youth through research. Included are design considerations, measurement strategies, and the context through which the project is culturally grounded for relevance and fit within a local community. The process included (1) refining the program to include salient, stakeholder-identified behavioral components; (2) refining the collaborative effort to embrace the capacity for facilitating relevant behavior change on targeted health-related outcomes to enhance intervention effectiveness; and (3) including the accurate assessment of intervention efficacy via precise assessment of diabetes-related health outcomes. We explain the process of collaborating with community partners to enhance the cultural relevance and sustainability of intervention effects on both individuals and communities. We discuss the rationale for empirical support for academic-community collaborations that function in both a "top-down" and a "bottom-up" manner to advance the science and practice of sustainable and efficacious community health promotion. © 2015 Society for Public Health Education.

Creating an Outcomes-Based Tool for Learning Barrier Assessment in an Outpatient Education Program.

ERIC Educational Resources Information Center

Hernandez, Teri L.; Rupnow, Jana M.; Currie, Kristi A.; Procious, James K.; Adams, Jenny

2003-01-01

An outcomes-based assessment instrument was devised to screen patients for learning problems that would impede patient education in cardiac rehabilitation. Criteria for seven barriers were established: hearing, language, cultural, religious, vision, cognitive, emotional). Points of data collection and a rationale for collection were identified.…

Strengthening Resilience in Children and Youths: Maximizing Opportunities through the Schools

ERIC Educational Resources Information Center

Brooks, Jean E.

2006-01-01

Children and youths are at risk of some negative outcomes because of hazards in their environment. A review of the literature on resilience provides guidelines for minimizing risks and promoting positive outcomes for children and youths. This article provides a rationale for incorporating resilience-building efforts in schools and explores ways in…

Rationale and Methods of the Substance Use and Psychological Injury Combat Study (SUPIC): A Longitudinal Study of Army Service Members Returning from Deployment in FY2008–2011

PubMed Central

Larson, Mary Jo; Adams, Rachel Sayko; Mohr, Beth A.; Harris, Alex H. S.; Merrick, Elizabeth L.; Funk, Wendy; Hofmann, Keith; Wooten, Nikki R.; Jeffery, Diana D.; Williams, Thomas V.

2013-01-01

SUPIC will examine whether early detection and intervention for post-deployment problems among Army Active Duty and National Guard/Reservists returning from Iraq or Afghanistan are associated with improved long-term substance use and psychological outcomes. This paper describes the rationale and significance of SUPIC, and presents demographic and deployment characteristics of the study sample (N=643,205), and self-reported alcohol use and health problems from the subsample with matched post-deployment health assessments (N=487,600). This longitudinal study aims to provide new insight into the long-term post-deployment outcomes of Army members by combining service member data from the Military Health System and Veterans Health Administration. PMID:23869459

Protocol: realist synthesis of the impact of unemployment insurance policies on poverty and health.

PubMed

Molnar, Agnes; O'Campo, Patricia; Ng, Edwin; Mitchell, Christiane; Muntaner, Carles; Renahy, Emilie; St John, Alexander; Shankardass, Ketan

2015-02-01

Unemployment insurance is an important social protection policy that buffers unemployed workers against poverty and poor health. Most unemployment insurance studies focus on whether increases in unemployment insurance generosity are predictive of poverty and health outcomes. Less work has used theory-driven approaches to understand and explain how and why unemployment insurance works, for whom, and under what circumstances. Given this, we present a realist synthesis protocol that seeks to unpack how contextual influences trigger relevant mechanisms to generate poverty and health outcomes. In this protocol, we conceptualize unemployment insurance as a key social protection policy; provide a supporting rationale on the need for a realist synthesis; and describe our process on identifying context-mechanism-outcome pattern configurations. Six methodological steps are described: initial theory development, search strategy; selection and appraisal of documents; data extraction; analysis and synthesis process; and presentation and dissemination of revised theory. Our forthcoming realist synthesis will be the first to build and test theory on the intended and unintended outcomes of unemployment insurance policies. Anticipated findings will allow policymakers to move beyond 'black box' approaches to consider 'mechanism-based' explanations that explicate the logic on how and why unemployment insurance matters. Copyright © 2014 Elsevier Ltd. All rights reserved.

Educational reform and the public: Two case studies of Poland and Saskatchewan (Canada)

NASA Astrophysics Data System (ADS)

Kaproń, Danuta; Stephan, Werner

1991-09-01

The involvement of the public in educational reform processes in modern democratic societies primarily serves the purpose of politically legitimizing the reform agenda. This study examines the rationales implicitly or explicitly submitted to the public to explain why educational reforms in the two countries should be endorsed. Although differences in the political culture caution against a hasty comparison of the two case studies, a number of politico-economic similarities allow for a valid juxtaposition. In Poland the context of socio-political and economic renewal prompted the reformers to emphasize the human-capital model which heightened public awareness and participation in the debate surrounding the reform. Public involvement in Saskatchewan was negatively affected for mainly two reasons. First, the government evidently manipulated public input by various means and thereby appears to have predetermined the outcome. Second, the rationale for the reform, based on a free-market model, tightened the linkage between the needs of the labour market and the mandate of the schools. As a result, public interest and participation was greatly diminished.

A problem-based learning curriculum for occupational therapy education.

PubMed

Royeen, C B

1995-04-01

To prepare practitioners and researchers who are well equipped to deal with the inevitable myriad changes in health care and in society coming in the 21st century, a new focus is needed in occupational therapy education. In addition to proficiency in clinical skills and technical knowledge, occupational therapy graduates will need outcome competencies underlying the skills of critical reflection. In this article, the author presents (a) the rationale for the need for change in occupational therapy education, (b) key concepts of clinical reasoning and critical reflection pertaining to the outcome such change in occupational therapy education should address, (c) problem-based learning as a process and educational method to prepare occupational therapists in these competencies, and (d) the experience of the Program in Occupational Therapy at Shenandoah University in Winchester, Virginia, in implementing a problem-based learning curriculum.

Two-step epigenetic Mendelian randomization: a strategy for establishing the causal role of epigenetic processes in pathways to disease

PubMed Central

Relton, Caroline L; Davey Smith, George

2012-01-01

The burgeoning interest in the field of epigenetics has precipitated the need to develop approaches to strengthen causal inference when considering the role of epigenetic mediators of environmental exposures on disease risk. Epigenetic markers, like any other molecular biomarker, are vulnerable to confounding and reverse causation. Here, we present a strategy, based on the well-established framework of Mendelian randomization, to interrogate the causal relationships between exposure, DNA methylation and outcome. The two-step approach first uses a genetic proxy for the exposure of interest to assess the causal relationship between exposure and methylation. A second step then utilizes a genetic proxy for DNA methylation to interrogate the causal relationship between DNA methylation and outcome. The rationale, origins, methodology, advantages and limitations of this novel strategy are presented. PMID:22422451

Development of an Outcome Measurement Tool for a Teen Parent Wraparound Program

ERIC Educational Resources Information Center

Fries, Derrick; Carney, Karen J.; Blackman-Urteaga, Laura; Savas, Sue Ann

2012-01-01

This article chronicles the search for and development of an outcome measurement tool for teen parents receiving community-based wraparound services. The criteria for selecting functional assessment tools available in the literature is presented along with the barriers experienced in using two of these well-cited tools. The rationale for in-house…

Perioperative ketorolac in high risk breast cancer patients. Rationale, feasibility and methodology of a prospective randomized placebo-controlled trial.

PubMed

Forget, Patrice; Berlière, Martine; van Maanen, Aline; Duhoux, Francois P; Machiels, Jean-Pascal; Coulie, Pierre G; Bouche, Gauthier; De Kock, Marc

2013-10-01

Ketorolac, a NSAID routinely used during surgery proposed to have anticancer effects, is a promising way to improve postoperative oncological outcome. This effect may be particularly prominent in patients with elevated preoperative inflammatory scores, like the neutrophil:lymphocyte ratio. In this paper, we describe the rationale, the preliminary analyses in our patients, the feasibility and the methodology of a prospective randomized trial called "Ketorolac in Breast Cancer trial" (KBCt) (NCT01806259). Copyright © 2013 Elsevier Ltd. All rights reserved.

Non-speech oro-motor exercise use in acquired dysarthria management: regimes and rationales.

PubMed

Mackenzie, Catherine; Muir, Margaret; Allen, Carolyn

2010-01-01

Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy manuals and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. The investigation sought to collect development-phase data, in accordance with the Medical Research Council (MRC) evaluation of complex interventions. The aims were to establish the extent of use of NSOMExs in acquired disorders, the exercise regimes in use for dysarthria, with which dysarthric populations, and the anticipated clinical outcomes. A further aim was to determine the influencing rationales where NSOMExs were or were not used in dysarthria intervention. Speech and language therapists throughout Scotland, Wales, and Northern Ireland, working with adult-acquired dysarthria, were identified by their service heads. They received postal questionnaires comprising 21 closed and two open questions, covering respondent biographics, use of NSOMExs, anticipated clinical outcomes, and practice influencing rationales. One hundred and ninety-one (56% response) completed questionnaires were returned. Eighty-one per cent of respondents used NSOMExs in dysarthria. There was no association with years of speech and language therapy experience. Those who used and those who did not use NSOMExs provided similar influencing rationales, including evidence from their own practice, and Higher Education Institute teaching. More experienced speech and language therapists were more likely than those more recently qualified to be guided by results from their own practice. Input from the attended Higher Education Institute was more influential for those less experienced than for those more experienced. Clinical outcome aims were not confined to speech, but also included improvements in movement, sensory awareness, appearance, emotional status, dysphagia and drooling. NSOMExs were used with many neurological disorders, especially stroke, all dysarthria classes, especially flaccid, and all severity levels. Tongue and lip exercises were more frequent than face, jaw and soft palate. The most common regimes were four to six repetitions of each exercise, during three practice periods daily, each of 6–10 min. NSOMExs are a frequent component of dysarthria management in the UK-devolved government countries. This confirmation, along with the details of speech and language therapy practice, provides a foundation for clinical research which will compare outcomes for people with dysarthria, whose management includes and does not include NSOMExs. Speech and language therapy practice may be guided by evidence that speech outcome is or is not affected by NSOMExs.

Rationale and study protocol for the Nursing Home Compare Plus (NHCPlus) randomized controlled trial: A personalized decision aid for patients transitioning from the hospital to a skilled-nursing facility.

PubMed

Sorkin, Dara H; Amin, Alpesh; Weimer, David L; Sharit, Joseph; Ladd, Heather; Mukamel, Dana B

2016-03-01

Annually more than 3 million people are admitted to one of the 15,965 skilled nursing facilities (SNFs) in the United States, with 90% of admissions occurring from a hospital. Although the Centers for Medicare and Medicaid Services (CMS) publishes several internet-based report cards, including one for nursing homes (Nursing Home Compare, NHC), they are not widely used. This is due, in part, to the complexity of the information available and the fact that the choice of nursing homes is typically made while in the hospital without access to the web-based NHC. We developed Nursing Home Compare Plus (NHCPlus) to address these limitations and to improve the decision-making process. This paper describes the design and rationale of a two-arm randomized controlled trial designed to test the effectiveness of NHCPlus compared to usual care only, in a sample of patients being discharged from the hospital to an SNF (N=229). Assessments were conducted within 24h prior to patient discharge and 30-days post discharge. Primary outcomes to be examined included the use of NHC, increased choice of nursing homes with better reported outcomes, and increased distance between patient/family residence and nursing home. Secondary outcomes included satisfaction with the decision to go to a nursing home, confidence in the choice of nursing home, and reduced hospital length of stay. NHCPlus is an innovative mobile application designed to allow patients to personalize their choice of nursing homes to meet their medical needs and preferences. The application to other quality report cards is discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Rationale and study protocol for the Nursing Home Compare Plus (NHCPlus) randomized controlled trial: A personalized decision aid for patients transitioning from the hospital to a skilled-nursing facility

PubMed Central

Sorkin, Dara H.; Amin, Alpesh; Weimer, David L.; Sharit, Joseph; Ladd, Heather

2016-01-01

Background Annually more than 3 million people are admitted to one of the 15,965 skilled nursing facilities (SNFs) in the United States with 90% of admissions occurring from a hospital. Although the Centers for Medicare and Medicaid Services (CMS) publishes several web-based report cards, including one for nursing homes (Nursing Home Compare, NHC), they are not widely used. This is due, in part, to the complexity of the information available and the fact that the choice of nursing homes is typically made while in the hospital without access to the web-based NHC. We developed Nursing Home Compare Plus (NHCPlus) to address these limitations and to improve the decision-making process. Methods/Design This paper describes the design and rationale of a two-arm randomized controlled trial designed to test the effectiveness of NHCPlus compared to usual care only, in a sample of patients being discharged from the hospital to an SNF (N=229). Assessments were conducted within 24-hours prior to patient discharge and 30-days post discharge. Primary outcomes to be examined included use of NHC, increased choice of nursing homes with better reported outcomes, and increased distance between patient/family residence and nursing home. Secondary outcomes included satisfaction with the decision to go to a nursing home, confidence in the choice of nursing home, and reduced hospital length of stay. Discussion NHCPlus is an innovative mobile application designed to allow patients to personalize their choice of nursing homes to meet their medical needs and preferences. The application to other quality report cards is discussed. PMID:26772624

A Rationale for Relating Salaries to Learner Outcomes.

ERIC Educational Resources Information Center

Benedict, Gary C.; Gerardi, Robert J.

1985-01-01

Presents a formula for relating teacher salaries to student achievement. Discusses the problems inherent in measuring student achievement and the importance of the principal's administrative training. Includes a chart and diagrams. (MD)

Collaborative Behavioral Management for Drug-Involved Parolees: Rationale and Design of the Step'n Out Study

PubMed Central

FRIEDMANN, PETER D.; KATZ, ELIZABETH C.; RHODES, ANNE G.; TAXMAN, FAYE S.; O'CONNELL, DANIEL J.; FRISMAN, LINDA K.; BURDON, WILLIAM M.; FLETCHER, BENNETT W.; LITT, MARK D.; CLARKE, JENNIFER; MARTIN, STEVEN S.

2009-01-01

This article describes the rationale, study design, and implementation for the Step'n Out study of the Criminal Justice Drug Abuse Treatment Studies. Step'n Out tests the relative effectiveness of collaborative behavioral management of drug-involved parolees. Collaborative behavioral management integrates the roles of parole officers and treatment counselors to provide role induction counseling, contract for pro-social behavior, and deliver contingent reinforcement of behaviors consistent with treatment objectives. The Step'n Out study will randomize 450 drug-involved parolees to collaborative behavioral management or usual parole. Follow-up at 3-and 9-months will assess primary outcomes of rearrest, crime and drug use. If collaborative behavioral management is effective, its wider adoption could improve the outcomes of community reentry of drug-involved ex-offenders. PMID:19809591

Transition from oxcarbazepine to eslicarbazepine acetate: A single center study.

PubMed

Mäkinen, Jussi; Rainesalo, Sirpa; Peltola, Jukka

2017-03-01

There is limited clinical evidence for comparison between oxcarbazepine (OXC) and eslicarbazepine acetate (ESL) in terms of tolerability, or how to execute the change from OXC to ESL. We report the process of transitioning patients with focal epilepsy from previous OXC treatment to ESL due to tolerability problems. The rationale for change from OXC is reported, and the outcome with respective to this rationale is analyzed in terms of tolerability and efficacy. The subjects were transitioned overnight from OXC to ESL in a hospital inpatient setting. An evaluation of the effects of the transition was made after 1 and 3 months. All adverse events (AEs) were recorded following the transition period. Subjects were classified by outcome in terms of AEs. Twenty-three subjects were transitioned from OXC to ESL. Fifteen patients OXC-related AEs reduced significantly after transition. Particularly, most of (93%) the AEs presented in the morning resolved after transition to ESL. No patient had an increase in seizure frequency following the transition. The incidence of ESL-related AEs was 39% at 1 month and 13% at 3 month follow-up; however, all patients continued ESL throughout the study period. This study demonstrates that patients suffering from OXC-related AEs improve in terms of tolerability after a switch to ESL with maintaining seizure control. This improvement is more pronounced if the OXC-related AEs are most evident following morning dosing of OXC. Transition can be safely executed in an outpatient setting.

Pridopidine: Overview of Pharmacology and Rationale for its Use in Huntington's Disease.

PubMed

Waters, Susanna; Tedroff, Joakim; Ponten, Henrik; Klamer, Daniel; Sonesson, Clas; Waters, Nicholas

2018-01-01

Despite advances in understanding the pathophysiology of Huntington's disease (HD), there are currently no effective pharmacological agents available to treat core symptoms or to stop or prevent the progression of this hereditary neurodegenerative disorder. Pridopidine, a novel small molecule compound, has demonstrated potential for both symptomatic treatment and disease modifying effects in HD. While pridopidine failed to achieve its primary efficacy outcomes (Modified motor score) in two trials (MermaiHD and HART) there were consistent effects on secondary outcomes (TMS). In the most recent study (PrideHD) pridiopidine did not differ from placebo on TMS, possibly due to a large enduring placebo effect.This review describes the process, based on in vivo systems response profiling, by which pridopidine was discovered and discusses its pharmacological profile, aiming to provide a model for the system-level effects, and a rationale for the use of pridopidine in patients affected by HD. Considering the effects on brain neurochemistry, gene expression and behaviour in vivo, pridopidine displays a unique effect profile. A hallmark feature in the behavioural pharmacology of pridopidine is its state-dependent inhibition or activation of dopamine-dependent psychomotor functions. Such effects are paralleled by strengthening of synaptic connectivity in cortico-striatal pathways suggesting pridopidine has potential to modify phenotypic expression as well as progression of HD. The preclinical pharmacological profile is discussed with respect to the clinical results for pridopidine, and proposals are made for further investigation, including preclinical and clinical studies addressing disease progression and effects at different stages of HD.

Using General Outcome Measures to Predict Student Performance on State-Mandated Assessments: An Applied Approach for Establishing Predictive Cutscores

ERIC Educational Resources Information Center

Leblanc, Michael; Dufore, Emily; McDougal, James

2012-01-01

Cutscores for reading and math (general outcome measures) to predict passage on New York state-mandated assessments were created by using a freely available Excel workbook. The authors used linear regression to create the cutscores and diagnostic indicators were provided. A rationale and procedure for using this method is outlined. This method…

Outcome for Children Receiving the Early Start Denver Model before and after 48 Months

ERIC Educational Resources Information Center

Vivanti, Giacomo; Dissanayake, Cheryl

2016-01-01

The Early Start Denver Model (ESDM) is an intervention program recommended for pre-schoolers with autism ages 12-48 months. The rationale for this recommendation is the potential for intervention to affect developmental trajectories during early sensitive periods. We investigated outcomes of 32 children aged 18-48 months and 28 children aged…

Toward a Revised Assessment Model: Rationales and Strategies for Assessing Students' Technological Authorship

ERIC Educational Resources Information Center

De Hertogh, Lori Beth

2014-01-01

I argue in this article that digital composing practices require composition teachers to rethink the way we articulate learning outcomes and conduct classroom assessment. To accomplish this, we must revise the language we use to talk about outcomes and assessment in the context of new media. We also need to better understand how technologies are…

Implications of Middle School Behavior Problems for High School Graduation and Employment Outcomes of Young Adults: Estimation of a Recursive Model

ERIC Educational Resources Information Center

Karakus, Mustafa C.; Salkever, David S.; Slade, Eric P.; Ialongo, Nicholas; Stuart, Elizabeth

2012-01-01

The potentially serious adverse impacts of behavior problems during adolescence on employment outcomes in adulthood provide a key economic rationale for early intervention programs. However, the extent to which lower educational attainment accounts for the total impact of adolescent behavior problems on later employment remains unclear. As an…

A review and rationale for studying the cardiovascular effects of drinking water arsenic in women of reproductive age

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kwok, Richard K., E-mail: rkwok@rti.org

2007-08-01

Drinking water arsenic has been shown to be associated with a host of adverse health outcomes at exposure levels > 300 {mu}g of As/L. However, the results are not consistent at exposures below this level. We have reviewed selected articles that examine the effects of drinking water arsenic on cardiovascular outcomes and present a rationale for studying these effects on women of reproductive age, and also over the course of pregnancy when they would potentially be more susceptible to adverse cardiovascular and reproductive outcomes. It is only recently that reproductive effects have been linked to drinking water arsenic. However, theremore » is a paucity of information about the cardiovascular effects of drinking water arsenic on women of reproductive age. Under the cardiovascular challenge of pregnancy, we hypothesize that women with a slightly elevated exposure to drinking water arsenic may exhibit adverse cardiovascular outcomes at higher rates than in the general population. Studying sensitive clinical and sub-clinical indicators of disease in susceptible sub-populations may yield important information about the potentially enormous burden of disease related to low-level drinking water arsenic exposure.« less

Failure to Rescue, Rescue Surgery and Centralization of Postoperative Complications: A Challenge for General and Acute Care Surgeons.

PubMed

Zago, Mauro; Bozzo, Samantha; Carrara, Giulia; Mariani, Diego

2017-01-01

To explore the current literature on the failure to rescue and rescue surgery concepts, to identify the key items for decreasing the failure to rescue rate and improve outcome, to verify if there is a rationale for centralization of patients suffering postoperative complications. There is a growing awareness about the need to assess and measure the failure to rescue rate, on institutional, regional and national basis. Many factors affect failure to rescue, and all should be individually analyzed and considered. Rescue surgery is one of these factors. Rescue surgery assumes an acute care surgery background. Measurement of failure to rescue rate should become a standard for quality improvement programs. Implementation of all clinical and organizational items involved is the key for better outcomes. Preparedness for rescue surgery is a main pillar in this process. Centralization of management, audit, and communication are important as much as patient centralization. Celsius.

Rationale and Design of the Lung Cancer Screening Implementation. Evaluation of Patient-Centered Care Study.

PubMed

Miranda, Leah S; Datta, Santanu; Melzer, Anne C; Wiener, Renda Soylemez; Davis, James M; Tong, Betty C; Golden, Sara E; Slatore, Christopher G

2017-10-01

Screening for lung cancer using low-dose computed tomography has been demonstrated to reduce lung cancer-related mortality and is being widely implemented. Further research in this area is needed to assess the impact of screening on patient-centered outcomes. Here, we describe the design and rationale for a new study entitled Lung Cancer Screening Implementation: Evaluation of Patient-Centered Care. The protocol is composed of an interconnected series of studies evaluating patients and clinicians who are engaged in lung cancer screening in real-world settings. The primary goal of this study is to evaluate communication processes that are being used in routine care and to identify best practices that can be readily scaled up for implementation in multiple settings. We hypothesize that higher overall quality of patient-clinician communication processes will be associated with lower levels of distress and decisional conflict as patients decide whether or not to participate in lung cancer screening. This work is a critical step toward identifying modifiable mechanisms that are associated with high quality of care for the millions of patients who will consider lung cancer screening. Given the enormous potential benefits and burdens of lung cancer screening on patients, clinicians, and the healthcare system, it is important to identify and then scale up quality communication practices that positively influence patient-centered care.

In vivo animal stroke models: a rationale for rodent and non-human primate models

PubMed Central

Tajiri, Naoki; Dailey, Travis; Metcalf, Christopher; Mosley, Yusef I.; Lau, Tsz; Staples, Meaghan; van Loveren, Harry; Kim, Seung U.; Yamashima, Tetsumori; Yasuhara, Takao; Date, Isao; Kaneko, Yuji; Borlongan, Cesario V.

2013-01-01

On average, every four minutes an individual dies from a stroke, accounting for 1 out of every 18 deaths in the United States. Apporximately 795,000 Americans have a new or recurrent stroke each year, with just over 600,000 of these being first attack [1]. There have been multiple animal models of stroke demonstrating that novel therapeutics can help improve the clinical outcome. However, these results have failed to show the same outcomes when tested in human clinical trials. This review will discuss the current in vivo animal models of stroke, advantages and limitations, and the rationale for employing these animal models to satisfy translational gating items for examination of neuroprotective, as well as neurorestorative strategies in stroke patients. An emphasis in the present discussion of therapeutics development is given to stem cell therapy for stroke. PMID:23682299

Does the addition of visceral manipulation improve outcomes for patients with low back pain? Rationale and study protocol.

PubMed

Panagopoulos, John; Hancock, Mark; Ferreira, Paulo

2013-07-01

There has been no randomised controlled trial conducted to investigate the effectiveness of visceral manipulation (VM) for the treatment of low back pain (LBP). The primary aim of this study would be to investigate whether the addition of VM, to a standard physiotherapy treatment regimen, improves pain 6 weeks post treatment commencement in people with LBP. Secondary aims would be to examine the effect of VM on disability and functional outcomes at 2, 6 and 52 weeks post-treatment commencement and pain at 2 and 52 weeks. This paper describes the rationale and design of a randomised controlled trial investigating the addition of VM to a standard physiotherapy treatment algorithm which includes manual therapy, specific exercise and functional exercise prescription. Analysis of data would be carried out by a statistician blinded to group allocation and by intention-to-treat. Copyright © 2013 Elsevier Ltd. All rights reserved.

Palliative Care Scorecard.

PubMed

Kittelson, Sheri; Pierce, Read; Youngwerth, Jeanie

2017-05-01

In response to poor healthcare quality outcomes and rising costs, healthcare reform triple aim has increased requirements for providers to demonstrate value to payers, partners, and the public. Electronically automating measurement of the meaningful impact of palliative care (PC) programs on clinical, operational, and financial systems over time is imperative to the success of the field and the goal of development of this automated PC scorecard. The scorecard was organized into a format of quality measures identified by the Measuring What Matters (MWM) project that are defined as important to the team, automatically extracted from the electronic health record, valid, and can be impacted over time. The scorecard was initially created using University of Florida Health (UF) data, a new PC program, and successfully applied and implemented at University of Colorado Anschutz Medical Campus (CU), a second institution with a mature PC program. Clinical metrics are organized in the scorecard based on MWM and described in terms of the metric definition, rationale for selection, measure type (structure, process, or outcome), and whether this represents a direct or proxy measure. The process of constructing the scorecard helped identify areas within both systems for potential improvement in team structure, clinical processes, and outcomes. In addition, by automating data extraction, the scorecard decreases costs associated with manual data entry and extraction, freeing clinical staff to care for patients and increasing the value of PC delivered to patients.

Benchmarking facilities providing care: An international overview of initiatives

PubMed Central

Thonon, Frédérique; Watson, Jonathan; Saghatchian, Mahasti

2015-01-01

We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully. PMID:26770800

Pretest Measures of the Study Outcome and the Elimination of Selection Bias: Evidence from Three Within Study Comparisons.

PubMed

Hallberg, Kelly; Cook, Thomas D; Steiner, Peter M; Clark, M H

2018-04-01

This paper examines how pretest measures of a study outcome reduce selection bias in observational studies in education. The theoretical rationale for privileging pretests in bias control is that they are often highly correlated with the outcome, and in many contexts, they are also highly correlated with the selection process. To examine the pretest's role in bias reduction, we use the data from two within study comparisons and an especially strong quasi-experiment, each with an educational intervention that seeks to improve achievement. In each study, the pretest measures are consistently highly correlated with post-intervention measures of themselves, but the studies vary the correlation between the pretest and the process of selection into treatment. Across the three datasets with two outcomes each, there are three cases where this correlation is low and three where it is high. A single wave of pretest always reduces bias across the six instances examined, and it eliminates bias in three of them. Adding a second pretest wave eliminates bias in two more instances. However, the pattern of bias elimination does not follow the predicted pattern-that more bias reduction ensues as a function of how highly the pretest is correlated with selection. The findings show that bias is more complexly related to the pretest's correlation with selection than we hypothesized, and we seek to explain why.

Implications of Middle School Behavior Problems for High School Graduation and Employment Outcomes of Young Adults: Estimation of a Recursive Model. NBER Working Paper No. 16383

ERIC Educational Resources Information Center

Karakus, Mustafa C.; Salkever, David S.; Slade, Eric P.; Ialongo, Nicholas; Stuart, Elizabeth

2010-01-01

The potentially serious adverse impacts of behavior problems during adolescence on employment outcomes in adulthood provide a key economic rationale for early intervention programs. However, the extent to which lower educational attainment accounts for the total impact of adolescent behavior problems on later employment remains unclear. As an…

Self-rated health appraisal as cultural and identity process: African American elders' health and evaluative rationales.

PubMed

McMullen, Carmit K; Luborsky, Mark R

2006-08-01

We explored self-rated health by using a meaning-centered theoretical foundation. Self-appraisals, such as self-rated health, reflect a cultural process of identity formation, whereby identities are multiple, simultaneously individual and collective, and produced by specific historical formations. Anthropological research in Philadelphia determined (a) how African American elders appraise their health, and (b) how health evaluations reflect cultural and historical experiences within a community. We interviewed and observed 35 adults aged 65 to 80, stratified by gender and self-rated health. We validated theme analysis of focused interview questions against the larger data set of field notes and transcripts. Health appraisal reflected a complex process of adaptation and identity. Criteria for health included: independent functioning, physical condition, control and responsibility for health, and overall feeling. Evaluative rationales that shaped health appraisals were comparisons, restricted possibilities for self-evaluation, and ways of handling adversity. Evaluative rationales mitigated undesirable health identities (including low self-reported health) and provided mechanisms for claiming desired health identities despite adversity. Describing the criteria and evaluative rationales underlying self-appraisals of health extends current understandings of self-rated health and illustrates the sociohistorical context of individual assessments of well-being.

Rationale for the Diabetic Retinopathy Clinical Research Network Treatment Protocol for Center-involved Diabetic Macular Edema

PubMed Central

Aiello, Lloyd Paul; Beck, Roy W; Bressler, Neil M.; Browning, David J.; Chalam, KV; Davis, Matthew; Ferris, Frederick L; Glassman, Adam; Maturi, Raj; Stockdale, Cynthia R.; Topping, Trexler

2011-01-01

Objective Describe the underlying principles used to develop a web-based algorithm that incorporated intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for diabetic macular edema (DME) in a Diabetic Retinopathy Clinical Research Network (DRCR.net) randomized clinical trial. Design Discussion of treatment protocol for DME. Participants Subjects with vision loss from DME involving the center of the macula. Methods The DRCR.net created an algorithm incorporating anti-VEGF injections in a comparative effectiveness randomized clinical trial evaluating intravitreal ranibizumab with prompt or deferred (≥24 weeks) focal/grid laser in eyes with vision loss from center-involved DME. Results confirmed that intravitreal ranibizumab with prompt or deferred laser provides superior visual acuity outcomes, compared with prompt laser alone through at least 2 years. Duplication of this algorithm may not be practical for clinical practice. In order to share their opinion on how ophthalmologists might emulate the study protocol, participating DRCR.net investigators developed guidelines based on the algorithm's underlying rationale. Main Outcome Measures Clinical guidelines based on a DRCR.net protocol. Results The treatment protocol required real time feedback from a web-based data entry system for intravitreal injections, focal/grid laser, and follow-up intervals. Guidance from this system indicated whether treatment was required or given at investigator discretion and when follow-up should be scheduled. Clinical treatment guidelines, based on the underlying clinical rationale of the DRCR.net protocol, include repeating treatment monthly as long as there is improvement in edema compared with the previous month, or until the retina is no longer thickened. If thickening recurs or worsens after discontinuing treatment, treatment is resumed. Conclusions Duplication of the approach used in the DRCR.net randomized clinical trial to treat DME involving the center of the macula with intravitreal ranibizumab may not be practical in clinical practice, but likely can be emulated based on an understanding of the underlying rationale for the study protocol. Inherent differences between a web-based treatment algorithm and a clinical approach may lead to differences in outcomes that are impossible to predict. The closer the clinical approach is to the algorithm used in the study, the more likely the outcomes will be similar to those published. PMID:22136692

Building and executing a research agenda toward conducting implementation science in medical education.

PubMed

Carney, Patricia A; Crites, Gerald E; Miller, Karen H; Haight, Michelle; Stefanidis, Dimitrios; Cichoskikelly, Eileen; Price, David W; Akinola, Modupeola O; Scott, Victoria C; Kalishman, Summers

2016-01-01

Implementation science (IS) is the study of methods that successfully integrate best evidence into practice. Although typically applied in healthcare settings to improve patient care and subsequent outcomes, IS also has immediate and practical applications to medical education toward improving physician training and educational outcomes. The objective of this article is to illustrate how to build a research agenda that focuses on applying IS principles in medical education. We examined the literature to construct a rationale for using IS to improve medical education. We then used a generalizable scenario to step through a process for applying IS to improve team-based care. IS provides a valuable approach to medical educators and researchers for making improvements in medical education and overcoming institution-based challenges. It encourages medical educators to systematically build upon the research outcomes of others to guide decision-making while evaluating the successes of best practices in individual environments and generate additional research questions and findings. IS can act as both a driver and a model for educational research to ensure that best educational practices are easier and faster to implement widely.

Tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign trial: Rationale and design.

PubMed

Liu, Liping; Wang, Yilong; Meng, Xia; Li, Na; Tan, Ying; Nie, Ximing; Liu, Dacheng; Zhao, Xingquan

2017-04-01

Rationale Acute intracerebral hemorrhage inflicts a high-economic and -health burden. Computed tomography angiography spot sign is a predictor of hematoma expansion, is associated with poor clinical outcome and is an important stratifying variable for patients treated with haemostatic therapy. Aims We aim to compare the effect of treatment with tranexamic acid to placebo for the prevention of hemorrhage growth in patients with high-risk acute intracerebral hemorrhage with a positive spot sign. Design The tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign (TRAIGE) is a prospective, multicenter, placebo-controlled, double-blind, investigator-led, randomized clinical trial that will include an estimated 240 participants. Patients with intracerebral hemorrhage demonstrating symptom onset within 8 h and with the spot sign as a biomarker for ongoing hemorrhage, and no contraindications for antifibrinolytic therapy, will be enrolled to receive either tranexamic acid or placebo. The primary outcome measure is the presence of hemorrhage growth defined as an increase in intracerebral hemorrhage volume >33% or >6 ml from baseline to 24 ± 2 h. The secondary outcomes include safety and clinical outcomes. Conclusion The TRAIGE trial evaluates the efficacy of haemostatic therapy with tranexamic acid in the prevention of hemorrhage growth among high-risk patients with acute intracerebral hemorrhage.

Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest.

PubMed

Morrison, Laurie J; Nichol, Graham; Rea, Thomas D; Christenson, Jim; Callaway, Clifton W; Stephens, Shannon; Pirrallo, Ronald G; Atkins, Dianne L; Davis, Daniel P; Idris, Ahamed H; Newgard, Craig

2008-08-01

To describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium (ROC) population-based registry; ROC Epistry-Cardiac Arrest. The ROC Epistry--Cardiac Arrest is designed as a prospective population-based registry of all Emergency Medical Services (EMSs)-attended 9-1-1 calls for patients with out-of-hospital cardiac arrest occurring in the geographical area described by the eight US and three Canadian regions. The dataset was derived by an North American interdisciplinary steering committee. Enrolled cases include individuals of all ages who experience cardiac arrest outside the hospital, with evaluation by organized EMS personnel and: (a) attempts at external defibrillation (by lay responders or emergency personnel), or chest compressions by organized EMS personnel; (b) were pulseless but did not receive attempts to defibrillate or CPR by EMS personnel. Selected data items are categorized as mandatory or optional and undergo revisions approximately every 12 months. Where possible all definitions are referenced to existing literature. Where a common definition did not exist one was developed. Optional items include standardized CPR process data elements. It is anticipated the ROC Epistry--Cardiac Arrest will enroll between approximately 9000 and 13,500 treated all rhythm arrests and 4000 and 5000 ventricular fibrillation arrests annually and approximately 8000 EMS-attended but untreated arrests. We describe the rationale, development, design and future implications of the ROC Epistry--Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts and for the common data elements captured in both ROC Epistry--Cardiac Arrest and the ROC trials.

‘Trial Exegesis’: Methods for Synthesizing Clinical and Patient Reported Outcome (PRO) Data in Trials to Inform Clinical Practice. A Systematic Review

PubMed Central

Macefield, Rhiannon C.; Blencowe, Natalie S.; Brookes, Sara T.; Blazeby, Jane M.

2016-01-01

Purpose The CONSORT extension for patient reported outcomes (PROs) aims to improve reporting, but guidance on the optimal integration with clinical data is lacking. This study examines in detail the reporting of PROs and clinical data from randomized controlled trials (RCTs) in gastro-intestinal cancer to inform design and reporting of combined PRO and clinical data from trials to improve the ‘take home’ message for clinicians to use in practice. Materials and Methods The case study was undertaken in gastro-intestinal cancer trials. Well-conducted RCTs reporting PROs with validated instruments were identified and categorized into those combining PRO and clinical data in a single paper, or those separating data into linked primary and supplemental papers. Qualitative methods were developed to examine reporting of the critical interpretation of the trial results (trial exegesis) in the papers in relation of the PRO and clinical outcomes and applied to each publication category. Results were used to inform recommendations for practice. Results From 1917 screened abstracts, 49 high quality RCTs were identified reported in 36 combined and 15 linked primary and supplemental papers. In-depth analysis of manuscript text identified three categories for understanding trial exegesis: where authors reported a “detailed”, “general”, or absent PRO rationale and integrated interpretation of clinical and PRO results. A total of 11 (30%) and 6 (16%) combined papers reported “detailed” PRO rationale and integrated interpretation of results although only 2 (14%) and 1 (7%) primary papers achieved the same standard respectively. Supplemental papers provide better information with 11 (73%) and 3 (20%) achieving “detailed” rationale and integrated interpretation of results. Supplemental papers, however, were published a median of 20 months after the primary RCT data in lower impact factor journals (median 16.8 versus 5.2). Conclusion It is recommended that single papers, with detailed PRO rationale and integrated PRO and clinical data are published to optimize trial exegesis. Further work to examine whether this improves the use of PRO data to inform practice is needed. PMID:27571514

Moving toward implementation : an examination of the organizational and political structures of transit-oriented development.

DOT National Transportation Integrated Search

2009-06-01

The research explores the costs and impacts of Transit Oriented Development (TOD) and : addresses the rationale for designing transit-oriented neighborhoods. It also documents the : outcomes and the impacts of implementing such projects and examines ...

Descriptors for Law-Related Education.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison.

This guide provides a framework for developing a law-related curriculum in grades K-12. It is presented in nine major sections. Section I discusses the rationale for including law-related education in the curriculum. The rationale is that in order for citizens to make conscious choices, they must understand legal processes, reason through the need…

The dual process model of coping with bereavement: rationale and description.

PubMed

Stroebe, M; Schut, H

1999-01-01

There are shortcomings in traditional theorizing about effective ways of coping with bereavement, most notably, with respect to the so-called "grief work hypothesis." Criticisms include imprecise definition, failure to represent dynamic processing that is characteristic of grieving, lack of empirical evidence and validation across cultures and historical periods, and a limited focus on intrapersonal processes and on health outcomes. Therefore, a revised model of coping with bereavement, the dual process model, is proposed. This model identifies two types of stressors, loss- and restoration-oriented, and a dynamic, regulatory coping process of oscillation, whereby the grieving individual at times confronts, at other times avoids, the different tasks of grieving. This model proposes that adaptive coping is composed of confrontation--avoidance of loss and restoration stressors. It also argues the need for dosage of grieving, that is, the need to take respite from dealing with either of these stressors, as an integral part of adaptive coping. Empirical research to support this conceptualization is discussed, and the model's relevance to the examination of complicated grief, analysis of subgroup phenomena, as well as interpersonal coping processes, is described.

Quality and cost improvement of healthcare via complementary measurement and diagnosis of patient general health outcome using electronic health record data: research rationale and design.

PubMed

Stusser, Rodolfo J; Dickey, Richard A

2013-12-01

In this evolving 'third era of health', one of the US Health Care Reform Act's goals is to effectively facilitate the primary care physician's ability to better diagnose and manage the health outcome of the outpatient. That goal must include research on the complementary quantitative-qualitative assessment and rating of the patient's health status. This paper proposes an overview of the rationale and design of a research program for a balanced measurement and diagnostic clinical decision support system (CDSS) of the changing general health status of the patient -including disease- using electronic health record (EHR) data. The rationale, objectives, health metric-diagnostic tools architecture, simulation-optimization, and clinical trials are outlined. Resources, time frames, costs, feasibility, healthcare benefits and data-integration of the project are delineated. The basis and components of the research program to achieve an automated-CDSS to complement physician's clinical judgment, calculating a mathematical 'health equation' from each patient's EHR database, assisting physician-patient collaboration to diagnose, and improve general health outcomes is described. Use of multiple dimensional index, ways of classification, and causal factors' assessments, to arrive at the EHR-based CDSS algorithm-software providing a general health level and state rating of the patient are proposed. Its application could provide a compass for the general practitioner's best choice and use of the myriad of healthcare educational and technological options available with lower costs for everyday clinical practice and research. It could advance the approaches and focus of the 'eras of diseases', to the promising 'era of health', in an integrated, general approach to 'health.'

Linking Staff Development and Teacher Induction.

ERIC Educational Resources Information Center

Reiman, Alan J.; And Others

1988-01-01

This article describes a six-year effort to link inservice training for experienced teachers with teacher preservice and induction for the novice teacher. It provides a rationale for using staff development training to strengthen preservice and induction programs, and discusses program goals, training components, program outcomes, and…

Comparative Evaluation of Financing Programs: Insights From California’s Experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Deason, Jeff

Berkeley Lab examines criteria for a comparative assessment of multiple financing programs for energy efficiency, developed through a statewide public process in California. The state legislature directed the California Alternative Energy and Advanced Transportation Financing Authority (CAEATFA) to develop these criteria. CAEATFA's report to the legislature, an invaluable reference for other jurisdictions considering these topics, discusses the proposed criteria and the rationales behind them in detail. Berkeley Lab's brief focuses on several salient issues that emerged during the criteria development and discussion process. Many of these issues are likely to arise in other states that plan to evaluate the impactsmore » of energy efficiency financing programs, whether for a single program or multiple programs. Issues discussed in the brief include: -The stakeholder process to develop the proposed assessment criteria -Attribution of outcomes - such as energy savings - to financing programs vs. other drivers -Choosing the outcome metric of primary interest: program take-up levels vs. savings -The use of net benefits vs. benefit-cost ratios for cost-effectiveness evaluation -Non-energy factors -Consumer protection factors -Market transformation impacts -Accommodating varying program goals in a multi-program evaluation -Accounting for costs and risks borne by various parties, including taxpayers and utility customers, in cost-effectiveness analysis -How to account for potential synergies among programs in a multi-program evaluation« less

The ethics of policy writing: how should hospitals deal with moral disagreement about controversial medical practices?

PubMed Central

Winkler, E

2005-01-01

Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it. Using, as an example, the controversy about patient's refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency. Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO's obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy. PMID:16199594

The role of skin substitutes in the treatment of burn injuries.

PubMed

Shakespeare, Peter G

2005-01-01

Extensive burn wounds are difficult to manage and repair. Several engineered skin substitutes have been developed to aid in this process. These substitutes are designed with particular objectives in mind which dictate the circumstances under which they can, and should, be employed to promote healing or prepare the burn wound for final closure with autograft. This article discusses some of the rationale behind the use of skin substitutes and reviews some of the substitutes in use at the present time. Current perspectives suggest that skin substitute use is still in its infancy and that there is some way to go before their role in clinical practice becomes clear. Nevertheless the prospect of being able to supply new wound repair components and to influence the healing process to modify outcome and improve the quality of the healed burn wound will ensure a continuing high degree of interest in these potentially useful and beneficial medical devices.

Change the management of patients with heart failure: Rationale and design of the CHAMP-HF registry.

PubMed

DeVore, Adam D; Thomas, Laine; Albert, Nancy M; Butler, Javed; Hernandez, Adrian F; Patterson, J Herbert; Spertus, John A; Williams, Fredonia B; Turner, Stuart J; Chan, Wing W; Duffy, Carol I; McCague, Kevin; Mi, Xiaojuan; Fonarow, Gregg C

2017-07-01

Heart failure (HF) with reduced ejection fraction (HFrEF) is a common and costly condition that diminishes patients' health status and confers a poor prognosis. Despite the availability of multiple guideline-recommended pharmacologic and cardiac device therapies for patients with chronic HFrEF, outcomes remain suboptimal. Currently, there is limited insight into the rationale underlying clinical decisions by health care providers and patient factors that guide the use and intensity of outpatient HF treatments. A better understanding of current practice patterns has the potential to improve patients' outcomes. The CHAnge the Management of Patients with Heart Failure (CHAMP-HF) registry will evaluate the care and outcomes of patients with chronic HFrEF by assessing real-world treatment patterns, as well as the reasons for and barriers to medication treatment changes. CHAMP-HF will enroll approximately 5,000 patients with chronic HFrEF (left ventricular ejection fraction ≤40%) at approximately 150 US sites, and patients will be followed for a maximum duration of 24 months. Participating sites will collect data from both providers (HF history, examination findings, results of diagnostic studies, pharmacotherapy treatment patterns, decision-making factors, and clinical outcomes) and patients (medication adherence and patient-reported outcomes). The CHAMP-HF registry will provide a unique opportunity to study practice patterns and the adoption of new HF therapies across a diverse mix of health care providers and outpatient practices in the United States that care for HFrEF patients. Copyright © 2017 Elsevier Inc. All rights reserved.

"Waiting on the words": procedures and outcomes of a drama class for individuals with aphasia.

PubMed

Cherney, Leora R; Oehring, Ann K; Whipple, Keith; Rubenstein, Ted

2011-08-01

Drama therapy offers an authentic medium through which people with aphasia can interact and share their experiences. We describe the rationale and procedures of a drama class, informed by the principles and practices of drama therapy, in which individuals with chronic aphasia conceptualized, wrote, and produced a play addressing their experiences of having, living with, and coping with the effects of aphasia. Sessions were cofacilitated by a speech-language pathologist and a drama therapist. We describe the drama activities and techniques in each of four distinct stages of a drama therapy process through which the group transitioned. We also summarize patient-reported outcomes of a representational group of seven participants. Subscales of the Burden of Stroke Scale and the Communication Confidence Rating Scale for Aphasia were administered before and after participation in the 18-week class. Means, standard deviations, and effect sizes were computed. Results indicated perceived improvements in both communication and mood. © Thieme Medical Publishers.

Combination Therapies for Traumatic Brain Injury: Retrospective Considerations

PubMed Central

Anderson, Gail; Atif, Fahim; Badaut, Jerome; Clark, Robert; Empey, Philip; Guseva, Maria; Hoane, Michael; Huh, Jimmy; Pauly, Jim; Raghupathi, Ramesh; Scheff, Stephen; Stein, Donald; Tang, Huiling; Hicks, Mona

2016-01-01

Abstract Patients enrolled in clinical trials for traumatic brain injury (TBI) may present with heterogeneous features over a range of injury severity, such as diffuse axonal injury, ischemia, edema, hemorrhage, oxidative damage, mitochondrial and metabolic dysfunction, excitotoxicity, inflammation, and other pathophysiological processes. To determine whether combination therapies might be more effective than monotherapy at attenuating moderate TBI or promoting recovery, the National Institutes of Health funded six preclinical studies in adult and immature male rats to evaluate promising acute treatments alone and in combination. Each of the studies had a solid rationale for its approach based on previous research, but only one reported significant improvements in long-term outcomes across a battery of behavioral tests. Four studies had equivocal results because of a lack of sensitivity of the outcome assessments. One study demonstrated worse results with the combination in comparison with monotherapies. While specific research findings are reported elsewhere, this article provides an overview of the study designs, insights, and recommendations for future research aimed at therapy development for TBI. PMID:25970337

The design, rationale, and baseline characteristics of a nationwide cohort registry in China: blood pressure and clinical outcome in TIA or ischemic stroke.

PubMed

Xu, Jie; Liu, Yi; Tao, Yongli; Xie, Xuewei; Gu, Hongqiu; Pan, Yuesong; Zhao, Xingquan; Wang, Yongjun; Yan, Aoshuang; Wang, Yilong

2016-01-01

The relationship between poststroke blood pressure (BP) and clinical outcomes in ischemic stroke (IS) is still controversial. However, there is no large BP database for IS or transient ischemic attack (TIA) in China. This study aims to describe the rationale, study design, and baseline characteristics of a nationwide BP database in IS or TIA patients in China. The BOSS (blood pressure and clinical outcome in TIA or ischemic stroke) study was a hospital-based, prospective cohort study aiming to assess BP parameters and clinical outcome in IS/TIA patients. BP parameters were based on office BP, ambulatory BP, and home BP. Clinical outcomes included stroke recurrence, combined vascular events, and disability. Electronic case-report forms were used to record baseline and follow-up data. The patients were followed up for clinical outcomes at 3 months through face-to-face interview and at 12 months by telephone. Between October 2012 and February 2014, the BOSS registry recruited 2,608 patients from 61 hospitals, with a mean age of 62.5 years, 32.4% of whom were female, 88.9% with an entry diagnosis of IS, and 86% diagnosed with hypertension. The rates of patients lost-to-follow-up were 3.1% at 3 months and 5.1% at 1 year; 93% of patients completed ambulatory BP monitoring during hospitalization and 94.7% finished a 3-month BP diary. The BOSS registry will provide important evidence about BP management in the acute phase and secondary prevention for IS/TIA patients.

How can multi criteria decision analysis support value assessment of pharmaceuticals? - Findings from a systematic literature review.

PubMed

Kolasa, Katarzyna; Zah, Vladimir; Kowalczyk, Marta

2018-04-29

As budget constraints become more and more visible, there is growing recognition for greater transparency and greater stakeholders' engagement in the pharmaceuticals' pric-ing&reimbursement (P&R) decision making. New frameworks of drugs' value assessments are searched for. Among them, the multi-criteria decision analysis (MCDA) receives more and more attention. In 2014, ISPOR established Task Force to provide methodological recommendations for MCDA utilization in the health care decision making. Still, there is not so much knowledge about the real life experience with MCDA's adaptation to the P&R processes. Areas covered: A systematic literature review was performed to understand the rationale for MCDA adaptation, methodology used as well as its impact on P&R outcomes. Expert commentary: In total 102 hits were found through the search of databases, out of which 18 publications were selected. Although limited in scope, the review highlighted how MCDA can im-prove the decision making processes not only regarding pricing & reimbursement but also contribute to the the risk benefit assessment as well as optimization of treatment outcomes. Still none of re-viewed studies did report how MCDA results actually impacted the real life settings.

What’s in a drop? Correlating observations and outcomes to guide macromolecular crystallization experiments

PubMed Central

Luft, Joseph R.; Wolfley, Jennifer R.; Snell, Edward H.

2011-01-01

Observations of crystallization experiments are classified as specific outcomes and integrated through a phase diagram to visualize solubility and thereby direct subsequent experiments. Specific examples are taken from our high-throughput crystallization laboratory which provided a broad scope of data from 20 million crystallization experiments on 12,500 different biological macromolecules. The methods and rationale are broadly and generally applicable in any crystallization laboratory. Through a combination of incomplete factorial sampling of crystallization cocktails, standard outcome classifications, visualization of outcomes as they relate chemically and application of a simple phase diagram approach we demonstrate how to logically design subsequent crystallization experiments. PMID:21643490

Chemical Sensing in Process Analysis.

ERIC Educational Resources Information Center

Hirschfeld, T.; And Others

1984-01-01

Discusses: (1) rationale for chemical sensors in process analysis; (2) existing types of process chemical sensors; (3) sensor limitations, considering lessons of chemometrics; (4) trends in process control sensors; and (5) future prospects. (JN)

Development of Prosocial Skills. Final Report

ERIC Educational Resources Information Center

Parrila, Rauno K.; Ma, Xin; Fleming, Darcy; Rinaldi, Christina

2002-01-01

In part, this focus is a result of substantial research demonstrating strong links between early social competence and later life adjustment and healthy development. The close connection between prosocial skills and a wide variety of future developmental outcomes provides a compelling rationale to examine what factors are associated with…

Models for Theory-Based M.A. and Ph.D. Programs.

ERIC Educational Resources Information Center

Botan, Carl; Vasquez, Gabriel

1999-01-01

Presents work accomplished at the 1998 National Communication Association Summer Conference. Outlines reasons for theory-based education in public relations. Presents an integrated model of student outcomes, curriculum, pedagogy, and assessment for theory-based master's and doctoral programs, including assumptions made and rationale for such…

Development of a Publicly Available, Comprehensive Database of Fiber and Health Outcomes: Rationale and Methods

PubMed Central

Livingston, Kara A.; Chung, Mei; Sawicki, Caleigh M.; Lyle, Barbara J.; Wang, Ding Ding; Roberts, Susan B.; McKeown, Nicola M.

2016-01-01

Background Dietary fiber is a broad category of compounds historically defined as partially or completely indigestible plant-based carbohydrates and lignin with, more recently, the additional criteria that fibers incorporated into foods as additives should demonstrate functional human health outcomes to receive a fiber classification. Thousands of research studies have been published examining fibers and health outcomes. Objectives (1) Develop a database listing studies testing fiber and physiological health outcomes identified by experts at the Ninth Vahouny Conference; (2) Use evidence mapping methodology to summarize this body of literature. This paper summarizes the rationale, methodology, and resulting database. The database will help both scientists and policy-makers to evaluate evidence linking specific fibers with physiological health outcomes, and identify missing information. Methods To build this database, we conducted a systematic literature search for human intervention studies published in English from 1946 to May 2015. Our search strategy included a broad definition of fiber search terms, as well as search terms for nine physiological health outcomes identified at the Ninth Vahouny Fiber Symposium. Abstracts were screened using a priori defined eligibility criteria and a low threshold for inclusion to minimize the likelihood of rejecting articles of interest. Publications then were reviewed in full text, applying additional a priori defined exclusion criteria. The database was built and published on the Systematic Review Data Repository (SRDR™), a web-based, publicly available application. Conclusions A fiber database was created. This resource will reduce the unnecessary replication of effort in conducting systematic reviews by serving as both a central database archiving PICO (population, intervention, comparator, outcome) data on published studies and as a searchable tool through which this data can be extracted and updated. PMID:27348733

Management of tinnitus in English NHS audiology departments: an evaluation of current practice

PubMed Central

Hoare, Derek J; Gander, Phillip E; Collins, Luke; Smith, Sandra; Hall, Deborah A

2012-01-01

Rationale, aim and objective In 2009, the UK Department of Health formalized recommended National Health Service practices for the management of tinnitus from primary care onwards. It is timely therefore to evaluate the perceived practicality, utility and impact of those guidelines in the context of current practice. Methods We surveyed current practice by posting a 36-item questionnaire to all audiology and hearing therapy staff that we were able to identify as being involved in tinnitus patient care in England. Results In total, 138 out of 351 clinicians responded (39% response rate). The findings indicate a consensus opinion that management should be tailored to individual symptom profiles but that there is little standardization of assessment procedures or tools in use. Conclusions While the lack of standardized practice might provide flexibility to meet local demand, it has drawbacks. It makes it difficult to ascertain key standards of best practice, it complicates the process of clinical audit, it implies unequal patient access to care, and it limits the implementation of translational research outcomes. We recommend that core elements of practice should be standardized, including use of a validated tinnitus questionnaires and an agreed pathway for decision making to better understand the rationale for management strategies offered. PMID:21087449

Evaluation of genotoxicity testing of FDA approved large molecule therapeutics.

PubMed

Sawant, Satin G; Fielden, Mark R; Black, Kurt A

2014-10-01

Large molecule therapeutics (MW>1000daltons) are not expected to enter the cell and thus have reduced potential to interact directly with DNA or related physiological processes. Genotoxicity studies are therefore not relevant and typically not required for large molecule therapeutic candidates. Regulatory guidance supports this approach; however there are examples of marketed large molecule therapeutics where sponsors have conducted genotoxicity studies. A retrospective analysis was performed on genotoxicity studies of United States FDA approved large molecule therapeutics since 1998 identified through the Drugs@FDA website. This information was used to provide a data-driven rationale for genotoxicity evaluations of large molecule therapeutics. Fifty-three of the 99 therapeutics identified were tested for genotoxic potential. None of the therapeutics tested showed a positive outcome in any study except the peptide glucagon (GlucaGen®) showing equivocal in vitro results, as stated in the product labeling. Scientific rationale and data from this review indicate that testing of a majority of large molecule modalities do not add value to risk assessment and support current regulatory guidance. Similarly, the data do not support testing of peptides containing only natural amino acids. Peptides containing non-natural amino acids and small molecules in conjugated products may need to be tested. Copyright © 2014 Elsevier Inc. All rights reserved.

Patient-Reported Outcome (PRO) Consortium translation process: consensus development of updated best practices.

PubMed

Eremenco, Sonya; Pease, Sheryl; Mann, Sarah; Berry, Pamela

2017-01-01

This paper describes the rationale and goals of the Patient-Reported Outcome (PRO) Consortium's instrument translation process. The PRO Consortium has developed a number of novel PRO measures which are in the process of qualification by the U.S. Food and Drug Administration (FDA) for use in clinical trials where endpoints based on these measures would support product labeling claims. Given the importance of FDA qualification of these measures, the PRO Consortium's Process Subcommittee determined that a detailed linguistic validation (LV) process was necessary to ensure that all translations of Consortium-developed PRO measures are performed using a standardized approach with the rigor required to meet regulatory and pharmaceutical industry expectations, as well as having a clearly defined instrument translation process that the translation industry can support. The consensus process involved gathering information about current best practices from 13 translation companies with expertise in LV, consolidating the findings to generate a proposed process, and obtaining iterative feedback from the translation companies and PRO Consortium member firms on the proposed process in two rounds of review in order to update existing principles of good practice in LV and to provide sufficient detail for the translation process to ensure consistency across PRO Consortium measures, sponsors, and translation companies. The consensus development resulted in a 12-step process that outlines universal and country-specific new translation approaches, as well as country-specific adaptations of existing translations. The PRO Consortium translation process will play an important role in maintaining the validity of the data generated through these measures by ensuring that they are translated by qualified linguists following a standardized and rigorous process that reflects best practice.

The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives

PubMed Central

Audigé, Laurent; Cornelius, Carl-Peter; Ieva, Antonio Di; Prein, Joachim

2014-01-01

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal. PMID:25489387

The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives.

PubMed

Audigé, Laurent; Cornelius, Carl-Peter; Di Ieva, Antonio; Prein, Joachim

2014-12-01

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal.

Facilitating Children's Self-Concept: A Rationale and Evaluative Study

ERIC Educational Resources Information Center

Hay, Ian

2005-01-01

This study reports on the design and effectiveness of the Exploring Self-Concept program for primary school children using self-concept as the outcome measure. The program aims to provide a procedure that incorporates organisation, elaboration, thinking, and problem-solving strategies and links these to children's multidimensional self-concept.…

Reducing Teachers' Work-Family Conflict: From Theory to Practice

ERIC Educational Resources Information Center

Cinamon, Rachel Gali; Rich, Yisrael

2005-01-01

Work-family conflict is a vocational psychology variable whose antecedents and outcomes have been extensively investigated. In contrast, less effort has been invested in creating practical programs to prevent and reduce it. This article provides the rationale and describes the framework for a comprehensive organizational program designed to ease…

Instruments and Scoring Guide of the Experiential Education Evaluation Project.

ERIC Educational Resources Information Center

Conrad, Dan; Hedin, Diane

As a result of the Experiential Education Evaluation Project the publication identifies instruments used to measure and assess experiential learning programs. The following information is given for each instrument: rationale for its inclusion in the study; precise issues or outcomes designed to measure, validity and reliability data; and…

Interventions and Outcomes for Children with Dysphagia

ERIC Educational Resources Information Center

Gisel, Erika

2008-01-01

Feeding problems are common even in typically developing infants and children. However, they are more frequent and persistent in children with developmental disabilities. This article will provide an overview of current literature and a rationale underlying the interventions used for children with cerebral palsy (CP) who have eating impairments…

Evaluation of Title I ESEA Projects, 1976-77: Technical Reports. Report #77140.

ERIC Educational Resources Information Center

Philadelphia School District, PA. Office of Research and Evaluation.

This volume compiles technical reports of Title I Elementary and Secondary Education Act project evaluations conducted during the 1976-77 academic year in the school district of Philadelphia, Pennsylvania. The reports include rationale, expected outcomes, mode of operation, previous evaluative findings, current implementation, and attainment of…

Zero Tolerance Policy in Schools: Rationale, Consequences, and Alternatives.

ERIC Educational Resources Information Center

Casella, Ronnie

2003-01-01

Discusses theory/policies supporting zero tolerance policy in schools, including rational choice theory in criminology and national crime policies based on deterrence. Potential consequences of zero tolerance policy implementation are described and shown to involve outcomes similar to those identified by researchers studying national crime policy.…

One Size Fits All? Slow Cortical Potentials Neurofeedback: A Review

ERIC Educational Resources Information Center

Mayer, Kerstin; Wyckoff, Sarah N.; Strehl, Ute

2013-01-01

Objective: The intent of this manuscript was to review all published studies on slow cortical potentials (SCP) neurofeedback for the treatment of ADHD, with emphasis on neurophysiological rationale, study design, protocol, outcomes, and limitations. Method: For review, PubMed, MEDLINE, ERIC, and Google Scholar searches identified six studies and…

Adolescent Male-to-Female Transgender Voice and Communication Therapy

ERIC Educational Resources Information Center

Hancock, Adrienne; Helenius, Lauren

2012-01-01

Current research to describe and evaluate effectiveness of voice and communication therapy for male-to-female transgender people is limited to adults. This paper provides rationale, procedures, and outcomes from voice and communication therapy for a male-to-female transgender adolescent 15 years of age. Treatment addressed vocal hygiene, breath…

Engaging Students Online with the Smithsonian: A Case Study

ERIC Educational Resources Information Center

Engelke, Lynn-Steven

2015-01-01

In 2012, the Smithsonian Center for Learning and Digital Access (SCLDA) launched Smithsonian Quests, an online program for student self-directed learning that is recognized and rewarded with digital badges. This article examines the rationale, development, implementation, and outcomes of the Smithsonian Quests program, lessons learned along the…

Sustainability of Higher Education Institutions in Taiwan

ERIC Educational Resources Information Center

Su, H. Jenny; Chang, Tzu-chau

2010-01-01

Purpose: The purpose of this paper is to provide the rationale and context for recent national policy and funded initiatives to support sustainability developments within higher education in Taiwan, including practical and educational aspects. Concrete examples and specific outcomes are reviewed, to produce a profile across the higher education…

Access & Excellence: The Open-Door College.

ERIC Educational Resources Information Center

Roueche, John E.; Baker, George A., III

Drawing from an in-depth case study of the organizational climate, leadership, teaching, systems, programs, and student outcomes at Miami-Dade Community College (MDCC), this book addresses questions related to the achievement of both open access and high academic standards in the community college. Chapter I presents the rationale for the study…

Intercultural Sensitivity through Short-Term Study Abroad

ERIC Educational Resources Information Center

Bloom, Melanie; Miranda, Arturo

2015-01-01

One of the foremost-cited rationales for study abroad during college is the development of a global perspective and intercultural sensitivity. Although this argument is mentioned frequently in promotional materials for study abroad, it has not yet been backed by research based on the outcomes of students' study abroad experiences. As more…

Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes.

PubMed

Brauchli, Rebecca; Jenny, Gregor J; Füllemann, Désirée; Bauer, Georg F

2015-01-01

Studies using the Job Demands-Resources (JD-R) model commonly have a heterogeneous focus concerning the variables they investigate-selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model was operationalized and tested with a generalizable set of job characteristics and positive and negative health outcomes among a heterogeneous sample of 2,159 employees. Applying a theory-driven and a data-driven approach, measures which were generally relevant for all employees were selected. Results from structural equation modeling indicated that the model fitted the data. Multiple group analyses indicated invariance across six organizations, gender, job positions, and three times of measurement. Initial evidence was found for the validity of an expanded JD-R health model. Thereby this study contributes to the current research on job characteristics and health by combining the core idea of the JD-R model with the broader concepts of salutogenic and pathogenic health development processes as well as both positive and negative health outcomes.

Development of a software tool using deterministic logic for the optimization of cochlear implant processor programming.

PubMed

Govaerts, Paul J; Vaerenberg, Bart; De Ceulaer, Geert; Daemers, Kristin; De Beukelaer, Carina; Schauwers, Karen

2010-08-01

An intelligent agent, Fitting to Outcomes eXpert, was developed to optimize and automate Cochlear implant (CI) programming. The current article describes the rationale, development, and features of this tool. Cochlear implant fitting is a time-consuming procedure to define the value of a subset of the available electric parameters based primarily on behavioral responses. It is comfort-driven with high intraindividual and interindividual variability both with respect to the patient and to the clinician. Its validity in terms of process control can be questioned. Good clinical practice would require an outcome-driven approach. An intelligent agent may help solve the complexity of addressing more electric parameters based on a range of outcome measures. A software application was developed that consists of deterministic rules that analyze the map settings in the processor together with psychoacoustic test results (audiogram, A(section sign)E phoneme discrimination, A(section sign)E loudness scaling, speech audiogram) obtained with that map. The rules were based on the daily clinical practice and the expertise of the CI programmers. The data transfer to and from this agent is either manual or through seamless digital communication with the CI fitting database and the psychoacoustic test suite. It recommends and executes modifications to the map settings to improve the outcome. Fitting to Outcomes eXpert is an operational intelligent agent, the principles of which are described. Its development and modes of operation are outlined, and a case example is given. Fitting to Outcomes eXpert is in use for more than a year now and seems to be capable to improve the measured outcome. It is argued that this novel tool allows a systematic approach focusing on outcome, reducing the fitting time, and improving the quality of fitting. It introduces principles of artificial intelligence in the process of CI fitting.

The importance of functional impairment to mental health outcomes: A case for reassessing our goals in depression treatment research

PubMed Central

McKnight, Patrick E.; Kashdan, Todd B.

2009-01-01

Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims–1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures. PMID:19269076

Building and executing a research agenda toward conducting implementation science in medical education

PubMed Central

Carney, Patricia A.; Crites, Gerald E.; Miller, Karen H.; Haight, Michelle; Stefanidis, Dimitrios; Cichoskikelly, Eileen; Price, David W.; Akinola, Modupeola O.; Scott, Victoria C.; Kalishman, Summers

2016-01-01

Background Implementation science (IS) is the study of methods that successfully integrate best evidence into practice. Although typically applied in healthcare settings to improve patient care and subsequent outcomes, IS also has immediate and practical applications to medical education toward improving physician training and educational outcomes. The objective of this article is to illustrate how to build a research agenda that focuses on applying IS principles in medical education. Approach We examined the literature to construct a rationale for using IS to improve medical education. We then used a generalizable scenario to step through a process for applying IS to improve team-based care. Perspectives IS provides a valuable approach to medical educators and researchers for making improvements in medical education and overcoming institution-based challenges. It encourages medical educators to systematically build upon the research outcomes of others to guide decision-making while evaluating the successes of best practices in individual environments and generate additional research questions and findings. Conclusions IS can act as both a driver and a model for educational research to ensure that best educational practices are easier and faster to implement widely. PMID:27565131

Putting culture in the curriculum: a European project.

PubMed

Sairanen, Raija; Richardson, Eileen; Kelly, Hélène; Bergknut, Eva; Koskinen, Liisa; Lundberg, Pranee; Muir, Nita; Olt, Helen; De Vlieger, Lily

2013-03-01

The purpose of this paper is to describe the rationale for and the method of designing a framework for a European curriculum to promote intercultural competence in health care students. The background relating to the migration of people into and across Europe is cited as the factor driving the need for such a project. The project group emerged from the European organisation known as COHEHRE (Consortium of Higher Education Institutes in Health and Rehabilitation in Europe). Composed of a group of nurse educators from 5 European countries it charts the process which led them to create a curriculum framework. The completed work is available in the form of a CD-ROM. The paper describes the steps taken to reach the project outcomes over 4 years. The methods of dissemination of the project outcomes are included. The discussion considers the journey of the group towards the outcomes of the project and identifies the need to discover how effective the framework is in achieving the aims of the group. In conclusion it articulates the hope that this work will improve the care which is shown to all recipients of health care whatever their cultural background. Copyright © 2012 Elsevier Ltd. All rights reserved.

Rationale for the diabetic retinopathy clinical research network treatment protocol for center-involved diabetic macular edema.

PubMed

Aiello, Lloyd Paul; Beck, Roy W; Bressler, Neil M; Browning, David J; Chalam, K V; Davis, Matthew; Ferris, Frederick L; Glassman, Adam R; Maturi, Raj K; Stockdale, Cynthia R; Topping, Trexler M

2011-12-01

To describe the underlying principles used to develop a web-based algorithm that incorporated intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for diabetic macular edema (DME) in a Diabetic Retinopathy Clinical Research Network (DRCR.net) randomized clinical trial. Discussion of treatment protocol for DME. Subjects with vision loss resulting from DME involving the center of the macula. The DRCR.net created an algorithm incorporating anti-VEGF injections in a comparative effectiveness randomized clinical trial evaluating intravitreal ranibizumab with prompt or deferred (≥24 weeks) focal/grid laser treatment in eyes with vision loss resulting from center-involved DME. Results confirmed that intravitreal ranibizumab with prompt or deferred laser provides superior visual acuity outcomes compared with prompt laser alone through at least 2 years. Duplication of this algorithm may not be practical for clinical practice. To share their opinion on how ophthalmologists might emulate the study protocol, participating DRCR.net investigators developed guidelines based on the algorithm's underlying rationale. Clinical guidelines based on a DRCR.net protocol. The treatment protocol required real-time feedback from a web-based data entry system for intravitreal injections, focal/grid laser treatment, and follow-up intervals. Guidance from this system indicated whether treatment was required or given at investigator discretion and when follow-up should be scheduled. Clinical treatment guidelines, based on the underlying clinical rationale of the DRCR.net protocol, include repeating treatment monthly as long as there is improvement in edema compared with the previous month or until the retina is no longer thickened. If thickening recurs or worsens after discontinuing treatment, treatment is resumed. Duplication of the approach used in the DRCR.net randomized clinical trial to treat DME involving the center of the macula with intravitreal ranibizumab may not be practical in clinical practice, but likely can be emulated based on an understanding of the underlying rationale for the study protocol. Inherent differences between a web-based treatment algorithm and a clinical approach may lead to differences in outcomes that are impossible to predict. The closer the clinical approach is to the algorithm used in the study, the more likely the outcomes will be similar to those published. Proprietary or commercial disclosure may be found after the references. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Use of surrogate outcomes in US FDA drug approvals, 2003-2012: a survey.

PubMed

Yu, Tsung; Hsu, Yea-Jen; Fain, Kevin M; Boyd, Cynthia M; Holbrook, Janet T; Puhan, Milo A

2015-11-27

To evaluate, across a spectrum of diseases, how often surrogate outcomes are used as a basis for drug approvals by the US Food and Drug Administration (FDA), and whether and how the rationale for using treatment effects on surrogates as predictors of treatment effects on patient-centred outcomes is discussed. We used the Drugs@FDA website to identify drug approvals produced from 2003 to 2012 by the FDA. We focused on four diseases (chronic obstructive pulmonary disease (COPD), type 1 or 2 diabetes, glaucoma and osteoporosis) for which surrogates are commonly used in trials. We reviewed the drug labels and medical reviews to provide empirical evidence on how surrogate outcomes are handled by the FDA. Of 1043 approvals screened, 58 (6%) were for the four diseases of interest. Most drugs for COPD (7/9, 78%), diabetes (26/26, 100%) and glaucoma (9/9, 100%) were approved based on surrogates while for osteoporosis, most drugs (10/14, 71%) were also approved for patient-centred outcomes (fractures). The rationale for using surrogates was discussed in 11 of the 43 (26%) drug approvals based on surrogates. In these drug approvals, we found drug approvals for diabetes are more likely than the other examined conditions to contain a discussion of trial evidence demonstrating that treatment effects on surrogate outcomes predict treatment effects on patient-centred outcomes. Our results suggest that the FDA did not use a consistent approach to address surrogates in assessing the benefits and harms of drugs for COPD, type 1 or 2 diabetes, glaucoma and osteoporosis. For evaluating new drugs, patient-centred outcomes should be chosen whenever possible. If the use of surrogate outcomes is necessary, then a consistent approach is important to review the evidence for surrogacy and consider surrogate's usage in the treatment and population under study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The consequence of spatial visual processing dysfunction caused by traumatic brain injury (TBI).

PubMed

Padula, William V; Capo-Aponte, Jose E; Padula, William V; Singman, Eric L; Jenness, Jonathan

2017-01-01

A bi-modal visual processing model is supported by research to affect dysfunction following a traumatic brain injury (TBI). TBI causes dysfunction of visual processing affecting binocularity, spatial orientation, posture and balance. Research demonstrates that prescription of prisms influence the plasticity between spatial visual processing and motor-sensory systems improving visual processing and reducing symptoms following a TBI. The rationale demonstrates that visual processing underlies the functional aspects of binocularity, balance and posture. The bi-modal visual process maintains plasticity for efficiency. Compromise causes Post Trauma Vision Syndrome (PTVS) and Visual Midline Shift Syndrome (VMSS). Rehabilitation through use of lenses, prisms and sectoral occlusion has inter-professional implications in rehabilitation affecting the plasticity of the bi-modal visual process, thereby improving binocularity, spatial orientation, posture and balance Main outcomes: This review provides an opportunity to create a new perspective of the consequences of TBI on visual processing and the symptoms that are often caused by trauma. It also serves to provide a perspective of visual processing dysfunction that has potential for developing new approaches of rehabilitation. Understanding vision as a bi-modal process facilitates a new perspective of visual processing and the potentials for rehabilitation following a concussion, brain injury or other neurological events.

Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design.

PubMed

Fortinsky, Richard H; Gitlin, Laura N; Pizzi, Laura T; Piersol, Catherine Verrier; Grady, James; Robison, Julie T; Molony, Sheila

2016-07-01

Dementia is the leading cause of loss of independence in older adults worldwide. In the U.S., approximately 15 million family members provide care to relatives with dementia. This paper presents the rationale and design for a translational study in which an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers (CGs) is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission. The 4-month Care of Persons with Dementia in their Environments (COPE) intervention is designed to optimize older adults' functional independence, and to improve CG dementia management skills and health-related outcomes. COPE features 10 in-home occupational therapy visits, and 1 in-home visit and 1 telephone contact by an advanced practice nurse. COPE was deemed efficacious in a published randomized clinical trial. In the present study, older adults with dementia enrolled in the Connecticut Home Care Program for Elders (CHCPE) and their CGs are randomly assigned to receive COPE plus their ongoing CHCPE services, or to continue receiving CHCPE services only. The primary outcome for older adults with dementia is functional independence; secondary outcomes are activity engagement, quality of life, and prevention or alleviation of neuropsychiatric symptoms. CG outcomes include perceived well-being and confidence in using activities to manage dementia symptoms. Translational outcomes include net financial benefit of COPE, and feasibility and acceptability of COPE implementation into the CHCPE. COPE has the potential to improve health-related outcomes while saving Medicaid waiver and state revenue-funded home care program costs nationwide. Copyright © 2016 Elsevier Inc. All rights reserved.

Early family-based intervention in the path to alcohol problems: rationale and relationship between treatment process characteristics and child and parenting outcomes.

PubMed

Nye, C L; Zucker, R A; Fitzgerald, H E

1999-03-01

Risk for subsequent development of alcohol problems is not uniform across the population of alcoholic families, but varies with parental comorbidity and family history. Recent studies have also identified disruptive child behavior problems in the preschool years as predictive of alcoholism in adulthood. Given the quality of risk structure in highest risk families, prevention programming is more appropriately family based rather than individual. A family-based intervention program for the prevention of conduct problems among preschool-age sons of alcoholic fathers was implemented to change this potential mediating risk structure. A population-based recruitment strategy enrolled 52 alcoholic families in a 10-month intervention involving parent training and marital problem solving. The study examined the interplay between parent treatment investment and parent and therapist expectations and satisfaction in predicting change in child behavior and authoritative parenting style during the program, and for 6 months afterward among the 29 families whose sustained involvement allowed these effects to be evaluated. Parent expectations at pretreatment influenced their early investment in the program, which in turn predicted child and parenting outcomes. Parent and therapist satisfaction ratings during treatment were associated with one another and with expectations that the program would continue to promote changes in their child. Parent investment was a particularly salient influence on outcome, as higher investment throughout the program was associated with improvement in child behavior and authoritative parenting at termination. Findings indicate that treatment process characteristics mediate the influence of baseline parent functioning on treatment success and that treatment changes themselves predict later child outcomes.

Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial.

PubMed

Sung, Vivian W; Borello-France, Diane; Dunivan, Gena; Gantz, Marie; Lukacz, Emily S; Moalli, Pamela; Newman, Diane K; Richter, Holly E; Ridgeway, Beri; Smith, Ariana L; Weidner, Alison C; Meikle, Susan

2016-10-01

Mixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12 months. ESTEEM is a multisite, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12 months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure, and need for additional treatment. The final study design was implemented in November 2013 across eight clinical sites in the Pelvic Floor Disorders Network. As of 27 February 2016, 433 total/472 targeted participants had been randomized. We describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision making.

Telephone-based mindfulness training to reduce stress in women with myocardial infarction: Rationale and design of a multicenter randomized controlled trial.

PubMed

Spruill, Tanya M; Reynolds, Harmony R; Dickson, Victoria Vaughan; Shallcross, Amanda J; Visvanathan, Pallavi D; Park, Chorong; Kalinowski, Jolaade; Zhong, Hua; Berger, Jeffrey S; Hochman, Judith S; Fishman, Glenn I; Ogedegbe, Gbenga

2018-04-21

Elevated stress is associated with adverse cardiovascular disease outcomes and accounts in part for the poorer recovery experienced by women compared with men after myocardial infarction (MI). Psychosocial interventions improve outcomes overall but are less effective for women than for men with MI, suggesting the need for different approaches. Mindfulness-based cognitive therapy (MBCT) is an evidence-based intervention that targets key psychosocial vulnerabilities in women including rumination (i.e., repetitive negative thinking) and low social support. This article describes the rationale and design of a multicenter randomized controlled trial to test the effects of telephone-delivered MBCT (MBCT-T) in women with MI. We plan to randomize 144 women reporting elevated perceived stress at least two months after MI to MBCT-T or enhanced usual care (EUC), which each involve eight weekly telephone sessions. Perceived stress and a set of patient-centered health outcomes and potential mediators will be assessed before and after the 8-week telephone programs and at 6-month follow-up. We will test the hypothesis that MBCT-T will be associated with greater 6-month improvements in perceived stress (primary outcome), disease-specific health status, quality of life, depression and anxiety symptoms, and actigraphy-based sleep quality (secondary outcomes) compared with EUC. Changes in mindfulness, rumination and perceived social support will be evaluated as potential mediators in exploratory analyses. If found to be effective, this innovative, scalable intervention may be a promising secondary prevention strategy for women with MI experiencing elevated perceived stress. Copyright © 2018 Elsevier Inc. All rights reserved.

Systematic information processing style and perseverative worry.

PubMed

Dash, Suzanne R; Meeten, Frances; Davey, Graham C L

2013-12-01

This review examines the theoretical rationale for conceiving of systematic information processing as a proximal mechanism for perseverative worry. Systematic processing is characterised by detailed, analytical thought about issue-relevant information, and in this way, is similar to the persistent, detailed processing of information that typifies perseverative worry. We review the key features and determinants of systematic processing, and examine the application of systematic processing to perseverative worry. We argue that systematic processing is a mechanism involved in perseverative worry because (1) systematic processing is more likely to be deployed when individuals feel that they have not reached a satisfactory level of confidence in their judgement and this is similar to the worrier's striving to feel adequately prepared, to have considered every possible negative outcome/detect all potential danger, and to be sure that they will successfully cope with perceived future problems; (2) systematic processing and worry are influenced by similar psychological cognitive states and appraisals; and (3) the functional neuroanatomy underlying systematic processing is located in the same brain regions that are activated during worrying. This proposed mechanism is derived from core psychological processes and offers a number of clinical implications, including the identification of psychological states and appraisals that may benefit from therapeutic interventions for worry-based problems. © 2013.

Sustainable e-Learning: Toward a Coherent Body of Knowledge

ERIC Educational Resources Information Center

Stepanyan, Karen; Littlejohn, Allison; Margaryan, Anoush

2013-01-01

This paper explores the concept of sustainable e-learning. It outlines a scoping review of the sustainability of e-learning practice in higher education. Prior to reporting the outcomes of the review, this paper outlines the rationale for conducting the study. The origins and the meaning of the term "sustainability" are explored, and…

77 FR 66848 - Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-07

... trials and device study design. Date and Time: The public workshop will be held on November 27, 2012... problem for PRO instruments. There have been various methodological approaches to determine MCID for... rationales for regulatory guidance of clinical trials and device study design. Approximately 45 days after...

Personality Correlates of Continuation and Outcome in Meditation and Erect Sitting Control Treatments.

ERIC Educational Resources Information Center

Smith, Jonathan C.

1978-01-01

Anxious college students were assigned to transcendental meditation (TM) and a control treatment. Demographic and pretest personality variables were correlated with continuation in treatment. The TM dropout was more disturbed and less self-critical than the person who continued. Differing treatment rationales rendered the treatments effective for…

A randomized controlled trial to prevent childhood obesity through early childhood feeding and parenting guidance: Rationale and design of study

USDA-ARS?s Scientific Manuscript database

Early and rapid growth in infants is strongly associated with early development and persistence of obesity in young children. Substantial research has linked child obesity/overweight to increased risks for serious health outcomes, which include adverse physical, psychological, behavioral, or social ...

Using Acceptance and Commitment Therapy during Methadone Dose Reduction: Rationale, Treatment Description, and a Case Report

ERIC Educational Resources Information Center

Stotts, Angela L.; Masuda, Akihiko; Wilson, Kelly

2009-01-01

Many clients who undergo methadone maintenance (MM) treatment for heroin and other opiate dependence prefer abstinence from methadone. Attempts at methadone detoxification are often unsuccessful, however, due to distressing physical as well as psychological symptoms. Outcomes from an MM client who voluntarily participated in an Acceptance and…

Sustainability and Ethics as Decision-Making Paradigms in Engineering Curricula

ERIC Educational Resources Information Center

El-Zein, Abbas; Airey, David; Bowden, Peter; Clarkeburn, Henriikka

2008-01-01

Purpose: The aim of this paper is to explore the rationale for teaching sustainability and engineering ethics within a decision-making paradigm, and critically appraise ways of achieving related learning outcomes. Design/methodology/approach: The paper presents the experience of the School of Civil Engineering at the University of Sydney in…

Teaching Writing within the Disciplines: A Viable Approach for English for Academic Purposes (EAP) Instructors

ERIC Educational Resources Information Center

Leopold, Lisa

2011-01-01

This case study of an adjunct-model English for Academic Purposes (EAP) writing course linked to a policy-analysis course describes an effective approach for putting "specificity" into practice in EAP curriculum design. The rationale for interdisciplinary collaboration, the positive learning outcomes from the EAP writing course, the…

Supporting Vocationally Oriented Learning in the High School Years: Rationale, Tasks, Challenges

ERIC Educational Resources Information Center

Halpern, Robert

2012-01-01

This article highlights the limitations of our current educational system in terms of vocational learning and highlights the role that vocational learning can play in supporting youth development and improving youth outcomes. It discusses the role that nonschool settings can play in supporting vocational learning and suggests strategies to improve…

Children's Vocational Development: A Research Rationale

ERIC Educational Resources Information Center

Porfeli, Erik J.; Hartung, Paul J.; Vondracek, Fred W.

2008-01-01

Vocational development research and interventions have focused primarily on adolescents and young adults. The lack of attention to career development antecedents in children has led to a serious neglect of this period of life when the foundation is laid for career choices and outcomes in later life. A harmful by-product is the frequent preclusion…

Evaluation of Title I ESEA Projects, 1977-1978: Technical Reports. Report Number 7877.

ERIC Educational Resources Information Center

Philadelphia School District, PA. Office of Research and Evaluation.

Technical reports of projects funded under the Elementary and Secondary Education Act Title I and summer components of the projects in the Philadelphia, Pennsylvania school system are presented. Following a summary statement, each project is described separately and contains information on the project's rationale, expected outcomes, mode of…

Rationale and design of the SMaRT trial: A randomised, prospective, parallel, non-blinded, one-centre trial to evaluate the use of magnetic resonance imaging in acute setting in patients presenting with suspected scaphoid fracture.

PubMed

Rua, Tiago; Vijayanathan, Sanjay; Parkin, David; Goh, Vicky; McCrone, Paul; Gidwani, Sam

2018-04-01

Background Wrist injury is a common presentation to the Emergency Department in the United Kingdom. Among these injuries, the scaphoid is the most common fractured carpal bone. However, given the limited ability of conventional radiography to accurately diagnose a suspected scaphoid fracture on presentation, its diagnosis and management remain challenging. Despite the vast clinical evidence supporting the superior accuracy of magnetic resonance imaging, there is little to no evidence around the real-world clinical and economic impact of immediate magnetic resonance imaging in the management of suspected scaphoid fractures. Methods Review of design and implementation challenges associated with the identification and subsequent recruitment of eligible patients, implementation of a novel clinical pathway in an acute setting, rationale behind the primary and secondary outcomes selected and measurement of the primary outcome. Results The Scaphoid Magnetic Resonance Imaging in Trauma trial is a single-site prospective, randomised, non-blinded, parallel design trial that aims to evaluate the use of immediate magnetic resonance imaging in the management of patients presenting to the acute setting with suspected scaphoid fractures. The primary outcome is the total 3-month cost per patient associated with the diagnosis and treatment of suspected scaphoid fractures. It is hypothesised that the immediate use of magnetic resonance imaging, a more accurate but expensive imaging modality, in patients with negative findings in the initial four-view radiography, will reduce the overall National Health Service costs by promoting definitive care and avoiding unnecessary diagnostic and treatment procedures. Other rationale design considerations in the recruitment, randomisation, data acquisition and intervention implementation are also discussed. Several of these challenges derive from real-world operational issues associated with the provision of magnetic resonance imaging in an intrinsically complex acute setting. Staff engagement during the trial's planning phase, combined with an extensive training programme rolled out prior to the trial's launch, were essential to raise staff awareness and engagement. Given the acute nature of the clinical condition, the latter was deemed essential as the eligibility assessment, recruitment, randomisation and treatment allocation processes all need to happen in a very tight time frame. Limitations Findings from the Scaphoid Magnetic Resonance Imaging in Trauma trial might not be generalisable to other National Health Service hospitals, foreign healthcare systems nor patient presentations outside normal magnetic resonance imaging working hours. Conclusion The Scaphoid Magnetic Resonance Imaging in Trauma trial was designed to evaluate the costs, patient satisfaction and clinical outcomes around the management of suspected scaphoid fractures and ultimately provide solid evidence on which to base the United Kingdom and international clinical practice. This article discusses the steps considered in the design of this novel trial, with particular emphasis on the issues and lessons learned during the planning and implementation stages.

Innovation Related to the Tenure, Succession Pattern and Reference Group Orientation of the Principal. Final Report.

ERIC Educational Resources Information Center

Reynolds, James A.; Reynolds, Larry J.

The purposes of this study were to develop a conceptual rationale that might serve as the basis for a model of the change process and to test hypotheses derived from the rationale. It was believed that this approach would make a contribution to a growing body of research which views the school in the broader context of organizational theory. The…

The use of the analytic hierarchy process to aid decision making in acquired equinovarus deformity.

PubMed

van Til, Janine A; Renzenbrink, Gerbert J; Dolan, James G; Ijzerman, Maarten J

2008-03-01

To increase the transparency of decision making about treatment in patients with equinovarus deformity poststroke. The analytic hierarchy process (AHP) was used as a structured methodology to study the subjective rationale behind choice of treatment. An 8-hour meeting at a centrally located rehabilitation center in The Netherlands, during which a patient video was shown to all participants (using a personal computer and a large screen) and the patient details were provided on paper. A panel of 10 health professionals from different backgrounds. Not applicable. The performance of the applicable treatments on outcome, impact, comfort, cosmetics, daily effort, and risks and side effects of treatment, as well as the relative importance of criteria in the choice of treatment. According to the model, soft-tissue surgery (.413) ranked first as the preferred treatment, followed by orthopedic footwear (.181), ankle-foot orthosis (.147), surface electrostimulation (.137), and finally implanted electrostimulation (.123). Outcome was the most influential consideration affecting treatment choice (.509), followed by risk and side effects (.194), comfort (.104), daily effort (.098), cosmetics (.065), and impact of treatment (.030). Soft-tissue surgery was judged best on outcome, daily effort, comfortable shoe wear, and cosmetically acceptable result and was thereby preferred as a treatment alternative by the panel in this study. In contrast, orthosis and orthopedic footwear are usually preferred in daily practice. The AHP method was found to be suitable methodology for eliciting subjective opinions and quantitatively comparing treatments in the absence of scientific evidence.

Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study.

PubMed

Wang, Philip S; Simon, Gregory E; Kessler, Ronald C

2008-04-01

Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers. Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study. This randomized controlled trial compared telephone outreach, care management, and optional psychotherapy to usual care among depressed workers in large national corporations. By 12 months, the intervention significantly improved depression outcomes, work retention, and hours worked among the employed. Results of the Work Outcomes Research and Cost-effectiveness Study trial and other studies suggest that enhanced depression care programs represent a human capital investment opportunity for employers.

The process for technology transfer in Baltimore

NASA Technical Reports Server (NTRS)

Golden, T. S.

1978-01-01

Ingredients essential for a successful decision process relative to proper technological choices for a large city were determined during four years of experience in the NASA/Baltimore Applications Project. The general approach, rationale, and process of technology transfer are discussed.

A Rationale for the Outcomes of Insurgencies: A Comparison Case Study Between Insurgencies in Peru and Nepal

DTIC Science & Technology

2014-12-01

December 1987 and February 1992.100 Sigmund Freud notes such violent attitudes, and documents that human instincts are of two types—those that...Routledge Contemporary South Asia Series, 2010), 144. 101 Sigmund Freud , “Why War,” in Conflict after the Cold War: Arguments on Causes of War and

More than a Body's Work: Widening Cultural Participation through an International Exploration of Young People's Construction of Visual Image and Identity

ERIC Educational Resources Information Center

Bianchi, June

2008-01-01

The article presents the rationale, methodology, and selected outcomes from "More than a body's work," a collaborative, international, arts educational interactive research project. The project, taking place in both New York and England, explored the ways in which young people construct and "perform" identity through the…

Civil Rights Questions: Where Race, Economics, and Criminal Justice Intersect.

ERIC Educational Resources Information Center

Dutton, Marghi

This curriculum unit on civil rights questions in the United States was developed as a history-social science project at San Jose State University. The unit is intended for high school students and needs one or two class periods to complete. It provides the teacher with a rationale, a framework, history-social science standards, student outcomes,…

Non-Speech Oro-Motor Exercise Use in Acquired Dysarthria Management: Regimes and Rationales

ERIC Educational Resources Information Center

Mackenzie, Catherine; Muir, Margaret; Allen, Carolyn

2010-01-01

Background: Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy manuals and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. Aims:…

Using Flipped Classroom Components in Blended Courses to Maximize Student Learning

ERIC Educational Resources Information Center

Heinerichs, Scott; Pazzaglia, Gina; Gilboy, Mary Beth

2016-01-01

Context: The flipped classroom is an educational approach that has become popular in higher education because it is student centered. Objective: To provide a rationale for a specific way of approaching the flipped classroom using a blended course design and resources necessary to help instructors be successful. Main Outcome Measure(s): Three class…

Collaborative Research in Child Welfare: A Rationale for Rigorous Participatory Evaluation Designs to Promote Sustained Systems Change

ERIC Educational Resources Information Center

Collins-Camargo, Crystal; Shackelford, Kim; Kelly, Michael; Martin-Galijatovic, Ramie

2011-01-01

Expansion of the child welfare evidence base is a major challenge. The field must establish how organizational systems and practice techniques yield outcomes for children and families. Needed research must be grounded in practice and must engage practitioners and administrators via participatory evaluation. The extent to which successful practices…

Ethical Blind Spots in Leading for Learning: An Australian Study

ERIC Educational Resources Information Center

Bezzina, Michael

2013-01-01

Purpose: This study aims to explore the dynamics by which exposure to a moral rationale is given expression in schools, and how this is perceived as impacting on teaching, leadership practice and student outcomes. Design/methodology/approach: A total of 11 Australian schools were part of a project in which they were supported in applying a…

Designing a strategy to promote safe, innovative off-label use of medications.

PubMed

Ansani, Nicole; Sirio, Carl; Smitherman, Thomas; Fedutes-Henderson, Bethany; Skledar, Susan; Weber, Robert J; Zgheib, Nathalie; Branch, Robert

2006-01-01

Innovative off-label medication use (defined as prescribing with reasonable rationale for use, but insufficient evidence to allay safety, efficacy, and cost-effectiveness concerns, yet is not clinical research) is common practice and provides challenges to ensuring high-quality health care and patient safety. This article describes a strategy to promote policy and standardization of innovative off-label medication use, ensure oversight of patient safety, and prospectively assess efficacy. A multidisciplinary group developed a policy and process to regulate innovative off-label medication use that standardizes formulary review, maximizes peer expertise input, and minimizes institution liability by evaluating the effectiveness of use, promoting evidence-based practices, and ensuring ethical obligations to patients and society. This strategy has been implemented through institutional staff structure. The review process balances benefits/risks for biologically plausible therapy that lacks rigorous data support. The authors' strategy illustrates collaboration that enables a priori consideration for innovative off-label medication use while providing safety surveillance and outcomes monitoring.

Perineural invasion in head and neck cancers - a review-

PubMed Central

Frunza, A; Slavescu, D; Lascar, I

2014-01-01

Abstract Rationale: perineural invasion is an under-recognized way of metastatic spread via tumoral invasion of the nerves. It is encountered in malignancies located in the head and neck but also in cancers involving the pancreas, colon and rectum, prostate, biliary tract and stomach. For some tumors, it may be the only way of metastatic spread. It represents a marker for poor outcome, with increased risk for locoregional recurrence and reduced survival rates. The molecular mechanisms behind this process are not yet fully understood; research is done to identify new therapeutic targets in order to achieve disease control. Objective: to make a rigorous analysis of this phenomenon and to highlight the best therapeutic approach. Method and results: a review of the current literature in order to harmonize the international protocols to our local pathology. Discussions: the surgical intervention is decisive to defeat the malignant process but must be associated with modern therapeutic methods, such as the image-guided radiation therapy and immunotherapy. PMID:25408713

Interactions between parasites and microbial communities in the human gut.

PubMed

Berrilli, Federica; Di Cave, David; Cavallero, Serena; D'Amelio, Stefano

2012-01-01

The interactions between intestinal microbiota, immune system, and pathogens describe the human gut as a complex ecosystem, where all components play a relevant role in modulating each other and in the maintenance of homeostasis. The balance among the gut microbiota and the human body appear to be crucial for health maintenance. Intestinal parasites, both protozoans and helminths, interact with the microbial community modifying the balance between host and commensal microbiota. On the other hand, gut microbiota represents a relevant factor that may strongly interfere with the pathophysiology of the infections. In addition to the function that gut commensal microbiota may have in the processes that determine the survival and the outcome of many parasitic infections, including the production of nutritive macromolecules, also probiotics can play an important role in reducing the pathogenicity of many parasites. On these bases, there is a growing interest in explaining the rationale on the possible interactions between the microbiota, immune response, inflammatory processes, and intestinal parasites.

Interactions between parasites and microbial communities in the human gut

PubMed Central

Berrilli, Federica; Di Cave, David; Cavallero, Serena; D'Amelio, Stefano

2012-01-01

The interactions between intestinal microbiota, immune system, and pathogens describe the human gut as a complex ecosystem, where all components play a relevant role in modulating each other and in the maintenance of homeostasis. The balance among the gut microbiota and the human body appear to be crucial for health maintenance. Intestinal parasites, both protozoans and helminths, interact with the microbial community modifying the balance between host and commensal microbiota. On the other hand, gut microbiota represents a relevant factor that may strongly interfere with the pathophysiology of the infections. In addition to the function that gut commensal microbiota may have in the processes that determine the survival and the outcome of many parasitic infections, including the production of nutritive macromolecules, also probiotics can play an important role in reducing the pathogenicity of many parasites. On these bases, there is a growing interest in explaining the rationale on the possible interactions between the microbiota, immune response, inflammatory processes, and intestinal parasites. PMID:23162802

Rationale and design of the ENhancing outcomes through Goal Assessment and Generating Engagement in Diabetes Mellitus (ENGAGE-DM) pragmatic trial.

PubMed

Lauffenburger, Julie C; Lewey, Jennifer; Jan, Saira; Nanchanatt, Gina; Makanji, Sagar; Ferro, Christina A; Sheehan, John; Wittbrodt, Eric; Morawski, Kyle; Lee, Jessica; Ghazinouri, Roya; Choudhry, Niteesh K

2017-08-01

Poor glycemic control among patients with diabetes may stem from poor medication and lifestyle adherence or a failure to appropriately intensify therapy. A patient-centered approach could discern the most likely possibility and would then, as appropriate, address patient barriers to non-adherence (using behavioral interviewing methods such as motivational interviewing) or help facilitate choices among treatment augmentation options (using methods such as shared decision-making). To test the impact of a novel telephone-based patient-centered intervention on glycemic control for patients with poorly-controlled diabetes. ENGAGE-DM (ENhancing outcomes through Goal Assessment and Generating Engagement in Diabetes Mellitus) is a pragmatic trial of patients with poorly-controlled diabetes receiving treatment with an oral hypoglycemic agent. We randomized 1400 patients in a large health insurer to intervention or usual care. The intervention is delivered over the telephone by a pharmacist and consists of a 2-step process that integrates brief negotiated interviewing and shared decision-making to identify patient-concordant goals and options for enhancing patients' diabetes management. The trial's primary outcome is disease control, assessed using glycosylated hemoglobin values. Secondary outcomes include medication adherence measures, assessed using pharmacy claims data. This trial will determine whether a novel highly-scalable patient engagement strategy improves disease control and adherence to medications among individuals with poorly-controlled diabetes. Copyright © 2017. Published by Elsevier Inc.

Towards a Job Demands-Resources Health Model: Empirical Testing with Generalizable Indicators of Job Demands, Job Resources, and Comprehensive Health Outcomes

PubMed Central

Brauchli, Rebecca; Jenny, Gregor J.; Füllemann, Désirée; Bauer, Georg F.

2015-01-01

Studies using the Job Demands-Resources (JD-R) model commonly have a heterogeneous focus concerning the variables they investigate—selective job demands and resources as well as burnout and work engagement. The present study applies the rationale of the JD-R model to expand the relevant outcomes of job demands and job resources by linking the JD-R model to the logic of a generic health development framework predicting more broadly positive and negative health. The resulting JD-R health model was operationalized and tested with a generalizable set of job characteristics and positive and negative health outcomes among a heterogeneous sample of 2,159 employees. Applying a theory-driven and a data-driven approach, measures which were generally relevant for all employees were selected. Results from structural equation modeling indicated that the model fitted the data. Multiple group analyses indicated invariance across six organizations, gender, job positions, and three times of measurement. Initial evidence was found for the validity of an expanded JD-R health model. Thereby this study contributes to the current research on job characteristics and health by combining the core idea of the JD-R model with the broader concepts of salutogenic and pathogenic health development processes as well as both positive and negative health outcomes. PMID:26557718

Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain

PubMed Central

2009-01-01

Background Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes. Methods/Design The Cancer Health Empowerment for Living without Pain (Ca-HELP) Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California. A total of 265 cancer patients with at least moderate pain severity (Worst Pain Numerical Analog Score >=4 out of 10) or pain-related impairment (Likert score >= 3 out of 5) were randomly assigned to receive tailored education and coaching (TEC) or educationally-enhanced usual care (EUC); 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components (assess, correct, teach, prepare, rehearse, portray). Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits (56%) were audio-recorded for later communication coding. Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks. Discussion Building on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment (primary outcomes); self-efficacy and quality of life (secondary outcomes); and relationships among processes and outcomes of cancer pain care. If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost. Trial Registration [Clinical Trials Identifier: NCT00283166] PMID:19737424

How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change.

PubMed

Gilissen, J; Pivodic, L; Gastmans, C; Vander Stichele, R; Deliens, L; Breuer, E; Van den Block, L

2018-02-14

Advance care planning (ACP) has been identified as particularly relevant for nursing home residents, but it remains unclear how or under what circumstances ACP works and can best be implemented in such settings. We aimed to develop a theory that outlines the hypothetical causal pathway of ACP in nursing homes, i.e. what changes are expected, by means of which processes and under what circumstances. The Theory of Change approach is a participatory method of programme design and evaluation whose underlying intention is to improve understanding of how and why a programme works. It results in a Theory of Change map that visually represents how, why and under what circumstances ACP is expected to work in nursing home settings in Belgium. Using this approach, we integrated the results of two workshops with stakeholders (n = 27) with the results of a contextual analysis and a systematic literature review. We identified two long-term outcomes that ACP can achieve: to improve the correspondence between residents’ wishes and the care/treatment they receive and to make sure residents and their family feel involved in planning their future care and are confident their care will be according to their wishes. Besides willingness on the part of nursing home management to implement ACP and act accordingly, other necessary preconditions are identified and put in chronological order. These preconditions serve as precursors to, or requirements for, accomplishing successful ACP. Nine original key intervention components with specific rationales are identified at several levels (resident/family, staff or nursing home) to target the preconditions: selection of a trainer, ensuring engagement by management, training ACP reference persons, in-service education for healthcare staff, information for staff, general practitioners, residents and their family, ACP conversations and documentation, regular reflection sessions, multidisciplinary meetings, and formal monitoring. The Theory of Change map presented here illustrates a theory of how ACP is expected to work in order to achieve its desired long-term outcomes while highlighting organisational factors that potentially facilitate the implementation and sustainability of ACP. We provide the first comprehensive rationale of how ACP is expected to work in nursing homes, something that has been called for repeatedly.

Descriptions of Space Processing Applications Rocket (SPAR) experiments

NASA Technical Reports Server (NTRS)

Naumann, R. J. (Editor)

1979-01-01

The experiments for all the Space Processing Applications Rocket experiments, including those flown on previous Space Processing flights as well as those under development for future flights are described. The experiment objective, rationale, approach, and results or anticipated results are summarized.

Comprehension of Connected Discourse.

ERIC Educational Resources Information Center

Mosberg, Ludwig; Shima, Fred

A rationale was developed for researching reading comprehension based on information gain. Previous definitions of comprehension which were reviewed included operational vs. nonoperational and skills vs. processes. Comprehension was viewed as an informational processing event which includes a constellation of cognitive and learning processes. Two…

Integrated worker health protection and promotion programs: overview and perspectives on health and economic outcomes.

PubMed

Pronk, Nicolaas P

2013-12-01

To describe integrated worker health protection and promotion (IWHPP) program characteristics, to discuss the rationale for the integration of occupational safety and health and worksite health promotion programs, and to summarize what is known about the impact of these programs on health and economic outcomes. A descriptive assessment of the current state of the IWHPP field and a review of studies on the effectiveness of IWHPP programs on health and economic outcomes were undertaken. Sufficient evidence of effectiveness was found for IWHPP programs when health outcomes were considered. Impact on productivity-related outcomes is considered promising, but inconclusive, whereas insufficient evidence was found for health care expenditures. Existing evidence supports an integrated approach in terms of health outcomes but will benefit significantly from research designed to support the business case for employers of various company sizes and industry types.

Integrated Worker Health Protection and Promotion Programs: Overview and Perspectives on Health and Economic Outcomes

PubMed Central

Pronk, Nicolaas P.

2014-01-01

Objective To describe integrated worker health protection and promotion (IWHPP) program characteristics, to discuss the rationale for integration of OSH and WHP programs, and to summarize what is known about the impact of these programs on health and economic outcomes. Methods A descriptive assessment of the current state of the IWHPP field and a review of studies on the effectiveness of IWHPP programs on health and economic outcomes. Results Sufficient evidence of effectiveness was found for IWHPP programs when health outcomes are considered. Impact on productivity-related outcomes is considered promising, but inconclusive, whereas insufficient evidence was found for health care expenditures. Conclusions Existing evidence supports an integrated approach in terms of health outcomes but will benefit significantly from research designed to support the business case for employers of various company sizes and industry types. PMID:24284747

Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe.

PubMed

Chibanda, Dixon; Verhey, Ruth; Munetsi, Epiphany; Cowan, Frances M; Lund, Crick

2016-01-01

There is a paucity of data on how to deliver complex interventions that seek to reduce the treatment gap for mental disorders, particularly in sub-Saharan Africa. The need for well-documented protocols which clearly describe the development and the scale-up of programs and interventions is necessary if such interventions are to be replicated elsewhere. This article describes the use of a theory of change (ToC) model to develop a brief psychological intervention for common mental disorders and its' evaluation through a cluster randomized controlled trial in Zimbabwe. A total of eight ToC workshops were held with a range of stakeholders over a 6-month period with a focus on four key components of the program: formative work, piloting, evaluation and scale-up. A ToC map was developed as part of the process with defined causal pathways leading to the desired impact. Interventions, indicators, assumptions and rationale for each point along the causal pathway were considered. Political buy-in from stakeholders together with key resources, which included human, facility/infrastructure, communication and supervision were identified as critical needs using the ToC approach. Ten (10) key interventions with specific indicators, assumptions and rationale formed part of the final ToC map, which graphically illustrated the causal pathway leading to the development of a psychological intervention and the successful implementation of a cluster randomized controlled trial. ToC workshops can enhance stakeholder engagement through an iterative process leading to a shared vision that can improve outcomes of complex mental health interventions particularly where scaling up of the intervention is desired.

“I am not telling. The mobile is telling”: Factors influencing the outcomes of a community health worker mHealth intervention in India

PubMed Central

Dieleman, Marjolein; Kraamwinkel, Nadine; Van Belle, Sara; Chaudoury, Murari; Broerse, Jacqueline E. W.

2018-01-01

Introduction Improving maternal health outcomes remains a priority in Low and Middle Income Countries. With the rapid proliferation of mobile health technologies, there is an increased interest in understanding how these technologies can effectively improve maternal health outcomes particularly maternal health seeking knowledge and behaviors. However, few studies present clear explanations of the program developers’ rationale (theory of change) and contextual factors that could influence program outcomes. This mixed-methods study assesses Mobile for Mothers, a community health workers (CHW) utilized maternal mHealth intervention. We present the program developers’ rationale and utilize it as a framework to guide our study that aimed to identify intervention-related and contextual factors, which influence the observed outcomes of a CHW, utilized mHealth intervention. Materials and methods Quantitative methods (a questionnaire with 740 women who received the intervention and survey of 57 CHWs who utilized the intervention) and qualitative methods (12 interviews and 4 group discussions with CHWs and 20 interviews and 5 group discussions with pregnant and lactating women and 15 interviews and 2 group discussions with men) were conducted. These were used to understand how the mHealth intervention was implemented and to gain insight into contextual factors that potentially influenced the observed intervention outcomes. Results Results were grouped following three categories: (1) perceptions and experiences of CHWs utilizing the mHealth technology; (2) CHW-related outcomes; and (3) contextual factors that influence maternal health-seeking behavior. The overall response of CHWs and community members to the intervention was positive. However, contextual factors like the relationship between the CHWs and their respective communities, the pregnant women’s decision-making power and lack of access due to financial influenced the observed outcomes. Conclusion Mobile health applications are promising interventions for improving the performance of CHWs and health-seeking behavior of pregnant women. However, the contextual factors play a crucial role in intervention outcomes and need to be explicated by program developers during intervention design and implementation. PMID:29584773

Cultural Studies, Indigenous Knowledge and Pedagogies of Hope

ERIC Educational Resources Information Center

Stewart-Harawira, Makere

2005-01-01

Notions of crisis and chaos have become the rationale for a new discourse in which empire is the logical outcome of a world no longer secure. One level at which this is manifested is in the rejection by the USA of international agreements to which it is signatory, in the demonstrated failure of the Bretton Woods system to meet its declared…

Counting Chickens before They Are Hatched: An Examination of Student Retention, Graduation, Attrition, and Dropout Measurement Validity in an Online Master's Environment

ERIC Educational Resources Information Center

Haydarov, Rustam; Moxley, Virginia; Anderson, Dawn

2013-01-01

This article examines definitions, rationales, and calculations associated with higher education performance measures: persistence, retention rate, attrition rate, drop-out rate, and graduation rate. Strengths and limitations of these measures are scrutinized relative to online master's programs. Outcomes of a sample of students (N = 96) enrolled…

Place-Based Picture Books as an Adult Learning Tool: Supporting Agricultural Learning in Papua New Guinea

ERIC Educational Resources Information Center

Simoncini, Kym; Pamphilon, Barbara; Mikhailovich, Katja

2017-01-01

This article describes the rationale, development, and outcomes of two place-based, dual-language picture books with agricultural messages for women farmers and their families in Papua New Guinea. The purpose of the books was to disseminate better agricultural and livelihood practices to women farmers with low literacy. The books were designed and…

Will Raising the Participation Age in England Solve the NEET Problem?

ERIC Educational Resources Information Center

Maguire, Sue

2013-01-01

This paper considers the rationale for introducing the raising of the participation age (RPA) in learning in England from 2013 and assesses how, if fully implemented, it could contribute to improving the outcomes for young people who do not participate in any form of post-16 education, employment or training, and are currently defined as not in…

First Graders' Responses to School-Taught Mathematics as a Function of Their Spontaneous Conceptions of Basic Algebraic Relationships.

ERIC Educational Resources Information Center

Kaplan, Rochelle Goldberg

The rationale of this study is based on the premise that the outcomes of children's learning are specifically shaped by the interaction of their individual cognitive structures with the presentations of curricular content in the classroom. Therefore, since the interpretive tools that children apply to instructional content may vary substantially,…

Rational and Boundedly Rational Behavior in a Binary Choice Sender-Receiver Game

ERIC Educational Resources Information Center

Landi, Massimiliano; Colucci, Domenico

2008-01-01

The authors investigate the strategic rationale behind the message sent by Osama bin Laden on the eve of the 2004 U.S. Presidential elections. They model this situation as a signaling game in which a population of receivers takes a binary choice, the outcome is decided by majority rule, sender and receivers have conflicting interests, and there is…

Conservation of design knowledge. [of large complex spaceborne systems

NASA Technical Reports Server (NTRS)

Sivard, Cecilia; Zweben, Monte; Cannon, David; Lakin, Fred; Leifer, Larry

1989-01-01

This paper presents an approach for acquiring knowledge about a design during the design process. The objective is to increase the efficiency of the lifecycle management of a space-borne system by providing operational models of the system's structure and behavior, as well as the design rationale, to human and automated operators. A design knowledge acquisition system is under development that compares how two alternative design versions meet the system requirements as a means for automatically capturing rationale for design changes.

A Cluster-Randomized Trial of Restorative Practices: An Illustration to Spur High-Quality Research and Evaluation.

PubMed

Acosta, Joie D; Chinman, Matthew; Ebener, Patricia; Phillips, Andrea; Xenakis, Lea; Malone, Patrick S

2016-01-01

Restorative Practices in schools lack rigorous evaluation studies. As an example of rigorous school-based research, this paper describes the first randomized control trial of restorative practices to date, the Study of Restorative Practices. It is a 5-year, cluster-randomized controlled trial (RCT) of the Restorative Practices Intervention (RPI) in 14 middle schools in Maine to assess whether RPI impacts both positive developmental outcomes and problem behaviors and whether the effects persist during the transition from middle to high school. The two-year RPI intervention began in the 2014-2015 school year. The study's rationale and theoretical concerns are discussed along with methodological concerns including teacher professional development. The theoretical rationale and description of the methods from this study may be useful to others conducting rigorous research and evaluation in this area.

Specifying the non-specific factors underlying opioid analgesia: Expectancy, attention, and affect

PubMed Central

Atlas, Lauren Y.; Wielgosz, Joseph; Whittington, Robert A.; Wager, Tor D.

2013-01-01

Rationale Psychological processes such as expectancy, attention, and affect directly influence clinical outcomes. These factors are grouped together as “nonspecific” factors, or placebo effects, in the medical literature, and their individual contributions are rarely considered. The pain-reducing effects of analgesic treatments may reflect changes in these psychological factors, rather than pure drug effects on pain. Furthermore, drug effects may not be isolated by drug vs. placebo comparisons if drugs interact with relevant psychological processes. Objectives To determine whether the analgesic effects of opioid and placebo treatment are mediated by changes in attention, expectancy, or affect. Methods We crossed intravenous administration of a potent opioid analgesic, remifentanil, with information about drug delivery (treatment expectancy, or placebo) using a balanced placebo design. We measured drug and treatment expectancy effects on pain, attention, and responses to emotional images. We also examined interactions with cue-based expectations about noxious stimulation, or stimulus expectancy. Results Pain was additively influenced by treatment expectancy, stimulus expectancy, and drug concentration. Attention performance showed a small but significant interaction between drug and treatment expectancy. Finally, remifentanil enhanced responses to both positive and negative emotional images. Conclusions The pain-relieving effects of opioid drugs are unlikely to be mediated by changes in threat or affective processing. Standard open-label opioid administration influences multiple clinically relevant cognitive and emotional processes. Psychological factors can combine with drug effects to influence multiple outcomes in distinct ways. The influence of specific psychological factors should be considered when developing and testing pharmacological treatments. PMID:24096537

Using three-dimensional imaging to assess treatment outcomes in orthodontics: a progress report from the University of the Pacific.

PubMed

Baumrind, S; Carlson, S; Beers, A; Curry, S; Norris, K; Boyd, R L

2003-01-01

Past research in integrated three-dimensional (3D) craniofacial mapping at the Craniofacial Research Instrumentation Laboratory (CRIL) of the University of the Pacific is summarized in narrative form. The advantages and limitations of recent commercial developments in the application of cone beam geometry volumetric X-ray scanners in dentistry and surface digital mapping of study casts are discussed. The rationale for methods currently in development at CRIL for merging longitudinal information from existing 3D study casts and two-dimensional lateral X-ray cephalograms in studies of orthodontic treatment outcome is presented.

Inquiry into terminal decline: five objectives for future study.

PubMed

Gerstorf, Denis; Ram, Nilam

2013-10-01

Notions of terminal decline propose that late-life change is primarily driven by processes closely tied to pathology and mortality rather than chronological age. We use the rationales of longitudinal research as outlined by Baltes and Nesselroade (Baltes, P., & Nesselroade, J. [1979]. History and rationale of longitudinal research. In J. R. Nesselroade & P. Baltes (Eds.), Longitudinal research in the study of behavior and development [pp. 1-39]. San Diego, CA: Academic Press) as a framework for organizing research on terminal decline. In doing so, we note that there are relatively robust descriptions of terminal decline across a variety of different domains, as well as the extent of interindividual differences in the levels of function, rates of change, and timing of terminal decline (research rationales 1 and 2). However, there is much more to learn about the interrelations among change in different domains, the underlying mechanisms of change, and the factors that contribute to interindividual differences in change (research rationales 3-5). Needed are new study designs and analytical models that better address the structural, temporal, and causal interrelations that contribute to and protect against terminal decline.

Rationale and design of the HOME trial: A pragmatic randomized controlled trial of home-based human papillomavirus (HPV) self-sampling for increasing cervical cancer screening uptake and effectiveness in a U.S. healthcare system.

PubMed

Winer, Rachel L; Tiro, Jasmin A; Miglioretti, Diana L; Thayer, Chris; Beatty, Tara; Lin, John; Gao, Hongyuan; Kimbel, Kilian; Buist, Diana S M

2018-01-01

Women who delay or do not attend Papanicolaou (Pap) screening are at increased risk for cervical cancer. Trials in countries with organized screening programs have demonstrated that mailing high-risk (hr) human papillomavirus (HPV) self-sampling kits to under-screened women increases participation, but U.S. data are lacking. HOME is a pragmatic randomized controlled trial set within a U.S. integrated healthcare delivery system to compare two programmatic approaches for increasing cervical cancer screening uptake and effectiveness in under-screened women (≥3.4years since last Pap) aged 30-64years: 1) usual care (annual patient reminders and ad hoc outreach by clinics) and 2) usual care plus mailed hrHPV self-screening kits. Over 2.5years, eligible women were identified through electronic medical record (EMR) data and randomized 1:1 to the intervention or control arm. Women in the intervention arm were mailed kits with pre-paid envelopes to return samples to the central clinical laboratory for hrHPV testing. Results were documented in the EMR to notify women's primary care providers of appropriate follow-up. Primary outcomes are detection and treatment of cervical neoplasia. Secondary outcomes are cervical cancer screening uptake, abnormal screening results, and women's experiences and attitudes towards hrHPV self-sampling and follow-up of hrHPV-positive results (measured through surveys and interviews). The trial was designed to evaluate whether a programmatic strategy incorporating hrHPV self-sampling is effective in promoting adherence to the complete screening process (including follow-up of abnormal screening results and treatment). The objective of this report is to describe the rationale and design of this pragmatic trial. Copyright © 2017 Elsevier Inc. All rights reserved.

West End Walkers 65+: a randomised controlled trial of a primary care-based walking intervention for older adults: study rationale and design.

PubMed

Macmillan, Freya; Fitzsimons, Claire; Black, Karen; Granat, Malcolm H; Grant, Margaret P; Grealy, Madeleine; Macdonald, Hazel; McConnachie, Alex; Rowe, David A; Shaw, Rebecca; Skelton, Dawn A; Mutrie, Nanette

2011-02-19

In Scotland, older adults are a key target group for physical activity intervention due to the large proportion who are inactive. The health benefits of an active lifestyle are well established but more research is required on the most effective interventions to increase activity in older adults. The 'West End Walkers 65+' randomised controlled trial aims to examine the feasibility of delivering a pedometer-based walking intervention to adults aged 65 years through a primary care setting and to determine the efficacy of this pilot. The study rationale, protocol and recruitment process are discussed in this paper. The intervention consisted of a 12-week pedometer-based graduated walking programme and physical activity consultations. Participants were randomised into an immediate intervention group (immediate group) or a 12-week waiting list control group (delayed group) who then received the intervention. For the pilot element of this study, the primary outcome measure was pedometer step counts. Secondary outcome measures of sedentary time and physical activity (time spent lying/sitting, standing or walking; activPAL™ monitor), mood (Positive and Negative Affect Schedule), functional ability (Perceived Motor-Efficacy Scale for Older Adults), quality of life (Short-Form (36) Health Survey version 2) and loneliness (UCLA Loneliness Scale) were assessed. Focus groups with participants and semi-structured interviews with the research team captured their experiences of the intervention. The feasibility component of this trial examined recruitment via primary care and retention of participants, appropriateness of the intervention for older adults and the delivery of the intervention by a practice nurse. West End Walkers 65+ will determine the feasibility and pilot the efficacy of delivering a pedometer-based walking intervention through primary care to Scottish adults aged 65 years. The study will also examine the effect of the intervention on the well-being of participants and gain an insight into both participant and research team member experiences of the intervention.

Bringing life course home: a pilot to reduce pregnancy risk through housing access and family support.

PubMed

Allen, Deborah; Feinberg, Emily; Mitchell, Heavenly

2014-02-01

Proponents of life course comment that while the theory is persuasive, translating theory to practice is daunting. This paper speaks to the challenges and possibilities of intervention based on life course theory. It describes Healthy Start in Housing (HSiH), a partnership between the Boston Public Health Commission (BPHC) and the Boston Housing Authority (BHA) to reduce stress due to housing insecurity among low-income, pregnant women. HSiH seeks improved birth outcomes and long term health of mothers and infants. BHA goals are improved quality of life for participants, greater public housing stability and enhanced impact of housing on community well-being. HSiH is a 1 year pilot offering 75 housing units to pregnant women at risk of adverse birth outcomes and homelessness. BHA provides housing and expedites processing of HSiH applications; BPHC staff oversee enrollment, guide women through the application process, and provide enhanced, long-term case management. Of 130 women referred to HSiH to date, 53 were ineligible, 59 have submitted applications, 13 are preparing applications and 5 dropped out. Nineteen women have been housed. Among eligible women, 58 % had medical conditions, 56 % mental health conditions, and 14 % prior adverse outcomes; 30 % had multiple risks. Standardized assessments reflected high levels of depressive symptoms; 41 % had symptoms consistent with post-traumatic stress disorder. Life course theory provides both the framework and the rationale for HSiH. HSiH experience confirms the salience of daily social experience to women's health and the importance of addressing stressors and stress in women's lives.

The impact of care pathways for exacerbation of Chronic Obstructive Pulmonary Disease: rationale and design of a cluster randomized controlled trial

PubMed Central

2010-01-01

Background Hospital treatment of chronic obstructive pulmonary disease (COPD) frequently does not follow published evidences. This lack of adherence can contribute to the high morbidity, mortality and readmissions rates. The European Quality of Care Pathway (EQCP) study on acute exacerbations of COPD (NTC00962468) is undertaken to determine how care pathways (CP) as complex intervention for hospital treatment of COPD affects care variability, adherence to evidence based key interventions and clinical outcomes. Methods An international cluster Randomized Controlled Trial (cRCT) will be performed in Belgium, Italy, Ireland and Portugal. Based on the power analysis, a sample of 40 hospital teams and 398 patients will be included in the study. In the control arm of the study, usual care will be provided. The experimental teams will implement a CP as complex intervention which will include three active components: a formative evaluation of the quality and organization of care, a set of evidence based key interventions, and support on the development and implementation of the CP. The main outcome will be six-month readmission rate. As a secondary endpoint a set of clinical outcome and performance indicators (including care process evaluation and team functioning indicators) will be measured in both groups. Discussion The EQCP study is the first international cRCT on care pathways. The design of the EQCP project is both a research study and a quality improvement project and will include a realistic evaluation framework including process analysis to further understand why and when CP can really work. Trial Registration number NCT00962468 PMID:21092098

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design.

PubMed

Jolly, Kate; Duda, Joan L; Daley, Amanda; Eves, Frank F; Mutrie, Nanette; Ntoumanis, Nikos; Rouse, Peter C; Lodhia, Rekha; Williams, Geoffrey C

2009-06-08

The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT)-based exercise referral consultation. An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT) exercise on prescription intervention. 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n = 7) or to the SDT-based intervention (n = 6).Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes) via structural equation modelling. The trial is registered as Current Controlled trials ISRCTN07682833.

Endoscopic hip osteotomies: less invasive approaches to peri-acetabular, proximal femoral and pubic symphyseal procedures

PubMed Central

Matsuda, Dean K.; Matsuda, Nicole A.

2015-01-01

Beyond the recent expansion of extra-articular hip arthroscopy into the peri-trochanteric and subgluteal space, this instructional course lecture introduces three innovative procedures: endoscopy-assisted periacetabular osteotomy, closed derotational proximal femoral osteotomy and endoscopic pubic symphysectomy. Supportive rationale, evolving indications, key surgical techniques and emerging outcomes are presented for these innovative less invasive procedures. PMID:27011827

Cognitive and Affective Outcomes in Children as a Function of Participation in SCIL, an Individualized Version of the SCIS Program.

ERIC Educational Resources Information Center

Appel, Marilyn; And Others

An overview and rationale for the Science Curriculum for Individualized Learning (SCIL) are provided. SCIL is the result of the individualization of the SCIS program. The SCIL management system is based on the exploration, invention, and discovery concepts of Piagetian theory. An evaluation study of two SCIl units, Interactions and Systems and…

Different Strategies, Different Outcomes? The History and Trends of the Inclusive and Special Education in Alberta (Canada) and in Finland

ERIC Educational Resources Information Center

Jahnukainen, Markku

2011-01-01

This study compares the strategies and delivery of education for students with special educational needs in the province of Alberta, Canada, and in the country of Finland, in the European Union. The rationale for comparing these two jurisdictions is grounded by the idea that both of these areas have high general standards of living, a…

Le Pouvoir Du Théâtre: Foreign Languages, Higher Education, and Capturing the Notion of Symbolic Competence

ERIC Educational Resources Information Center

Keneman, Margaret Lynn

2017-01-01

The study of foreign languages has historically been a cornerstone in higher education for a variety of very good reasons, one being that it will help students develop a sensitivity to diversity. This rationale is compelling in theory, but requires a practical approach for instruction that actually guides students towards such a learning outcome.…

Coronary diet intervention with olive oil and cardiovascular prevention study (the CORDIOPREV study); rationale, methods, and baseline characteristics: a clinical trial comparing the efficacy of a Mediterranean diet rich...

USDA-ARS?s Scientific Manuscript database

Coronary heart disease (CHD) represents a major global health burden. However, despite the well-known influence that dietary habits exert over the progression of this disease, there are no well-established and scientifically sound dietary approaches to prevent the onset of clinical outcomes in secon...

Learning Foreign Languages with ClipFlair: Using Captioning and Revoicing Activities to Increase Students' Motivation and Engagement

ERIC Educational Resources Information Center

Baños, Rocío; Sokoli, Stavroula

2015-01-01

The purpose of this paper is to present the rationale and outcomes of ClipFlair, a European-funded project aimed at countering the factors that discourage Foreign Language Learning (FLL) by providing a motivating, easily accessible online platform to learn a foreign language through revoicing (e.g. dubbing) and captioning (e.g. subtitling). This…

Principles of endoscopic ear surgery.

PubMed

Tarabichi, Muaaz; Kapadia, Mustafa

2016-10-01

The aim of this review is to study the rationale, limitations, techniques, and long-term outcomes of endoscopic ear surgery. The article discusses the advantages of endoscopic ear surgery in treating cholesteatoma and how the hidden sites like facial recess, sinus tympani, and anterior epitympanum are easily accessed using the endoscope. Transcanal endoscopic approach allows minimally invasive removal of cholesteatoma with results that compare well to traditional postauricular tympanomastoidectomy.

Ballet Doesn't Have to Be Boring: Engaging Students in the Creative Process

ERIC Educational Resources Information Center

Scheff, Helene

2005-01-01

For many years, the author has incorporated creative process into the way she teaches ballet class. The author shares the philosophical, practical, and artistic reasons for the creative process in ballet classes. She also shares the rationale and how this practice developed over time.

A Simplified Program Needs Assessment Process.

ERIC Educational Resources Information Center

Clark, Larry

A rationale, background information, and a discussion of methodology are presented for a needs assessment process intended for pilot implementation at Western Piedmont Community College (WPCC). This process was designed to assess the local need for paraprofessional programs in the Human Services area, i.e., Early Childhood Associate, Mental Health…

Synthesis of Individual Transition Plans: Format and Process.

ERIC Educational Resources Information Center

La Mar, Kathleen; Rosenberg, Bill

This document presents a prototype Individual Transition Plan (ITP) process and format for students receiving special education services. Following an overview of the role of transition, a section on the ITP process discusses pre-meeting activities, conducting an ITP meeting, monitoring and evaluating the ITP meeting, and a rationale for the…

A Course on Plasma Processing in Integrated Circuit Fabrication.

ERIC Educational Resources Information Center

Sawin, Herbert H.; Reif, Rafael

1983-01-01

Describes a course, taught jointly by electrical/chemical engineering departments at the Massachusetts Institute of Technology, designed to teach the fundamental science of plasma processing as well as to give an overview of the present state of industrial processes. Provides rationale for course development, texts used, class composition, and…

Psychosocial rehabilitation after war trauma with adaptive disclosure: Design and rationale of a comparative efficacy trial.

PubMed

Yeterian, Julie D; Berke, Danielle S; Litz, Brett T

2017-10-01

Posttraumatic stress disorder (PTSD) from warzone exposure is associated with chronic and disabling social and occupational problems. However, functional impairment is rarely assessed or targeted directly in PTSD treatments, which instead focus on symptom reduction. Trauma-related contributors to diminished functioning, including guilt, shame, and anger resulting from morally compromising or loss-based war experiences, are also underemphasized. The goal of this clinical trial is to fill a substantial gap in the treatment of military-related PTSD by testing a modified Adaptive Disclosure (AD) therapy for war-related PTSD stemming from moral injury and traumatic loss focused on improving psychosocial functioning AD. This paper describes the rationale and design of a multi-site randomized controlled trial comparing AD to Present-Centered Therapy (PCT). We will recruit 186 veterans with PTSD, who will be assessed at baseline, post-treatment, and 3- and 6-months post-treatment. Primary outcomes are functional changes (i.e., functioning/disability and quality of life). Secondary outcomes are mental health variables (i.e., PTSD, depression, guilt, shame). We hypothesize that veterans treated with AD will experience greater improvements in all outcomes compared to those treated with PCT. This trial will advance knowledge in rehabilitation research by testing the first therapy specifically designed to address psychosocial functioning among veterans with war-related PTSD. The results may improve the quality of mental health care for veterans by offering an ecologically sound treatment for experiences that are uniquely impactful for war veterans. Published by Elsevier Inc.

Redactions in protocols for drug trials: what industry sponsors concealed.

PubMed

Marquardsen, Mikkel; Ogden, Michelle; Gøtzsche, Peter C

2018-04-01

Objective To describe the redactions in contemporary protocols for industry-sponsored randomised drug trials with patient relevant outcomes and to evaluate whether there was a legitimate rationale for the redactions. Design Cohort study. Under the Freedom of Information Act, we requested access to trial protocols approved by a research ethics committee in Denmark from October 2012 to March 2013. We received 17 consecutive protocols, which had been redacted before we got them, and nine protocols without redactions. In five additional cases, the companies refused to let the committees give us access, and in three other cases, documents were missing. Participants Not applicable. Setting Not applicable. Main outcome measure Amount and nature of redactions in 22 predefined key protocol variables. Results The redactions were most widespread in those sections of the protocol where there is empirical evidence of substantial problems with the trustworthiness of published drug trials: data analysis, handling of missing data, detection and analysis of adverse events, definition of the outcomes, interim analyses and premature termination of the study, sponsor's access to incoming data while the study is running, ownership to the data and investigators' publication rights. The parts of the text that were redacted differed widely, both between companies and within the same company. Conclusions We could not identify any legitimate rationale for the redactions. The current mistrust in industry-sponsored drug trials can only change if the industry offers unconditional access to its trial protocols and other relevant documents and data.

Low-molecular-weight heparin to prevent recurrent venous thromboembolism in pregnancy: Rationale and design of the Highlow study, a randomised trial of two doses.

PubMed

Bleker, Suzanne M; Buchmüller, Andrea; Chauleur, Céline; Ní Áinle, Fionnuala; Donnelly, Jennifer; Verhamme, Peter; Jacobsen, Anne Flem; Ganzevoort, Wessel; Prins, Martin; Beyer-Westendorf, Jan; DeSancho, Maria; Konstantinides, Stavros; Pabinger, Ingrid; Rodger, Marc; Decousus, Hervé; Middeldorp, Saskia

2016-08-01

Women with a history of venous thromboembolism (VTE) have a 2% to 10% absolute risk of VTE recurrence during subsequent pregnancies. Therefore, current guidelines recommend that all pregnant women with a history of VTE receive pharmacologic thromboprophylaxis. The optimal dose of low-molecular-weight heparin (LMWH) for thromboprophylaxis is unknown. In the Highlow study (NCT 01828697; www.highlowstudy.org), we compare a fixed low dose of LMWH with an intermediate dose of LMWH for the prevention of pregnancy-associated recurrent VTE. We present the rationale and design features of this study. The Highlow study is an investigator-initiated, multicentre, international, open-label, randomised trial. Pregnant women with a history of VTE and an indication for ante- and postpartum pharmacologic thromboprophylaxis are included before 14weeks of gestation. The primary efficacy outcome is symptomatic recurrent VTE during pregnancy and 6weeks postpartum. The primary safety outcomes are clinically relevant bleeding, blood transfusions before 6weeks postpartum and mortality. Patients are closely monitored to detect cutaneous reactions to LMWH and are followed for 3months after delivery. A central independent adjudication committee adjudicates all suspected outcome events. The Highlow study is the first large randomised controlled trial in pregnancy that will provide high-quality evidence on the optimal dose of LWMH thromboprophylaxis for the prevention of recurrent VTE in pregnant women with a history of VTE. Copyright © 2016 Elsevier Ltd. All rights reserved.

Safety Planning for Military (SAFE MIL): rationale, design, and safety considerations of a randomized controlled trial to reduce suicide risk among psychiatric inpatients.

PubMed

Ghahramanlou-Holloway, Marjan; Brown, Gregory K; Currier, Glenn W; Brenner, Lisa; Knox, Kerry L; Grammer, Geoffrey; Carreno-Ponce, Jaime T; Stanley, Barbara

2014-09-01

Mental health related hospitalizations and suicide are both significant public health problems within the United States Department of Defense (DoD). To date, few evidence-based suicide prevention programs have been developed for delivery to military personnel and family members admitted for psychiatric inpatient care due to suicidal self-directed violence. This paper describes the rationale and detailed methodology for a study called Safety Planning for Military (SAFE MIL) which involves a randomized controlled trial (RCT) at the largest military treatment facility in the United States. The purpose of this study is to test the efficacy of a brief, readily accessible, and personalized treatment called the Safety Planning Intervention (Stanley and Brown, 2012). Primary outcomes, measured by blinded assessors at one and six months following psychiatric discharge, include suicide ideation, suicide-related coping, and attitudes toward help seeking. Additionally, given the study's focus on a highly vulnerable patient population, a description of safety considerations for human subjects' participation is provided. Based on this research team's experience, the implementation of an infrastructure in support of RCT research within DoD settings and the processing of regulatory approvals for a clinical trial with high risk suicidal patients are expected to take up to 18-24 months. Recommendations for expediting the advancement of clinical trials research within the DoD are provided in order to maximize cost efficacy and minimize the research to practice gap. Published by Elsevier Inc.

Stakeholders' expectations and perceived effects of the pharmacy ownership liberalization reform in Sweden: a qualitative interview study.

PubMed

Wisell, Kristin; Winblad, Ulrika; Sporrong, Sofia Kälvemark

2016-08-12

Reforms in the health-care sector, including the pharmacy sector, can have different rationales. The Swedish pharmacies were prior to 2009 organized in a state-owned monopoly. In 2009, a liberalization of the ownership took place, in which a majority of the pharmacies were sold to private owners. The rationales for this liberalization changed profoundly during the preparatory work, making it probable that other rationales than the ones first expressed existed. The aim of this study was to explore the underlying rationales (not stated in official documents) for the liberalization in the Swedish pharmacy sector, and also to compare the expectations with the perceived outcomes. Semi-structured interviews were conducted with representatives from key stakeholder organizations; i.e., political, patient, and professional organizations. The analysis was performed in steps, and themes were developed in an inductive manner. One expectation among the political organization participants was that the ownership liberalization would create opportunities for ideas. The competition introduced in the market was supposed to lead to a more diversified pharmacy sector. After the liberalization, the participants in favor of the liberalization were surprised that the pharmacies were so similar. Among the professional organization participants, one important rationale for the liberalization was to get better use of the pharmacists' knowledge. However, all the professional, and some of the patient organization participants, thought that the counseling in the pharmacies had deteriorated after the liberalization. As expected in the interviews, the post-liberalization pharmacy sector consists of more pharmacies. However, an unexpected perceived effect of the liberalization was, among participants from all the stakeholder groups, less access to prescription medicines in the pharmacies. This study showed that the political organization participants had an ideological basis for their opinion. The political stakeholders did not have a clear view about what the liberalization should lead to, apart from abolishing the monopoly. The perceived effects are quite similar in the different stakeholder groups, and not as positive as were expected.

Study of young patients with myocardial infarction: Design and rationale of the YOUNG-MI Registry.

PubMed

Singh, Avinainder; Collins, Bradley; Qamar, Arman; Gupta, Ankur; Fatima, Amber; Divakaran, Sanjay; Klein, Josh; Hainer, Jon; Jarolim, Petr; Shah, Ravi V; Nasir, Khurram; Di Carli, Marcelo F; Bhatt, Deepak L; Blankstein, Ron

2017-11-01

The YOUNG-MI registry is a retrospective study examining a cohort of young adults age ≤ 50 years with a first-time myocardial infarction. The study will use the robust electronic health records of 2 large academic medical centers, as well as detailed chart review of all patients, to generate high-quality longitudinal data regarding the clinical characteristics, management, and outcomes of patients who experience a myocardial infarction at a young age. Our findings will provide important insights regarding prevention, risk stratification, treatment, and outcomes of cardiovascular disease in this understudied population, as well as identify disparities which, if addressed, can lead to further improvement in patient outcomes. © 2017 Wiley Periodicals, Inc.

Connective tissue disease related interstitial lung diseases and idiopathic pulmonary fibrosis: provisional core sets of domains and instruments for use in clinical trials

PubMed Central

Saketkoo, Lesley Ann; Mittoo, Shikha; Huscher, Dörte; Khanna, Dinesh; Dellaripa, Paul F; Distler, Oliver; Flaherty, Kevin R; Frankel, Sid; Oddis, Chester V; Denton, Christopher P; Fischer, Aryeh; Kowal-Bielecka, Otylia M; LeSage, Daphne; Merkel, Peter A; Phillips, Kristine; Pittrow, David; Swigris, Jeffrey; Antoniou, Katerina; Baughman, Robert P; Castelino, Flavia V; Christmann, Romy B; Christopher-Stine, Lisa; Collard, Harold R; Cottin, Vincent; Danoff, Sonye; Highland, Kristin B; Hummers, Laura; Shah, Ami A; Kim, Dong Soon; Lynch, David A; Miller, Frederick W; Proudman, Susanna M; Richeldi, Luca; Ryu, Jay H; Sandorfi, Nora; Sarver, Catherine; Wells, Athol U; Strand, Vibeke; Matteson, Eric L; Brown, Kevin K; Seibold, James R

2014-01-01

Rationale Clinical trial design in interstitial lung diseases (ILDs) has been hampered by lack of consensus on appropriate outcome measures for reliably assessing treatment response. In the setting of connective tissue diseases (CTDs), some measures of ILD disease activity and severity may be confounded by non-pulmonary comorbidities. Methods The Connective Tissue Disease associated Interstitial Lung Disease (CTD-ILD) working group of Outcome Measures in Rheumatology—a non-profit international organisation dedicated to consensus methodology in identification of outcome measures—conducted a series of investigations which included a Delphi process including >248 ILD medical experts as well as patient focus groups culminating in a nominal group panel of ILD experts and patients. The goal was to define and develop a consensus on the status of outcome measure candidates for use in randomised controlled trials in CTD-ILD and idiopathic pulmonary fibrosis (IPF). Results A core set comprising specific measures in the domains of lung physiology, lung imaging, survival, dyspnoea, cough and health-related quality of life is proposed as appropriate for consideration for use in a hypothetical 1-year multicentre clinical trial for either CTD-ILD or IPF. As many widely used instruments were found to lack full validation, an agenda for future research is proposed. Conclusion Identification of consensus preliminary domains and instruments to measure them was attained and is a major advance anticipated to facilitate multicentre RCTs in the field. PMID:24368713

Input-Based Approaches to Teaching Grammar: A Review of Classroom-Oriented Research.

ERIC Educational Resources Information Center

Ellis, Rod

1999-01-01

Examines the theoretical rationales (universal grammar, information-processing theories, skill-learning theories) for input-based grammar teaching and reviews classroom-oriented research (i.e., enriched-input studies, input-processing studies) that has integrated this option. (Author/VWL)

Toward the next generation of negative symptom assessments: the collaboration to advance negative symptom assessment in schizophrenia.

PubMed

Blanchard, Jack J; Kring, Ann M; Horan, William P; Gur, Raquel

2011-03-01

Negative symptoms in schizophrenia are related to poor functional outcome, persistent over time, a source of burden for caregivers, and only minimally responsive to currently available medications. A major challenge to developing efficacious interventions concerns the valid and reliable assessment of negative symptoms. In a recent consensus statement on negative symptoms, a central recommendation was the need to develop new assessment approaches that address the limitations of existing instruments. In the current report, we summarize the background and rationale for the Collaboration to Advance Negative Symptom Assessment in Schizophrenia (CANSAS). The CANSAS project is an National Institute of Mental Health-funded multisite study that is constructing a next-generation negative symptom scale, the Clinical Assessment Interview for Negative Symptoms (CAINS). The CAINS is being developed within a data-driven iterative process that seeks to ensure the measure's reliability, validity, and utility for both basic psychopathology and treatment development research.

A relational framework for understanding bullying: Developmental antecedents and outcomes.

PubMed

Rodkin, Philip C; Espelage, Dorothy L; Hanish, Laura D

2015-01-01

This article reviews current research on the relational processes involved in peer bullying, considering developmental antecedents and long-term consequences. The following themes are highlighted: (a) aggression can be both adaptive and maladaptive, and this distinction has implications for bullies' functioning within peer social ecologies; (b) developmental antecedents and long-term consequences of bullying have not been well-distinguished from the extant research on aggressive behavior; (c) bullying is aggression that operates within relationships of power and abuse. Power asymmetry and repetition elements of traditional bullying definitions have been hard to operationalize, but without these specifications and more dyadic measurement approaches there may be little rationale for a distinct literature on bullying--separate from aggression. Applications of a relational approach to bullying are provided using gender as an example. Implications for future research are drawn from the study of relationships and interpersonal theories of developmental psychopathology. (c) 2015 APA, all rights reserved).

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement.

PubMed

Chimento, George F; Thomas, Leslie C

2017-09-01

The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

Music-Based Training for Pediatric CI Recipients: A Systematic Analysis of Published Studies

PubMed Central

Gfeller, Kate

2016-01-01

In recent years, there has been growing interest in the use of music-based training to enhance speech and language development in children with normal hearing and some forms of communication disorders, including pediatric CI users. The use of music training for CI users may initially seem incongruous given that signal processing for CIs presents a degraded version of pitch and timbre, both key elements in music. Furthermore, empirical data of systematic studies of music training, particularly in relation to transfer to speech skills are limited. This study describes the rationale for music training of CI users, describes key features of published studies of music training with CI users, and highlights some developmental and logistical issues that should be taken into account when interpreting or planning studies of music training and speech outcomes with pediatric CI recipients. PMID:27246744

Respiratory Morbidity in a Coffee Processing Workplace With Sentinel Obliterative Bronchiolitis Cases

PubMed Central

Bailey, Rachel L.; Cox-Ganser, Jean M.; Duling, Matthew G.; LeBouf, Ryan F.; Martin, Stephen B.; Bledsoe, Toni A.; Green, Brett J.; Kreiss, Kathleen

2016-01-01

Rationale Obliterative bronchiolitis in former coffee workers prompted a cross-sectional study of current workers. Diacetyl and 2,3-pentanedione levels were highest in areas for flavoring and grinding/packaging unflavored coffee. Methods We interviewed 75 (88%) workers, measured lung function, and created exposure groups based on work history. We calculated standardized morbidity ratios (SMRs) for symptoms and spirometric abnormalities. We examined health outcomes by exposure groups. Results SMRs were elevated 1.6-fold for dyspnea and 2.7-fold for obstruction. The exposure group working in both coffee flavoring and grinding/packaging of unflavored coffee areas had significantly lower mean ratio of forced expiratory volume in 1 s to forced vital capacity and percent predicted mid-expiratory flow than workers without such exposure. Conclusion Current workers have occupational lung morbidity associated with high diacetyl and 2,3-pentanedione exposures, which were not limited to flavoring areas. PMID:26523478

Group Learning Assessments as a Vital Consideration in the Implementation of New Peer Learning Pedagogies in the Basic Science Curriculum of Health Profession Programs

PubMed Central

Briggs, Charlotte L.; Doubleday, Alison F.

2016-01-01

Inspired by reports of successful outcomes in health profession education literature, peer learning has progressively grown to become a fundamental characteristic of health profession curricula. Many studies, however, are anecdotal or philosophical in nature, particularly when addressing the effectiveness of assessments in the context of peer learning. This commentary provides an overview of the rationale for using group assessments in the basic sciences curriculum of health profession programs and highlights the challenges associated with implementing group assessments in this context. The dearth of appropriate means for measuring group process suggests that professional collaboration competencies need to be more clearly defined. Peer learning educators are advised to enhance their understanding of social psychological research in order to implement best practices in the development of appropriate group assessments for peer learning. PMID:29349309

Group Learning Assessments as a Vital Consideration in the Implementation of New Peer Learning Pedagogies in the Basic Science Curriculum of Health Profession Programs.

PubMed

Briggs, Charlotte L; Doubleday, Alison F

2016-01-01

Inspired by reports of successful outcomes in health profession education literature, peer learning has progressively grown to become a fundamental characteristic of health profession curricula. Many studies, however, are anecdotal or philosophical in nature, particularly when addressing the effectiveness of assessments in the context of peer learning. This commentary provides an overview of the rationale for using group assessments in the basic sciences curriculum of health profession programs and highlights the challenges associated with implementing group assessments in this context. The dearth of appropriate means for measuring group process suggests that professional collaboration competencies need to be more clearly defined. Peer learning educators are advised to enhance their understanding of social psychological research in order to implement best practices in the development of appropriate group assessments for peer learning.

Introduction to Department of Defense Research on Burn Pits, Biomarkers, and Health Outcomes Related to Deployment in Iraq and Afghanistan.

PubMed

Mallon, Col Timothy M; Rohrbeck, Maj Patricia; Haines, Maj Kevin M; Jones, Dean P; Utell, Mark; Hopke, Philip K; Phipps, Richard P; Walker, Douglas I; Thatcher, Thomas; Woeller, Collynn F; Baird, Coleen P; Pollard, Harvey B; Dalgard, Clifton L; Gaydos, Joel C

2016-08-01

This paper provides an overview of our study that was designed to assess the health impact of environmental exposures to open pit burning in deployed troops. The rationale for the study and the structure of the research plan was laid out. An overview of each article in the supplement was provided. The cohort of deployed Service members was assessed for airborne exposure, relevant biomarkers, and health outcomes following deployment to Balad, Iraq, and/or Bagram, Afghanistan. Polycyclic aromatic hydrocarbon (PAH) exposures were elevated, and serum biomarkers were statistically different postdeployment. Associations were noted between PAHs and dioxins and microRNAs. Some health outcomes were evident in deployers compared with nondeployers. Future research will examine the associations between demographic variables, smoking status, biomarker levels, and related health outcomes.

Rationale and Design of the Randomized Evaluation of an Ambulatory Care Pharmacist-Led Intervention to Optimize Urate Lowering Pathways (RAmP-UP) Study

PubMed Central

Coburn, Brian W; Cheetham, T Craig; Rashid, Nazia; Chang, John M; Levy, Gerald D; Kerimian, Artak; Low, Kimberly J; Redden, David T; Bridges, S Louis; Saag, Kenneth G; Curtis, Jeffrey R; Mikuls, Ted R

2016-01-01

Background Despite the availability of effective therapies, most gout patients achieve suboptimal treatment outcomes. Current best practices suggest gradual dose-escalation of urate lowering therapy and serial serum urate (sUA) measurement to achieve sUA < 6.0 mg/dl. However, this strategy is not routinely used. Here we present the study design rationale and development for a pharmacist-led intervention to promote sUA goal attainment. Methods To overcome barriers in achieving optimal outcomes, we planned and implemented the Randomized Evaluation of an Ambulatory Care Pharmacist-Led Intervention to Optimize Urate Lowering Pathways (RAmP-UP) study. This is a large pragmatic cluster-randomized trial designed to assess a highly automated, pharmacist-led intervention to optimize allopurinol treatment in gout. Ambulatory clinics (n=101) from a large health system were randomized to deliver either the pharmacist-led intervention or usual care to gout patients over the age of 18 years newly initiating allopurinol. All participants received educational materials and could opt-out of the study. For intervention sites, pharmacists conducted outreach primarily via an automated telephone interactive voice recognition system. The outreach, guided by a gout care algorithm developed for this study, systematically promoted adherence assessment, facilitated sUA testing, provided education, and adjusted allopurinol dosing. The primary study outcomes are achievement of sUA < 6.0 mg/dl and treatment adherence determined after one year. With follow-up ongoing, study results will be reported subsequently. Conclusion Ambulatory care pharmacists and automated calling technology represent potentially important, underutilized resources for improving health outcomes for gout patients. PMID:27449546

Rationale and design of the randomized evaluation of an Ambulatory Care Pharmacist-Led Intervention to Optimize Urate Lowering Pathways (RAmP-UP) Study.

PubMed

Coburn, Brian W; Cheetham, T Craig; Rashid, Nazia; Chang, John M; Levy, Gerald D; Kerimian, Artak; Low, Kimberly J; Redden, David T; Bridges, S Louis; Saag, Kenneth G; Curtis, Jeffrey R; Mikuls, Ted R

2016-09-01

Despite the availability of effective therapies, most gout patients achieve suboptimal treatment outcomes. Current best practices suggest gradual dose-escalation of urate lowering therapy and serial serum urate (sUA) measurement to achieve sUA<6.0mg/dl. However, this strategy is not routinely used. Here we present the study design rationale and development for a pharmacist-led intervention to promote sUA goal attainment. To overcome barriers in achieving optimal outcomes, we planned and implemented the Randomized Evaluation of an Ambulatory Care Pharmacist-Led Intervention to Optimize Urate Lowering Pathways (RAmP-UP) study. This is a large pragmatic cluster-randomized trial designed to assess a highly automated, pharmacist-led intervention to optimize allopurinol treatment in gout. Ambulatory clinics (n=101) from a large health system were randomized to deliver either the pharmacist-led intervention or usual care to gout patients over the age of 18years newly initiating allopurinol. All participants received educational materials and could opt-out of the study. For intervention sites, pharmacists conducted outreach primarily via an automated telephone interactive voice recognition system. The outreach, guided by a gout care algorithm developed for this study, systematically promoted adherence assessment, facilitated sUA testing, provided education, and adjusted allopurinol dosing. The primary study outcomes are achievement of sUA<6.0mg/dl and treatment adherence determined after one year. With follow-up ongoing, study results will be reported subsequently. Ambulatory care pharmacists and automated calling technology represent potentially important, underutilized resources for improving health outcomes for gout patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Rationale and design of the Staying Positive with Arthritis (SPA) Study: A randomized controlled trial testing the impact of a positive psychology intervention on racial disparities in pain.

PubMed

Hausmann, Leslie R M; Ibrahim, Said A; Kwoh, C Kent; Youk, Ada; Obrosky, D Scott; Weiner, Debra K; Vina, Ernest; Gallagher, Rollin M; Mauro, Genna T; Parks, Acacia

2018-01-01

Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Americans. Existing arthritis treatments yield small to moderate improvements in pain and have not been effective at reducing racial disparities in the management of pain. The biopsychosocial model of pain and evidence from the positive psychology literature suggest that increasing positive psychological skills (e.g., gratitude, kindness) could improve pain and functioning and reduce disparities in osteoarthritis pain management. Activities to cultivate positive psychological skills have been developed and validated; however, they have not been tested in patients with osteoarthritis, their effects on racial differences in health outcomes have not been examined, and evidence of their effects on health outcomes in patients with other chronic illnesses is of limited quality. In this article we describe the rationale and design of Staying Positive with Arthritis (SPA) study, a randomized controlled trial in which 180 African American and 180 White primary care patients with chronic pain from knee osteoarthritis will be randomized to a 6-week program of either positive skill-building activities or neutral control activities. The primary outcomes will be self-reported pain and functioning as measured by the WOMAC Osteoarthritis Index. We will assess these primary outcomes and potential, exploratory psychosocial mediating variables at an in-person baseline visit and by telephone at 1, 3, and 6months following completion of the assigned program. If effective, the SPA program would be a novel, theoretically-informed psychosocial intervention to improve quality and equity of care in the management of chronic pain from osteoarthritis. Published by Elsevier Inc.

Cost justification of clinical pharmacy services on a general surgery team: focus on diagnosis-related group cases.

PubMed

Bertch, K E; Hatoum, H T; Willett, M S; Witte, K W

1988-11-01

We used a novel approach to cost-justify clinical pharmacy services on a general surgery team in nine diagnosis-related group cases. The clinical pharmacist monitored nine patients longitudinally on a general surgery team from admission to discharge and intervened in their therapeutic management. Each recommendation was analyzed for rationale, acceptance, perceived impact on quality and/or cost of patient care, whether self-initiated or solicited, and impact on patient outcome. Types of recommendations and outcomes were categorized by process and outcome measurement criteria. Total cost avoidance per patient was calculated using costs of drug therapy, laboratory tests, and length of stay. Accounting for cost of clinical pharmacy services, net cost avoidance per patient was calculated. The clinical pharmacist made 101 recommendations on nine patients. Physicians accepted 82 percent of the recommendations; 77 percent of the recommendations were self-initiated and 23 percent were solicited. Recommendations had a perceived impact on cost, quality, or both at 13, 31, and 56 percent, respectively. Most recommendations (79 percent) brought patient therapy to a level of conformance with current standards of practice as documented in the medical literature. Recommendations that potentially preserved a major organ function by preventing drug-induced toxicity or the exacerbation of existing problems constituted 16 percent of the total. None of the accepted recommendations adversely affected patient outcome and 23 percent directly resulted in a measurable positive outcome in patient care. A total of four hospital days was potentially saved for two cases. Based on objective outcome criteria, a 1.9-day increase in therapeutic control was documented per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Progress on core outcome sets for critical care research.

PubMed

Blackwood, Bronagh; Marshall, John; Rose, Louise

2015-10-01

Appropriate selection and definition of outcome measures are essential for clinical trials to be maximally informative. Core outcome sets (an agreed, standardized collection of outcomes measured and reported in all trials for a specific clinical area) were developed due to established inconsistencies in trial outcome selection. This review discusses the rationale for, and methods of, core outcome set development, as well as current initiatives in critical care. Recent systematic reviews of reported outcomes and measurement instruments relevant to the critically ill highlight inconsistencies in outcome selection, definition, and measurement, thus establishing the need for core outcome sets. Current critical care initiatives include development of core outcome sets for trials aimed at reducing mechanical ventilation duration; rehabilitation following critical illness; long-term outcomes in acute respiratory failure; and epidemic and pandemic studies of severe acute respiratory infection. Development and utilization of core outcome sets for studies relevant to the critically ill is in its infancy compared to other specialties. Notwithstanding, core outcome set development frameworks and guidelines are available, several sets are in various stages of development, and there is strong support from international investigator-led collaborations including the International Forum for Acute Care Trialists.

The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study.

PubMed

Reeves, Gloria M; Wehring, Heidi J; Connors, Kathleen M; Bussell, Kristin; Schiffman, Jason; Medoff, Deborah R; Tsuji, Thomas; Walker, Jane; Brown, Alicia; Strobeck, Danielle; Clough, Tammy; Rush, Caitlin B; Riddle, Mark A; Love, Raymond C; Zachik, Albert; Hoagwood, Kimberly; Olin, S Serene; Stephan, Sharon; Okuzawa, Nana; Edwards, Sarah; Baquet, Claudia; dosReis, Susan

2015-12-01

The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their child's recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on "family-centered" care in this study is strongly supported by the active role of consumers in study design and implementation.

NITRIC OXIDE FOR THE ADJUNCTIVE TREATMENT OF SEVERE MALARIA: HYPOTHESIS AND RATIONALE

PubMed Central

Hawkes, Michael; Opoka, Robert Opika; Namasopo, Sophie; Miller, Christopher; Conroy, Andrea L.; Serghides, Lena; Kim, Hani; Thampi, Nisha; Liles, W. Conrad; John, Chandy C.; Kain, Kevin C.

2011-01-01

We hypothesize that supplemental inhaled nitric oxide (iNO) will improve outcomes in children with severe malaria receiving standard antimalarial therapy. The rationale for the hypothesized efficacy of iNO rests on: (1) biological plausibility, based on known actions of NO in modulating endothelial activation; (2) pre-clinical efficacy data from animal models of experimental cerebral malaria; and (3) a human trial of the NO precursor L-arginine, which improved endothelial function in adults with severe malaria. iNO is an attractive new candidate for the adjunctive treatment of severe malaria, given its proven therapeutic efficacy in animal studies, track record of safety in clinical practice and numerous clinical trials, inexpensive manufacturing costs, and ease of administration in settings with limited healthcare infrastructure. We plan to test this hypothesis in a randomized controlled trial (ClinicalTrials.gov Identifier: NCT01255215). PMID:21745716

A Cluster-Randomized Trial of Restorative Practices: An Illustration to Spur High-Quality Research and Evaluation

PubMed Central

Acosta, Joie D.; Chinman, Matthew; Ebener, Patricia; Phillips, Andrea; Xenakis, Lea; Malone, Patrick S.

2017-01-01

Restorative Practices in schools lack rigorous evaluation studies. As an example of rigorous school-based research, this paper describes the first randomized control trial of restorative practices to date, the Study of Restorative Practices. It is a 5-year, cluster-randomized controlled trial (RCT) of the Restorative Practices Intervention (RPI) in 14 middle schools in Maine to assess whether RPI impacts both positive developmental outcomes and problem behaviors and whether the effects persist during the transition from middle to high school. The two-year RPI intervention began in the 2014–2015 school year. The study’s rationale and theoretical concerns are discussed along with methodological concerns including teacher professional development. The theoretical rationale and description of the methods from this study may be useful to others conducting rigorous research and evaluation in this area. PMID:28936104

Distance learning strategies for weight management utilizing social media: A comparison of phone conference call versus social media platform. Rationale and design for a randomized study.

PubMed

Willis, Erik A; Szabo-Reed, Amanda N; Ptomey, Lauren T; Steger, Felicia L; Honas, Jeffery J; Al-Hihi, Eyad M; Lee, Robert; Vansaghi, Lisa; Washburn, Richard A; Donnelly, Joseph E

2016-03-01

Management of obesity in the context of the primary care physician visit is of limited efficacy in part because of limited ability to engage participants in sustained behavior change between physician visits. Therefore, healthcare systems must find methods to address obesity that reach beyond the walls of clinics and hospitals and address the issues of lifestyle modification in a cost-conscious way. The dramatic increase in technology and online social networks may present healthcare providers with innovative ways to deliver weight management programs that could have an impact on health care at the population level. A randomized study will be conducted on 70 obese adults (BMI 30.0-45.0 kg/m(2)) to determine if weight loss (6 months) is equivalent between weight management interventions utilizing behavioral strategies by either a conference call or social media approach. The primary outcome, body weight, will be assessed at baseline and 6 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity will be assessed on the same schedule. In addition, a cost analysis and process evaluation will be completed. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementation and Use of the Pharmacy Curriculum Outcomes Assessment at US Schools of Pharmacy.

PubMed

Gortney, Justine Schuller; Bray, Brenda S; Salinitri, Francine D

2015-11-25

To describe how schools and colleges of pharmacy use the Pharmacy Curriculum Outcomes Assessment (PCOA) in relation to student assessment and curricular feedback. A survey was distributed to all programs that have implemented the PCOA. The survey was designed to assess 3 domains regarding the use of the PCOA: rationale for use, logistics of administration, and performance data review and distribution. A 79% response rate (41/52) was obtained. The mix of responses was 93% current PCOA users and 7% past users. The most common reasons for PCOA use were for programmatic assessment and benchmarking. The examination was most frequently administered during the P3 year, with minimal stakes attached to performance. Significant differences in responses based on public vs private institution were seen with respect to length of accreditation of current PCOA users, messaging to students regarding performance, inclusion of results in student advising, and distribution of results to stakeholders. Programs were using the PCOA primarily as an assessment in the P3 year for reasons related to programmatic and curricular assessment. Some differences existed between public and private institutional PCOA use and examination-related processes and results distribution.

Implementation and Use of the Pharmacy Curriculum Outcomes Assessment at US Schools of Pharmacy

PubMed Central

Bray, Brenda S.; Salinitri, Francine D.

2015-01-01

Objective. To describe how schools and colleges of pharmacy use the Pharmacy Curriculum Outcomes Assessment (PCOA) in relation to student assessment and curricular feedback. Methods. A survey was distributed to all programs that have implemented the PCOA. The survey was designed to assess 3 domains regarding the use of the PCOA: rationale for use, logistics of administration, and performance data review and distribution. Results. A 79% response rate (41/52) was obtained. The mix of responses was 93% current PCOA users and 7% past users. The most common reasons for PCOA use were for programmatic assessment and benchmarking. The examination was most frequently administered during the P3 year, with minimal stakes attached to performance. Significant differences in responses based on public vs private institution were seen with respect to length of accreditation of current PCOA users, messaging to students regarding performance, inclusion of results in student advising, and distribution of results to stakeholders. Conclusion. Programs were using the PCOA primarily as an assessment in the P3 year for reasons related to programmatic and curricular assessment. Some differences existed between public and private institutional PCOA use and examination-related processes and results distribution. PMID:26839427

Integrative medical therapy: examination of meditation's therapeutic and global medicinal outcomes via nitric oxide (review).

PubMed

Stefano, George B; Esch, Tobias

2005-10-01

Relaxation techniques are part of the integrative medicine movement that is of growing importance for mainstream medicine. Complementary medical therapies have the potential to affect many physiological systems. Repeatedly studies show the benefits of the placebo response and relaxation techniques in the treatment of hypertension, cardiac arrhythmias, chronic pain, insomnia, anxiety and mild and moderate depression, premenstrual syndrome, and infertility. In itself, relaxation is characterized by a decreased metabolism, heart rate, blood pressure, and rate of breathing as well as an increase in skin temperature. Relaxation approaches, such as progressive muscle relaxation, autogenic training, meditation and biofeedback, are effective in lowering systolic and diastolic blood pressure in hypertensive patients by a significant margin. Given this association with changes in vascular tone, we have hypothesized that nitric oxide, a demonstrated vasodilator substance, contribute to physiological activity of relaxation approaches. We examined the scientific literature concerning the disorders noted earlier for their nitric oxide involvement in an attempt to provide a molecular rationale for the positive effects of relaxation approaches, which are physiological and cognitive process. We conclude that constitutive nitric oxide may crucially contribute to potentially beneficial outcomes and effects in diverse pathologies, exerting a global healing effect.

Computer Simulation of Developmental Processes and Toxicities (SOT)

EPA Science Inventory

Rationale: Recent progress in systems toxicology and synthetic biology have paved the way to new thinking about in vitro/in silico modeling of developmental processes and toxicities, both for embryological and reproductive impacts. Novel in vitro platforms such as 3D organotypic ...

Effects of Role and Assignment Rationale on Attitudes Formed During Peer Tutoring

PubMed Central

Bierman, Karen Linn; Furman, Wyndol

2012-01-01

This study examined the role of contextual factors, such as assignment rationale, on the attitudinal effects of peer tutoring. Fourth-grade children engaged in brief tutoring experiences as either a tutor or tutee. Subjects received four rationales for being selected as tutor or tutee: (a) a competence rationale, (b) a physical characteristic rationale, (c) a chance rationale, or (d) no rationale. As predicted, tutors had more positive attitudes than tutees when they had been given a competence or physical characteristic rationale but not when the tutors were provided a chance rationale or no rationale. Additionally, the tutors’ and tutees’ attitudes were enhanced when no rationale was provided. Results are discussed in terms of their implications for a role-theory analysis of tutoring and their implications for applied programs. PMID:23946549

Effects of Role and Assignment Rationale on Attitudes Formed During Peer Tutoring.

PubMed

Bierman, Karen Linn; Furman, Wyndol

1981-02-01

This study examined the role of contextual factors, such as assignment rationale, on the attitudinal effects of peer tutoring. Fourth-grade children engaged in brief tutoring experiences as either a tutor or tutee. Subjects received four rationales for being selected as tutor or tutee: (a) a competence rationale, (b) a physical characteristic rationale, (c) a chance rationale, or (d) no rationale. As predicted, tutors had more positive attitudes than tutees when they had been given a competence or physical characteristic rationale but not when the tutors were provided a chance rationale or no rationale. Additionally, the tutors' and tutees' attitudes were enhanced when no rationale was provided. Results are discussed in terms of their implications for a role-theory analysis of tutoring and their implications for applied programs.

Definition and documentation of engineering processes

DOE Office of Scientific and Technical Information (OSTI.GOV)

McDonald, G.W.

1997-11-01

This tutorial is an extract of a two-day workshop developed under the auspices of the Quality Engineering Department at Sandia National Laboratories. The presentation starts with basic definitions and addresses why processes should be defined and documented. It covers three primary topics: (1) process considerations and rationale, (2) approach to defining and documenting engineering processes, and (3) an IDEFO model of the process for defining engineering processes.

New knowledge network evaluation method for design rationale management

NASA Astrophysics Data System (ADS)

Jing, Shikai; Zhan, Hongfei; Liu, Jihong; Wang, Kuan; Jiang, Hao; Zhou, Jingtao

2015-01-01

Current design rationale (DR) systems have not demonstrated the value of the approach in practice since little attention is put to the evaluation method of DR knowledge. To systematize knowledge management process for future computer-aided DR applications, a prerequisite is to provide the measure for the DR knowledge. In this paper, a new knowledge network evaluation method for DR management is presented. The method characterizes the DR knowledge value from four perspectives, namely, the design rationale structure scale, association knowledge and reasoning ability, degree of design justification support and degree of knowledge representation conciseness. The DR knowledge comprehensive value is also measured by the proposed method. To validate the proposed method, different style of DR knowledge network and the performance of the proposed measure are discussed. The evaluation method has been applied in two realistic design cases and compared with the structural measures. The research proposes the DR knowledge evaluation method which can provide object metric and selection basis for the DR knowledge reuse during the product design process. In addition, the method is proved to be more effective guidance and support for the application and management of DR knowledge.

Designing a Web Site to Share Information with Parents

ERIC Educational Resources Information Center

Englund, Lillian White

2009-01-01

This article discusses the development and use of an on-line portfolio process. It presents a background rationale for the need and effectiveness of a communication tool that supports the use of the portfolio process throughout the education of a child with identified disabilities. The process for developing the individualized Web page is…

Orienting the Work-Based Curriculum Towards Work Process Knowledge: A Rationale and a German Case Study

ERIC Educational Resources Information Center

Boreham, Nick

2004-01-01

The term 'work process knowledge' refers to the knowledge needed for working in flexible and innovative business environments, including those in which information and communication technologies have been introduced to integrate previously separated production functions. It involves a systems-level understanding of the work process in the…

Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association.

PubMed

Nichol, Graham; Aufderheide, Tom P; Eigel, Brian; Neumar, Robert W; Lurie, Keith G; Bufalino, Vincent J; Callaway, Clifton W; Menon, Venugopal; Bass, Robert R; Abella, Benjamin S; Sayre, Michael; Dougherty, Cynthia M; Racht, Edward M; Kleinman, Monica E; O'Connor, Robert E; Reilly, John P; Ossmann, Eric W; Peterson, Eric

2010-02-09

Out-of-hospital cardiac arrest continues to be an important public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with out-of-hospital cardiac arrest by emergency medical services and among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post-cardiac arrest care. Effective hospital-based interventions for out-of-hospital cardiac arrest exist but are used infrequently. Barriers to implementation of these interventions include lack of knowledge, experience, personnel, resources, and infrastructure. A well-defined relationship between an increased volume of patients or procedures and better outcomes among individual providers and hospitals has been observed for several other clinical disorders. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. This statement describes the rationale for regional systems of care for patients resuscitated from cardiac arrest and the preliminary recommended elements of such systems. Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were established. A national process is necessary to develop and implement evidence-based guidelines for such systems that must include standards for the categorization, verification, and designation of components of such systems. The time to do so is now.

Effect of ticagrelor with clopidogrel on high on-treatment platelet reactivity in acute stroke or transient ischemic attack (PRINCE) trial: Rationale and design.

PubMed

Wang, Yilong; Lin, Yi; Meng, Xia; Chen, Weiqi; Chen, Guohua; Wang, Zhimin; Wu, Jialing; Wang, Dali; Li, Jianhua; Cao, Yibin; Xu, Yuming; Zhang, Guohua; Li, Xiaobo; Pan, Yuesong; Li, Hao; Liu, Liping; Zhao, Xingquan; Wang, Yongjun

2017-04-01

Rationale and aim Little is known about the safety and efficacy of the combination of ticagrelor and aspirin in acute ischemic stroke. This study aimed to evaluate whether the combination of ticagrelor and aspirin was superior to that of clopidogrel and aspirin in reducing the 90-day high on-treatment platelet reactivity for acute minor stroke or transient ischemic attack, especially for carriers of cytochrome P450 2C19 loss-of-function allele. Sample size and design This study was designed as a prospective, multicenter, randomized, open-label, active-controlled, and blind-endpoint, phase II b trial. The required sample size was 952 patients. It was registered with ClinicalTrials.gov (NCT02506140). Study outcomes The primary outcome was the proportion of patients with high on-treatment platelet reactivity at 90 days. High on-treatment platelet reactivity is defined as the P2Y12 reaction unit >208 measured using the VerifyNow P2Y12 assay. Conclusion The Platelet Reactivity in Acute Non-disabling Cerebrovascular Events study explored whether ticagrelor combined with aspirin could reduce further the proportion of patients with high on-treatment platelet reactivity at 90 days after acute minor stroke or transient ischemic attack compared with clopidogrel and aspirin.

48 CFR 30.602 - Materiality.

Code of Federal Regulations, 2010 CFR

2010-10-01

... REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION CAS Administration 30.602 Materiality. (a) In determining... and conclude the cost impact process; (2) Document the rationale for the determination; and (3) In the...

Amygdala abnormalities in first-degree relatives of individuals with schizophrenia unmasked by benzodiazepine challenge

PubMed Central

Wolf, Daniel H.; Satterthwaite, Theodore D.; Loughead, James; Pinkham, Amy; Overton, Eve; Elliott, Mark A.; Dent, Gersham W.; Smith, Mark A.; Gur, Ruben C.; Gur, Raquel E.

2014-01-01

Rationale Impaired emotion processing in schizophrenia predicts broader social dysfunction and has been related to negative symptom severity and amygdala dysfunction. Pharmacological modulation of emotion-processing deficits and related neural abnormalities may provide useful phenotypes for pathophysiological investigation. Objectives We used an acute benzodiazepine challenge to identify and modulate potential emotion-processing abnormalities in 20 unaffected first-degree relatives of individuals with schizophrenia, compared to 25 control subjects without a family history of psychosis. Methods An oral 1mg dose of the short-acting anxiolytic benzodiazepine alprazolam was administered in a balanced crossover placebo-controlled double-blind design, preceding identical 3T fMRI sessions approximately 1 week apart. Primary outcomes included fMRI activity in amygdala and related regions during two facial emotion-processing tasks: emotion identification and emotion memory. Results Family members exhibited abnormally strong alprazolam-induced reduction in amygdala and hippocampus activation during emotion identification, compared to equal reduction in both groups for the emotion memory task. Conclusions GABAergic modulation with alprazolam produced differential responses in family members vs. controls, perhaps by unmasking underlying amygdalar and/or GABAergic abnormalities. Such pharmacological fMRI paradigms could prove useful for developing drugs targeting specific neural circuits to treat or prevent schizophrenia. PMID:21603892

Developing psychotherapists’ competence through clinical supervision: protocol for a qualitative study of supervisory dyads

PubMed Central

2013-01-01

Background Mental health professionals face unique demands and stressors in their work, resulting in high rates of burnout and distress. Clinical supervision is a widely adopted and valued mechanism of professional support, development, and accountability, despite the very limited evidence of specific impacts on therapist or client outcomes. The current study aims to address this by exploring how psychotherapists develop competence through clinical supervision and what impact this has on the supervisees’ practice and their clients’ outcomes. This paper provides a rationale for the study and describes the protocol for an in-depth qualitative study of supervisory dyads, highlighting how it addresses gaps in the literature. Methods/Design The study of 16–20 supervisor-supervisee dyads uses a qualitative mixed method design, with two phases. In phase one, supervisors who are nominated as expert by their peers are interviewed about their supervision practice. In phase two, supervisors record a supervision session with a consenting supervisee; interpersonal process recall interviews are conducted separately with supervisor and supervisee to reflect in depth on the teaching and learning processes occurring. All interviews will be transcribed, coded and analysed to identify the processes that build competence, using a modified form of Consensual Qualitative Research (CQR) strategies. Using a theory-building case study method, data from both phases of the study will be integrated to develop a model describing the processes that build competence and support wellbeing in practising psychotherapists, reflecting the accumulated wisdom of the expert supervisors. Discussion The study addresses past study limitations by examining expert supervisors and their supervisory interactions, by reflecting on actual supervision sessions, and by using dyadic analysis of the supervisory pairs. The study findings will inform the development of future supervision training and practice and identify fruitful avenues for future research. PMID:23298408

Developing psychotherapists' competence through clinical supervision: protocol for a qualitative study of supervisory dyads.

PubMed

Schofield, Margot J; Grant, Jan

2013-01-08

Mental health professionals face unique demands and stressors in their work, resulting in high rates of burnout and distress. Clinical supervision is a widely adopted and valued mechanism of professional support, development, and accountability, despite the very limited evidence of specific impacts on therapist or client outcomes. The current study aims to address this by exploring how psychotherapists develop competence through clinical supervision and what impact this has on the supervisees' practice and their clients' outcomes. This paper provides a rationale for the study and describes the protocol for an in-depth qualitative study of supervisory dyads, highlighting how it addresses gaps in the literature. The study of 16-20 supervisor-supervisee dyads uses a qualitative mixed method design, with two phases. In phase one, supervisors who are nominated as expert by their peers are interviewed about their supervision practice. In phase two, supervisors record a supervision session with a consenting supervisee; interpersonal process recall interviews are conducted separately with supervisor and supervisee to reflect in depth on the teaching and learning processes occurring. All interviews will be transcribed, coded and analysed to identify the processes that build competence, using a modified form of Consensual Qualitative Research (CQR) strategies. Using a theory-building case study method, data from both phases of the study will be integrated to develop a model describing the processes that build competence and support wellbeing in practising psychotherapists, reflecting the accumulated wisdom of the expert supervisors. The study addresses past study limitations by examining expert supervisors and their supervisory interactions, by reflecting on actual supervision sessions, and by using dyadic analysis of the supervisory pairs. The study findings will inform the development of future supervision training and practice and identify fruitful avenues for future research.

The Hedgehog processing pathway is required for NSCLC growth and survival

PubMed Central

Rodriguez-Blanco, Jezabel; Schilling, Neal S.; Tokhunts, Robert; Giambelli, Camilla; Long, Jun; Liang Fei, Dennis; Singh, Samer; Black, Kendall E.; Wang, Zhiqiang; Galimberti, Fabrizio; Bejarano, Pablo A.; Elliot, Sharon; Glassberg, Marilyn K.; Nguyen, Dao M.; Lockwood, William W.; Lam, Wan L.; Dmitrovsky, Ethan; Capobianco, Anthony J.; Robbins, David J.

2013-01-01

Considerable interest has been generated from the results of recent clinical trials using SMOOTHENED (SMO) antagonists to inhibit the growth of HEDGEHOG (HH) signaling dependent tumors. This interest is tempered by the discovery of SMO mutations mediating resistance, underscoring the rationale for developing therapeutic strategies that interrupt HH signaling at levels distinct from those inhibiting SMO function. Here, we demonstrate that HH dependent non-small cell lung carcinoma (NSCLC) growth is sensitive to blockade of the HH pathway upstream of SMO, at the level of HH ligand processing. Individually, the use of different lentivirally delivered shRNA constructs targeting two functionally distinct HH-processing proteins, SKINNY HEDGEHOG (SKN) or DISPATCHED-1 (DISP-1), in NSCLC cell lines produced similar decreases in cell proliferation and increased cell death. Further, providing either an exogenous source of processed HH or a SMO agonist reverses these effects. The attenuation of HH processing, by knocking down either of these gene products, also abrogated tumor growth in mouse xenografts. Finally, we extended these findings to primary clinical specimens, showing that SKN is frequently over-expressed in NSCLC and that higher DISP-1 expression is associated with an unfavorable clinical outcome. Our results show a critical role for HH processing in HH-dependent tumors, identifies two potential druggable targets in the HH pathway, and suggest that similar therapeutic strategies could be explored to treat patients harboring HH ligand dependent cancers. PMID:22733134

Investigating Habituation to Premonitory Urges in Behavior Therapy for Tic Disorders.

PubMed

Houghton, David C; Capriotti, Matthew R; Scahill, Lawrence D; Wilhelm, Sabine; Peterson, Alan L; Walkup, John T; Piacentini, John; Woods, Douglas W

2017-11-01

Behavior therapy is effective for Persistent Tic Disorders (PTDs), but behavioral processes facilitating tic reduction are not well understood. One process, habituation, is thought to create tic reduction through decreases in premonitory urge severity. The current study tested whether premonitory urges decreased in youth with PTDs (N = 126) and adults with PTDs (N = 122) who participated in parallel randomized clinical trials comparing behavior therapy to psychoeducation and supportive therapy (PST). Trends in premonitory urges, tic severity, and treatment outcome were analyzed according to the predictions of a habituation model, whereby urge severity would be expected to decrease in those who responded to behavior therapy. Although adults who responded to behavior therapy showed a significant trend of declining premonitory urge severity across treatment, results failed to demonstrate that behavior therapy specifically caused changes in premonitory urge severity. In addition, reductions in premonitory urge severity in those who responded to behavior therapy were significant greater than those who did not respond to behavior therapy but no different than those who responded or did not respond to PST. Children with PTDs failed to show any significant changes in premonitory urges. Reductions in premonitory urge severity did not mediate the relationship between treatment and outcome in either adults or children. These results cast doubt on the notion that habituation is the therapeutic process underlying the effectiveness of behavior therapy, which has immediate implications for the psychoeducation and therapeutic rationale presented in clinical practice. Moreover, there may be important developmental changes in premonitory urges in PTDs, and alternative models of therapeutic change warrant investigation. Copyright © 2017. Published by Elsevier Ltd.

Standard Setting as Psychometric Due Process: Going a Little Further Down an Uncertain Road.

ERIC Educational Resources Information Center

Cizek, Gregory J.

The concept of due process provides an analogy for the process of standard setting that emphasizes many of the procedural and substantive elements of the process over technical and statistical concerns. Surely such concerns can and should continue to be addressed. However, a sound rationale for standard setting does not rest on this foundation.…

A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting - rationale, design and baseline characteristics.

PubMed

Laurence, Caroline; Gialamas, Angela; Yelland, Lisa; Bubner, Tanya; Ryan, Philip; Willson, Kristyn; Glastonbury, Briony; Gill, Janice; Shephard, Mark; Beilby, Justin

2008-08-06

Point of care testing (PoCT) may be a useful adjunct in the management of chronic conditions in general practice (GP). The provision of pathology test results at the time of the consultation could lead to enhanced clinical management, better health outcomes, greater convenience and satisfaction for patients and general practitioners (GPs), and savings in costs and time. It could also result in inappropriate testing, increased consultations and poor health outcomes resulting from inaccurate results. Currently there are very few randomised controlled trials (RCTs) in GP that have investigated these aspects of PoCT. The Point of Care Testing in General Practice Trial (PoCT Trial) was an Australian Government funded multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost effectiveness and satisfaction of PoCT in a GP setting.The PoCT Trial covered an 18 month period with the intervention consisting of the use of PoCT for seven tests used in the management of patients with diabetes, hyperlipidaemia and patients on anticoagulant therapy. The primary outcome measure was the proportion of patients within target range, a measure of therapeutic control. In addition, the PoCT Trial investigated the safety of PoCT, impact of PoCT on patient compliance to medication, stakeholder satisfaction, cost effectiveness of PoCT versus laboratory testing, and influence of geographic location. The paper provides an overview of the Trial Design, the rationale for the research methodology chosen and how the Trial was implemented in a GP environment. The evaluation protocol and data collection processes took into account the large number of patients, the broad range of practice types distributed over a large geographic area, and the inclusion of pathology test results from multiple pathology laboratories.The evaluation protocol developed reflects the complexity of the Trial setting, the Trial Design and the approach taken within the funding provided. The PoCT Trial is regarded as a pragmatic RCT, evaluating the effectiveness of implementing PoCT in GP and every effort was made to ensure that, in these circumstances, internal and external validity was maintained. 12612605000272695.

Practicing Engineering While Building with Blocks: Identifying Engineering Thinking

ERIC Educational Resources Information Center

Bagiati, Aikaterini; Evangelou, Demetra

2016-01-01

Children's free play naturally enhances skills of observation, communication, experimentation, as well as development of rationale and construction skills. These domains, while synthesised, can lead to the development of certain process models regarding the way constructions could be designed, built and improved. The Design Process model…

ADP--A Must in the Secondary School

ERIC Educational Resources Information Center

Majernik, John A.

1974-01-01

The rationale for including automated data processing (ADP) in secondary schools is given. ADP instruction: prepares students for data processing employment and for advanced ADP study, aids all students preparing for business careers, aids students in choosing a career, provides consumer information, and adds realism to other classroom…

Resegregation: A Second Generation School Desegregation Issue.

ERIC Educational Resources Information Center

National Inst. of Education (DHEW), Washington, DC. Educational Equity Group. Desegregation Studies Div.

The emphases of this paper are identification of system mechanisms and processes employed to achieve and enhance racial resegregation in education, placing an understanding of these mechanisms and processes within the context of the national desegregation efforts, presentation of the rationale for the National Institute of Education including…

Evaluation of a standard provision versus an autonomy promotive exercise referral programme: rationale and study design

PubMed Central

Jolly, Kate; Duda, Joan L; Daley, Amanda; Eves, Frank F; Mutrie, Nanette; Ntoumanis, Nikos; Rouse, Peter C; Lodhia, Rekha; Williams, Geoffrey C

2009-01-01

Background The National Institute of Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the utility of a Self Determination Theory (SDT)-based exercise referral consultation. Methods/Design Design: An exploratory cluster randomised controlled trial comparing standard provision exercise on prescription with a Self Determination Theory-based (SDT) exercise on prescription intervention. Participants: 347 people referred to the Birmingham Exercise on Prescription scheme between November 2007 and July 2008. The 13 exercise on prescription sites in Birmingham were randomised to current practice (n = 7) or to the SDT-based intervention (n = 6). Outcomes measured at 3 and 6-months: Minutes of moderate or vigorous physical activity per week assessed using the 7-day Physical Activity Recall; physical health: blood pressure and weight; health status measured using the Dartmouth CO-OP charts; anxiety and depression measured by the Hospital Anxiety and Depression Scale and vitality measured by the subjective vitality score; motivation and processes of change: perceptions of autonomy support from the advisor, satisfaction of the needs for competence, autonomy, and relatedness via physical activity, and motivational regulations for exercise. Discussion This trial will determine whether an exercise referral programme based on Self Determination Theory increases physical activity and other health outcomes compared to a standard programme and will test the underlying SDT-based process model (perceived autonomy support, need satisfaction, motivation regulations, outcomes) via structural equation modelling. Trial registration The trial is registered as Current Controlled trials ISRCTN07682833. PMID:19505293

Serious gaming during multidisciplinary rehabilitation for patients with complex chronic pain or fatigue complaints: study protocol for a controlled trial and process evaluation

PubMed Central

Joosen, Margot C W; Mert, Agali; Zedlitz, Aglaia; Vrijhoef, Hubertus J M

2017-01-01

Introduction Many individuals suffer from chronic pain or functional somatic syndromes and face boundaries for diminishing functional limitations by means of biopsychosocial interventions. Serious gaming could complement multidisciplinary interventions through enjoyment and independent accessibility. A study protocol is presented for studying whether, how, for which patients and under what circumstances, serious gaming improves patient health outcomes during regular multidisciplinary rehabilitation. Methods and analysis A mixed-methods design is described that prioritises a two-armed naturalistic quasi-experiment. An experimental group is composed of patients who follow serious gaming during an outpatient multidisciplinary programme at two sites of a Dutch rehabilitation centre. Control group patients follow the same programme without serious gaming in two similar sites. Multivariate mixed-modelling analysis is planned for assessing how much variance in 250 patient records of routinely monitored pain intensity, pain coping and cognition, fatigue and psychopathology outcomes is attributable to serious gaming. Embedded qualitative methods include unobtrusive collection and analyses of stakeholder focus group interviews, participant feedback and semistructured patient interviews. Process analyses are carried out by a systematic approach of mixing qualitative and quantitative methods at various stages of the research. Ethics and dissemination The Ethics Committee of the Tilburg School of Social and Behavioural Sciences approved the research after reviewing the protocol for the protection of patients’ interests in conformity to the letter and rationale of the applicable laws and research practice (EC 2016.25t). Findings will be presented in research articles and international scientific conferences. Trial registration number A prospective research protocol for the naturalistic quasi-experimental outcome evaluation was entered in the Dutch trial register (registration number: NTR6020; Pre-results). PMID:28600377

Review: Assessment of completeness of reporting in intervention studies using livestock: an example from pain mitigation interventions in neonatal piglets.

PubMed

O'Connor, A; Anthony, R; Bergamasco, L; Coetzee, J F; Dzikamunhenga, R S; Johnson, A K; Karriker, L A; Marchant-Forde, J N; Martineau, G P; Millman, S T; Pajor, E A; Rutherford, K; Sprague, M; Sutherland, M A; von Borell, E; Webb, S R

2016-04-01

Accurate and complete reporting of study methods, results and interpretation are essential components for any scientific process, allowing end-users to evaluate the internal and external validity of a study. When animals are used in research, excellence in reporting is expected as a matter of continued ethical acceptability of animal use in the sciences. Our primary objective was to assess completeness of reporting for a series of studies relevant to mitigation of pain in neonatal piglets undergoing routine management procedures. Our second objective was to illustrate how authors can report the items in the Reporting guidElines For randomized controLled trials for livEstoCk and food safety (REFLECT) statement using examples from the animal welfare science literature. A total of 52 studies from 40 articles were evaluated using a modified REFLECT statement. No single study reported all REFLECT checklist items. Seven studies reported specific objectives with testable hypotheses. Six studies identified primary or secondary outcomes. Randomization and blinding were considered to be partially reported in 21 and 18 studies, respectively. No studies reported the rationale for sample sizes. Several studies failed to report key design features such as units for measurement, means, standard deviations, standard errors for continuous outcomes or comparative characteristics for categorical outcomes expressed as either rates or proportions. In the discipline of animal welfare science, authors, reviewers and editors are encouraged to use available reporting guidelines to ensure that scientific methods and results are adequately described and free of misrepresentations and inaccuracies. Complete and accurate reporting increases the ability to apply the results of studies to the decision-making process and prevent wastage of financial and animal resources.

CHD7 Expression Predicts Survival Outcomes in Patients with Resected Pancreatic Cancer

PubMed Central

Colbert, Lauren E.; Petrova, Aleksandra V.; Fisher, Sarah B.; Pantazides, Brooke G.; Madden, Matthew Z.; Hardy, Claire W.; Warren, Matthew D.; Pan, Yunfeng; Nagaraju, Ganji P.; Liu, Elaine A.; Saka, Burcu; Hall, William A.; Shelton, Joseph W.; Gandhi, Khanjan; Pauly, Rini; Kowalski, Jeanne; Kooby, David A.; El-Rayes, Bassel F.; Staley, Charles A.; Adsay, N. Volkan; Curran, Walter J.; Landry, Jerome C.; Maithel, Shishir K.; Yu, David S.

2014-01-01

Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease with poor outcomes with current therapies. Gemcitabine is the primary adjuvant drug used clinically, but its effectiveness is limited. In this study, our objective was to utilize a rationale-driven approach to identify novel biomarkers for outcome in patients with early-stage resected PDAC treated with adjuvant gemcitabine. Using a synthetic lethal screen in human PDAC cells, we identified 93 genes including 55 genes linked to DNA damage responses (DDR) that demonstrated gemcitabine sensitization when silenced, including CHD7 which functions in chromatin remodeling. CHD7 depletion sensitized PDAC cells to gemcitabine and delayed their growth in tumor xenografts. Moreover, CHD7 silencing impaired ATR-dependent phosphorylation of CHK1 and increased DNA damage induced by gemcitabine. CHD7 was dysregulated, ranking above the 90th percentile in differential expression in a panel of PDAC clinical specimens, highlighting its potential as a biomarker. Immunohistochemical analysis of specimens from 59 resected PDAC patients receiving adjuvant gemcitabine revealed that low CHD7 expression was associated with increased recurrence-free survival (RFS) and overall survival (OS), in univariate and multivariate analyses. Notably, CHD7 expression was not associated with RFS or OS for patients not receiving gemcitabine. Thus, low CHD7 expression was correlated selectively with gemcitabine sensitivity in this patient population. These results supported our rationale-driven strategy to exploit dysregulated DDR pathways in PDAC to identify genetic determinants of gemcitabine sensitivity, identifying CHD7 as a novel biomarker candidate to evaluate further for individualizing PDAC treatment. PMID:24626090

Dose density in adjuvant chemotherapy for breast cancer.

PubMed

Citron, Marc L

2004-01-01

Dose-dense chemotherapy increases the dose intensity of the regimen by delivering standard-dose chemotherapy with shorter intervals between the cycles. This article discusses the rationale for dose-dense therapy and reviews the results with dose-dense adjuvant regimens in recent clinical trials in breast cancer. The papers for this review covered evidence of a dose-response relation in cancer chemotherapy; the rationale for dose-intense (and specifically dose-dense) therapy; and clinical experience with dose-dense regimens in adjuvant chemotherapy for breast cancer, with particular attention to outcomes and toxicity. Evidence supports maintaining the dose intensity of adjuvant chemotherapy within the conventional dose range. Disease-free and overall survival with combination cyclophosphamide, methotrexate, and fluorouracil are significantly improved when patients receive within 85% of the planned dose. Moderate and high dose cyclophosphamide, doxorubicin, and fluorouracil within the standard range results in greater disease-free and overall survival than the low dose regimen. The sequential addition of paclitaxel after concurrent doxorubicin and cyclophosphamide also significantly improves survival. Disease-free and overall survival with dose-dense sequential or concurrent doxorubicin, cyclophosphamide, and paclitaxel with filgrastim (rhG-CSF; NEUPOGEN) support are significantly greater than with conventional schedules (q21d). The delivered dose intensity of adjuvant chemotherapy within the standard dose range is an important predictor of the clinical outcome. Prospective trials of high-dose chemotherapy have shown no improvement over standard regimens, and toxicity was greater. Dose-dense adjuvant chemotherapy improves the clinical outcomes with doxorubicin-containing regimens. Filgrastim support enables the delivery of dose-dense chemotherapy and reduces the risk of neutropenia and its complications.

Circle of life: rationale, design, and baseline results of an HIV prevention intervention among young American Indian adolescents of the Northern Plains.

PubMed

Kaufman, Carol E; Mitchell, Christina M; Beals, Janette; Desserich, Jennifer A; Wheeler, Cindy; Keane, Ellen M; Whitesell, Nancy Rumbaugh; Sam, Angela; Sedey, Cory

2010-03-01

In spite of significant disparities in sexual health outcomes for American Indian youth, no studies exist examining the effectiveness of HIV-prevention interventions. Circle of Life is an HIV-prevention intervention specifically developed for American Indian middle-school youth. We describe the rationale, methodology, and baseline results of a longitudinal randomized trial of Circle of Life conducted among American Indian youth aged 11-15 in a reservation community. The innovative design includes two pre-intervention waves to determine patterns of behavior prior to the intervention that might be associated with a differential impact of the intervention on sexual risk. We used one-way analysis of variance and chi-square tests to test for significant differences between randomized group assignment at each baseline wave and generalized estimating equations (GEE) to test significant differences in the rate of change in outcomes by group longitudinally. We present the collaborative and adaptive strategies for consenting, assenting, and data collection methodology in this community. Achieved response rates are comparable to other similar studies. Results from the two baseline waves indicate that few outcomes significantly varied by randomized intervention assignment. Ten percent of youth reported having had sex at Wave 1, rising to 15% at Wave 2. Among those who had had sex, the majority (>70%) reported using a condom at last sex. The project is well positioned to carry out the longitudinal assessments of the intervention to determine the overall impact of the Circle of Life and the differential impact by pre-intervention patterns of behavior across youth.

Global mineral resource assessment: porphyry copper assessment of Mexico: Chapter A in Global mineral resource assessment

USGS Publications Warehouse

Hammarstrom, Jane M.; Robinson, Gilpin R.; Ludington, Steve; Gray, Floyd; Drenth, Benjamin J.; Cendejas-Cruz, Francisco; Espinosa, Enrique; Pérez-Segura, Efrén; Valencia-Moreno, Martín; Rodríguez-Castañeda, José Luis; Vásquez-Mendoza, Rigobert; Zürcher, Lukas

2010-01-01

This report includes a brief overview of porphyry copper deposits in Mexico, a description of the assessment process used, a summary of results, and appendixes. Appendixes A through K contain summary information for each tract, as follows: location, the geologic feature assessed, the rationale for tract delineation, tables and descriptions of known deposits and significant prospects, exploration history, model selection, rationale for the estimates, assessment results, and references. The accompanying digital map files (shapefiles) provide permissive tract outlines, assessment results, and data for deposits and prospects in a GIS format (appendix L).

The Studying Multiple Outcomes After Aural Rehabilitative Treatment Study: Study Design and Baseline Results

PubMed Central

Li, Lingsheng; Blake, Caitlin; Sung, Yoon; Shpritz, Barnett; Chen, David; Genther, Dane J.; Betz, Joshua; Lin, Frank R.

2017-01-01

Hearing loss may affect critical domains of health and functioning in older adults. This article describes the rationale and design of the Studying Multiple Outcomes After Aural Rehabilitative Treatment (SMART) study, which was developed to determine to what extent current hearing rehabilitative therapies could mitigate the effects of hearing loss on health outcomes. One hundred and forty-five patients ≥50 years receiving hearing aids (HA) or cochlear implants (CI) were recruited from the Johns Hopkins Department of Otolaryngology-HNS. A standardized outcome battery was administered to assess cognitive, social, mental, and physical functioning. Of the 145 participants aged 50 to 94.9 years who completed baseline evaluations, CI participants had significantly greater loneliness, social isolation, and poorer hearing and communicative function compared with HA participants. This study showed that standardized measures of health-related outcomes commonly used in gerontology appear sensitive to hearing impairment and are feasible to implement in clinical studies of hearing loss. PMID:28491918

Rationale, design, and methods for process evaluation in the Childhood Obesity Research Demonstration project

USDA-ARS?s Scientific Manuscript database

The cross-site process evaluation plan for the Childhood Obesity Research Demonstration (CORD) project is described here. The CORD project comprises 3 unique demonstration projects designed to integrate multi-level, multi-setting health care and public health interventions over a 4-year funding peri...

Visual Literacy/Process Writing.

ERIC Educational Resources Information Center

Karolides, Nicholas J., Ed.

1984-01-01

The articles in this journal issue provide a rationale and methods for enhancing students' critical awareness of visual media and for a process approach to composition instruction. The titles of the articles and their authors are as follows: (1) "Reel English: Film Study in the High Schools" (James Griswold); (2) "Introducing History Media"…

Leadership Development as a Dialogic Process: The Rationale and Concept of an International Leadership Institute

ERIC Educational Resources Information Center

Kedian, Jeremy; Giles, David; Morrison, Michele; Fletcher, Murray

2016-01-01

Rapidly changing educational contexts demand deft leadership responses. In this fluid environment, it is imperative that leadership learning models sound educational praxis. Such praxis necessitates the inclusion of participant voices within relational and dialogic processes that enable authentic, creative and collaborative thinking. This paper…

A Design Rationale Capture Using REMAP/MM

DTIC Science & Technology

1994-06-01

company-wide down-sizing, the power company has determined that an automated service order processing system is the most economical solution. This new...service order processing system for a large power company can easily be 37 led. A system of this complexity would typically require three to five years

AN ANALYSIS OF THE BEHAVIORAL PROCESSES INVOLVED IN SELF-INSTRUCTION WITH TEACHING MACHINES.

ERIC Educational Resources Information Center

HOLLAND, JAMES G.; SKINNER, B.F.

THIS COLLECTION OF PAPERS CONSTITUTES THE FINAL REPORT OF A PROJECT DEVOTED TO AN ANALYSIS OF THE BEHAVIORAL PROCESSES UNDERLYING PROGRAMED INSTRUCTION. THE PAPERS ARE GROUPED UNDER THREE HEADINGS--(1) "PROGRAMING RESEARCH," (2) "BASIC SKILLS--RATIONALE AND PROCEDURE," AND (3) "BASIC SKILLS--SPECIFIC SKILLS." THE…

Documenting the Engineering Design Process

ERIC Educational Resources Information Center

Hollers, Brent

2017-01-01

Documentation of ideas and the engineering design process is a critical, daily component of a professional engineer's job. While patent protection is often cited as the primary rationale for documentation, it can also benefit the engineer, the team, company, and stakeholders through creating a more rigorously designed and purposeful solution.…

Tools for Achieving TQE.

ERIC Educational Resources Information Center

Latta, Raymond F.; Downey, Carolyn J.

This book presents a wide array of sophisticated problem-solving tools and shows how to use them in a humanizing way that involves all stakeholders in the process. Chapter 1 develops the rationale for educational stakeholders to consider quality tools. Chapter 2 highlights three quality group-process tools--brainstorming, the nominal group…

Functional Analytic Psychotherapy for Interpersonal Process Groups: A Behavioral Application

ERIC Educational Resources Information Center

Hoekstra, Renee

2008-01-01

This paper is an adaptation of Kohlenberg and Tsai's work, Functional Analytical Psychotherapy (1991), or FAP, to group psychotherapy. This author applied a behavioral rationale for interpersonal process groups by illustrating key points with a hypothetical client. Suggestions are also provided for starting groups, identifying goals, educating…

A methodology for fostering commercialization of electric and hybrid vehicle propulsion systems

NASA Technical Reports Server (NTRS)

Thollot, P. A.; Musial, N. T.

1980-01-01

The rationale behind, and a proposed approach for, application of government assistance to accelerate the process of moving a new electric vehicle propulsion system product from technological readiness to profitable marketplace acceptance and utilization are described. Emphasis is on strategy, applicable incentives, and an implementation process.

Study protocol and rationale for a randomized double-blinded crossover trial of phentermine-topiramate ER versus placebo to treat binge eating disorder and bulimia nervosa.

PubMed

Dalai, Shebani Sethi; Adler, Sarah; Najarian, Thomas; Safer, Debra Lynn

2018-01-01

Bulimia nervosa (BN) and binge eating disorder (BED) are associated with severe psychological and medical consequences. Current therapies are limited, leaving up to 50% of patients symptomatic despite treatment, underscoring the need for additional treatment options. Qsymia, an FDA-approved medication for obesity, combines phentermine and topiramate ER. Topiramate has demonstrated efficacy for both BED and BN, but limited tolerability. Phentermine is FDA-approved for weight loss. A rationale for combined phentermine/topiramate for BED and BN is improved tolerability and efficacy. While a prior case series exploring Qsymia for BED showed promise, randomized studies are needed to evaluate Qsymia's safety and efficacy when re-purposed in eating disorders. We present a study protocol for a Phase I/IIa single-center, prospective, double-blinded, randomized, crossover trial examining safety and preliminary efficacy of Qsymia for BED and BN. Adults with BED (n=15) or BN (n=15) are randomized 1:1 to receive 12weeks Qsymia (phentermine/topiramate ER, 3.75mg/23mg-15mg/92mg) or placebo, followed by 2-weeks washout and 12-weeks crossover, where those on Qsymia receive placebo and vice versa. Subsequently participants receive 8weeks follow-up off study medications. The primary outcome is the number of binge days/week measured by EDE. Secondary outcomes include average number of binge episodes, percentage abstinence from binge eating, and changes in weight/vitals, eating psychopathology, and mood. To our knowledge this is the first randomized, double-blind protocol investigating the safety and efficacy of phentermine/topiramate in BED and BN. We highlight the background and rationale for this study, including the advantages of a crossover design. Clinicaltrials.gov identifier NCT02553824 registered on 9/17/2015. https://clinicaltrials.gov/ct2/show/NCT02553824. Copyright © 2017 Elsevier Inc. All rights reserved.

Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study.

PubMed

Berry, Diane C; Neal, Madeline; Hall, Emily G; Schwartz, Todd A; Verbiest, Sarah; Bonuck, Karen; Goodnight, William; Brody, Seth; Dorman, Karen F; Menard, Mary K; Stuebe, Alison M

2013-10-10

Women who are diagnosed with gestational diabetes mellitus (GDM) are at increased risk for developing prediabetes and type 2 diabetes mellitus (T2DM). To date, there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM. This paper describes the rationale, design and methodology of a 2-year, randomized, controlled study being conducted in North Carolina. Using a two-group, repeated measures, experimental design, we will test a 14- week intensive intervention on the benefits of breastfeeding, understanding gestational diabetes and risk of progression to prediabetes and T2DM, nutrition and exercise education, coping skills training, physical activity (Phase I), educational and motivational text messaging and 3 months of continued monthly contact (Phase II). A total of 100 African American, non-Hispanic white, and bilingual Hispanic women between 22-36 weeks of pregnancy who are diagnosed with GDM and their infants will be randomized to either the experimental group or the wait-listed control group. The first aim of the study is to determine the feasibility of the intervention. The second aim of study is to test the effects of the intervention on maternal outcomes from baseline (22-36 weeks pregnant) to 10 months postpartum. Primary maternal outcomes will include fasting blood glucose and weight (BMI) from baseline to 10 months postpartum. Secondary maternal outcomes will include clinical, adiposity, health behaviors and self-efficacy outcomes from baseline to 10 months postpartum. The third aim of the study is to quantify the effects of the intervention on infant feeding and growth. Infant outcomes will include weight status and breastfeeding from birth through 10 months of age. Data analysis will include general linear mixed-effects models. Safety endpoints include adverse event reporting. Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory, reducing the burden of metabolic disease across two generations. NCT01809431.

Rationale, design, and methodology for the optimizing outcomes in women with gestational diabetes mellitus and their infants study

PubMed Central

2013-01-01

Background Women who are diagnosed with gestational diabetes mellitus (GDM) are at increased risk for developing prediabetes and type 2 diabetes mellitus (T2DM). To date, there have been few interdisciplinary interventions that target predominantly ethnic minority low-income women diagnosed with GDM. This paper describes the rationale, design and methodology of a 2-year, randomized, controlled study being conducted in North Carolina. Methods/Design Using a two-group, repeated measures, experimental design, we will test a 14- week intensive intervention on the benefits of breastfeeding, understanding gestational diabetes and risk of progression to prediabetes and T2DM, nutrition and exercise education, coping skills training, physical activity (Phase I), educational and motivational text messaging and 3 months of continued monthly contact (Phase II). A total of 100 African American, non-Hispanic white, and bilingual Hispanic women between 22–36 weeks of pregnancy who are diagnosed with GDM and their infants will be randomized to either the experimental group or the wait-listed control group. The first aim of the study is to determine the feasibility of the intervention. The second aim of study is to test the effects of the intervention on maternal outcomes from baseline (22–36 weeks pregnant) to 10 months postpartum. Primary maternal outcomes will include fasting blood glucose and weight (BMI) from baseline to 10 months postpartum. Secondary maternal outcomes will include clinical, adiposity, health behaviors and self-efficacy outcomes from baseline to 10 months postpartum. The third aim of the study is to quantify the effects of the intervention on infant feeding and growth. Infant outcomes will include weight status and breastfeeding from birth through 10 months of age. Data analysis will include general linear mixed-effects models. Safety endpoints include adverse event reporting. Discussion Findings from this trial may lead to an effective intervention to assist women diagnosed with GDM to improve maternal glucose homeostasis and weight as well as stabilize infant growth trajectory, reducing the burden of metabolic disease across two generations. Trial registration NCT01809431 PMID:24112417

Health in All Policies: From rhetoric to implementation and evaluation - the Finnish experience.

PubMed

Ståhl, Timo

2018-02-01

The principles of the Health in All Policies (HiAP) approach are not new. Their international roots can be traced back to 1978 and the Alma-Ata Declaration and the 1986 Ottawa Charter. In Finland, the roots of HiAP go back to 1972 when the Economic Council of Finland, chaired by the Prime Minister, launched the 'Report of the working group exploring the goals of health'. The paper discusses the history, rationale, and implementation of the principles underlying the umbrella concept of HiAP. A rationale for implementing a new concept - HiAP in 2006 during the Finnish European Union presidency - is given. The focus here will be on implementation of HiAP. International material supporting the implementation is introduced and practical examples from Finland presented. The Benchmarking System for Health Promotion Capacity Building is introduced, since it has been used as a primary source of information for monitoring and evaluating HiAP in Finland at the local level. The experience from Finland clearly indicates that HiAP as an approach and as a way of working requires long-term commitment and vision. For working across sectors it is crucial to have data on health and health determinants and analyses of the links between health outcomes, health determinants, and policies across sectors and levels of governance. Intersectoral structures, processes, and tools for the identification of problems and solutions, decisions, and implementation across sectors are prerequisites of HiAP. Legislative backing has proven to be useful, especially in providing continuation and sustainability.

Rationale and methodology of a collaborative learning project in congenital cardiac care

PubMed Central

Wolf, Michael J.; Lee, Eva K.; Nicolson, Susan C.; Pearson, Gail D.; Witte, Madolin K.; Huckaby, Jeryl; Gaies, Michael; Shekerdemian, Lara S.; Mahle, William T.

2018-01-01

Background Collaborative learning is a technique through which individuals or teams learn together by capitalizing on one another’s knowledge, skills, resources, experience, and ideas. Clinicians providing congenital cardiac care may benefit from collaborative learning given the complexity of the patient population and team approach to patient care. Rationale and development Industrial system engineers first performed broad-based time-motion and process analyses of congenital cardiac care programs at 5 Pediatric Heart Network core centers. Rotating multidisciplinary team site visits to each center were completed to facilitate deep learning and information exchange. Through monthly conference calls and an in-person meeting, we determined that duration of mechanical ventilation following infant cardiac surgery was one key variation that could impact a number of clinical outcomes. This was underscored by one participating center’s practice of early extubation in the majority of its patients. A consensus clinical practice guideline using collaborative learning was developed and implemented by multidisciplinary teams from the same 5 centers. The 1-year prospective initiative was completed in May 2015, and data analysis is under way. Conclusion Collaborative learning that uses multidisciplinary team site visits and information sharing allows for rapid structured fact-finding and dissemination of expertise among institutions. System modeling and machine learning approaches objectively identify and prioritize focused areas for guideline development. The collaborative learning framework can potentially be applied to other components of congenital cardiac care and provide a complement to randomized clinical trials as a method to rapidly inform and improve the care of children with congenital heart disease. PMID:26995379

A cluster-randomized controlled knowledge translation feasibility study in Alberta community pharmacies using the PARiHS framework: study protocol.

PubMed

Rosenthal, Meagen M; Tsuyuki, Ross T; Houle, Sherilyn Kd

2015-01-01

Despite evidence of benefit for pharmacist involvement in chronic disease management, the provision of these services in community pharmacy has been suboptimal. The Promoting Action on Research Implementation in Health Services (PARiHS) framework suggests that for knowledge translation to be effective, there must be evidence of benefit, a context conducive to implementation, and facilitation to support uptake. We hypothesize that while the evidence and context components of this framework are satisfied, that uptake into practice has been insufficient because of a lack of facilitation. This protocol describes the rationale and methods of a feasibility study to test a facilitated pharmacy practice intervention based on the PARiHS framework, to assist community pharmacists in increasing the number of formal and documented medication management services completed for patients with diabetes, dyslipidemia, and hypertension. A cluster-randomized before-after design will compare ten pharmacies from within a single organization, with the unit of randomization being the pharmacy. Pharmacies will be randomized to facilitated intervention based on the PARiHS framework or usual practice. The Alberta Context Tool will be used to establish the context of practice in each pharmacy. Pharmacies randomized to the intervention will receive task-focused facilitation from an external facilitator, with the goal of developing alternative team processes to allow the greater provision of medication management services for patients with diabetes, hypertension, and dyslipidemia. The primary outcome will be a process evaluation of the needs of community pharmacies to provide more clinical services, the acceptability and uptake of modifications made, and the willingness of pharmacies to participate. Secondary outcomes will include the change in the number of formal and documented medication management services in the aforementioned chronic conditions provided 6 months before, versus after, the intervention between the two groups, and identification of feasible quantitative outcomes for evaluating the effect of the intervention on patient care outcomes. To date, the study has identified and enrolled the ten pharmacies required and initiated the intervention process. This study will be the first to examine the role of facilitation in pharmacy practice, with the goal of scalable and sustainable practice change. Clinicaltrials.gov identifier NCT02191111.

Comparative analysis of rationale used by dentists and patient for final esthetic outcome of dental treatment.

PubMed

Reddy, S Varalakshmi; Madineni, Praveen Kumar; Sudheer, A; Gujjarlapudi, Manmohan Choudary; Sreedevi, B; Reddy, Patelu Sunil Kumar

2013-05-01

To compare and evaluate the perceptions of esthetics among dentists and patients regarding the final esthetic outcome of a dental treatment. Esthetics is a matter of perception and is associated with the way different people look at an object. What constitutes esthetic for a particular person may not be acceptable for another. Hence it is subjective in nature. This becomes more obvious during the post-treatment evaluation of esthetics by dentist and the concerned patient. Opinion seldom matches. Hence, the study is a necessary part of the process of understanding the mind of dentist and patient regarding what constitutes esthetics. A survey has been conducted by means of a questionnaire consisting of 10 questions, on two groups of people. First group consists of 100 dentists picked at random in Kanyakumari district of Tamil Nadu, India. Second group consisted of 100 patients who required complete denture prosthesis. The second group was divided into two subgroups A and B. Subgroup A consisting of 50 men and subgroup B consisting of 50 women. In each subgroup 25 patients were selected in age group of 40 to 50 and 25 patients were selected in the age group of 50 to 60. The questionnaire was given to both the groups and asked to fill up, which was then statistically analyzed to look for patterns of thought process among them. Results were subjected to statistical analysis by Student's t-test. Perceptions of esthetics differs from dentist who is educated regarding esthetic principles of treatment and a patient who is not subjected to such education. Since, the questions were formulated such that patients could better understand the underlying problem, the final outcome of survey is a proof that dentists need to take into account what the patient regards as esthetics in order to provide a satisfactory treatment. CLINICAL AND ACADEMIC SIGNIFICANCE: The current study helps the dentist to better educate the patient regarding esthetics so that patient appreciates the final scientifically based esthetic outcome of treatment. It also helps the dental students to understand the underlying patient's thought process regarding esthetics.

Development of Food Acceptance Patterns.

ERIC Educational Resources Information Center

Birch, Leann L.

1990-01-01

Provides a rationale for the significance of the study of early feeding and delineates major issues that require investigation. Includes a list of acquisition processes implicated in the development of food acceptance patterns. (RH)

The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures

PubMed Central

Ma, Junli; Ma, Limin; Wang, Zhifa; Zhu, Xiongjie; Wang, Weijian

2017-01-01

Abstract Rationale: Precise bony reduction and reconstruction of optimal contour in treating comminuted mandibular fractures is very difficult using traditional techniques and devices. The aim of this report is to introduce our experiences in using virtual surgery and three-dimensional (3D) printing technique in treating this clinical challenge. Patient concerns: A 26-year-old man presented with severe trauma in the maxillofacial area due to fall from height. Diagnosis: Computed tomography images revealed middle face fractures and comminuted mandibular fracture including bilateral condyles. Interventions and outcomes: The computed tomography data was used to construct the 3D cranio-maxillofacial models; then the displaced bone fragments were virtually reduced. On the basis of the finalized model, a customized titanium mesh tray was designed and fabricated using selective laser melting technology. During the surgery, a submandibular approach was adopted to repair the mandibular fracture. The reduction and fixation were performed according to preoperative plan, the bone defects in the mental area were reconstructed with iliac bone graft. The 3D-printed mesh tray served as an intraoperative template and carrier of bone graft. The healing process was uneventful, and the patient was satisfied with the mandible contour. Lessons: Virtual surgical planning combined with 3D printing technology enables surgeon to visualize the reduction process preoperatively and guide intraoperative reduction, making the reduction less time consuming and more precise. 3D-printed titanium mesh tray can provide more satisfactory esthetic outcomes in treating complex comminuted mandibular fractures. PMID:28682875

Establishing the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry

PubMed Central

Bray, Janet; Smith, Karen; Walker, Tony; Grantham, Hugh; Hein, Cindy; Thorrowgood, Melanie; Smith, Anthony; Smith, Tony; Dicker, Bridget; Swain, Andy; Bailey, Mark; Bosley, Emma; Pemberton, Katherine; Cameron, Peter; Nichol, Graham; Finn, Judith

2016-01-01

Introduction Out-of-hospital cardiac arrest (OHCA) is a global health problem with low survival. Regional variation in survival has heightened interest in combining cardiac arrest registries to understand and improve OHCA outcomes. While individual OHCA registries exist in Australian and New Zealand ambulance services, until recently these registries have not been combined. The aim of this protocol paper is to describe the rationale and methods of the Australian Resuscitation Outcomes Consortium (Aus-ROC) OHCA epidemiological registry (Epistry). Methods and analysis The Aus-ROC Epistry is designed as a population-based cohort study. Data collection started in 2014. Six ambulance services in Australia (Ambulance Victoria, SA Ambulance Service, St John Ambulance Western Australia and Queensland Ambulance Service) and New Zealand (St John New Zealand and Wellington Free Ambulance) currently contribute data. All OHCA attended by ambulance, regardless of aetiology or patient age, are included in the Epistry. The catchment population is approximately 19.3 million persons, representing 63% of the Australian population and 100% of the New Zealand population. Data are collected using Utstein-style definitions. Information incorporated into the Epistry includes demographics, arrest features, ambulance response times, treatment and patient outcomes. The primary outcome is ‘survival to hospital discharge’, with ‘return of spontaneous circulation’ as a key secondary outcome. Ethics and dissemination Ethics approval was independently sought by each of the contributing registries. Overarching ethics for the Epistry was provided by Monash University HREC (Approval No. CF12/3938—2012001888). A population-based OHCA registry capturing the majority of Australia and New Zealand will allow risk-adjusted outcomes to be determined, to enable benchmarking across ambulance providers, facilitate the identification of system-wide strategies associated with survival from OHCA, and allow monitoring of temporal trends in process and outcomes to improve patient care. Findings will be shared with participating ambulance services and the academic community. PMID:27048638

Adopting public values and climate change adaptation strategies in urban forest management: A review and analysis of the relevant literature.

PubMed

Ordóñez Barona, Camilo

2015-12-01

Urban trees are a dominant natural element in cities; they provide important ecosystem services to urban citizens and help urban areas adapt to climate change. Many rationales have been proposed to provide a purpose for urban forest management, some of which have been ineffective in addressing important ecological and social management themes. Among these rationales we find a values-based perspective, which sees management as a process where the desires of urban dwellers are met. Another perspective is climate change adaptation, which sees management as a process where urban forest vulnerability to climate change is reduced and resilience enhanced. Both these rationales have the advantage of complementing, enhancing, and broadening urban forest management objectives. A critical analysis of the literature on public values related to urban forests and climate change adaptation in the context of urban forests is undertaken to discuss what it means to adopt these two issues in urban forest management. The analysis suggests that by seeing urban forest management as a process by which public values are satisfied and urban-forest vulnerabilities to climate change are reduced, we can place issues such as naturalization, adaptive management, and engaging people in management at the centre of urban forest management. Focusing urban forest management on these issues may help ensure the success of programs focused on planting more trees and increasing citizen participation in urban forest management. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol.

PubMed

Fine, Naomi B; Achituv, Michal; Etkin, Amit; Merin, Ofer; Shalev, Arieh Y

2018-01-01

Background : The immediate aftermath of traumatic events is a period of enhanced neural plasticity, following which some survivors remain with post-traumatic stress disorder (PTSD) whereas others recover. Evidence points to impairments in emotional reactivity, emotion regulation, and broader executive functions as critically contributing to PTSD. Emerging evidence further suggests that the neural mechanisms underlying these functions remain plastic in adulthood and that targeted retraining of these systems may enhance their efficiency and could reduce the likelihood of developing PTSD. Administering targeted neurocognitive training shortly after trauma exposure is a daunting challenge. This work describes a study design addressing that challenge. The study evaluated the direct effects of cognitive remediation training on neurocognitive mechanisms that hypothetically underlay PTSD, and the indirect effect of this intervention on emerging PTSD symptoms. Method : We describe a study rationale, design, and methodological choices involving: (a) participants' enrolment; (b) implementation and management of a daily self-administered, web-based intervention; (c) reliable, timely screening and assessment of treatment of eligible survivors; and (d) defining control conditions and outcome measures. We outline the rationale of choices made regarding study sample, timing of intervention, measurements, monitoring participants' adherence, and ways to harmonize and retain interviewers' fidelity and mitigate eventual burnout by repeated contacts with recently traumatized survivors. Conclusion : Early web-based interventions targeting causative mechanisms of PTSD can be informed by the model presented in this paper.

Rationale, design and baseline data of a mixed methods study examining the clinical impact of a brief transition programme for young people with juvenile idiopathic arthritis: the DON'T RETARD project

PubMed Central

Hilderson, Deborah; Westhovens, Rene; Wouters, Carine; Van der Elst, Kristien; Goossens, Eva; Moons, Philip

2013-01-01

Objectives To describe (1) the content of a transition programme for young people with juvenile idiopathic arthritis (JIA) designed as a brief intervention, (2) the rationale and design of a mixed-methods study evaluating the clinical impact of this transition programme and (3) to provide baseline data of the intervention group. Design An ‘embedded experimental’ design is used for the evaluation of the transition programme. A ‘one-group pretest-posttest, with a non-equivalent posttest-only comparison group design’ is used to quantitatively evaluate the impact of the transition programme, applying both longitudinal and comparative analyses. Subsequently, experiences of adolescents and their parents who participated in the experimental group will be analysed qualitatively using content analysis. Setting Participants in the intervention are recruited at a tertiary care centre in Belgium. The comparison group participants are recruited from one tertiary and three secondary care centres in Belgium. Participants The intervention group consists of 33 young people (25 females; 8 males) with a median age of 16 years. Main diagnoses are persistent or extended oligoarticular JIA (33%), polyarticular JIA (30%), enthesitis-related JIA (21%) or systemic arthritis (15%). Intervention The transition programme comprises eight key components: (1) transition coordinator; (2) providing information and education; (3) availability by telephone; (4) information about and contact with an adult care programme; (5) guidance of parents; (6) meeting with peers; (7) transfer plan; and (8) actual transfer to adult care. Primary and secondary outcomes The primary outcome is health status, as perceived by the adolescents. Secondary outcomes are health status, as perceived by the parents; medication adherence; illness-related knowledge; quality of life; fatigue; promotion of independence; support of autonomy; behavioural control and psychological control. Results At baseline, the median score was 69.2 (Q1=60.0;Q3=92.9) on psychosocial health and 68.8 (Q1=56.3; Q3=89.1) on physical health. Rheumatic-specific health scores ranged from 62.5 to 100. Conclusions We present the rationale and design of a study intended to evaluate a transition programme for adolescents with JIA as a brief intervention. PMID:24302502

Validation of the National Institutes of Health Patient-Reported Outcomes Measurement Information System Survey as a Quality-of-Life Instrument for Patients with Malignant Brain Tumors and Their Caregivers.

PubMed

Romero, Melissa M; Flood, Lisa Sue; Gasiewicz, Nanci K; Rovin, Richard; Conklin, Samantha

2015-12-01

At present there is a lack of well-validated surveys used to measure quality of life in patients with malignant brain tumors and their caregivers. The main objective of this pilot study was to validate the National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH PROMIS) survey for use as a quality-of-life measure in this population. This article presents the rationale for using the NIH PROMIS instrument as a quality-of-life measure for patients with malignant brain tumors and their caregivers. Copyright © 2015 Elsevier Inc. All rights reserved.

Vitamin D and Heart Failure.

PubMed

Marshall Brinkley, D; Ali, Omair M; Zalawadiya, Sandip K; Wang, Thomas J

2017-10-01

Vitamin D is principally known for its role in calcium homeostasis, but preclinical studies implicate multiple pathways through which vitamin D may affect cardiovascular function and influence risk for heart failure. Many adults with cardiovascular disease have low vitamin D status, making it a potential therapeutic target. We review the rationale and potential role of vitamin D supplementation in the prevention and treatment of chronic heart failure. Substantial observational evidence has associated low vitamin D status with the risk of heart failure, ventricular remodeling, and clinical outcomes in heart failure, including mortality. However, trials assessing the influence of vitamin D supplementation on surrogate markers and clinical outcomes in heart failure have generally been small and inconclusive. There are insufficient data to recommend routine assessment or supplementation of vitamin D for the prevention or treatment of chronic heart failure. Prospective trials powered for clinical outcomes are warranted.

Improving PTSD Outcomes in OIF/OEF Returnees: A Randomized Clinical Trial of Hydrocortisone Augmentation of Prolonged Exposure Therapy

DTIC Science & Technology

2012-08-01

Melissa D . Altman, PhD will ensure that the ratings are accomplished in a reasonable time frame, and make the results available to the PI and co...Glucocorticoid augmentation of prolonged exposure therapy: rationale and case report. European Journal of Traumatology. 2010(1): 5643. d . Solutions to...Brief Assessment of Cognition in Schizophrenia (BACS): Symbol-Coding Category Fluency: Animal Naming Trail Making Test: Part A Timed paper

Investigation of Prognostic Ability of Novel Imaging Markers for Traumatic Brain Injury (TBI)

DTIC Science & Technology

2011-10-01

testing None of the above Psychological / Sociological ID: VIEW4514342955C00Name: Type of Research View: Lay Summary 1 * Provide a summary of the...best describe the current clinical status of the patient and which markers best predict a patient’s outcome status. ID: VIEW475E142D4E000Name: Lay ... Summary View: Justification, Objective, & Research Design 1 * Provide context, justification, and scientific/scholarly rationale for the study: Currently

Can anesthetic treatment worsen outcome in status epilepticus?

PubMed

Sutter, Raoul; Kaplan, Peter W

2015-08-01

Status epilepticus refractory to first-line and second-line antiepileptic treatments challenges neurologists and intensivists as mortality increases with treatment refractoriness and seizure duration. International guidelines advocate anesthetic drugs, such as continuously administered high-dose midazolam, propofol, and barbiturates, for the induction of therapeutic coma in patients with treatment-refractory status epilepticus. The seizure-suppressing effect of anesthetic drugs is believed to be so strong that some experts recommend using them after benzodiazepines have failed. Although the rationale for the use of anesthetic drugs in patients with treatment-refractory status epilepticus seems clear, the recommendation of their use in treating status epilepticus is based on expert opinions rather than on strong evidence. Randomized trials in this context are lacking, and recent studies provide disturbing results, as the administration of anesthetics was associated with poor outcome independent of possible confounders. This calls for caution in the straightforward use of anesthetics in treating status epilepticus. However, there are still more questions than answers, and current evidence for the adverse effects of anesthetic drugs in patients with status epilepticus remains too limited to advocate a change of treatment algorithms. In this overview, the rationale and the conflicting clinical implications of anesthetic drugs in patients with treatment-refractory status epilepticus are discussed, and remaining questions are elaborated. This article is part of a Special Issue entitled "Status Epilepticus". Copyright © 2015 Elsevier Inc. All rights reserved.

Biological diversity, dietary diversity, and eye health in developing country populations: establishing the evidence-base.

PubMed

Bélanger, Julie; Johns, Timothy

2008-09-01

Human and ecosystem health converge around biological diversity issues. Cultivated and wild plants as food and medicine make essential contributions to human health, which in turn provides rationales for conservation. While wild and cultivated plant diversity reasonably facilitates dietary diversity and positive health outcomes, the challenges of demonstrating this relationship limit its impact in concept, policy, and practice. We present a rationale for testing the dietary contribution of biological diversity to improved eye health as a case study based on existing phytochemical, pharmacological, and clinical knowledge. We consider the empirical evidence needed to substantiate, interpret, and apply this relationship at a population and ecosystem level within a unified research framework. Epidemiological data strongly support the prevention of childhood vitamin A deficiency blindness, cataract, and age-related macular degeneration by fruit and vegetable consumption. Phytonutrients, including the carotenoids lutein and zeaxanthin, protect the eye from oxidative stress and harmful light exposure. Laboratory, community, and population level research should prioritize food composition of dietary plants from both agriculture and the wild. Intervention studies, focus groups, and transmission of knowledge of local species and varieties within communities will further interpretation of epidemiological data. Population-based studies combining clinical data and measures of access and consumption of biological diversity are key to demonstrating the important relationships among biodiversity, dietary diversity, and health outcomes.

The effectiveness and cost-evaluation of manual therapy and physical therapy in patients with sub-acute and chronic non specific neck pain. Rationale and design of a Randomized Controlled Trial (RCT)

PubMed Central

2010-01-01

Background Manual Therapy applied to patients with non specific neck pain has been investigated several times. In the Netherlands, manual therapy as applied according to the Utrecht School of Manual Therapy (MTU) has not been the subject of a randomized controlled trial. MTU differs in diagnoses and treatment from other forms of manual therapy. Methods/Design This is a single blind randomized controlled trial in patients with sub-acute and chronic non specific neck pain. Patients with neck complaints existing for two weeks (minimum) till one year (maximum) will participate in the trial. 180 participants will be recruited in thirteen primary health care centres in the Netherlands. The experimental group will be treated with MTU during a six week period. The control group will be treated with physical therapy (standard care, mainly active exercise therapy), also for a period of six weeks. Primary outcomes are Global Perceived Effect (GPE) and functional status (Neck Disability Index (NDI-DV)). Secondary outcomes are neck pain (Numeric Rating Scale (NRS)), Eurocol, costs and quality of life (SF36). Discussion This paper presents details on the rationale of MTU, design, methods and operational aspects of the trial. Trial registration ClinicalTrials.gov Identifier: NCT00713843 PMID:20096136

Study rationale and design of OPTIMISE, a randomised controlled trial on the effect of benchmarking on quality of care in type 2 diabetes mellitus.

PubMed

Nobels, Frank; Debacker, Noëmi; Brotons, Carlos; Elisaf, Moses; Hermans, Michel P; Michel, Georges; Muls, Erik

2011-09-22

To investigate the effect of physician- and patient-specific feedback with benchmarking on the quality of care in adults with type 2 diabetes mellitus (T2DM). Study centres in six European countries were randomised to either a benchmarking or control group. Physicians in both groups received feedback on modifiable outcome indicators (glycated haemoglobin [HbA1c], glycaemia, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein [LDL]-cholesterol and triglycerides) for each patient at 0, 4, 8 and 12 months, based on the four times yearly control visits recommended by international guidelines. The benchmarking group also received comparative results on three critical quality indicators of vascular risk (HbA1c, LDL-cholesterol and systolic blood pressure [SBP]), checked against the results of their colleagues from the same country, and versus pre-set targets. After 12 months of follow up, the percentage of patients achieving the pre-determined targets for the three critical quality indicators will be assessed in the two groups. Recruitment was completed in December 2008 with 3994 evaluable patients. This paper discusses the study rationale and design of OPTIMISE, a randomised controlled study, that will help assess whether benchmarking is a useful clinical tool for improving outcomes in T2DM in primary care. NCT00681850.

Study rationale and design of OPTIMISE, a randomised controlled trial on the effect of benchmarking on quality of care in type 2 diabetes mellitus

PubMed Central

2011-01-01

Background To investigate the effect of physician- and patient-specific feedback with benchmarking on the quality of care in adults with type 2 diabetes mellitus (T2DM). Methods Study centres in six European countries were randomised to either a benchmarking or control group. Physicians in both groups received feedback on modifiable outcome indicators (glycated haemoglobin [HbA1c], glycaemia, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein [LDL]-cholesterol and triglycerides) for each patient at 0, 4, 8 and 12 months, based on the four times yearly control visits recommended by international guidelines. The benchmarking group also received comparative results on three critical quality indicators of vascular risk (HbA1c, LDL-cholesterol and systolic blood pressure [SBP]), checked against the results of their colleagues from the same country, and versus pre-set targets. After 12 months of follow up, the percentage of patients achieving the pre-determined targets for the three critical quality indicators will be assessed in the two groups. Results Recruitment was completed in December 2008 with 3994 evaluable patients. Conclusions This paper discusses the study rationale and design of OPTIMISE, a randomised controlled study, that will help assess whether benchmarking is a useful clinical tool for improving outcomes in T2DM in primary care. Trial registration NCT00681850 PMID:21939502

How To Optimize Organizational Effectiveness through Leadership: The Case for a Process-Based Organization.

ERIC Educational Resources Information Center

Rieley, James B.

This paper presents the issues relating to, the rationale, and the methodology for the implementation of a process-based organizational structure. Following an overview of leadership theory and traditional organizational structure, a model of the circular organization is presented. In the circular organization, the leader occupies a middle, rather…

Peer Collaboration: Improving Teaching through Comprehensive Peer Review

ERIC Educational Resources Information Center

Smith, Shelley L.

2014-01-01

This article includes a brief rationale and review of the literature on peer review of teaching (PRT). Based on that literature review, it offers a proposal for an optimal formative review process that results in a teaching portfolio that would reflect a faculty member's efforts and successes in a critically reflective PRT process, and contributes…

Faculty Member Engagement in Canadian University Internationalization: A Consideration of Understanding, Motivations and Rationales

ERIC Educational Resources Information Center

Friesen, Rhonda

2013-01-01

Faculty members are key agents in the institutional internationalization process within Canadian higher education. In the growing volumes of literature on internationalization, however, few authors consider how faculty members perceive their role in this process. In this study I take a phenomenological research approach to explore the…

Case Study: Developing Graduate Engineers at Kentz Engineers & Constructors

ERIC Educational Resources Information Center

O'Donnell, Hugh; Karallis, Takis; Sandelands, Eric; Cassin, James; O'Neill, Donal

2008-01-01

Purpose: The aim of this paper is to outline the approach and process in place within Kentz Engineers & Constructors to develop graduate engineers on an international basis. Design/methodology/approach: The approach adopted is that of a case study which describes activities and processes within the organization and the rationale behind them,…

The Composing Process: A Critical Review of Some Recent Studies.

ERIC Educational Resources Information Center

Crismore, Avon

Six of the 10 existing research studies that attempt to characterize the composing process by examining certain components and behaviors are critically reviewed in this paper. For each study, the aims and data gathering and sampling procedures are described, and the findings, interpretations, design, and rationale of the research are critically…

The Rationale for Experiential/Participatory Learning. Working Papers in Early Childhood Development 16.

ERIC Educational Resources Information Center

Torkington, Kate

Experiential learning has been defined as the process whereby knowledge is created through the transformation of the experience of the learner who is at the center of the learning process. Modern experiential learning theory begins with John Dewey and his "Experience and Education" (1938). Coleman (1976) describes traditional learning as…

Global Biology Research Program: Program plan

NASA Technical Reports Server (NTRS)

1983-01-01

Biological processes which play a dominant role in these cycles which transform and transfer much of this material throughout the biosphere are examined. A greater understanding of planetary biological processes as revealed by the interaction of the biota and the environment. The rationale, scope, research strategy, and research priorities of the global biology is presented.

COMPARATIVE POTENCY METHOD FOR CANCER RISK ASSESSMENT: CLARIFICATION OF THE RATIONALE, THEORETICAL BASIS, AND APPLICATION TO DIESEL PARTICULATE EMISSIONS

EPA Science Inventory

The rapid increase in new combustion technologies and new fuels for automobiles, residential and industrial heating, and other energy-related processes poses a particularly unique problem for both the scientific assessment of risk and the regulatory decision-making process that m...

Audience and Witnessing: Research into Dramatherapy using Vignettes and aMSN Messenger

ERIC Educational Resources Information Center

Jones, Phil

2008-01-01

This article describes the process of research undertaken to examine therapists' responses to the concept of the core processes of change in dramatherapy. The research uses a combination of vignette description and analysis using aMSN messenger. The article describes the theoretical underpinning and rationale to the approach, and the…

The Execution and Evaluation of an Integrated Business Common Core Curriculum.

ERIC Educational Resources Information Center

Pharr, Steven W.; Morris, John S.; Stover, Dana; Byers, C. Randall; Reyes, Mario G.

1998-01-01

Describes the rationale, process, and organization of an integrated, cross-disciplinary undergraduate program known as the Integrated Business Common Core (IBC) at the University of Idaho. Indicates that IBC's goal is to provide students with an understanding of key business issues, with emphasis on processes. (2 tables and 11 references) (JDI)

Self-Rated Health Appraisal as Cultural and Identity Process: African American Elders' Health and Evaluative Rationales

ERIC Educational Resources Information Center

McMullen, Carmit K.; Luborsky, Mark R.

2006-01-01

Purpose: We explored self-rated health by using a meaning-centered theoretical foundation. Self-appraisals, such as self-rated health, reflect a cultural process of identity formation, whereby identities are multiple, simultaneously individual and collective, and produced by specific historical formations. Anthropological research in Philadelphia…

Rationale for a preliminary operational definition of physical frailty and sarcopenia in the SPRINTT trial.

PubMed

Cesari, Matteo; Landi, Francesco; Calvani, Riccardo; Cherubini, Antonio; Di Bari, Mauro; Kortebein, Patrick; Del Signore, Susanna; Le Lain, Regis; Vellas, Bruno; Pahor, Marco; Roubenoff, Ronenn; Bernabei, Roberto; Marzetti, Emanuele

2017-02-01

In the present article, the rationale that guided the operationalization of the theoretical concept of physical frailty and sarcopenia (PF&S), the condition of interest for the "Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies" (SPRINTT) trial, is presented. In particular, the decisions lead to the choice of the adopted instruments, and the reasons for setting the relevant thresholds are explained. In SPRINTT, the concept of physical frailty is translated with a Short Physical Performance Battery score of ≥3 and ≤9. Concurrently, sarcopenia is defined according to the recent definitions of low muscle mass proposed by the Foundation for the National Institutes of Health-Sarcopenia Project. Given the preventive purpose of SPRINTT, older persons with mobility disability (operationalized as incapacity to complete a 400-m walk test within 15 min; primary outcome of the trial) at the baseline are not included within the diagnostic spectrum of PF&S.

Organ Donation in the 50+ Age Demographic: Survey Results on Decision Rationale and Information Preferences.

PubMed

Tartaglia, Alexander; Dodd-McCue, Diane; Myer, Kevin A; Mullins, Andrew

2016-09-01

The rate of organ donation by older potential donors is significantly declining even though recent studies show positive clinical outcomes with organs transplanted from older donors. This study examined the 50+ age demographic to identify the rationale for donation decisions, preferred media methods of donation information delivery, and responsiveness to an age-tailored donation message. Results from 579 surveys, 87% from the 50+ age demographic, found respondents prone to self-select themselves as medically ineligible based on current medication and health status, even though they might be medically suitable donors. Their incentive to pursue additional information on donation is limited except when motivated by personal accounts within their families and communities. In addition, even when computer literate, they continue to favor the printed or spoken word for donation information delivery. The results suggest an opportunity for those working with older adults to develop more personalized, localized donation education programs targeting this age demographic. © The Author(s) 2014.

Perspectives on voice treatment for unilateral vocal fold paralysis.

PubMed

Walton, Chloe; Carding, Paul; Flanagan, Kieran

2018-06-01

Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphonia resulting in glottal insufficiency. To restore glottal sufficiency and reduce the presenting dysphonia, treatment involving either surgical intervention, voice therapy or a combination of the two is typically provided. Currently, there is no consensus for the most effective voice treatment for UVFP. This results in an inability to compare current studies, and a lack of treatment effectiveness for the management of UVFP. This study aims to review the most recent literature for the management of dysphonia due to UVFP to establish the current evidence base for voice treatment options. There was found to be a lack of consistency in the rationale, selection and timing of the surgical intervention and/or voice therapy being provided for patients with UVFP. Further consensus is required for the rationale and selection of voice treatment prescriptions for the management of UVFP in order to improve treatment effectiveness and voice outcomes in patients with UVFP.

Rationale for the Use of CAD/CAM Technology in Implant Prosthodontics

PubMed Central

Abduo, Jaafar; Lyons, Karl

2013-01-01

Despite the predictable longevity of implant prosthesis, there is an ongoing interest to continue to improve implant prosthodontic treatment and outcomes. One of the developments is the application of computer-aided design and computer-aided manufacturing (CAD/CAM) to produce implant abutments and frameworks from metal or ceramic materials. The aim of this narrative review is to critically evaluate the rationale of CAD/CAM utilization for implant prosthodontics. To date, CAD/CAM allows simplified production of precise and durable implant components. The precision of fit has been proven in several laboratory experiments and has been attributed to the design of implants. Milling also facilitates component fabrication from durable and aesthetic materials. With further development, it is expected that the CAD/CAM protocol will be further simplified. Although compelling clinical evidence supporting the superiority of CAD/CAM implant restorations is still lacking, it is envisioned that CAD/CAM may become the main stream for implant component fabrication. PMID:23690778

The Mediterranean healthy eating, ageing, and lifestyle (MEAL) study: rationale and study design.

PubMed

Grosso, Giuseppe; Marventano, Stefano; D'Urso, Maurizio; Mistretta, Antonio; Galvano, Fabio

2017-08-01

There is accumulating evidence suggesting that Mediterranean lifestyles, including nutrition and sleeping patterns as well as social integration, may play a role in reducing age-related diseases. However, the literature is mostly deficient of evidence provided by Italian Mediterranean islands that more closely adhered to the originally described lifestyles. In this paper, we described the rationale and the study design of the Mediterranean healthy Eating, Ageing, and Lifestyle (MEAL) study, a prospective population-based cohort established in Sicily, southern Italy. The main exposures investigated are classical determinants of health, including demographic, nutritional habits, smoking and physical activity status, as well as eating-related behaviors, sleeping habits, sun exposure, social resources, and perceived stress. Anthropometric measurements will be collected. The main outcomes included depression, quality of life, and, after the follow-up period, also cardiovascular disease and cancer. The MEAL study may provide important data to increase our knowledge regarding the prevalence, incidence, and risk factors of age-related disorders in the Mediterranean region.

Ethnicity and mental health: conceptualization, definition and operationalization of ethnicity from a Canadian context.

PubMed

Clarke, D E; Colantonio, A; Rhodes, A E; Escobar, M

2008-01-01

The current study provides a critical review of Canadian studies on ethnicity and mental health with respect to the definition, conceptualization and operationalization of ethnicity. It provides a discussion on the methodological issues related to these factors and their implications to guide future research and enable comparability of results across studies. Sociological Abstracts, PsycINFO, MEDLINE and CINAHL were used to identify relevant Canadian articles published between January 1980 and December 2004. The review highlights a number of key issues for future researchers to consider such as the need for: 1) clear rationales as to why ethnicity is important to their outcome of interest; 2) clarity on the definition of ethnicity, which affects its conceptualization and operationalization; 3) a theoretically driven conceptualization of ethnicity, which should be related to the research question of interest; and 4) clear rationales for the decisions made regarding the data source used, the operationalization of ethnicity, and the ethnic categories included in their studies.

Pilot study: incorporation of pharmacogenetic testing in medication therapy management services.

PubMed

Haga, Susanne B; Allen LaPointe, Nancy M; Moaddeb, Jivan; Mills, Rachel; Patel, Mahesh; Kraus, William E

2014-11-01

Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered medication therapy management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach.

The At Home/Chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities

PubMed Central

Streiner, David L; Adair, Carol; Aubry, Tim; Barker, Jayne; Distasio, Jino; Hwang, Stephen W; Komaroff, Janina; Latimer, Eric; Somers, Julian; Zabkiewicz, Denise M

2011-01-01

Introduction Housing First is a complex housing and support intervention for homeless individuals with mental health problems. It has a sufficient knowledge base and interest to warrant a test of wide-scale implementation in various settings. This protocol describes the quantitative design of a Canadian five city, $110 million demonstration project and provides the rationale for key scientific decisions. Methods A pragmatic, mixed methods, multi-site field trial of the effectiveness of Housing First in Vancouver, Winnipeg, Toronto, Montreal and Moncton, is randomising approximately 2500 participants, stratified by high and moderate need levels, into intervention and treatment as usual groups. Quantitative outcome measures are being collected over a 2-year period and a qualitative process evaluation is being completed. Primary outcomes are housing stability, social functioning and, for the economic analyses, quality of life. Hierarchical linear modelling is the primary data analytic strategy. Ethics and dissemination Research ethics board approval has been obtained from 11 institutions and a safety and adverse events committee is in place. The results of the multi-site analyses of outcomes at 12 months and 2 years will be reported in a series of core scientific journal papers. Extensive knowledge exchange activities with non-academic audiences will occur throughout the duration of the project. Trial registration number This study has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374. PMID:22102645

The implementation research institute: training mental health implementation researchers in the United States

PubMed Central

2013-01-01

Background The Implementation Research Institute (IRI) provides two years of training in mental health implementation science for 10 new fellows each year. The IRI is supported by a National Institute of Mental Health (NIMH) R25 grant and the Department of Veterans Affairs (VA). Fellows attend two annual week-long trainings at Washington University in St. Louis. Training is provided through a rigorous curriculum, local and national mentoring, a ‘learning site visit’ to a federally funded implementation research project, pilot research, and grant writing. Methods This paper describes the rationale, components, outcomes to date, and participant experiences with IRI. Results IRI outcomes include 31 newly trained implementation researchers, their new grant proposals, contributions to other national dissemination and implementation research training, and publications in implementation science authored by the Core Faculty and fellows. Former fellows have obtained independent research funding in implementation science and are beginning to serve as mentors for more junior investigators. Conclusions Based on the number of implementation research grant proposals and papers produced by fellows to date, the IRI is proving successful in preparing new researchers who can inform the process of making evidence-based mental healthcare more available through real-world settings of care and who are advancing the field of implementation science. PMID:24007290

Rationale and design of the IMPACT EU-trial: improve management of heart failure with procalcitonin biomarkers in cardiology (BIC)-18.

PubMed

Möckel, Martin; Slagman, Anna; Vollert, Jörn Ole; Ebmeyer, Stefan; Wiemer, Jan C; Searle, Julia; Giannitsis, Evangelos; Kellum, John A; Maisel, Alan

2018-02-01

To evaluate the effectiveness of procalcitonin (PCT)-guided antibiotic treatment compared to current treatment practice to reduce 90-day all-cause mortality in emergency patients with shortness of breath (SOB) and suspected acute heart failure (AHF). Concomitant AHF and lower respiratory tract (or other bacterial) infection in emergency patients with dyspnea are common and can be difficult to diagnose. Early and adequate initiation of antibiotic therapy (ABX) significantly improves patient outcome, but superfluous prescription of ABX maybe harmful. In a multicentre, prospective, randomized, controlled process trial with an open intervention, adult emergency patients with SOB and increased levels of natriuretic peptides will be randomized to either a standard care group or a PCT-guided group with respect to the initiation of antibiotic treatment. In the PCT-guided group, the initiation of antibiotic therapy is based on the results of acute PCT measurements at admission, using a cut-off of 0.2 ng/ml. A two-stage sample-size adaptive design is used; an interim analysis was done after completion of 50% of patients and the final sample size remained unchanged. Primary endpoint is 90-day all-cause mortality. The current study will provide evidence, whether the routine use of PCT in patients with suspected AHF improves outcome.

The implementation of the Open Access paradigm to the EC-FP7 MED-SUV (Mediterranean Supersite Volcanoes) project

NASA Astrophysics Data System (ADS)

Puglisi, Giuseppe; Brito, Fabrice; Caumont, Hervé; D'Auria, Luca; Fernandez, José; Mazzetti, Paolo; Mathieu, Pierre Philippe; Nativi, Stefano; Papeschi, Fabrizio; Pepe, Antonio; Reitano, Danilo; Sangianantoni, Agata; Scarpato, Giovanni; Spampinato, Letizia

2016-04-01

The overall goal of the EC-FP7 Mediterranean Supersite Volcanoes (MED-SUV) project is to apply the rationale of the Supersites GEO initiative to Campi Flegrei/Vesuvius and Mt. Etna to reduce the volcanic risk, by improving the understanding of the underlying geophysical processes, through the integration and sharing of the in-situ and Earth Observation (EO) data sets and the implementation of new instruments and monitoring systems. The project involves 24 EU and no-EU partners, including research and academic institutions, space agencies and SMEs. In this framework, the application of the Open Access paradigm has offered the opportunity to study and apply practical solutions concerning the data management (i.e. data polices, foreground exploitation and sustainability), intellectual property rights (i.e., ownership, licences, agreements) and technical issues (i.e., design and implementation of an interoperability e-infrastructure, access systems, etc.). This contribution presents pro and cons encountered in the project, as well as the main outcomes of the implementation of the Open Access to the Italian Supersites. This experience will be exploited in the building of international research infrastructures, such as EPOS, and the outcomes of the project will contribute to foster the Open Access to the research data in a wide context, as the GEO-GEOSS framework.

The 'Walking for Wellbeing in the West' randomised controlled trial of a pedometer-based walking programme in combination with physical activity consultation with 12 month follow-up: rationale and study design

PubMed Central

Fitzsimons, Claire F; Baker, Graham; Wright, Annemarie; Nimmo, Myra A; Ward Thompson, Catharine; Lowry, Ruth; Millington, Catherine; Shaw, Rebecca; Fenwick, Elisabeth; Ogilvie, David; Inchley, Joanna; Foster, Charlie E; Mutrie, Nanette

2008-01-01

Background Scotland has a policy aimed at increasing physical activity levels in the population, but evidence on how to achieve this is still developing. Studies that focus on encouraging real world participants to start physical activity in their settings are needed. The Walking for Well-being in the West study was designed to assess the effectiveness of a pedometer-based walking programme in combination with physical activity consultation. The study was multi-disciplinary and based in the community. Walking for Well-being in the West investigated whether Scottish men and women, who were not achieving the current physical activity recommendation, increased and maintained walking behaviour over a 12 month period. This paper outlines the rationale and design of this innovative and pragmatic study. Methods Participants were randomised into two groups: Group 1: Intervention (pedometer-based walking programme combined with a series of physical activity consultations); Group 2: Waiting list control for 12 weeks (followed by minimal pedometer-based intervention). Physical activity (primary outcome) was measured using pedometer step counts (7 day) and the International Physical Activity Questionnaire (long version). Psychological processes were measured using questionnaires relating to the Transtheoretical Model of Behaviour Change, mood (Positive and Negative Affect Schedule) and quality of life (Euroqol EQ-5D instrument). Physiological measures included anthropometric and metabolic outcomes. Environmental influences were assessed subjectively (Neighbourhood Quality of Life Survey) and objectively (neighbourhood audit tool and GIS mapping). The qualitative evaluation employed observation, semi-structured interviews and focus groups. A supplementary study undertook an economic evaluation. Discussion Data analysis is on-going. Walking for Well-being in the West will demonstrate if a pedometer based walking programme, in combination with physical activity consultation results in a sustainable increase in walking behaviour in this sample of Scottish adults over a 12 month period. The study will examine the complex relationships between behavioural change, health consequences and the role of the environment, in conjunction with the cost effectiveness of this approach and a detailed insight into the participants' experiences of the intervention. Trial registration Current Controlled Trials ISRCTN88907382 PMID:18655723

PRIME – PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice

PubMed Central

Walker, Anne E; Grimshaw, Jeremy; Johnston, Marie; Pitts, Nigel; Steen, Nick; Eccles, Martin

2003-01-01

Background Biomedical research constantly produces new findings but these are not routinely translated into health care practice. One way to address this problem is to develop effective interventions to translate research findings into practice. Currently a range of empirical interventions are available and systematic reviews of these have demonstrated that there is no single best intervention. This evidence base is difficult to use in routine settings because it cannot identify which intervention is most likely to be effective (or cost effective) in a particular situation. We need to establish a scientific rationale for interventions. As clinical practice is a form of human behaviour, theories of human behaviour that have proved useful in other similar settings may provide a basis for developing a scientific rationale for the choice of interventions to translate research findings into clinical practice. The objectives of the study are: to amplify and populate scientifically validated theories of behaviour with evidence from the experience of health professionals; to use this as a basis for developing predictive questionnaires using replicable methods; to identify which elements of the questionnaire (i.e., which theoretical constructs) predict clinical practice and distinguish between evidence compliant and non-compliant practice; and on the basis of these results, to identify variables (based on theoretical constructs) that might be prime targets for behaviour change interventions. Methods We will develop postal questionnaires measuring two motivational, three action and one stage theory to explore five behaviours with 800 general medical and 600 general dental practitioners. We will collect data on performance for each of the behaviours. The relationships between predictor variables (theoretical constructs) and outcome measures (data on performance) in each survey will be assessed using multiple regression analysis and structural equation modelling. In the final phase of the project, the findings from all surveys will be analysed simultaneously adopting a random effects approach to investigate whether the relationships between predictor variables and outcome measures are modified by behaviour, professional group or geographical location. PMID:14683530

Use of Mobile Devices and the Internet for Multimedia Informed Consent Delivery and Data Entry in a Pediatric Asthma Trial: Study Design and Rationale

PubMed Central

Blake, Kathryn; Holbrook, Janet T.; Antal, Holly; Shade, David; Bunnell, H. Timothy; McCahan, Suzanne M.; Wise, Robert A.; Pennington, Chris; Garfinkel, Paul; Wysocki, Tim

2015-01-01

Introduction Phase III / IV clinical trials are expensive and time consuming and often suffer from poor enrollment and retention rates. Pediatric trials are particularly difficult because scheduling around the parent, participant and potentially other sibling schedules can be burdensome. We are evaluating using the internet and mobile devices to conduct the consent process and study visits in a streamlined pediatric asthma trial. Our hypothesis is that these study processes will be noninferior and will be less expensive compared to a traditional pediatric asthma trial. Materials/Methods Parents and participants, aged 12 through 17 years, complete the informed consent process by viewing a multi-media website containing a consent video and study material in the streamlined trial. Participants are provided an iPad with WiFi and EasyOne spirometer for use during FaceTime visits and online twice daily symptom reporting during an 8-week run-in followed by 12-week study period. Outcomes are compared with participants completing a similarly designed traditional trial comparing the same treatments within the same pediatric health-system. After 8 weeks of open-label Advair 250/50 twice daily, participants in both trial types are randomized to Advair 250/50, Flovent 250, or Advair 100/50 given 1 inhalation twice daily. Study staff track time spent to determine study costs. Results Participants have been enrolled in the streamlined and traditional trials and recuitment is ongoing. Conclusions This project will provide important information on both clinical and economic outcomes for a novel method of conducting clinical trials. The results will be broadly applicable to trials of other diseases. PMID:25847579

Use of mobile devices and the internet for multimedia informed consent delivery and data entry in a pediatric asthma trial: Study design and rationale.

PubMed

Blake, Kathryn; Holbrook, Janet T; Antal, Holly; Shade, David; Bunnell, H Timothy; McCahan, Suzanne M; Wise, Robert A; Pennington, Chris; Garfinkel, Paul; Wysocki, Tim

2015-05-01

Phase III/IV clinical trials are expensive and time consuming and often suffer from poor enrollment and retention rates. Pediatric trials are particularly difficult because scheduling around the parent, participant and potentially other sibling schedules can be burdensome. We are evaluating using the internet and mobile devices to conduct the consent process and study visits in a streamlined pediatric asthma trial. Our hypothesis is that these study processes will be non-inferior and will be less expensive compared to a traditional pediatric asthma trial. Parents and participants, aged 12 through 17 years, complete the informed consent process by viewing a multi-media website containing a consent video and study material in the streamlined trial. Participants are provided an iPad with WiFi and EasyOne spirometer for use during FaceTime visits and online twice daily symptom reporting during an 8-week run-in followed by a 12-week study period. Outcomes are compared with participants completing a similarly designed traditional trial comparing the same treatments within the same pediatric health-system. After 8 weeks of open-label Advair 250/50 twice daily, participants in both trial types are randomized to Advair 250/50, Flovent 250, or Advair 100/50 given 1 inhalation twice daily. Study staff track time spent to determine study costs. Participants have been enrolled in the streamlined and traditional trials and recruitment is ongoing. This project will provide important information on both clinical and economic outcomes for a novel method of conducting clinical trials. The results will be broadly applicable to trials of other diseases. Copyright © 2015 Elsevier Inc. All rights reserved.

A randomised controlled trial of the efficacy of the ABCD Parenting Young Adolescents Program: rationale and methodology

PubMed Central

2010-01-01

Background The transition to adolescence is a time of increased vulnerability for risk taking and poor health, social and academic outcomes. Parents have an important role in protecting their children from these potential harms. While the effectiveness of parenting programs in reducing problem behavior has been demonstrated, it is not known if parenting programs that target families prior to the onset of significant behavioral difficulties in early adolescence (9-14 years) improve the wellbeing of adolescents and their parents. This paper describes the rationale and methodology of a randomised controlled trial testing the efficacy of a parenting program for the promotion of factors known to be associated with positive adolescent outcomes, such as positive parenting practices, parent-adolescent relationships and adolescent behavior. Methods/Design One hundred and eighty parents were randomly allocated to an intervention or wait list control group. Parents in the intervention group participated in the ABCD Parenting Young Adolescents Program, a 6-session behavioral family intervention program which also incorporates acceptance-based strategies. Participants in the Wait List control group did not receive the intervention during a six month waiting period. The study was designed to comply with recommendations of the CONSORT statement. The primary outcome measures were reduction in parent-adolescent conflict and improvements in parent-adolescent relationships. Secondary outcomes included improvements in parent psychosocial wellbeing, parenting self-efficacy and perceived effectiveness, parent-adolescent communication and adolescent behavior. Conclusions Despite the effectiveness of parenting programs in reducing child behavioral difficulties, very few parenting programs for preventing problems in adolescents have been described in the peer reviewed literature. This study will provide data which can be used to examine the efficacy of a universal parenting interventions for the promotion of protective factors associated with adolescent wellbeing and will add to the literature regarding the relationships between parent, parenting and adolescent factors. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12609000194268. PMID:20723219

Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS): rationale, design, and methods.

PubMed

Apers, Silke; Kovacs, Adrienne H; Luyckx, Koen; Alday, Luis; Berghammer, Malin; Budts, Werner; Callus, Edward; Caruana, Maryanne; Chidambarathanu, Shanthi; Cook, Stephen C; Dellborg, Mikael; Enomoto, Junko; Eriksen, Katrine; Fernandes, Susan M; Jackson, Jamie L; Johansson, Bengt; Khairy, Paul; Kutty, Shelby; Menahem, Samuel; Rempel, Gwen; Sluman, Maayke A; Soufi, Alexandra; Thomet, Corina; Veldtman, Gruschen; Wang, Jou-Kou; White, Kamila; Moons, Philip

2015-01-20

Data on patient-reported outcomes (PROs) in adults with congenital heart disease (CHD) are inconsistent and vary across the world. Better understanding of PROs and their differences across cultural and geographic barriers can best be accomplished via international studies using uniform research methods. The APPROACH-IS consortium (Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study) was created for this purpose and investigates PROs in adults with CHD worldwide. This paper outlines the project rationale, design, and methods. APPROACH-IS is a cross-sectional study. The goal is to recruit 3500-4000 adults with CHD from 15 countries in five major regions of the world (Asia, Australia, Europe, North and South America). Self-report questionnaires are administered to capture information on PRO domains: (i) perceived health status (12-item Short-form Health Survey & EuroQOL-5D); (ii) psychological functioning (Hospital Anxiety and Depression Scale); (iii) health behaviors (Health-Behavior Scale-Congenital Heart Disease); and (iv) quality of life (Linear Analog Scale & Satisfaction With Life Scale). Additionally, potential explanatory variables are assessed: (i) socio-demographic variables; (ii) medical history (chart review); (iii) sense of coherence (Orientation to Life Questionnaire); and (iv) illness perceptions (Brief Illness Perception Questionnaire). Descriptive analyses and multilevel models will examine differences in PROs and investigate potential explanatory variables. APPROACH-IS represents a global effort to increase research understanding and capacity in the field of CHD, and will have major implications for patient care. Results will generate valuable information for developing interventions to optimize patients' health and well-being. ClinicalTrials.gov: NCT02150603. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Childhood Adenotonsillectomy Trial (CHAT): Rationale, Design, and Challenges of a Randomized Controlled Trial Evaluating a Standard Surgical Procedure in a Pediatric Population

PubMed Central

Redline, Susan; Amin, Raouf; Beebe, Dean; Chervin, Ronald D.; Garetz, Susan L.; Giordani, Bruno; Marcus, Carole L.; Moore, Renee H.; Rosen, Carol L.; Arens, Raanan; Gozal, David; Katz, Eliot S.; Mitchell, Ronald B.; Muzumdar, Hiren; Taylor, H.G.; Thomas, Nina; Ellenberg, Susan

2011-01-01

Each year, over 500,000 adenotonsillectomies (AT), mostly for the treatment of pediatric obstructive sleep apnea (OSA) are performed in the US in children under 15 years of age. No definitive study, however, has been yet conducted that has rigorously evaluated the effectiveness of AT for not only improving sleep disordered breathing, but also for improving clinically relevant outcomes, such as neurocognitive function, behavior, and quality of life. The Childhood Adenotonsillectomy Trial (CHAT) was designed to assess neuropsychological and health outcomes in children randomized to receive early AT (eAT) as compared to Watchful Waiting with Supportive Care (WWSC). Important secondary goals of the study are to evaluate outcomes in subgroups defined by obesity and race. This paper addresses key elements in the design and implementation of a controlled trial for a widely used “standard practice” surgical intervention in a pediatric population, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel. The study framework that was established should provide a useful template for other pediatric controlled studies or other studies that evaluate surgical interventions. Citation: Redline S; Amin R; Beebe D; Chervin RD; Garetz SL; Giordani B; Marcus CL; Moore RH; Rosen CL; Arens R; Gozal D; Katz ES; Mitchell RB; Muzumdar H; Taylor HG; Thomas N; Ellenberg S. The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. SLEEP 2011;34(11):1509-1517. PMID:22043122

Rationale and study protocol for the 'active teen leaders avoiding screen-time' (ATLAS) group randomized controlled trial: an obesity prevention intervention for adolescent boys from schools in low-income communities.

PubMed

Smith, Jordan J; Morgan, Philip J; Plotnikoff, Ronald C; Dally, Kerry A; Salmon, Jo; Okely, Anthony D; Finn, Tara L; Babic, Mark J; Skinner, Geoff; Lubans, David R

2014-01-01

The negative consequences of unhealthy weight gain and the high likelihood of pediatric obesity tracking into adulthood highlight the importance of targeting youth who are 'at risk' of obesity. The aim of this paper is to report the rationale and study protocol for the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention intervention for adolescent boys living in low-income communities. The ATLAS intervention will be evaluated using a cluster randomized controlled trial in 14 secondary schools in the state of New South Wales (NSW), Australia (2012 to 2014). ATLAS is an 8-month multi-component, school-based program informed by self-determination theory and social cognitive theory. The intervention consists of teacher professional development, enhanced school-sport sessions, researcher-led seminars, lunch-time physical activity mentoring sessions, pedometers for self-monitoring, provision of equipment to schools, parental newsletters, and a smartphone application and website. Assessments were conducted at baseline and will be completed again at 9- and 18-months from baseline. Primary outcomes are body mass index (BMI) and waist circumference. Secondary outcomes include BMI z-scores, body fat (bioelectrical impedance analysis), physical activity (accelerometers), muscular fitness (grip strength and push-ups), screen-time, sugar-sweetened beverage consumption, resistance training skill competency, daytime sleepiness, subjective well-being, physical self-perception, pathological video gaming, and aggression. Hypothesized mediators of behavior change will also be explored. ATLAS is an innovative school-based intervention designed to improve the health behaviors and related outcomes of adolescent males in low-income communities. Copyright © 2013 Elsevier Inc. All rights reserved.

QUest for the Arrhythmogenic Substrate of Atrial fibRillation in Patients Undergoing Cardiac Surgery (QUASAR Study): Rationale and Design.

PubMed

van der Does, Lisette J M E; Yaksh, Ameeta; Kik, Charles; Knops, Paul; Lanters, Eva A H; Teuwen, Christophe P; Oei, Frans B S; van de Woestijne, Pieter C; Bekkers, Jos A; Bogers, Ad J J C; Allessie, Maurits A; de Groot, Natasja M S

2016-06-01

The heterogeneous presentation and progression of atrial fibrillation (AF) implicate the existence of different pathophysiological processes. Individualized diagnosis and therapy of the arrhythmogenic substrate underlying AF may be required to improve treatment outcomes. Therefore, this single-center study aims to identify the arrhythmogenic areas underlying AF by intra-operative, high-resolution, multi-site epicardial mapping in 600 patients with different heart diseases. Participants are divided into 12 groups according to the underlying heart diseases and presence of prior AF episodes. Mapping is performed with a 192-electrode array for 5-10 s during sinus rhythm and (induced) AF of the entire atrial surface. Local activation times are converted into activation and wave maps from which various electrophysiological parameters are derived. Postoperative cardiac rhythm registrations and a 5-year follow-up will show the incidence of postoperative and persistent AF. This project provides the first step in the development of a tool for individual AF diagnosis and treatment.

Ethical Dilemmas in Protecting Susceptible Subpopulations From Environmental Health Risks: Liberty, Utility, Fairness, and Accountability for Reasonableness

PubMed Central

Resnik, David B.; MacDougall, D. Robert; Smith, Elise M.

2018-01-01

Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we (1) consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; (2) show that these theories often fail to provide specific guidance concerning policy choices; and (3) argue that an approach to public decision making known as accountability for reasonableness can complement theories of justice in establishing acceptable environmental health risks for the general population and susceptible subpopulations. Since accountability for reasonableness focuses on the fairness of the decision-making process, not the outcome, it does not guarantee that susceptible subpopulations will receive a maximum level of protection, regardless of costs or other morally relevant considerations. PMID:29466133

Management of Hyperthyroidism during the Preconception Phase, Pregnancy, and the Postpartum Period.

PubMed

Sarkar, Sudipa; Bischoff, Lindsay A

2016-11-01

Hyperthyroidism can occur during pregnancy and the postpartum period, and the treatment of hyperthyroidism should be considered in the preconception phase. Pregnancy has multiple normal physiologic effects on thyroid hormone, which is a separate process distinct from syndromes such as transient hyperthyroidism of hyperemesis gravidarum. The rationale regarding antithyroid drug use during different stages of pregnancy is reviewed, including the literature regarding adverse neonatal outcomes such as aplasia cutis and methimazole embryopathy in the setting of first trimester maternal methimazole use. The use of treatment modalities for hyperthyroidism during pregnancy such as surgery is also discussed. Studies of maternal, fetal, and neonatal complications of hyperthyroidism are examined in this article. Moreover, the evidence regarding antithyroid drugs, specifically methimazole and propylthiouracil, during lactation is considered. Other disease conditions that can take place during pregnancy and the postpartum period such as hyperemesis gravidarum, subclinical hyperthyroidism, gestational trophoblastic disease, and postpartum thyroiditis and their treatments are also presented. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulsation-based method for reduction of nitrogen oxides content in torch combustion products

NASA Astrophysics Data System (ADS)

Berg, I. A.; Porshnev, S. V.; Oshchepkova, V. Y.; Kit, M.

2018-01-01

Out of all ways to fuel bum the torch combustion systems is used most often. Even though the processes in the steam boiler are stochastic, the system can be controlled rather easily by changing the flowrate of the air pumped into it and - in case of balanced flue units - exhausters load. Advantages offered by torch-based combustion systems are offset by a disadvantage resulted in oxidation of nitrogen contained in the air. This paper provides rationale for an NOx content reduction method that employs pulsation mode of fuel combustion; it also describes combustion control and monitoring system employed for implementation of this method. Described methodology can be used not only for pulsation combustion studies but also for studies of torches formed by conventional burning systems. The outcome of the experimental study supports the assumption that it is possible to create conditions for NOx content reduction in flue gases by means of cycling the fuel supply on/off valve at the rate of 6 Hz.

Handoffs: Transitions of Care for Children in the Emergency Department.

PubMed

2016-11-01

Transitions of care (ToCs), also referred to as handoffs or sign-outs, occur when the responsibility for a patient's care transfers from 1 health care provider to another. Transitions are common in the acute care setting and have been noted to be vulnerable events with opportunities for error. Health care is taking ideas from other high-risk industries, such as aerospace and nuclear power, to create models of structured transition processes. Although little literature currently exists to establish 1 model as superior, multiorganizational consensus groups agree that standardization is warranted and that additional work is needed to establish characteristics of ToCs that are associated with clinical or practice outcomes. The rationale for structuring ToCs, specifically those related to the care of children in the emergency setting, and a description of identified strategies are presented, along with resources for educating health care providers on ToCs. Recommendations for development, education, and implementation of transition models are included. Copyright © 2016 by the American Academy of Pediatrics.

The Peabody Treatment Progress Battery: history and methods for developing a comprehensive measurement battery for youth mental health.

PubMed

Riemer, Manuel; Athay, M Michele; Bickman, Leonard; Breda, Carolyn; Kelley, Susan Douglas; Vides de Andrade, Ana R

2012-03-01

There is increased need for comprehensive, flexible, and evidence-based approaches to measuring the process and outcomes of youth mental health treatment. This paper introduces a special issue dedicated to the Peabody Treatment Progress Battery (PTPB), a battery of measures created to meet this need. The PTPB is an integrated set of brief, reliable, and valid instruments that can be administered efficiently at low cost and can provide systematic feedback for use in treatment planning. It includes eleven measures completed by youth, caregivers, and/or clinicians that assess clinically-relevant constructs such as symptom severity, therapeutic alliance, life satisfaction, motivation for treatment, hope, treatment expectations, caregiver strain, and service satisfaction. This introductory article describes the rationale for the PTPB and its development and evaluation, detailing the specific analytic approaches utilized by the different papers in the special issue and a description of the study and samples from which the participants were taken.

Narrative communication in cancer prevention and control: a framework to guide research and application.

PubMed

Kreuter, Matthew W; Green, Melanie C; Cappella, Joseph N; Slater, Michael D; Wise, Meg E; Storey, Doug; Clark, Eddie M; O'Keefe, Daniel J; Erwin, Deborah O; Holmes, Kathleen; Hinyard, Leslie J; Houston, Thomas; Woolley, Sabra

2007-06-01

Narrative forms of communication-including entertainment education, journalism, literature, testimonials, and storytelling-are emerging as important tools for cancer prevention and control. To stimulate critical thinking about the role of narrative in cancer communication and promote a more focused and systematic program of research to understand its effects, we propose a typology of narrative application in cancer control. We assert that narrative has four distinctive capabilities: overcoming resistance, facilitating information processing, providing surrogate social connections, and addressing emotional and existential issues. We further assert that different capabilities are applicable to different outcomes across the cancer control continuum (e.g., prevention, detection, diagnosis, treatment, survivorship). This article describes the empirical evidence and theoretical rationale supporting propositions in the typology, identifies variables likely to moderate narrative effects, raises ethical issues to be addressed when using narrative communication in cancer prevention and control efforts, and discusses potential limitations of using narrative in this way. Future research needs based on these propositions are outlined and encouraged.

Education Research in Physical Therapy: Visions of the Possible.

PubMed

Jensen, Gail M; Nordstrom, Terrence; Segal, Richard L; McCallum, Christine; Graham, Cecilia; Greenfield, Bruce

2016-12-01

Education research has been labeled the "hardest science" of all, given the challenges of teaching and learning in an environment encompassing a mixture of social interactions, events, and problems coupled with a persistent belief that education depends more on common sense than on disciplined knowledge and skill. The American Educational Research Association specifies that education research-as a scientific field of study-examines teaching and learning processes that shape educational outcomes across settings and that a learning process takes place throughout a person's life. The complexity of learning and learning environments requires not only a diverse array of research methods but also a community of education researchers committed to exploring critical questions in the education of physical therapists. Although basic science research and clinical research in physical therapy have continued to expand through growth in the numbers of funded physical therapist researchers, the profession still lacks a robust and vibrant community of education researchers. In this perspective article, the American Council of Academic Physical Therapy Task Force on Education Research proposes a compelling rationale for building a much-needed foundation for education research in physical therapy, including a set of recommendations for immediate action. © 2016 American Physical Therapy Association.

From micronutrient recommendations to policy: consumer and stakeholder involvement.

PubMed

Timotijevic, L; Raats, M M; Barnett, J; Brown, K; Shepherd, R; Fernandez, L; Dömölki, L; Ruprich, J; Sonne, A-M; Hermoso, M; Koletzko, B; Frost-Andersen, L; Timmer, A

2010-06-01

To achieve the nutritional goals stipulated by micronutrient recommendations, greater attention must be paid to the behavioural routes to such nutritional outcomes. Coopting stakeholders and consumers into decisions regarding micronutrient recommendations is an important step towards achieving a greater link between micronutrient recommendations and behaviour. This study aims to examine the rationale and processes associated with consumer and stakeholder involvement in setting micronutrient recommendations across Europe. Using the contacts established through the Eurreca network of excellence (commissioned by the European Commission), the research involved in-depth desk research of key documents and communication channels linked to the process of setting micronutrient recommendations across seven countries: the United Kingdom, Norway, Denmark, Germany, Spain, the Czech Republic and Hungary. Stakeholder engagement is recognized by most countries as an important aspect of the process of setting micronutrient recommendations and their translation into policy, although there is notable variation in the extent to which this has been achieved across the seven countries and its effect on final decisions. Stakeholders were not involved at the outset of the process ('framing' of the problem) in any of the countries, and there was no evidence of consumer involvement and open public fora. Some of the key explanatory factors for diversity in the degree of involvement include historical sociopolitical context; the extent to which food and nutrition are key policy agenda; and the relative power of stakeholders in influencing food and nutrition policy.

Environmental Studies Model.

ERIC Educational Resources Information Center

George, David R.

1986-01-01

Presents a model of an environmental studies course that reflects a spaceship earth philosophy. Includes a rationale and a listing of concepts and processes for this action oriented program. Suggests several interdisciplinary experiences that emphasize problem-solving and decision-making skills. (ML)

A Theoretical Rationale for Cross-Cultural Family Counseling.

ERIC Educational Resources Information Center

Arciniega, Miguel; Newlon, Betty J.

1981-01-01

Proposes seven Adlerian axioms of behavior for the cross-cultural pluralistic counselor working with minority families. Defines cross-cultural family counseling and urges counselors to understand minority cultures and the acculturation process. Discusses counseling techniques. (JAC)

Use of overlapping buccal mucosa graft urethroplasty for complex anterior urethral strictures

PubMed Central

2015-01-01

Complex anterior urethral stricture disease typically manifests as a symptomatic, severely narrowed, long stricture (or multiple strictures) in which conventional excision and/or augmentation is not feasible. Overlapping buccal mucosal graft urethroplasty (OBMGU) is an innovative hybrid technique, combining the well-established principles of dorsal and ventral graft augmentation to allow single stage reconstruction of complex anterior urethral strictures. In this review, we discuss the rationale, techniques, and outcomes of OBMGU for complex anterior urethral strictures. PMID:26813234

Recent Advances in Gastrointestinal Stent Development

PubMed Central

Park, Jin-Seok; Jeong, Seok

2015-01-01

Endoscopic stenting is increasingly being used in the management of gastrointestinal luminal obstruction, and has become the current treatment of choice for the palliation of blockage caused by malignant or benign growths. A variety of stents have been developed to enhance the efficacy of the procedure, and improvements are ongoing. In this article, we review the history of, and recent advances in, gastrointestinal stenting. We describe the rationale behind the design as well as the resulting outcome for each stent type. PMID:26064820

Iliotibial band friction syndrome

PubMed Central

2010-01-01

Published articles on iliotibial band friction syndrome have been reviewed. These articles cover the epidemiology, etiology, anatomy, pathology, prevention, and treatment of the condition. This article describes (1) the various etiological models that have been proposed to explain iliotibial band friction syndrome; (2) some of the imaging methods, research studies, and clinical experiences that support or call into question these various models; (3) commonly proposed treatment methods for iliotibial band friction syndrome; and (4) the rationale behind these methods and the clinical outcome studies that support their efficacy. PMID:21063495

Rationale and design of a randomized controlled trial of the effect of retinol and vitamin D supplementation on treatment in active pulmonary tuberculosis patients with diabetes

PubMed Central

2013-01-01

Background The association between pulmonary tuberculosis (PTB) and diabetes mellitus (DM) has been previously attracted much attention. Diabetes alters immunity to tuberculosis, leading to more frequent treatment failure in TB patients with DM. Moreover, TB and DM often coincide with micronutrients deficiencies, such as retinol and vitamin D, which are especially important to immunity of the body and may influence pancreas β-cell function. However, the effects of retinol and vitamin D supplementation in active TB patients with diabetes on treatment outcomes, immune and nutrition state are still uncertain. We are conducting a randomized controlled trial of vitamin A and/or D in active PTB patients with DM in a network of 4 TB treatment clinics to determine whether the supplementation could improve the outcome in the patients. Methods/design This is a 2×2 factorial trial. We plan to enroll 400 active PTB patients with DM, and randomize them to VA (2000 IU daily retinol); VD (400 IU daily cholecalciferol); VAD (2000 IU daily retinol plus 400 IU cholecalciferol) or control (placebo) group. Our primary outcome measure is the efficacy of anti-tuberculosis treatment and ameliorating of glucose metabolism, and the secondary outcome measure being immune and nutrition status of the subjects. Of the first 37 subjects enrolled: 8 have been randomized to VA, 10 to VD, 9 to VAD and 10 to control. To date, the sample is 97.3% Han Chinese and 91.9% female. The average fasting plasma glucose level is 12.19 mmol/L. Discussion This paper describes the design and rationale of a randomized clinical trial comparing VA and/or VD supplementation to active pulmonary TB patients with DM. Our trial will allow rigorous evaluation of the efficacy of the supplementation to active TB and DM therapy for improving clinical outcomes and immunological condition. This detailed description of trial methodology can serve as a template for the development of future treatment scheme for active TB patient with DM. Trial registration ChiCTR-TRC-12002546 PMID:23442225

Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment: rationale and protocol for an international prospective, longitudinal cohort study (ULIS-III)

PubMed Central

Turner-Stokes, Lynne; Ashford, Stephen; Jacinto, Jorge; Maisonobe, Pascal; Balcaitiene, Jovita; Fheodoroff, Klemens

2016-01-01

Objectives Describe the rationale and protocol for the Upper Limb International Spasticity (ULIS)-III study, which aims to evaluate the impact of integrated spasticity management, involving multiple botulinum toxin A (BoNT-A) injection cycles and concomitant therapies, on patient-centred goal attainment. Outline novel outcome assessment methods for ULIS-III and report initial evaluation data from goal setting in early stages of the study. Design Large international longitudinal cohort study of integrated upper limb spasticity management, including BoNT-A. Participants and setting ULIS-III is a 2-year study expected to enrol >1000 participants at 58 study centres across 14 countries. Interventions The study design is non-interventional and intended to reflect real-life clinical practice. It will describe injection practices and additional treatment strategies, and record clinical decision-making in a serial approach to long-term spasticity management. Outcome measures ULIS-III will use a goal-directed approach to selection of targeted standardised measures to capture the diversity of presentation, goals and outcomes. ULIS-III will implement the Upper Limb Spasticity Index, a battery of assessments including a structured approach to goal attainment scaling (Goal Attainment Scaling—Evaluation of Outcomes for Upper Limb Spasticity tool), alongside a limited set of standardised measures, chosen according to patients' selected goal areas. Concomitant therapy inputs, patient satisfaction with engagement in goal setting, health economic end points and health-related quality of life data will also be captured. Results of initial evaluation of goal quality Recruitment started in January 2015. By June 2015, 58 sites had been identified and initial data collected for 79 patients across 13 sites in 3 countries. Goal setting data were quality-checked and centres rated on the basis of function-related and Specific, Measurable, Achievable, Realistic, Timed (SMART) characteristics of goal statements. Overall, 11/13 centres achieved the highest rating (A++). Conclusions ULIS-III will provide valuable information regarding treatment of and outcomes from real-life upper limb spasticity management worldwide. Trial registration number NCT02454803; Pre-results. PMID:27315835

A randomized controlled trial investigation of a non-stimulant in attention deficit hyperactivity disorder (ACTION): rationale and design.

PubMed

Tsang, Tracey W; Kohn, Michael R; Hermens, Daniel F; Clarke, Simon D; Clark, C Richard; Efron, Daryl; Cranswick, Noel; Lamb, Chris; Williams, Leanne M

2011-03-13

The ACTION study (Attention deficit hyperactivity disorder Controlled Trial Investigation Of a Non-stimulant) is a multi-center, double-blind, randomized cross-over trial of the non-stimulant medication, Atomoxetine, in children and adolescents with attention deficit hyperactivity disorder (ADHD). The primary aims are to examine the efficacy of atomoxetine for improving cognition and emotional function in ADHD and whether any improvements in these outcomes are more pronounced in participants with comorbid anxiety; and to determine if changes in these outcomes after atomoxetine are more reliable than changes in diagnostic symptoms of ADHD. This manuscript will describe the methodology and rationale for the ACTION study. Children and adolescents aged 6 - 17 y with ADHD will be enrolled. Clinical interview and validated scales will be used to confirm diagnosis and screen for exclusion criteria, which include concurrent stimulant use, and comorbid psychiatric or neurological conditions other than anxiety. Three assessment sessions will be conducted over the 13-week study period: Session 1 (Baseline, pre-treatment), Session 2 (six weeks, atomoxetine or placebo), and Session 3 (13 weeks, cross-over after one-week washout period). The standardized touch-screen battery, "IntegNeuro™", will be used to assess cognitive and emotional function. The primary measure of response will be symptom ratings, while quality of life will be a secondary outcome. Logistic regression will be used to determine predictors of treatment response, while repeated measures of analysis will determine any differences in effect of atomoxetine and placebo. The methodology for the ACTION study has been detailed. The ACTION study is the first controlled trial to investigate the efficacy of atomoxetine using objective cognitive and emotional function markers, and whether these objective measures predict outcomes with atomoxetine in ADHD with and without comorbid anxiety. First enrollment was in March 2008. The outcomes of this study will be a significant step towards a 'personalized medicine' (and therefore a more efficient) approach to ADHD treatment. Australian and New Zealand Clinical Trials Registry ANZCTRN12607000535471.

Rationale and design of a randomized controlled trial of the effect of retinol and vitamin D supplementation on treatment in active pulmonary tuberculosis patients with diabetes.

PubMed

Wang, Qiuzhen; Ma, Aiguo; Bygbjerg, Ib Christian; Han, Xiuxia; Liu, Yufeng; Zhao, Shanliang; Cai, Jing

2013-02-26

The association between pulmonary tuberculosis (PTB) and diabetes mellitus (DM) has been previously attracted much attention. Diabetes alters immunity to tuberculosis, leading to more frequent treatment failure in TB patients with DM. Moreover, TB and DM often coincide with micronutrients deficiencies, such as retinol and vitamin D, which are especially important to immunity of the body and may influence pancreas β-cell function. However, the effects of retinol and vitamin D supplementation in active TB patients with diabetes on treatment outcomes, immune and nutrition state are still uncertain. We are conducting a randomized controlled trial of vitamin A and/or D in active PTB patients with DM in a network of 4 TB treatment clinics to determine whether the supplementation could improve the outcome in the patients. This is a 2×2 factorial trial. We plan to enroll 400 active PTB patients with DM, and randomize them to VA (2000 IU daily retinol); VD (400 IU daily cholecalciferol); VAD (2000 IU daily retinol plus 400 IU cholecalciferol) or control (placebo) group. Our primary outcome measure is the efficacy of anti-tuberculosis treatment and ameliorating of glucose metabolism, and the secondary outcome measure being immune and nutrition status of the subjects. Of the first 37 subjects enrolled: 8 have been randomized to VA, 10 to VD, 9 to VAD and 10 to control. To date, the sample is 97.3% Han Chinese and 91.9% female. The average fasting plasma glucose level is 12.19 mmol/L. This paper describes the design and rationale of a randomized clinical trial comparing VA and/or VD supplementation to active pulmonary TB patients with DM. Our trial will allow rigorous evaluation of the efficacy of the supplementation to active TB and DM therapy for improving clinical outcomes and immunological condition. This detailed description of trial methodology can serve as a template for the development of future treatment scheme for active TB patient with DM. ChiCTR-TRC-12002546.

Re-Thinking Dewey's Democracy: Shifting from a Process of Participation to an Institution of Association

ERIC Educational Resources Information Center

Stone, Lynda

2016-01-01

Dewey's definition of democracy from "Democracy and Education" (1916) is analysed and rethought through a path exploring a shift from a conception of participation as a process to one of association as an institution. Contributions to this pathway among others come from political philosophy and educational philosophy. The rationale for…

Evaluating public participation in Chinese EIA. An integrated Public Participation Index and its application to the case of the New Beijing Airport

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brombal, Daniele; Moriggi, Angela; Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice

In recent years, China's government authorities have devoted increasing attention to the role of public participation processes in Environmental Impact Assessment (EIA). The capacity of these processes to influence decision-making remains widely debated. This paper aims at appraising the institutional rationale informing the implementation of public participation in China's EIA, benchmarking it against three conceptualisations: (1) Normative, based on objectives of empowerment and democratisation; (2) Substantive, where participation is pursued mainly to improve quality of decisions; (3) Instrumental, seeking participation as an instrument to legitimise decision-making processes. The appraisal is carried out by means of a new integrated index (Publicmore » Participation Index, PPI), which is applied to a case study representative of latest advancements in EIA public participation practices in China, namely the “New Beijing Airport Project”. Located 46 km south of downtown Beijing, the project was approved in 2014 and it is currently under construction. Results of the PPI application to this case study indicate that, despite progress made in recent years, the implementation of public participation in Chinese EIA still largely responds to an instrumental rationale, with limited capacity for the public to affect decisions. - Highlights: • In recent years China has strengthened EIA public participation (PP) legislation. • Despite progress, implementation of PP remains informed by an instrumental rationale. • A large gap exists between principles enunciated in regulations and implementation. • The Public Participation Index can be used to monitor China's EIA PP development.« less

The impact of nitric oxide in cardiovascular medicine: untapped potential utility.

PubMed

Pepine, Carl J

2009-05-01

The structural integrity and functional activity of the endothelium play an important role in atherogenesis and related adverse outcomes. Cardiovascular disease risk conditions contribute to oxidative stress, which causes a disruption in the balance between nitric oxide (NO) and reactive oxygen species, with a resulting relative decrease in bioavailable NO and/or the NO-soluble guanylate cyclase cascade in blood vessels. This leads to endothelial and vascular smooth muscle cell dysfunction, resulting in increased tone and alterations in cell growth and gene expression that create a prothrombotic, proinflammatory environment. This leads to formation, progression, and destabilization of atherosclerotic plaques which may result in myocardial infarction, stroke, and cardiovascular death. NO clearly has a critical role in the maintenance and repair of the vasculature, and a decrease in bioavailable NO is linked to adverse outcomes. This background provides the rationale for exploring the potential therapeutic role for NO-donating agents in the prevention of adverse cardiovascular outcomes.

Bayesian data analysis in observational comparative effectiveness research: rationale and examples.

PubMed

Olson, William H; Crivera, Concetta; Ma, Yi-Wen; Panish, Jessica; Mao, Lian; Lynch, Scott M

2013-11-01

Many comparative effectiveness research and patient-centered outcomes research studies will need to be observational for one or both of two reasons: first, randomized trials are expensive and time-consuming; and second, only observational studies can answer some research questions. It is generally recognized that there is a need to increase the scientific validity and efficiency of observational studies. Bayesian methods for the design and analysis of observational studies are scientifically valid and offer many advantages over frequentist methods, including, importantly, the ability to conduct comparative effectiveness research/patient-centered outcomes research more efficiently. Bayesian data analysis is being introduced into outcomes studies that we are conducting. Our purpose here is to describe our view of some of the advantages of Bayesian methods for observational studies and to illustrate both realized and potential advantages by describing studies we are conducting in which various Bayesian methods have been or could be implemented.

Fixation of comminuted midshaft clavicle fractures with bone fragments separated by soft tissue using a novel double ligature technique

PubMed Central

Ju, Wei-Na; Wang, Cheng-Xue; Wang, Tie-Jun; Qi, Bao-Chang

2017-01-01

Abstract Rationale: Clavicle fractures are common, and mostly occur in the midshaft. Methods for operative treatment of midshaft clavicle fractures are evolving, as they improve clinical outcomes compared with traditional conservative management. However, fixation of comminuted midshaft clavicle fractures with bone fragments separated by soft tissue remains a challenge. Patient concerns: Here, we present a case of comminuted midshaft clavicle fracture with a bone fragment separated from the main fracture by soft tissue. Diagnosis: Left comminuted midshaft clavicle fracture. Interventions: We treated this patient with a novel double ligature technique using absorbable suturing. Outcomes: In the past 7 years, we have treated >50 patients with this technique. We have achieved good clinical outcomes with no complications. Lessons: We recommend widespread use of our novel double ligature technique for treating comminuted midshaft clavicle fractures with bone fragments separated by soft tissue. PMID:29137088

Advancing the science for active surveillance: rationale and design for the Observational Medical Outcomes Partnership.

PubMed

Stang, Paul E; Ryan, Patrick B; Racoosin, Judith A; Overhage, J Marc; Hartzema, Abraham G; Reich, Christian; Welebob, Emily; Scarnecchia, Thomas; Woodcock, Janet

2010-11-02

The U.S. Food and Drug Administration (FDA) Amendments Act of 2007 mandated that the FDA develop a system for using automated health care data to identify risks of marketed drugs and other medical products. The Observational Medical Outcomes Partnership is a public-private partnership among the FDA, academia, data owners, and the pharmaceutical industry that is responding to the need to advance the science of active medical product safety surveillance by using existing observational databases. The Observational Medical Outcomes Partnership's transparent, open innovation approach is designed to systematically and empirically study critical governance, data resource, and methodological issues and their interrelationships in establishing a viable national program of active drug safety surveillance by using observational data. This article describes the governance structure, data-access model, methods-testing approach, and technology development of this effort, as well as the work that has been initiated.

Lambl's excrescences: A case report and review of the literature.

PubMed

Kamran, Haroon; Patel, Nirav; Singh, Gagandeep; Pasricha, Venu; Salifu, Moro; McFarlane, Samy I

2016-01-01

Lambl's excrescences are filamentous extensions of cardiac valves, mostly asymptomatic but rarely associated with catastrophic thromboembolic events such as acute ischemic stroke and acute coronary syndromes. Numerous case reports cited in the literature have addressed various spectrum of presentation of these syndromes and their outcomes based on therapies used. We encountered such a patient from our own experience who presented with an acute ischemic stroke with no other identifiable cause other than the Lambl's excrescences. We subsequently carried out an extensive literature search and based on our interpretation of the outcomes we decided to treat the patient to the best of our understanding. In the proceeding section we describe the case and the discussion and our rationale to treat the patient accordingly.

Workshop rationale

NASA Technical Reports Server (NTRS)

Billingsley, F. C.

1982-01-01

The problems involved in processing remotely sensed data are defined within the contex of the total information system structure. The correlation of various data sets through georeferencing and cataloging is emphasized along with geometric rectification. The sources and types of possible geometric errors are outlined.

Library Services to University Branch Campuses: The Ohio State Experience

ERIC Educational Resources Information Center

Schmidt, C. James; And Others

1970-01-01

The Ohio State University Main Library acquires and processes books, on a cost-supported contract basis, for each of four regional campus undergraduate libraries. The article describes requirements, rationale, and procedures, and diagrams procedural flow. (Author/NH)

Anticipating Reader Response: Why I Chose "The Tempest" for English Literature Survey.

ERIC Educational Resources Information Center

Jones, Dan C.

1985-01-01

Argues in favor of a reader-response approach to the process of selecting the literary works students read in introductory or survey courses. Offers a rationale for using "The Tempest" in such a course. (FL)

An observational study showed that explaining randomization using gambling-related metaphors and computer-agency descriptions impeded randomized clinical trial recruitment.

PubMed

Jepson, Marcus; Elliott, Daisy; Conefrey, Carmel; Wade, Julia; Rooshenas, Leila; Wilson, Caroline; Beard, David; Blazeby, Jane M; Birtle, Alison; Halliday, Alison; Stein, Rob; Donovan, Jenny L

2018-07-01

To explore how the concept of randomization is described by clinicians and understood by patients in randomized controlled trials (RCTs) and how it contributes to patient understanding and recruitment. Qualitative analysis of 73 audio recordings of recruitment consultations from five, multicenter, UK-based RCTs with identified or anticipated recruitment difficulties. One in 10 appointments did not include any mention of randomization. Most included a description of the method or process of allocation. Descriptions often made reference to gambling-related metaphors or similes, or referred to allocation by a computer. Where reference was made to a computer, some patients assumed that they would receive the treatment that was "best for them". Descriptions of the rationale for randomization were rarely present and often only came about as a consequence of patients questioning the reason for a random allocation. The methods and processes of randomization were usually described by recruiters, but often without clarity, which could lead to patient misunderstanding. The rationale for randomization was rarely mentioned. Recruiters should avoid problematic gambling metaphors and illusions of agency in their explanations and instead focus on clearer descriptions of the rationale and method of randomization to ensure patients are better informed about randomization and RCT participation. Copyright © 2018 University of Bristol. Published by Elsevier Inc. All rights reserved.

Systematic review of the association between oil and natural gas extraction processes and human reproduction.

PubMed

Balise, Victoria D; Meng, Chun-Xia; Cornelius-Green, Jennifer N; Kassotis, Christopher D; Kennedy, Rana; Nagel, Susan C

2016-09-15

This systematic review identified 45 original published research articles related to oil and gas extraction activities and human reproductive endpoints. Reproductive outcomes were categorized as [1] birth outcomes associated with maternal exposure, [2] semen quality, fertility, and birth outcomes associated with adult paternal exposure, [3] reproductive cancers, and [4] disruption of human sex steroid hormone receptors. The results indicate there is moderate evidence for an increased risk of preterm birth, miscarriage, birth defects, decreased semen quality, and prostate cancer. The quality of the evidence is low and/or inadequate for stillbirth, sex ratio, and birth outcomes associated with paternal exposure, and testicular cancer, female reproductive tract cancers, and breast cancer, and the evidence is inconsistent for an increased risk of low birth weight; therefore, no conclusions can be drawn for these health effects. There is ample evidence for disruption of the estrogen, androgen, and progesterone receptors by oil and gas chemicals, which provides a mechanistic rationale for how exposure to oil and gas activities may increase the health risks we have outlined. The results from this systematic review suggest there is a negative impact on human reproduction from exposure to oil and gas activities. Many of the 45 studies reviewed identified potential human health effects. Most of these studies focused on conventional oil and gas activities. Few studies have been conducted to evaluate the impact of unconventional oil and gas operations on human health. The impact of unconventional oil and gas activities may be greater than that of conventional activity, given that unconventional activities employ many of the same approaches and use dozens of known endocrine-disrupting chemicals in hydraulic fracturing. Copyright © 2016. Published by Elsevier Inc.

Case-mix adjustment for diabetes indicators: a systematic review.

PubMed

Calsbeek, Hiske; Markhorst, Joekle G M; Voerman, Gerlienke E; Braspenning, Jozé C C

2016-02-01

Case-mix adjustment is generally considered indispensable for fair comparison of healthcare performance. Inaccurate results are also unfair to patients as they are ineffective for improving quality. However, little is known about what factors should be adjusted for. We reviewed case-mix factors included in adjustment models for key diabetes indicators, the rationale for their inclusion, and their impact on performance. Systematic review. This systematic review included studies published up to June 2013 addressing case-mix factors for 6 key diabetes indicators: 2 outcomes and 2 process indicators for glycated hemoglobin (A1C), low-density lipoprotein cholesterol, and blood pressure. Factors were categorized as demographic, diabetes-related, comorbidity, generic health, geographic, or care-seeking, and were evaluated on the rationale for inclusion in the adjustment models, as well as their impact on indicator scores and ranking. Thirteen studies were included, mainly addressing A1C value and measurement. Twenty-three different case-mix factors, mostly demographic and diabetes-related, were identified, and varied from 1 to 14 per adjustment model. Six studies provided selection motives for the inclusion of case-mix factors. Marital status and body mass index showed a significant impact on A1C value. For the other factors, either no or conflicting associations were reported, or too few studies (n ≤ 2) investigated this association. Scientific knowledge about the relative importance of case-mix factors for diabetes indicators is emerging, especially for demographic and diabetes-related factors and indicators on A1C, but is still limited. Because arbitrary adjustment potentially results in inaccurate quality information, meaningful stratification that demonstrates inequity in care might be a better guide, as it can be a driver for quality improvement.

Rationale, design, and baseline findings from HIPP: A randomized controlled trial testing a home-based, individually-tailored physical activity print intervention for African American women in the Deep South.

PubMed

Pekmezi, Dori; Ainsworth, Cole; Joseph, Rodney; Bray, Molly S; Kvale, Elizabeth; Isaac, Shiney; Desmond, Renee; Meneses, Karen; Marcus, Bess; Demark-Wahnefried, Wendy

2016-03-01

African American women report high rates of physical inactivity and related health disparities. In our previous formative research, we conducted a series of qualitative assessments to examine physical activity barriers and intervention preferences among African American women in the Deep South. These data were used to inform a 12-month Home-based, Individually-tailored Physical activity Print (HIPP) intervention, which is currently being evaluated against a wellness contact control condition among 84 post-menopausal African American women residing in the metropolitan area of Birmingham, Alabama. This paper reports the rationale, design and baseline findings of the HIPP trial. The accrued participants had an average age of 57 (SD=4.7), a BMI of 32.1 kg/m(2) (SD=5.16) with more than half (55%) having a college education and an annual household income under $50,000 (53.6%). At baseline, participants reported an average of 41.5 min/week (SD=49.7) of moderate intensity physical activity, and 94.1% were in the contemplation or preparation stages of readiness for physical activity. While social support for exercise from friends and family was low, baseline levels of self-efficacy, cognitive and behavioral processes of change, decisional balance, outcome expectations, and enjoyment appeared promising. Baseline data indicated high rates of obesity and low levels of physical activity, providing strong evidence of need for intervention. Moreover, scores on psychosocial measures suggested that such efforts may be well received. This line of research in technology-based approaches for promoting physical activity in African American women in the Deep South has great potential to address health disparities and impact public health. Copyright © 2016 Elsevier Inc. All rights reserved.

Rationale, design, and baseline findings from HIPP: A randomized controlled trial testing a Home-based, Individually-tailored Physical activity Print intervention for African American women in the Deep South

PubMed Central

Pekmezi, Dori; Ainsworth, Cole; Joseph, Rodney; Bray, Molly S.; Kvale, Elizabeth; Isaac, Shiney; Desmond, Renee; Meneses, Karen; Marcus, Bess; Demark-Wahnefried, Wendy

2016-01-01

African American women report high rates of physical inactivity and related health disparities. In our previous formative research, we conducted a series of qualitative assessments to examine physical activity barriers and intervention preferences among African American women in the Deep South. These data were used to inform a 12-month Home-based, Individually-tailored Physical activity Print (HIPP) intervention, which is currently being evaluated against a wellness contact control condition among 84 post-menopausal African American women residing in the metropolitan area of Birmingham, Alabama. This paper reports the rationale, design and baseline findings of the HIPP trial. The accrued participants had an average age of 57 (SD= 4.7), a BMI of 32.1 kg/m2 (SD=5.16) with more than half (55%) having a college education and an annual household income under $50,000 (53.6%). At baseline, participants reported an average of 41.5 minutes/week (SD=49.7) of moderate intensity physical activity, and 94.1% were in the contemplation or preparation stages of readiness for physical activity. While social support for exercise from friends and family was low, baseline levels of self-efficacy, cognitive and behavioral processes of change, decisional balance, outcome expectations, and enjoyment appeared promising. Baseline data indicated high rates of obesity and low levels of physical activity, providing strong evidence of need for intervention. Moreover, scores on psychosocial measures suggested that such efforts may be well received. This line of research in technology-based approaches for promoting physical activity in African American women in the Deep South has great potential to address health disparities and impact public health. PMID:26944022

2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

PubMed

Idris, Ahamed H; Bierens, Joost J L M; Perkins, Gavin D; Wenzel, Volker; Nadkarni, Vinay; Morley, Peter; Warner, David S; Topjian, Alexis; Venema, Allart M; Branche, Christine M; Szpilman, David; Morizot-Leite, Luiz; Nitta, Masahiko; Løfgren, Bo; Webber, Jonathon; Gräsner, Jan-Thorsten; Beerman, Stephen B; Youn, Chun Song; Jost, Ulrich; Quan, Linda; Dezfulian, Cameron; Handley, Anthony J; Hazinski, Mary Fran

2017-09-01

Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations. Copyright © 2017 European Resuscitation Council, American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

Ethical Dilemmas in Office Practice: Physician Response and Rationale

PubMed Central

Secundy, Marian Gray

1985-01-01

A survey of black and white family physicians in the District of Columbia is described. The survey provides insight into decision-making processes and the ability to recognize ethical dilemmas in medical practice. Comments were elicited to hypothetical case vignettes typical of ethical conflict in office practice. Findings note physician ability to recognize ethical dilemmas in day-to-day aspects of medical practice. Methods of decision making and rationale for decisions made, however, appear to be inconsistent, nonuniversal, and individualistic without evidence of specific models or criteria. No significant differences were noted between black and white physicians. The need in physician training for clarification and development of criteria is evident. PMID:4078929

Comparing Political Experiences (CPE).

ERIC Educational Resources Information Center

Gillespie, Judith A.; Patrick, John J.

The rationale, goals, curriculum components, instructional strategies, and curriculum development process of a two-semester, secondary-level political science course, "Comparing Political Experiences," are described in this paper. Developed as part of the High School Political Science Curriculum Project at Indiana University, the major…

The Development of Talent through Curriculum.

ERIC Educational Resources Information Center

Van Tassel-Baska, Joyce

1995-01-01

An integrated curriculum model (ICM) is applied to the talent development process. Discussion focuses on a rationale for such a model, model features, applications in two federally funded curriculum projects, and relationship of the ICM to curriculum reform variables and implementation considerations. (DB)

Measuring voice outcomes: state of the science review.

PubMed

Carding, Pau N; Wilson, J A; MacKenzie, K; Deary, I J

2009-08-01

Researchers evaluating voice disorder interventions currently have a plethora of voice outcome measurement tools from which to choose. Faced with such a wide choice, it would be beneficial to establish a clear rationale to guide selection. This article reviews the published literature on the three main areas of voice outcome assessment: (1) perceptual rating of voice quality, (2) acoustic measurement of the speech signal and (3) patient self-reporting of voice problems. We analysed the published reliability, validity, sensitivity to change and utility of the common outcome measurement tools in each area. From the data, we suggest that routine voice outcome measurement should include (1) an expert rating of voice quality (using the Grade-Roughness-Breathiness-Asthenia-Strain rating scale) and (2) a short self-reporting tool (either the Vocal Performance Questionnaire or the Vocal Handicap Index 10). These measures have high validity, the best reported reliability to date, good sensitivity to change data and excellent utility ratings. However, their application and administration require attention to detail. Acoustic measurement has arguable validity and poor reliability data at the present time. Other areas of voice outcome measurement (e.g. stroboscopy and aerodynamic phonatory measurements) require similarly detailed research and analysis.

Faculty Performance Management System: The Faculty Development/Evaluation System at Beaufort Technical College, 1986-1987. Revised.

ERIC Educational Resources Information Center

Tobias, Earole; And Others

Designed for faculty members at Beaufort Technical College (BTC) in South Carolina, this handbook describes the college's faculty evaluation process and procedures. The first sections of the handbook explain the rationale and method for the faculty evaluation process, state the purposes and objectives of the system, and offer a model which breaks…

Field methods and data processing techniques associated with mapped inventory plots

Treesearch

William A. Bechtold; Stanley J. Zarnoch

1999-01-01

The U.S. Forest Inventory and Analysis (FIA) and Forest Health Monitoring (FHM) programs utilize a fixed-area mapped-plot design as the national standard for extensive forest inventories. The mapped-plot design is explained, as well as the rationale for its selection as the national standard. Ratio-of-means estimators am presented as a method to process data from...

Educational Process Navigator as Means of Creation of Individual Educational Path of a Student

ERIC Educational Resources Information Center

Khuziakhmetov, Anvar N.; Sytina, Nadezhda S.

2016-01-01

Rationale of the problem stated in the article is caused by search for new alternative models for individual educational paths of students in the continuous multi-level education system on the basis of the navigators of the educational process, being a visual matrix of individual educational space. The purpose of the article is to develop the…

The development of the 1999 management plan for the Tasmanian Wilderness World Heritage Area (Australia)

Treesearch

Nicholas Sawyer

2000-01-01

This paper describes the multi-stage public consultation process and other aspects of the development by the Tasmanian Parks and Wildlife Service of the second (1999) management plan for the Tasmanian Wilderness World Heritage Area (Australia). It describes the background to, and rationale for, the process used in developing the plan; it details the consultation...

Procedure M - A framework for stratified area estimation. [in multispectral scanner data processing

NASA Technical Reports Server (NTRS)

Kauth, R. J.; Cicone, R. C.; Malila, W. A.

1980-01-01

This paper describes Procedure M, a systematic approach to processing multispectral scanner data for classification and acreage estimation. A general discussion of the rationale and development of the procedure is given in the context of large-area agricultural applications. Specific examples are given in the form of test results on acreage estimation of spring small grains.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gordon, K.

The paper discusses the following: What will the future electric industry look like; The industry as it has been until recently; The critical factors of price and cost; The movement to allow customer choice in the states; The role of the federal government; Elements of the process, rationales, implications and new requirements. The paper then describes what the restructured market will look like and the transition process to that end.

State-Space Modeling of Dynamic Psychological Processes via the Kalman Smoother Algorithm: Rationale, Finite Sample Properties, and Applications

ERIC Educational Resources Information Center

Song, Hairong; Ferrer, Emilio

2009-01-01

This article presents a state-space modeling (SSM) technique for fitting process factor analysis models directly to raw data. The Kalman smoother via the expectation-maximization algorithm to obtain maximum likelihood parameter estimates is used. To examine the finite sample properties of the estimates in SSM when common factors are involved, a…

A randomised study of perioperative esmolol infusion for haemodynamic stability during major vascular surgery; rationale and design of DECREASE-XIII.

PubMed

Bakker, E J; Ravensbergen, N J; Voute, M T; Hoeks, S E; Chonchol, M; Klimek, M; Poldermans, D

2011-09-01

This article describes the rationale and design of the DECREASE-XIII trial, which aims to evaluate the potential of esmolol infusion, an ultra-short-acting beta-blocker, during surgery as an add-on to chronic low-dose beta-blocker therapy to maintain perioperative haemodynamic stability during major vascular surgery. A double-blind, placebo-controlled, randomised trial. A total of 260 vascular surgery patients will be randomised to esmolol or placebo as an add-on to standard medical care, including chronic low-dose beta-blockers. Esmolol is titrated to maintain a heart rate within a target window of 60-80 beats per minute for 24 h from the induction of anaesthesia. Heart rate and ischaemia are assessed by continuous 12-lead electrocardiographic monitoring for 72 h, starting 1 day prior to surgery. The primary outcome measure is duration of heart rate outside the target window during infusion of the study drug. Secondary outcome measures will be the efficacy parameters of occurrence of cardiac ischaemia, troponin T release, myocardial infarction and cardiac death within 30 days after surgery and safety parameters such as the occurrence of stroke and hypotension. This study will provide data on the efficacy of esmolol titration in chronic beta-blocker users for tight heart-rate control and reduction of ischaemia in patients undergoing vascular surgery as well as data on safety parameters. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

A systematic review of titles and abstracts of experimental studies in medical education: many informative elements missing.

PubMed

Cook, David A; Beckman, Thomas J; Bordage, Georges

2007-11-01

Informative titles and abstracts facilitate reading and searching the literature. To evaluate the quality of titles and abstracts of full-length reports of experimental studies in medical education. We used a random sample of 110 articles (of 185 eligible articles) describing education experiments. Articles were published in 2003 and 2004 in Academic Medicine, Advances in Health Sciences Education, American Journal of Surgery, Journal of General Internal Medicine, Medical Education and Teaching and Learning in Medicine. Titles were categorised as informative, indicative, neither, or both. Abstracts were evaluated for the presence of a rationale, objective, descriptions of study design, setting, participants, study intervention and comparison group, main outcomes, results and conclusions. Of the 105 articles suitable for review, 86 (82%) had an indicative title and 10 (10%) had a title that was both indicative and informative. A rationale was present in 66 abstracts (63%), objectives were present in 84 (80%), descriptions of study design in 20 (19%), setting in 29 (28%), and number and stage of training of participants in 42 (40%). The study intervention was defined in 55 (52%) abstracts. Among the 48 studies with a control or comparison group, this group was defined in 21 abstracts (44%). Study outcomes were defined in 64 abstracts (61%). Data were presented in 48 (46%) abstracts. Conclusions were presented in 97 abstracts (92%). Reports of experimental studies in medical education frequently lack the essential elements of informative titles and abstracts. More informative reporting is needed.

Better exercise adherence after treatment for cancer (BEAT Cancer) study: Rationale, design, and methods

PubMed Central

Rogers, Laura Q.; McAuley, Edward; Anton, Philip M.; Courneya, Kerry S.; Vicari, Sandra; Hopkins-Price, Patricia; Verhulst, Steven; Mocharnuk, Robert; Hoelzer, Karen

2011-01-01

Most breast cancer survivors do not engage in regular physical activity. Our physical activity behavior change intervention for breast cancer survivors significantly improved physical activity and health outcomes post-intervention during a pilot, feasibility study. Testing in additional sites with a larger sample and longer follow-up is warranted to confirm program effectiveness short and longer term. Importantly, the pilot intervention resulted in changes in physical activity and social cognitive theory constructs, enhancing our potential for testing mechanisms mediating physical activity behavior change. Here, we report the rationale, design, and methods for a two-site, randomized controlled trial comparing the effects of the BEAT Cancer physical activity behavior change intervention to usual care on short and longer term physical activity adherence among breast cancer survivors. Secondary aims include examining social cognitive theory mechanisms of physical activity behavior change and health benefits of the intervention. Study recruitment goal is 256 breast cancer survivors with a history of ductal carcinoma in situ or Stage I, II, or IIIA disease who have completed primary cancer treatment. Outcome measures are obtained at baseline, 3 months (i.e., immediately post-intervention), 6 months, and 12 months and include physical activity, psychosocial factors, fatigue, sleep quality, lower extremity joint dysfunction, cardiorespiratory fitness, muscle strength, and waist-to-hip ratio. Confirming behavior change effectiveness, health effects, and underlying mechanisms of physical activity behavior change interventions will facilitate translation to community settings for improving the health and well-being of breast cancer survivors. PMID:21983625

Rationales for Commonly "Challenged" Taught Books.

ERIC Educational Resources Information Center

Shugert, Diane P., Ed.; And Others

1983-01-01

Intended for teachers, this focused journal issue contains separate rationales for teaching books that have been challenged as appropriate instructional materials. Following a discussion of the purpose for rationales and suggestions for using them, the journal presents rationales for teaching the following books: "To Kill a Mockingbird,""The Diary…

Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review.

PubMed

Birken, Sarah A; Powell, Byron J; Presseau, Justin; Kirk, M Alexis; Lorencatto, Fabiana; Gould, Natalie J; Shea, Christopher M; Weiner, Bryan J; Francis, Jill J; Yu, Yan; Haines, Emily; Damschroder, Laura J

2017-01-05

Over 60 implementation frameworks exist. Using multiple frameworks may help researchers to address multiple study purposes, levels, and degrees of theoretical heritage and operationalizability; however, using multiple frameworks may result in unnecessary complexity and redundancy if doing so does not address study needs. The Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF) are both well-operationalized, multi-level implementation determinant frameworks derived from theory. As such, the rationale for using the frameworks in combination (i.e., CFIR + TDF) is unclear. The objective of this systematic review was to elucidate the rationale for using CFIR + TDF by (1) describing studies that have used CFIR + TDF, (2) how they used CFIR + TDF, and (2) their stated rationale for using CFIR + TDF. We undertook a systematic review to identify studies that mentioned both the CFIR and the TDF, were written in English, were peer-reviewed, and reported either a protocol or results of an empirical study in MEDLINE/PubMed, PsycInfo, Web of Science, or Google Scholar. We then abstracted data into a matrix and analyzed it qualitatively, identifying salient themes. We identified five protocols and seven completed studies that used CFIR + TDF. CFIR + TDF was applied to studies in several countries, to a range of healthcare interventions, and at multiple intervention phases; used many designs, methods, and units of analysis; and assessed a variety of outcomes. Three studies indicated that using CFIR + TDF addressed multiple study purposes. Six studies indicated that using CFIR + TDF addressed multiple conceptual levels. Four studies did not explicitly state their rationale for using CFIR + TDF. Differences in the purposes that authors of the CFIR (e.g., comprehensive set of implementation determinants) and the TDF (e.g., intervention development) propose help to justify the use of CFIR + TDF. Given that the CFIR and the TDF are both multi-level frameworks, the rationale that using CFIR + TDF is needed to address multiple conceptual levels may reflect potentially misleading conventional wisdom. On the other hand, using CFIR + TDF may more fully define the multi-level nature of implementation. To avoid concerns about unnecessary complexity and redundancy, scholars who use CFIR + TDF and combinations of other frameworks should specify how the frameworks contribute to their study. PROSPERO CRD42015027615.

Rationale, design and baseline data of a mixed methods study examining the clinical impact of a brief transition programme for young people with juvenile idiopathic arthritis: the DON'T RETARD project.

PubMed

Hilderson, Deborah; Westhovens, Rene; Wouters, Carine; Van der Elst, Kristien; Goossens, Eva; Moons, Philip

2013-12-02

To describe (1) the content of a transition programme for young people with juvenile idiopathic arthritis (JIA) designed as a brief intervention, (2) the rationale and design of a mixed-methods study evaluating the clinical impact of this transition programme and (3) to provide baseline data of the intervention group. An 'embedded experimental' design is used for the evaluation of the transition programme. A 'one-group pretest-posttest, with a non-equivalent posttest-only comparison group design' is used to quantitatively evaluate the impact of the transition programme, applying both longitudinal and comparative analyses. Subsequently, experiences of adolescents and their parents who participated in the experimental group will be analysed qualitatively using content analysis. Participants in the intervention are recruited at a tertiary care centre in Belgium. The comparison group participants are recruited from one tertiary and three secondary care centres in Belgium. The intervention group consists of 33 young people (25 females; 8 males) with a median age of 16 years. Main diagnoses are persistent or extended oligoarticular JIA (33%), polyarticular JIA (30%), enthesitis-related JIA (21%) or systemic arthritis (15%). The transition programme comprises eight key components: (1) transition coordinator; (2) providing information and education; (3) availability by telephone; (4) information about and contact with an adult care programme; (5) guidance of parents; (6) meeting with peers; (7) transfer plan; and (8) actual transfer to adult care. The primary outcome is health status, as perceived by the adolescents. Secondary outcomes are health status, as perceived by the parents; medication adherence; illness-related knowledge; quality of life; fatigue; promotion of independence; support of autonomy; behavioural control and psychological control. At baseline, the median score was 69.2 (Q1=60.0;Q3=92.9) on psychosocial health and 68.8 (Q1=56.3; Q3=89.1) on physical health. Rheumatic-specific health scores ranged from 62.5 to 100. We present the rationale and design of a study intended to evaluate a transition programme for adolescents with JIA as a brief intervention.

Knowledge Discovery in Databases.

ERIC Educational Resources Information Center

Norton, M. Jay

1999-01-01

Knowledge discovery in databases (KDD) revolves around the investigation and creation of knowledge, processes, algorithms, and mechanisms for retrieving knowledge from data collections. The article is an introductory overview of KDD. The rationale and environment of its development and applications are discussed. Issues related to database design…

Metaphor and Knowing: Analysis, Synthesis, Rationale.

ERIC Educational Resources Information Center

Rico, Gabriele Lusser

Evidence is presented to indicate that human knowing involves both a propositional mode stressing discourse, sequence, and logic and an appositional mode characterized by metaphoric constructs, holistic relationships, and the capacity to process many variables simultaneously. Separate sections discuss our culture's heavy emphasis on propositional…

The definition and role of quality of life in Germany's early assessment of drug benefit: a qualitative approach.

PubMed

Lohrberg, David; Augustin, Matthias; Blome, Christine

2016-02-01

In 2011, Germany introduced a new form of drug benefit assessment, linking reimbursement prices to drug benefit and making quality of life (QoL) one of the main benefit criteria. Thus, QoL outcomes co-determine drug prices in Germany. QoL has, however, not been defined in the regulations. This study analyzed the definition and role of QoL in Germany's drug benefit assessment. It serves as a case study on the complexity of QoL as a parameter of health technology and drug assessments, which have become mandatory in almost all industrialized countries. In a qualitative analysis, the publicly available dossiers (summaries), dossier evaluations, protocols of the oral hearings, the final resolutions of the Federal Joint Committee (G-BA) and its rationale of all benefit assessments completed by 2013 (n = 66) were processed. Additionally, quantitative data on the decision outcomes were collected. Only two decisions drew on QoL outcomes as "main justifications" for additional benefit. It was due to a lack of valid and statistically significant QoL results, a deficient presentation of QoL data, or differing understandings of QoL, that QoL benefit was not demonstrated in more than two cases. While manufacturers applied wider definitions of QoL, the assessment institutions questioned evidence if it was not reported with the help of validated QoL questionnaires or deviated from their definition of QoL. The German experience with QoL as a drug benefit criterion highlights the importance of a clear QoL definition and according methodological regulations.

An intervention to reduce sitting and increase light-intensity physical activity at work: Design and rationale of the ‘Stand & Move at Work’ group randomized trial

PubMed Central

Buman, Matthew P.; Mullane, Sarah L.; Toledo, Meynard J.; Rydell, Sarah A.; Gaesser, Glenn A.; Crespo, Noe C.; Hannan, Peter; Feltes, Linda; Vuong, Brenna; Pereira, Mark A

2016-01-01

Background American workers spend 70–80% of their time at work being sedentary. Traditional approaches to increase moderate-vigorous physical activity (MVPA) may be perceived to be harmful to productivity. Approaches that target reductions in sedentary behavior and/or increases in standing or light-intensity physical activity [LPA] may not interfere with productivity and may be more feasible to achieve through small changes accumulated throughout the workday. Methods/Design This group randomized trial (i.e., cluster randomized trial) will test the relative efficacy of two sedentary behavior focused interventions in 24 worksites across two states (N=720 workers). The MOVE+ intervention is a multilevel individual, social, environmental, and organizational intervention targeting increases in light-intensity physical activity in the workplace. The STAND+ intervention is the MOVE+ intervention with the addition of the installation and use of sit-stand workstations to reduce sedentary behavior and enhance light-intensity physical activity opportunities. Our primary outcome will be objectively-measured changes in sedentary behavior and light-intensity physical activity over 12 months, with additional process measures at 3 months and longer-term sustainability outcomes at 24 months. Our secondary outcomes will be a clustered cardiometabolic risk score (comprised of fasting glucose, insulin, triglycerides, HDL-cholesterol, and blood pressure), workplace productivity, and job satisfaction. Discussion This study will determine the efficacy of a multilevel workplace intervention (including the use of a sit-stand workstation) to reduce sedentary behavior and increase LPA and concomitant impact on cardiometabolic health, workplace productivity, and satisfaction. PMID:27940181

Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach.

PubMed

Brendryen, Håvar; Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny

2013-01-23

Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. The descriptions of the treatment rationale for Balance, the alcohol intervention reported herein, provides an intervention blueprint that will aid in interpreting the results from future program evaluations. It will ease comparisons of program rationales across interventions, and may assist intervention development. By putting just-in-time therapy within a complete theoretical and practical context, including the tunnel delivery strategy and the self-regulation perspective, we have contributed to an understanding of how multiple delivery strategies in eHealth interventions can be combined. Additionally, this is a call for action to improve the reporting practices within eHealth research. Possible ways to achieve such improvement include using a systematic and structured approach, and for intervention reports to be published after peer-review and separately from evaluation reports.

Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach

PubMed Central

Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny

2013-01-01

Background Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. Objective The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. Methods We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. Results The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. Conclusions The descriptions of the treatment rationale for Balance, the alcohol intervention reported herein, provides an intervention blueprint that will aid in interpreting the results from future program evaluations. It will ease comparisons of program rationales across interventions, and may assist intervention development. By putting just-in-time therapy within a complete theoretical and practical context, including the tunnel delivery strategy and the self-regulation perspective, we have contributed to an understanding of how multiple delivery strategies in eHealth interventions can be combined. Additionally, this is a call for action to improve the reporting practices within eHealth research. Possible ways to achieve such improvement include using a systematic and structured approach, and for intervention reports to be published after peer-review and separately from evaluation reports. PMID:23612478

Teaching Economics to Young Adolescents: A Research-Based Rationale.

ERIC Educational Resources Information Center

Davis, James E.

This booklet presents a research-based rationale for teaching economics at the middle/junior high school level in the United States. Chapter 1, "Introduction," describes the project in which the rationale was developed and outlines the remainder of the document. Chapter 2, "Elements of a Rationale for Middle School Economic Education," presents…

The credibility of exposure therapy: Does the theoretical rationale matter?

PubMed

Arch, Joanna J; Twohig, Michael P; Deacon, Brett J; Landy, Lauren N; Bluett, Ellen J

2015-09-01

Little is understood about how the public perceives exposure-based therapy (ET) for treating anxiety and trauma-related disorders or how ET rationales affect treatment credibility. Distinct approaches to framing ET are practiced, including those emphasized in traditional cognitive behavioral therapy, acceptance and commitment therapy, and the more recent inhibitory learning model. However, their relative effect on ET's credibility remains unknown. A final sample of 964 U.S. adults provided baseline views of ET. Participants rated ET treatment credibility following a simple ET definition (pre-rationale) and following randomization to rationale modules addressing ET goals, fear, and cognitive strategies from distinct theoretical perspectives (post-rationale). Baseline ET views, symptoms, and sociodemographic characteristics were examined as putative moderators and predictors. At baseline, the majority had never heard of ET. From pre- to post-rationale, ET treatment credibility significantly increased but the rationales' theoretical perspective had little impact. More negative baseline ET views, specific ethnic/racial minority group status, and lower education moderated or predicted greater increases in treatment credibility following the rationale. ET remains relatively unknown as a treatment for anxiety or trauma, supporting the need for direct-to-consumer marketing. Diverse theory-driven rationales similarly increased ET credibility, particularly among those less likely to use ET. Copyright © 2015 Elsevier Ltd. All rights reserved.

Serious gaming during multidisciplinary rehabilitation for patients with complex chronic pain or fatigue complaints: study protocol for a controlled trial and process evaluation.

PubMed

Vugts, Miel A P; Joosen, Margot C W; Mert, Agali; Zedlitz, Aglaia; Vrijhoef, Hubertus J M

2017-06-08

Many individuals suffer from chronic pain or functional somatic syndromes and face boundaries for diminishing functional limitations by means of biopsychosocial interventions. Serious gaming could complement multidisciplinary interventions through enjoyment and independent accessibility. A study protocol is presented for studying whether, how, for which patients and under what circumstances, serious gaming improves patient health outcomes during regular multidisciplinary rehabilitation. A mixed-methods design is described that prioritises a two-armed naturalistic quasi-experiment. An experimental group is composed of patients who follow serious gaming during an outpatient multidisciplinary programme at two sites of a Dutch rehabilitation centre. Control group patients follow the same programme without serious gaming in two similar sites. Multivariate mixed-modelling analysis is planned for assessing how much variance in 250 patient records of routinely monitored pain intensity, pain coping and cognition, fatigue and psychopathology outcomes is attributable to serious gaming. Embedded qualitative methods include unobtrusive collection and analyses of stakeholder focus group interviews, participant feedback and semistructured patient interviews. Process analyses are carried out by a systematic approach of mixing qualitative and quantitative methods at various stages of the research. The Ethics Committee of the Tilburg School of Social and Behavioural Sciences approved the research after reviewing the protocol for the protection of patients' interests in conformity to the letter and rationale of the applicable laws and research practice (EC 2016.25t). Findings will be presented in research articles and international scientific conferences. A prospective research protocol for the naturalistic quasi-experimental outcome evaluation was entered in the Dutch trial register (registration number: NTR6020; Pre-results). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Utility of the Department of Defense Serum Repository in Assessing Deployment Exposure.

PubMed

Lushniak, Boris; Mallon, Col Timothy M; Gaydos, Joel C; Smith, David J

2016-08-01

This paper describes why the research project was conducted in terms of demonstrating the utility of the Department of Defense Serum Repository in addressing deployment environmental exposures. The history deployment exposure surveillance was reviewed and the rationale for developing validated biomarkers that were detected in sera in postdeployment samples and compared with nondeployed controls was described. The goal was to find validated biomarkers that are associated with both exposures and health outcomes. The articles in this supplement described novel serum biomarkers that were found to be associated with deployment exposures and weakly associated with some health outcomes. Future research must continue to validate the use of serum biomarkers when operational contingencies prevent the gold standard collection of real-time breathing zone samples in deployed service members.

Benefit of Preemptive Pharmacogenetic Information on Clinical Outcome.

PubMed

Roden, Dan M; Van Driest, Sara L; Mosley, Jonathan D; Wells, Quinn S; Robinson, Jamie R; Denny, Joshua C; Peterson, Josh F

2018-05-01

The development of new knowledge around the genetic determinants of variable drug action has naturally raised the question of how this new knowledge can be used to improve the outcome of drug therapy. Two broad approaches have been taken: a point-of-care approach in which genotyping for specific variant(s) is undertaken at the time of drug prescription, and a preemptive approach in which multiple genetic variants are typed in an individual patient and the information archived for later use when a drug with a "pharmacogenetic story" is prescribed. This review addresses the current state of implementation, the rationale for these approaches, and barriers that must be overcome. Benefits to pharmacogenetic testing are only now being defined and will be discussed. © 2018 American Society for Clinical Pharmacology and Therapeutics.

How Community Organizing Promotes Health Equity, And How Health Equity Affects Organizing.

PubMed

Pastor, Manuel; Terriquez, Veronica; Lin, May

2018-03-01

Public health scholarship increasingly recognizes community organizing as a vehicle for unleashing the collective power necessary to uproot socioeconomic inequities at the core of health disparities. In this article we reverse the analytical focus from how organizing can affect health equity, and we consider how the frame of health equity has shaped grassroots organizing. Using evidence from a range of cases in California, we suggest that the health equity frame can guide and justify grassroots groups' efforts to improve the health outcomes of marginalized populations; connect issues such as housing and school discipline to health; and provide a rationale for community organizing groups to directly address the trauma experienced by their own members and staff, who often come from communities at risk for poor health outcomes.

Strategic plan modelling by hospital senior administration to integrate diversity management.

PubMed

Newhouse, John J

2010-11-01

Limited research suggests that some hospital senior administrators and chief executive officers (CEOs) have employed a strategic planning function to achieve diversity management practices. As the hospital industry struggles with how to integrate diversity practices to improve patient satisfaction, increase the quality of care and enhance clinical outcomes for minority populations, understanding the planning process involved in this endeavour becomes significant for senior hospital administrators. What is not well understood is what this strategic planning process represents and how it is applied to integrate diversity management. Scant research exists about the type of strategic models that hospital CEOs employ when they wish to reposition their organizations through diversity management. This study examines the strategic planning models used by senior administrators to integrate diversity management for an institutional-wide agenda. A qualitative survey process was used for CEOs in the states of New York, Pennsylvania, New Jersey and Delaware. The key research questions dealt with what type of strategic plan approach senior administrators used for integrating diversity management and what rationale they used to pursue this. Significant differences were reported between three types of strategic plan modelling used by CEOs. Also, when comparing past and current practices over time, such differences existed. The need to integrate diversity management is underscored by this study. How senior hospital administrators apply strategic plan models and what impact these approaches have represent the major implications that this study offers.

Natural Resource Information System, design analysis

NASA Technical Reports Server (NTRS)

1972-01-01

The computer-based system stores, processes, and displays map data relating to natural resources. The system was designed on the basis of requirements established in a user survey and an analysis of decision flow. The design analysis effort is described, and the rationale behind major design decisions, including map processing, cell vs. polygon, choice of classification systems, mapping accuracy, system hardware, and software language is summarized.

Project Canada West. The Factors Affecting the Structural Growth of a City.

ERIC Educational Resources Information Center

Western Curriculum Project on Canada Studies, Edmonton (Alberta).

This project examined the development of the physical structure of a city in preparation for the designing of a unit of study on Urbanization for grades five through twelve. The rationale is focused on the effect physical structure has on the processes and functions of urban life. Recognizing the need for a method or process to examine city forms,…

Weight management by phone conference call: A comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial

PubMed Central

Lambourne, Kate; Washburn, Richard A.; Gibson, Cheryl; Sullivan, Debra K.; Goetz, Jeannine; Lee, Robert; Smith, Bryan K.; Mayo, Matthew S.; Donnelly, Joseph E.

2012-01-01

State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25–39.9 kg/m2) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed. PMID:22664647

Weight management by phone conference call: a comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial.

PubMed

Lambourne, Kate; Washburn, Richard A; Gibson, Cheryl; Sullivan, Debra K; Goetz, Jeannine; Lee, Robert; Smith, Bryan K; Mayo, Matthew S; Donnelly, Joseph E

2012-09-01

State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25-39.9 kg/m(2)) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed. Copyright © 2012 Elsevier Inc. All rights reserved.

Neonatal Neuroprotection: Bringing Best Practice to the Bedside in the NICU.

PubMed

Lockridge, Terrie

Preterm birth interrupts the precise process of fetal maturation, forcing critical neurologic growth to continue within the Neonatal Intensive Care Unit (NICU). Concern for the impact of the NICU experience on the developing brain led to a unit-based Quality Improvement (QI) project to promote best outcomes for our graduates. The objective was to implement a standard of care for neonatal neuroprotection in a large urban tertiary center. A multidisciplinary committee researched and developed the Neonatal Neuroprotective Best Practice Guidelines to identify optimal interventions, as well as provide physiologic rationales to reinforce importance of these practices. An educational initiative accompanied release of this document to support consistency in clinical practice and to stress the critical role that every caregiver played in a child's outcome. As the Best Practice Guidelines encompassed virtually all aspects of caregiving in the NICU, it was impractical to measure the impact of such a broad range of interventions in a methodical manner. The full effect of these interventions will not likely be evident until NICU graduates have grown into childhood and adolescence. These constraints limited the scope of this QI project to the practicalities of identifying neuroprotective best practice and bringing it to the bedside. When combined with evidence-based medical and nursing care, neuroprotective care represents the best means of facilitating normal development and minimizing disability for our NICU graduates.

Developing an effective IM/IT strategy.

PubMed

Kramer, Sarah; Walker, Joanne; Falk, Will

2009-01-01

Healthcare organizations and systems around the world lag far behind banking, manufacturing, travel and other industries in their use of information management/information technology (IM/IT) to deliver high-quality products and services. Across Canada, healthcare organizations, as well as governments, understand that information and information technology are needed to deliver quality care and to sustain our publicly funded health system. However, insufficient funding, few experienced resources, lack of strong leadership and absence of clear business/clinical rationale have restricted innovation and advancement in the use of IM/IT to improve healthcare delivery and patient outcomes.

Requirements for a Device-Based Training and Testing Program for M1 Gunnery. Volume 1. Rationale and Summary of Results

DTIC Science & Technology

1988-03-01

or cognition skills required, on the difficulty of the motor skills re- quired, and how closely outcomes are tied to behavior. For example, because of...influence whether or not the batter arrives safely on base. Thus, while batting average is an accepted index of hitting proficiency, it ignores potential...instructions be behavioral (let up on the swing) or cognitive (watch for the slow pitch). Third, within limits, there are a variety of ways to hit a baseball

Use of a structured functional evaluation process for independent medical evaluations of claimants presenting with disabling mental illness: rationale and design for a multi-center reliability study.

PubMed

Bachmann, Monica; de Boer, Wout; Schandelmaier, Stefan; Leibold, Andrea; Marelli, Renato; Jeger, Joerg; Hoffmann-Richter, Ulrike; Mager, Ralph; Schaad, Heinz; Zumbrunn, Thomas; Vogel, Nicole; Bänziger, Oskar; Busse, Jason W; Fischer, Katrin; Kunz, Regina

2016-07-29

Work capacity evaluations by independent medical experts are widely used to inform insurers whether injured or ill workers are capable of engaging in competitive employment. In many countries, evaluation processes lack a clearly structured approach, standardized instruments, and an explicit focus on claimants' functional abilities. Evaluation of subjective complaints, such as mental illness, present additional challenges in the determination of work capacity. We have therefore developed a process for functional evaluation of claimants with mental disorders which complements usual psychiatric evaluation. Here we report the design of a study to measure the reliability of our approach in determining work capacity among patients with mental illness applying for disability benefits. We will conduct a multi-center reliability study, in which 20 psychiatrists trained in our functional evaluation process will assess 30 claimants presenting with mental illness for eligibility to receive disability benefits [Reliability of Functional Evaluation in Psychiatry, RELY-study]. The functional evaluation process entails a five-step structured interview and a reporting instrument (Instrument of Functional Assessment in Psychiatry [IFAP]) to document the severity of work-related functional limitations. We will videotape all evaluations which will be viewed by three psychiatrists who will independently rate claimants' functional limitations. Our primary outcome measure is the evaluation of claimant's work capacity as a percentage (0 to 100 %), and our secondary outcomes are the 12 mental functions and 13 functional capacities assessed by the IFAP-instrument. Inter-rater reliability of four psychiatric experts will be explored using multilevel models to estimate the intraclass correlation coefficient (ICC). Additional analyses include subgroups according to mental disorder, the typicality of claimants, and claimant perceived fairness of the assessment process. We hypothesize that a structured functional approach will show moderate reliability (ICC ≥ 0.6) of psychiatric evaluation of work capacity. Enrollment of actual claimants with mental disorders referred for evaluation by disability/accident insurers will increase the external validity of our findings. Finding moderate levels of reliability, we will continue with a randomized trial to test the reliability of a structured functional approach versus evaluation-as-usual.

Effects of Providing a Rationale for Learning a Lesson on Students' Motivation and Learning in Online Learning Environments

ERIC Educational Resources Information Center

Shin, Tae Seob

2010-01-01

This study examined whether providing a rationale for learning a particular lesson influences students' motivation and learning in online learning environments. A mixed-method design was used to investigate the effects of two types of rationales (former student vs. instructor rationales) presented in an online introductory educational psychology…

Why Do Higher Education Institutions Internationalize? An Investigation of the Multilevel Determinants of Internationalization Rationales

ERIC Educational Resources Information Center

Seeber, Marco; Cattaneo, Mattia; Huisman, Jeroen; Paleari, Stefano

2016-01-01

In recent decades internationalization has risen to prominence in higher education institutions (HEIs). Scholars have identified several rationales for internationalization. There is however a lack of conceptual understanding and empirical evidence for which rationale(s) for internationalization are chosen by a given HEI and why. The goal of this…

How to Develop a Better Guidance Program.

ERIC Educational Resources Information Center

Lawrence, William W.

Designed for school board members, superintendents, administrators, counselors, and teachers, the paper outlines steps toward the systematic development of a guidance program. Following a rationale and introduction, the paper recommends a specific process for program development: (1) the identification of student needs through formal needs…

Intermediality: Bridge to Critical Media Literacy.

ERIC Educational Resources Information Center

Pailliotet, Ann Watts; Semali, Ladislaus; Rodenberg, Rita K.; Giles, Jackie K.; Macaul, Sherry L.

2000-01-01

Defines "intermediality" as the ability to critically read and write with and across varied symbol systems. Relates it to critical media literacy. Offers rationales for teaching critical media literacy in general, and intermedial instruction in particular. Identifies seven guiding intermedial elements: theory, texts, processes, contexts,…

Art and drama: partners in therapy.

PubMed

Irwin, E C; Rubin, J A; Shapiro, M I

1975-01-01

An art-drama therapy group for latency-age boys made possible the exploration of personal symbols and intense fantasies which resulted in a therapeutically powerful and productive experience. This paper describes the background, rationale, and dynamic process of this group. Multimodal expressive arts therapy is supported.

PSYCHOSOCIAL INTERVENTION EFFECTS ON ADAPTATION, DISEASE COURSE AND BIOBEHAVIORAL PROCESSES IN CANCER

PubMed Central

Antoni, Michael H.

2012-01-01

A diagnosis of cancer and subsequent treatments place demands on psychological adaptation. Behavioral research suggests the importance of cognitive, behavioral, and social factors in facilitating adaptation during active treatment and throughout cancer survivorship, which forms the rationale for the use of many psychosocial interventions in cancer patients. This cancer experience may also affect physiological adaptation systems (e.g., neuroendocrine) in parallel with psychological adaptation changes (negative affect). Changes in adaptation may alter tumor growth-promoting processes (increased angiogenesis, migration and invasion, and inflammation) and tumor defense processes (decreased cellular immunity) relevant for cancer progression and the quality of life of cancer patients. Some evidence suggests that psychosocial intervention can improve psychological and physiological adaptation indicators in cancer patients. However, less is known about whether these interventions can influence tumor activity and tumor growth-promoting processes and whether changes in these processes could explain the psychosocial intervention effects on recurrence and survival documented to date. Documenting that psychosocial interventions can modulate molecular activities (e.g., transcriptional indicators of cell signaling) that govern tumor promoting and tumor defense processes on the one hand, and clinical disease course on the other is a key challenge for biobehavioral oncology research. This mini-review will summarize current knowledge on psychological and physiological adaptation processes affected throughout the stress of the cancer experience, and the effects of psychosocial interventions on psychological adaptation, cancer disease progression, and changes in stress-related biobehavioral processes that may mediate intervention effects on clinical cancer outcomes. Very recent intervention work in breast cancer will be used to illuminate emerging trends in molecular probes of interest in the hope of highlighting future paths that could move the field of biobehavioral oncology intervention research forward. PMID:22627072

Psychosocial intervention effects on adaptation, disease course and biobehavioral processes in cancer.

PubMed

Antoni, Michael H

2013-03-01

A diagnosis of cancer and subsequent treatments place demands on psychological adaptation. Behavioral research suggests the importance of cognitive, behavioral, and social factors in facilitating adaptation during active treatment and throughout cancer survivorship, which forms the rationale for the use of many psychosocial interventions in cancer patients. This cancer experience may also affect physiological adaptation systems (e.g., neuroendocrine) in parallel with psychological adaptation changes (negative affect). Changes in adaptation may alter tumor growth-promoting processes (increased angiogenesis, migration and invasion, and inflammation) and tumor defense processes (decreased cellular immunity) relevant for cancer progression and the quality of life of cancer patients. Some evidence suggests that psychosocial intervention can improve psychological and physiological adaptation indicators in cancer patients. However, less is known about whether these interventions can influence tumor activity and tumor growth-promoting processes and whether changes in these processes could explain the psychosocial intervention effects on recurrence and survival documented to date. Documenting that psychosocial interventions can modulate molecular activities (e.g., transcriptional indicators of cell signaling) that govern tumor promoting and tumor defense processes on the one hand, and clinical disease course on the other is a key challenge for biobehavioral oncology research. This mini-review will summarize current knowledge on psychological and physiological adaptation processes affected throughout the stress of the cancer experience, and the effects of psychosocial interventions on psychological adaptation, cancer disease progression, and changes in stress-related biobehavioral processes that may mediate intervention effects on clinical cancer outcomes. Very recent intervention work in breast cancer will be used to illuminate emerging trends in molecular probes of interest in the hope of highlighting future paths that could move the field of biobehavioral oncology intervention research forward. Copyright © 2012 Elsevier Inc. All rights reserved.

The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods.

PubMed

Kaplan, Bonnie J; Giesbrecht, Gerald F; Leung, Brenda M Y; Field, Catherine J; Dewey, Deborah; Bell, Rhonda C; Manca, Donna P; O'Beirne, Maeve; Johnston, David W; Pop, Victor J; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P; Eliasziw, Misha; McCargar, Linda J; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M; Letourneau, Nicole; Martin, Jonathan W

2014-01-01

The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration. © 2012 John Wiley & Sons Ltd.

Analysing data from patient-reported outcome and quality of life endpoints for cancer clinical trials: a start in setting international standards.

PubMed

Bottomley, Andrew; Pe, Madeline; Sloan, Jeff; Basch, Ethan; Bonnetain, Franck; Calvert, Melanie; Campbell, Alicyn; Cleeland, Charles; Cocks, Kim; Collette, Laurence; Dueck, Amylou C; Devlin, Nancy; Flechtner, Hans-Henning; Gotay, Carolyn; Greimel, Eva; Griebsch, Ingolf; Groenvold, Mogens; Hamel, Jean-Francois; King, Madeleine; Kluetz, Paul G; Koller, Michael; Malone, Daniel C; Martinelli, Francesca; Mitchell, Sandra A; Moinpour, Carol M; Musoro, Jammbe; O'Connor, Daniel; Oliver, Kathy; Piault-Louis, Elisabeth; Piccart, Martine; Pimentel, Francisco L; Quinten, Chantal; Reijneveld, Jaap C; Schürmann, Christoph; Smith, Ashley Wilder; Soltys, Katherine M; Taphoorn, Martin J B; Velikova, Galina; Coens, Corneel

2016-11-01

Measures of health-related quality of life (HRQOL) and other patient-reported outcomes generate important data in cancer randomised trials to assist in assessing the risks and benefits of cancer therapies and fostering patient-centred cancer care. However, the various ways these measures are analysed and interpreted make it difficult to compare results across trials, and hinders the application of research findings to inform publications, product labelling, clinical guidelines, and health policy. To address these problems, the Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data (SISAQOL) initiative has been established. This consortium, directed by the European Organisation for Research and Treatment of Cancer (EORTC), was convened to provide recommendations on how to standardise the analysis of HRQOL and other patient-reported outcomes data in cancer randomised trials. This Personal View discusses the reasons why this project was initiated, the rationale for the planned work, and the expected benefits to cancer research, patient and provider decision making, care delivery, and policy making. Copyright © 2016 Elsevier Ltd. All rights reserved.

Personalized Risk Estimator for Rheumatoid Arthritis (PRE-RA) Family Study: Rationale and design for a randomized controlled trial evaluating rheumatoid arthritis risk education to first-degree relatives

PubMed Central

Sparks, Jeffrey A.; Iversen, Maura D.; Kroouze, Rachel Miller; Mahmoud, Taysir G.; Triedman, Nellie A.; Kalia, Sarah S.; Atkinson, Michael L.; Lu, Bing; Deane, Kevin D.; Costenbader, Karen H.; Green, Robert C.; Karlson, Elizabeth W.

2014-01-01

We present the rationale, design features, and protocol of the Personalized Risk Estimator for Rheumatoid Arthritis (PRE-RA) Family Study (ClinicalTrials.gov NCT02046005). The PRE-RA Family Study is an NIH-funded prospective, randomized controlled trial designed to compare the willingness to change behaviors in first-degree relatives of rheumatoid arthritis (RA) patients without RA after exposure to RA risk educational programs. Consented subjects are randomized to receive education concerning their personalized RA risk based on demographics, RA-associated behaviors, genetics and biomarkers or to receive standard RA information. Four behavioral factors associated with RA risk were identified from prior studies for inclusion in the risk estimate: cigarette smoking, excess body weight, poor oral health, and low fish intake. Personalized RA risk information is presented through an online tool that collects data on an individual's specific age, gender, family history, and risk-related behaviors; presents genetic and biomarker results; displays relative and absolute risk of RA; and provides personalized feedback and education. The trial outcomes will be changes in willingness to alter behaviors from baseline to 6 weeks, 6 months, and 12 months in the three intervention groups. The design and execution of this trial that targets a special population at risk for RA, while incorporating varied risk factors into a single risk tool, offer distinct challenges. We provide the theoretical rationale for the PRE-RA Family Study and highlight particular design features of this trial that utilize personalized risk education as an intervention. PMID:25151341

Client cognitive responses to counselor paradoxical and nonparadoxical directives.

PubMed

Lee, D Y; Rossiter, B; Martin, J; Uhlemann, M R

1990-09-01

Client cognitive responses to counselor paradoxical and nonparadoxical directives were examined. It was predicted (a) that clients who received paradoxical symptom prescriptions would display a greater negativity toward the counselor and counseling than those who received nonparadoxical directives; and (b) that clients who received no rationale for the paradoxical directives would display a greater negativity than those who received a rationale. Thirty clients who had reported performance anxiety received one 45-minute counseling interview. Ten clients received paradoxical directives with a rationale, 10 received paradoxical directives with no rationale, and 10 received nonparadoxical directives. Results showed no significant differences in either client in-session negativity or out-of-session implementation of directives between the paradoxical and nonparadoxical conditions and between the rationale and no rationale paradoxical conditions. Possible implications of the findings are discussed.

Theory-Based Active Ingredients of Effective Treatments for Substance Use Disorders

PubMed Central

Moos, Rudolf H.

2007-01-01

This paper describes four related theories that specify common social processes that protect individuals from developing substance use disorders and may underlie effective psychosocial treatments for these disorders: social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. It then provides an overview of the rationale and evidence for four effective psychosocial treatments for substance use disorders: motivational interviewing and motivational enhancement therapy, 12-step facilitation treatment, cognitive-behavioral treatment and behavioral family counseling, and contingency management and community reinforcement approaches. The presumed active ingredients of these treatments are described in terms of how they exemplify the social processes highlighted by the four theories. The identified common components of effective treatment include support, goal direction, and structure; an emphasis on rewards that compete with substance use, a focus on abstinence-oriented norms and models, and attempts to develop self-efficacy and coping skills. Several issues that need to be addressed to enhance our understanding of the active ingredients involved in effective treatment are discussed, including how to develop measures of these ingredients, how well the ingredients predict outcomes and influence conceptually comparable aspects of clients’ life contexts, and how much their influence varies depending upon clients’ demographic and personal characteristics. PMID:17129682

Theory-based active ingredients of effective treatments for substance use disorders.

PubMed

Moos, Rudolf H

2007-05-11

This paper describes four related theories that specify common social processes that protect individuals from developing substance use disorders and may underlie effective psychosocial treatments for these disorders: social control theory, behavioral economics and behavioral choice theory, social learning theory, and stress and coping theory. It then provides an overview of the rationale and evidence for four effective psychosocial treatments for substance use disorders: motivational interviewing and motivational enhancement therapy, 12-step facilitation treatment, cognitive-behavioral treatment and behavioral family counseling, and contingency management and community reinforcement approaches. The presumed active ingredients of these treatments are described in terms of how they exemplify the social processes highlighted by the four theories. The identified common components of effective treatment include support, goal direction, and structure; an emphasis on rewards that compete with substance use, a focus on abstinence-oriented norms and models, and attempts to develop self-efficacy and coping skills. Several issues that need to be addressed to enhance our understanding of the active ingredients involved in effective treatment are discussed, including how to develop measures of these ingredients, how well the ingredients predict outcomes and influence conceptually comparable aspects of clients' life contexts, and how much their influence varies depending upon clients' demographic and personal characteristics.

Video in the Evaluation Process.

ERIC Educational Resources Information Center

Pelletier, Raymond J.

The rationale and methodology for using videotape recordings to test foreign language listening comprehension are discussed. First, the advantages of using video in teaching and testing listening comprehension are examined and the specific listening skills to be developed at the beginning level are outlined. Issues in the selection of video…

Plant Study Guide.

ERIC Educational Resources Information Center

Brynildson, Inga

Appropriate for secondary school botany instruction, this study guide focuses on the important roles of plants in human lives. Following a rationale for learning the basic skills of a botanist, separate sections discuss the process sunlight undergoes during photosynthesis, the flow of energy in the food chain, alternative plant lifestyles, plant…

Space Station Planetology Experiments (SSPEX)

NASA Technical Reports Server (NTRS)

Greeley, R. (Editor); Williams, R. J. (Editor)

1986-01-01

A meeting of 50 planetary scientists considered the uses of the Space Station to support experiments in their various disciplines. Abstracts (28) present concepts for impact and aeolian processes, particle formation and interaction, and other planetary science experiments. Summaries of the rationale, hardware concepts, accomodations, and recommendations are included.

40 CFR 63.2520 - What reports must I submit and when?

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) National Emission Standards for Hazardous Air Pollutants: Miscellaneous Organic Chemical... from streams that contain energetics and organic peroxides, and rationale for why meeting the emission... lb/yr, the total uncontrolled organic HAP emissions from the batch process vents in an MCPU will be...

Social Information Processing Analysis (SIPA): Coding Ongoing Human Communication.

ERIC Educational Resources Information Center

Fisher, B. Aubrey; And Others

1979-01-01

The purpose of this paper is to present a new analytical system to be used in communication research. Unlike many existing systems devised ad hoc, this research tool, a system for interaction analysis, is embedded in a conceptual rationale based on modern systems theory. (Author)

A Rationale for Developmental Testing and Training.

ERIC Educational Resources Information Center

Arner, Robert S.

Man's phylogenetic development has resulted in a potential for environmental interaction in a symbolic and conceptual manner. There are ontogenetic requirements to develop such potential. The process by which man learns is sequential and involves perceptual-motor-cognitive abilities. There is an optimum respectivity period at each developmental…

Development Communication in Action: Building Understanding and Creating Participation.

ERIC Educational Resources Information Center

Moemeka, Andrew A.

Addressing the use of communication (interpersonal, folk, traditional, group, organizational, and mass media) in the development process, this book discusses some of the conceptual and theoretical basis for integrating communication effectively into development plans and execution. It also examines the rationale and practical necessity for such…

Introduction to the Ninth Edition

PubMed Central

Akl, Elie A.; Crowther, Mark; Schünemann, Holger J.; Gutterman, David D.; Zelman Lewis, Sandra

2012-01-01

The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines differs substantially from the prior versions both in process and in content. In this introduction, we describe some of the differences and the rationale for the changes. PMID:22315255

Applying Constructivism to Improve Public Relations for Education

ERIC Educational Resources Information Center

Marek, Michael

2005-01-01

Educators are often hesitant to use techniques of public relations and marketing communication to attempt to alter undesirable understandings of the rationale and processes of education held by external constituencies. This paper shows that contemporary practice in public relations and marketing communication can be conceptualized as an…

Phenomenological Analysis of Rationale for School Transfer Credit Policies

ERIC Educational Resources Information Center

Melton, Amye M.

2012-01-01

Students face challenges when attempting to transfer college credits; sometimes, the process results in having to retake classes already completed at another institution. A qualitative phenomenological study, grounded in an advocacy/participatory worldview, was used to explore how leaders of higher learning institutions determined reasons academic…

Effect of genetic testing for risk of type 2 diabetes mellitus on health behaviors and outcomes: study rationale, development and design.

PubMed

Cho, Alex H; Killeya-Jones, Ley A; O'Daniel, Julianne M; Kawamoto, Kensaku; Gallagher, Patrick; Haga, Susanne; Lucas, Joseph E; Trujillo, Gloria M; Joy, Scott V; Ginsburg, Geoffrey S

2012-01-18

Type 2 diabetes is a prevalent chronic condition globally that results in extensive morbidity, decreased quality of life, and increased health services utilization. Lifestyle changes can prevent the development of diabetes, but require patient engagement. Genetic risk testing might represent a new tool to increase patients' motivation for lifestyle changes. Here we describe the rationale, development, and design of a randomized controlled trial (RCT) assessing the clinical and personal utility of incorporating type 2 diabetes genetic risk testing into comprehensive diabetes risk assessments performed in a primary care setting. Patients are recruited in the laboratory waiting areas of two primary care clinics and enrolled into one of three study arms. Those interested in genetic risk testing are randomized to receive either a standard risk assessment (SRA) for type 2 diabetes incorporating conventional risk factors plus upfront disclosure of the results of genetic risk testing ("SRA+G" arm), or the SRA alone ("SRA" arm). Participants not interested in genetic risk testing will not receive the test, but will receive SRA (forming a third, "no-test" arm). Risk counseling is provided by clinic staff (not study staff external to the clinic). Fasting plasma glucose, insulin levels, body mass index (BMI), and waist circumference are measured at baseline and 12 months, as are patients' self-reported behavioral and emotional responses to diabetes risk information. Primary outcomes are changes in insulin resistance and BMI after 12 months; secondary outcomes include changes in diet patterns, physical activity, waist circumference, and perceived risk of developing diabetes. The utility, feasibility, and efficacy of providing patients with genetic risk information for common chronic diseases in primary care remain unknown. The study described here will help to establish whether providing type 2 diabetes genetic risk information in a primary care setting can help improve patients' clinical outcomes, risk perceptions, and/or their engagement in healthy behavior change. In addition, study design features such as the use of existing clinic personnel for risk counseling could inform the future development and implementation of care models for the use of individual genetic risk information in primary care. ClinicalTrials.gov: NCT00849563.

Interns overestimate the effectiveness of their hand-off communication.

PubMed

Chang, Vivian Y; Arora, Vineet M; Lev-Ari, Shiri; D'Arcy, Michael; Keysar, Boaz

2010-03-01

Theories from the psychology of communication may be applicable in understanding why hand-off communication is inherently problematic. The purpose of this study was to assess whether postcall pediatric interns can correctly estimate the patient care information and rationale received by on-call interns during hand-off communication. Pediatric interns at the University of Chicago were interviewed about the hand-off. Postcall interns were asked to predict what on-call interns would report as the important pieces of information communicated during the hand-off about each patient, with accompanying rationale. Postcall interns also guessed on-call interns' rating of how well the hand-offs went. Then, on-call interns were asked to list the most important pieces of information for each patient that postcall interns communicated during the hand-off, with accompanying rationale. On-call interns also rated how well the hand-offs went. Interns had access to written hand-offs during the interviews. We conducted 52 interviews, which constituted 59% of eligible interviews. Seventy-two patients were discussed. The most important piece of information about a patient was not successfully communicated 60% of the time, despite the postcall intern's believing that it was communicated. Postcall and on-call interns did not agree on the rationales provided for 60% of items. In addition, an item was more likely to be effectively communicated when it was a to-do item (65%) or an item related to anticipatory guidance (69%) compared with a knowledge item (38%). Despite the lack of agreement on content and rationale of information communicated during hand-offs, peer ratings of hand-off quality were high. Pediatric interns overestimated the effectiveness of their hand-off communication. Theories from communication psychology suggest that miscommunication is caused by egocentric thought processes and a tendency for the speaker to overestimate the receiver's understanding. This study demonstrates that systematic causes of miscommunication may play a role in hand-off quality.

Redesigning care for patients at increased hospitalization risk: the Comprehensive Care Physician model.

PubMed

Meltzer, David O; Ruhnke, Gregory W

2014-05-01

Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model's effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model's potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure.

Implementation outcomes of Multidimensional Family Therapy-Detention to Community: a reintegration program for drug-using juvenile detainees.

PubMed

Liddle, Howard A; Dakof, Gayle A; Henderson, Craig; Rowe, Cindy

2011-06-01

Responding to urgent calls for effective interventions to address young offenders' multiple and interconnected problems, a new variant of an existing empirically-validated intervention for drug-using adolescents, Multidimensional Family Therapy (MDFT)-Detention to Community (DTC) was tested in a two-site controlled trial. This article (a) outlines the rationale and protocol basics of the MDFT-DTC intervention, a program for substance-using juvenile offenders that links justice and substance abuse treatment systems to facilitate adolescents' post-detention community reintegration; (b) presents implementation outcomes, including fidelity, treatment engagement and retention rates, amount of services received, treatment satisfaction, and substance abuse-juvenile justice system collaboration outcomes; and (c) details the implementation and sustainability challenges in a cross-system (substance abuse treatment and juvenile justice) adolescent intervention. Findings support the effectiveness of the MDFT-DTC intervention, and the need to develop a full implementation model in which transfer and dissemination issues could be explored more fully, and tested experimentally.

The role of treatment delivery factors in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia.

PubMed

Weck, Florian; Grikscheit, Florian; Höfling, Volkmar; Kordt, Anne; Hamm, Alfons O; Gerlach, Alexander L; Alpers, Georg W; Arolt, Volker; Kircher, Tilo; Pauli, Paul; Rief, Winfried; Lang, Thomas

2016-08-01

Treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) are considered to be important for cognitive behavioral therapy (CBT) for panic disorder and agoraphobia (PD/AG). In the current study, four independent raters conducted process evaluations based on 168 two-hour videotapes of 84 patients with PD/AG treated with exposure-based CBT. Two raters evaluated patients' interpersonal behavior in Session 1. Two raters evaluated treatment delivery factors in Session 6, in which therapists provided the rationale for conducting exposure exercises. At the 6-month follow-up, therapists' adherence (r=0.54) and therapeutic alliance (r=0.31) were significant predictors of changes in agoraphobic avoidance behavior; therapist competence was not associated with treatment outcomes. Patients' interpersonal behavior in Session 1 was a significant predictor of the therapeutic alliance in Session 6 (r=0.17). The findings demonstrate that treatment delivery factors, particularly therapist adherence, are relevant to the long-term success of CBT for PD/AG. Copyright © 2016 Elsevier Ltd. All rights reserved.

CULTURAL ADAPTATIONS OF EVIDENCE-BASED HOME-VISITATION MODELS IN TRIBAL COMMUNITIES.

PubMed

Hiratsuka, Vanessa Y; Parker, Myra E; Sanchez, Jenae; Riley, Rebecca; Heath, Debra; Chomo, Julianna C; Beltangady, Moushumi; Sarche, Michelle

2018-05-01

The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities. © 2018 Michigan Association for Infant Mental Health.

[Innovative medicinal products: the new criteria of the Italian Medicines Agency.

PubMed

Mammarella, Federica; Tafuri, Giovanni

2018-05-01

The Italian Medicines Agency (AIFA), which has the dual function of a regulatory and a reimbursement authority, has recently established new criteria to define innovative medicinal products. Indeed, the decision making process to grant the innovative status is based on the evaluation of the unmet medical need, the added therapeutic value compared to existing therapeutic options and the overall quality of clinical evidence, which is assessed based on the GRADE system. Following this evaluation, if a medicinal product is granted the status of "full innovativeness" for a specific therapeutic indication, its manufacturer can access dedicated yearly funds amounting to 500 million Euros each, depending on the type of medicine (one fund for oncology, the other for all other innovative medicinal products). Alternatively, the product can be granted the status of "conditional innovativeness" which allows immediate access to all Regional formularies, with no additional re-assessments at the local level. The third possible outcome is that no innovativeness is recognized. Starting from January 2018, a full report explaining the rationale for the Agency Committee's decision is made publicly available on the AIFA's website.

The Atom - The Final Link in the Division Process or the First Building Block? Pre-Instructional Conceptions about the Structure of Substances.

ERIC Educational Resources Information Center

Pfundt, Helga

The hypothesis as to the atomic structure of any given substance is introduced in many physics and chemistry textbooks by conveying the idea of repetitive division of a given amount of substance, for example, by grinding, dissolving, or evaporating. The rationale for this approach is the assumption of students inferring that this process of…

Job Skills Education Program. Design Specifications

DTIC Science & Technology

1985-03-01

training approach is supplied in part by research based on the depth-of- processing paradigm ( Craik & Lockhart , 1972; Craik & Tulving, 1975), which...discussion here develops a rationale for the approach, which is consistent with research on incidental learning ( Craik & Lockhart , 1972; Craik & Tulving, 1975...this meeting, a plan evolved to integrate available RCA results and contract products into the - JSEP design. 0 During the Task 1 in- process review, the

Identifying the Help Givers in a Community of Learners: Using Peer Reporting and Social Network Analysis as Strategies for Participant Selection

ERIC Educational Resources Information Center

Rook, Michael M.

2018-01-01

The author presents a three-step process for selecting participants for any study of a social phenomenon that occurs between people in locations and at times that are difficult to observe. The process is described with illustrative examples from a previous study of help giving in a community of learners. This paper includes a rationale for…

On the rationale for hysteresis in economic decisions

NASA Astrophysics Data System (ADS)

Rios, Luis A.; Rachinskii, Dmitrii; Cross, Rod

2017-02-01

In the social sciences there are plausible reasons to postulate that hysteresis effects are important. The available evidence, however, is predominantly at the macro level. In this paper we review the evidence regarding hysteresis in the neural processes underlying human behavior. We argue that there is a need for experimental and neuroimaging studies to fill the gap in knowledge about hysteresis processes at the micro level in the social sciences.

Peering into peer-review at GigaScience.

PubMed

Edmunds, Scott C

2013-01-24

Fostering and promoting more open and transparent science is one of the goals of GigaScience. One of the ways we have been doing this is by throwing light on the peer-review process and carrying out open peer-review as standard. In this editorial, we provide our rationale for undertaking this policy, give examples of our positive experiences to date, and encourage others to open up the normally opaque publication process.

A non-interventional comparative study of the 20:1 combination of cafedrine/theodrenaline versus ephedrine for the treatment of intra-operative arterial hypotension: the 'HYPOTENS' study design and rationale.

PubMed

Eberhart, Leopold; Geldner, Götz; Huljic, Susanne; Marggraf, Kerstin; Keller, Thomas; Koch, Tilo; Kranke, Peter

2018-06-01

To compare the effectiveness of 20:1 cafedrine/theodrenaline approved for use in Germany to ephedrine in the restoration of arterial blood pressure and on post-operative outcomes in patients with intra-operative arterial hypotension of any origin under standard clinical practice conditions. 'HYPOTENS' is a national, multi-center, prospective, open-label, two-armed, non-interventional study. Effectiveness and post-operative outcome following cafedrine/theodrenaline or ephedrine therapy will be evaluated in two cohorts of hypotensive patients. Cohort A includes patients aged ≥50 years with ASA-classification 2-4 undergoing non-emergency surgical procedures under general anesthesia. Cohort B comprises patients undergoing Cesarean section under spinal anesthesia. Participating surgical departments will be assigned to a treatment arm by routinely used anti-hypotensive agent. To minimize bias, matched department pairs will be compared in a stratified selection process. The composite primary end-point is the lower absolute deviation from individually determined target blood pressure (IDTBP) and the incidence of heart rate ≥100 beats/min in the first 15 min. Secondary end-points include incidence and degree of early post-operative delirium (cohort A), severity of fetal acidosis in the newborn (cohort B), upper absolute deviation from IDTBP, percentage increase in systolic blood pressure, and time to IDTBP. This open-label, non-interventional study design mirrors daily practice in the treatment of patients with intra-operative hypotension and ensures full treatment decision autonomy with respect to each patient's individual condition. Selection of participating sites by a randomization process addresses bias without interfering with the non-interventional nature of the study. First results are expected in 2018. ClinicalTrials.gov identifier: NCT02893241; DRKS identifier: DRKS00010740.

Video-game based exercises for older people with chronic low back pain: a protocol for a feasibility randomised controlled trial (the GAMEBACK trial).

PubMed

Zadro, Joshua Robert; Shirley, Debra; Simic, Milena; Mousavi, Seyed Javad; Ceprnja, Dragana; Maka, Katherine; Ferreira, Paulo

2017-06-01

To investigate the feasibility of implementing a video-game exercise programme for older people with chronic low back pain (LBP). Single-centred single-blinded randomised controlled trial (RCT). Physiotherapy outpatient department in a public hospital in Western Sydney, Australia. We will recruit 60 participants over 55 years old with chronic LBP from the waiting list. Participants will be randomised to receive video-game exercise (n=30) or to remain on the waiting list (n=30) for 8 weeks, with follow up at 3 and 6 months. Participants engaging in video-game exercises will be unsupervised and will complete video-game exercise for 60minutes, 3 times per week. Participants allocated to remain on the waiting list will be encouraged to maintain their usual levels of physical activity. The primary outcomes for this feasibility study will be study processes (recruitment and response rates, adherence to and experience with the intervention, and incidence of adverse events) relevant to the future design of a large RCT. Estimates of treatment efficacy (point estimates and 95% confidence intervals) on pain self-efficacy, care seeking, physical activity, fear of movement/re-injury, pain, physical function, disability, falls-efficacy, strength, and walking speed, will be our secondary outcome measures. Recruitment for this trial began in November 2015. This study describes the rationale and processes of a feasibility study investigating a video-game exercise programme for older people with chronic LBP. Results from the feasibility study will inform on the design and sample required for a large multicentre RCT. Australian New Zealand Clinical Trials Registry: ACTRN12615000703505. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Improving palliative care through teamwork (IMPACTT) in nursing homes: Study design and baseline findings.

PubMed

Temkin-Greener, Helena; Ladwig, Susan; Ye, Zhiqiu; Norton, Sally A; Mukamel, Dana B

2017-05-01

The 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life. This paper describes the design, rationale, and challenges of a two-arm randomized controlled trial of nursing home-based palliative care teams in 31 facilities. The impact of the intervention on residents' outcomes is measured with four risk-adjusted quality indicators: place of death (nursing home or hospital), number of hospitalizations, and self-reported pain and depression in the last 90-days of life. The effect of the intervention is also evaluated with regard to staff satisfaction and impact on care processes (e.g. palliative care competency, communication, coordination). Both secondary (e.g. the Minimum Data Set) and primary (e.g. staff surveys) data are employed to examine the effect of the intervention. Several challenges in conducting a complex, nursing home-based intervention have been identified. While sustainability of the intervention without research funding is not clear, we surmise that without changes to the payment model that put palliative care services in this care setting on par with the more "skilled" care, it will not be reasonable to expect any widespread efforts to implement facility-based palliative care services. Copyright © 2017 Elsevier Inc. All rights reserved.

The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research.

PubMed

Boyce, Maria B; Browne, John P; Greenhalgh, Joanne

2014-06-01

To synthesise qualitative studies that investigated the experiences of healthcare professionals with using information from patient-reported outcome measures (PROMs) to improve the quality of care. A qualitative systematic review was conducted by searching PubMed, PsycINFO and CINAHL with no time restrictions. Hand searching was also performed. Eligible studies were evaluated using the Critical Appraisal Skills Programme toolkit for qualitative studies. A thematic synthesis identified common themes across studies. Study characteristics were examined to explain differences in findings. All healthcare settings. Healthcare professionals. Professionals' views of PROMs after receiving PROMs feedback about individual patients or groups of patients. Sixteen studies met the inclusion criteria. Barriers and facilitators to the use of PROMs emerged within four main themes: collecting and incorporating the data (practical), valuing the data (attitudinal), making sense of the data (methodological) and using the data to make changes to patient care (impact). Professionals value PROMs when they are useful for the clinical decision-making process. Practical barriers to the routine use of PROMs are prominent when the correct infrastructure is not in place before commencing data collection and when their use is disruptive to normal work routines. Technology can play a greater role in processing the information in the most efficient manner. Improvements to the interpretability of PROMs should increase their use. Attitudes to the use of PROMs may be improved by engaging professionals in the planning stage of the intervention and by ensuring a high level of transparency around the rationale for data collection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Rationale and Roadmap for Moon Exploration

NASA Astrophysics Data System (ADS)

Foing, B. H.; ILEWG Team

We discuss the different rationale for Moon exploration. This starts with areas of scientific investigations: clues on the formation and evolution of rocky planets, accretion and bombardment in the inner solar system, comparative planetology processes (tectonic, volcanic, impact cratering, volatile delivery), records astrobiology, survival of organics; past, present and future life. The rationale includes also the advancement of instrumentation: Remote sensing miniaturised instruments; Surface geophysical and geochemistry package; Instrument deployment and robotic arm, nano-rover, sampling, drilling; Sample finder and collector. There are technologies in robotic and human exploration that are a drive for the creativity and economical competitivity of our industries: Mecha-electronics-sensors; Tele control, telepresence, virtual reality; Regional mobility rover; Autonomy and Navigation; Artificially intelligent robots, Complex systems, Man-Machine interface and performances. Moon-Mars Exploration can inspire solutions to global Earth sustained development: In-Situ Utilisation of resources; Establishment of permanent robotic infrastructures, Environmental protection aspects; Life sciences laboratories; Support to human exploration. We also report on the IAA Cosmic Study on Next Steps In Exploring Deep Space, and ongoing IAA Cosmic Studies, ILEWG/IMEWG ongoing activities, and we finally discuss possible roadmaps for robotic and human exploration, starting with the Moon-Mars missions for the coming decade, and building effectively on joint technology developments.

A simple analytical model for signal amplification by reversible exchange (SABRE) process.

PubMed

Barskiy, Danila A; Pravdivtsev, Andrey N; Ivanov, Konstantin L; Kovtunov, Kirill V; Koptyug, Igor V

2016-01-07

We demonstrate an analytical model for the description of the signal amplification by reversible exchange (SABRE) process. The model relies on a combined analysis of chemical kinetics and the evolution of the nuclear spin system during the hyperpolarization process. The presented model for the first time provides rationale for deciding which system parameters (i.e. J-couplings, relaxation rates, reaction rate constants) have to be optimized in order to achieve higher signal enhancement for a substrate of interest in SABRE experiments.

Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial - Cell Phone Intervention for You (CITY).

PubMed

Batch, Bryan C; Tyson, Crystal; Bagwell, Jacqueline; Corsino, Leonor; Intille, Stephen; Lin, Pao-Hwa; Lazenka, Tony; Bennett, Gary; Bosworth, Hayden B; Voils, Corrine; Grambow, Steven; Sutton, Aziza; Bordogna, Rachel; Pangborn, Matthew; Schwager, Jenifer; Pilewski, Kate; Caccia, Carla; Burroughs, Jasmine; Svetkey, Laura P

2014-03-01

The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population. To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You (CITY) study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1) a behavioral intervention that is delivered almost entirely via cell phone technology (Cell Phone group); and 2) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone (Personal Coaching group), each compared to 3) a usual care, advice-only control condition. A total of 365 community-dwelling overweight/obese adults aged 18-35 years were randomized to receive one of these three interventions for 24 months in parallel group design. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 24 [corrected] months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014. If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss. ClinicalTrial.gov: NCT01092364. Published by Elsevier Inc.

Treatment of early-onset schizophrenia spectrum disorders (TEOSS): rationale, design, and methods.

PubMed

McClellan, Jon; Sikich, Linmarie; Findling, Robert L; Frazier, Jean A; Vitiello, Benedetto; Hlastala, Stefanie A; Williams, Emily; Ambler, Denisse; Hunt-Harrison, Tyehimba; Maloney, Ann E; Ritz, Louise; Anderson, Robert; Hamer, Robert M; Lieberman, Jeffrey A

2007-08-01

The Treatment of Early Onset Schizophrenia Spectrum Disorders Study is a publicly funded clinical trial designed to compare the therapeutic benefits, safety, and tolerability of risperidone, olanzapine, and molindone in youths with early-onset schizophrenia spectrum disorders. The rationale, design, and methods of the Treatment of Early Onset Schizophrenia Spectrum Disorders Study are described. Using a randomized, double-blind, parallel-group design at four sites, youths with EOSS (ages 8-19 years) were assigned to an 8-week acute trial of risperidone (0.5-6.0 mg/day), olanzapine (2.5-20 mg/day), or molindone (10-140 mg/day). Responders continued double-blind treatment for 44 weeks. The primary outcome measure was responder status at 8 weeks, defined by a 20% reduction in baseline Positive and Negative Symptom Scale scores plus ratings of significant improvement on the Clinical Global Impressions. Secondary outcome measures included assessments of psychopathology, functional impairment, quality of life, and medication safety. An intent-to-treat analytic plan was used. From February 2002 to May 2006, 476 youths were screened, 173 were further evaluated, and 119 were randomized. Several significant study modifications were required to address safety, the use of adjunctive medications, and the termination of the olanzapine treatment arm due to weight gain. The Treatment of Early Onset Schizophrenia Spectrum Disorders Study will inform clinical practice regarding the use of antipsychotic medications for youths with early-onset schizophrenia spectrum disorders. Important safety concerns emerged during the study, including higher than anticipated rates of suicidality and problems tapering thymoleptic agents before randomization.

Rationale and design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND).

PubMed

Hedayati, S Susan; Daniel, Divya M; Cohen, Scott; Comstock, Bryan; Cukor, Daniel; Diaz-Linhart, Yaminette; Dember, Laura M; Dubovsky, Amelia; Greene, Tom; Grote, Nancy; Heagerty, Patrick; Katon, Wayne; Kimmel, Paul L; Kutner, Nancy; Linke, Lori; Quinn, Davin; Rue, Tessa; Trivedi, Madhukar H; Unruh, Mark; Weisbord, Steven; Young, Bessie A; Mehrotra, Rajnish

2016-03-01

Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes. Published by Elsevier Inc.

Rationale and Design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND)

PubMed Central

Hedayati, S. Susan; Daniel, Divya M.; Cohen, Scott; Comstock, Bryan; Cukor, Daniel; Diaz-Linhart, Yaminette; Dember, Laura M.; Dubovsky, Amelia; Greene, Tom; Grote, Nancy; Heagerty, Patrick; Katon, Wayne; Kimmel, Paul L.; Kutner, Nancy; Linke, Lori; Quinn, Davin; Rue, Tessa; Trivedi, Madhukar H.; Unruh, Mark; Weisbord, Steven; Young, Bessie A.; Mehrotra, Rajnish

2015-01-01

Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes. PMID:26621218

Weight loss intervention for young adults using mobile technology: design and rationale of a randomized controlled trial – Cell phone Intervention for You (CITY)

PubMed Central

Batch, Bryan C.; Tyson, Crystal; Bagwell, Jacqueline; Corsino, Leonor; Intille, Stephen; Lin, Pao-Hwa; Lazenka, Tony; Bennett, Gary; Bosworth, Hayden B.; Voils, Corrine; Grambow, Steven; Sutton, Aziza; Bordogna, Rachel; Pangborn, Matthew; Schwager, Jenifer; Pilewski, Kate; Caccia, Carla; Burroughs, Jasmine; Svetkey, Laura P.

2014-01-01

Background The obesity epidemic has spread to young adults, leading to significant public health implications later in adulthood. Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic. Few weight loss trials have been conducted in young adults. It is unclear what weight loss strategies are beneficial in this population. Purpose To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You (CITY) study, which is a single center, randomized three-arm trial that compares the impact on weight loss of 1) a behavioral intervention that is delivered almost entirely via cell phone technology (Cell Phone group); and 2) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone (Personal Coaching group), each compared to; 3) a usual care, advice-only control condition. Methods A total of 365 community-dwelling overweight/obese adults aged 18–35 years were randomized to receive one of these three interventions for 24 months in parallel group design. Study personnel assessing outcomes were blinded to group assignment. The primary outcome is weight change at 12 months. We hypothesize that each active intervention will cause more weight loss than the usual care condition. Study completion is anticipated in 2014. Conclusions If effective, implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss. PMID:24462568

Study of Tomography Of Nephrolithiasis Evaluation (STONE): methodology, approach and rationale.

PubMed

Valencia, Victoria; Moghadassi, Michelle; Kriesel, Dana R; Cummings, Steve; Smith-Bindman, Rebecca

2014-05-01

Urolithiasis (kidney stones) is a common reason for Emergency Department (ED) visits, accounting for nearly 1% of all visits in the United States. Computed tomography (CT) has become the most common imaging test for these patients but there are few comparative effectiveness data to support its use in comparison to ultrasound. This paper describes the rationale and methods of STONE (Study of Tomography Of Nephrolithiasis Evaluation), a pragmatic randomized comparative effectiveness trial comparing different imaging strategies for patients with suspected urolithiasis. STONE is a multi-center, non-blinded pragmatic randomized comparative effectiveness trial of patients between ages 18 and 75 with suspected nephrolithiasis seen in an ED setting. Patients were randomized to one of three initial imaging examinations: point-of-care ultrasound, ultrasound performed by a radiologist or CT. Participants then received diagnosis and treatment per usual care. The primary aim is to compare the rate of severe SAEs (Serious Adverse Events) between the three arms. In addition, a broad range of secondary outcomes was assessed at baseline and regularly for six months post-baseline using phone, email and mail questionnaires. Excluding 17 patients who withdrew after randomization, a total of 2759 patients were randomized and completed a baseline questionnaire (n=908, 893 and 958 in the point-of-care ultrasound, radiology ultrasound and radiology CT arms, respectively). Follow-up is complete, and full or partial outcomes were assessed on over 90% of participants. The detailed methodology of STONE will provide a roadmap for comparative effectiveness studies of diagnostic imaging conducted in an ED setting. Published by Elsevier Inc.

Comprehensive approach for hypertension control in low-income populations: rationale and study design for the hypertension control program in Argentina.

PubMed

Mills, Katherine T; Rubinstein, Adolfo; Irazola, Vilma; Chen, Jing; Beratarrechea, Andrea; Poggio, Rosana; Dolan, Jacquelyn; Augustovski, Federico; Shi, Lizheng; Krousel-Wood, Marie; Bazzano, Lydia A; He, Jiang

2014-08-01

Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This article summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. Clinic patients with uncontrolled hypertension, their spouses and hypertensive family members will be enrolled. The comprehensive intervention program targets the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure [BP], health education for medication adherence and lifestyle modification) conducted by community health workers and a mobile health intervention. The primary outcome is net change in systolic BP from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic BP, BP control and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries.

Comprehensive Approach for Hypertension Control in Low-income Populations: Rationale and Study Design for the Hypertension Control Program in Argentina (HCPIA)

PubMed Central

Mills, Katherine T.; Rubinstein, Adolfo; Irazola, Vilma; Chen, Jing; Beratarrechea, Andrea; Poggio, Rosana; Dolan, Jacquelyn; Augustovski, Federico; Shi, Lizheng; Krousel-Wood, Marie; Bazzano, Lydia A.; He, Jiang

2014-01-01

Although the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials, this scientific knowledge has not been fully applied in the general population, especially in low-income communities. This paper summarizes interventions to improve hypertension management and describes the rationale and study design for a cluster randomized trial testing whether a comprehensive intervention program within a national public primary care system will improve hypertension control among uninsured hypertensive men and women and their families. We will recruit 1,890 adults from 18 clinics within a public primary care network in Argentina. Clinic patients with uncontrolled hypertension, their spouses and hypertensive family members will be enrolled. The comprehensive intervention program targets the primary care system through health care provider education, a home-based intervention among patients and their families (home delivery of antihypertensive medication, self-monitoring of blood pressure, health education for medication adherence and lifestyle modification) conducted by community health workers, and a mobile health intervention. The primary outcome is net change in systolic blood pressure from baseline to month 18 between intervention and control groups among hypertensive study participants. The secondary outcomes are net change in diastolic blood pressure, blood pressure control, and cost-effectiveness of the intervention. This study will generate urgently needed data on effective, practical, and sustainable intervention programs aimed at controlling hypertension and concomitant cardiovascular disease in underserved populations in low- and middle-income countries. PMID:24978148

Contemporary multilevel analysis of the effectiveness of water fluoridation in Australia.

PubMed

Do, Loc; Spencer, A John

2015-02-01

Water fluoridation was extended in Queensland, Australia, across 2009-2011. A research program was commenced to inform the rationale for and the outcome of this program, to estimate the effectiveness of water fluoridation in preventing caries and to predict changes in caries experience as a result of the extension of fluoridation. Queensland children were selected through a stratified random sample selection in 2010-2012. Oral epidemiological examinations provided individual-level outcomes for decayed, missing or filled primary or permanent tooth surfaces: dmfs (among 5-8-year-olds) and DMFS (9-14-year-olds). Explanatory factors at the individual-level, school-level and area-level fluoridation status were derived. Data were weighted to represent the population. Three-level multilevel multivariable models were sequentially specified for negative binomial distribution of dmfs/DMFS to estimate rate ratios (RR). The effectiveness of area-level water fluoridation was evaluated in the full models controlling for other factors. Data from 2,214 5-8 year-olds and 3,186 9-14 year-olds from 207 schools in 16 areas were analysed. Queensland's average dmfs was 4.23 and DMFS 1.47. The lowest levels of dental caries were observed in long-term fluoridated Townsville. In the full models, Townsville children had significantly lower caries experience (RR for dmfs: 0.61 (95%CI: 0.44-0.82); RR for DMFS 0.60 (95%CI: 0.42-0.88)) compared with children in non-fluoridated areas. Comparison of caries experience of children at the time of the extension of water fluoridation supported the rationale for this population health measure. © 2014 Public Health Association of Australia.

Rationale for Spiritually Oriented Cognitive Processing Therapy for Moral Injury in Active Duty Military and Veterans With Posttraumatic Stress Disorder.

PubMed

Koenig, Harold G; Boucher, Nathan A; Oliver, Rev John P; Youssef, Nagy; Mooney, Scott R; Currier, Joseph M; Pearce, Michelle

2017-02-01

Wartime experiences have long been known to cause ethical conflict, guilt, self-condemnation, difficulty forgiving, loss of trust, lack of meaning and purpose, and spiritual struggles. "Moral injury" (MI) (also sometimes called "inner conflict") is the term used to capture this emotional, cognitive, and behavioral state. In this article, we provide rationale for developing and testing Spiritually Oriented Cognitive Processing Therapy, a version of standard cognitive processing therapy for the treatment of MI in active duty and veteran service members (SMs) with posttraumatic stress disorder symptoms who are spiritual or religious (S/R). Many SMs have S/R beliefs that could increase vulnerability to MI. Because the injury is to deeply held moral standards and ethical values and often adversely affects spiritual beliefs and worldview, we believe that those who are S/R will respond more favorably to a therapy that directly targets this injury from a spiritually oriented perspective. An evidence-based treatment for MI in posttraumatic stress disorder that not only respects but also utilizes SMs' spiritual beliefs/behaviors may open the door to treatment for many S/R military personnel.

The WHO evidence-informed guideline development process and implications for vitamin and mineral research priorities: symposium rationale and summary.

PubMed

Neufeld, Lynnette M; Jalal, Chowdhury S B; Peña-Rosas, Juan Pablo; Tovey, David; Lutter, Chessa K; Stoltzfus, Rebecca J; Habicht, Jean-Pierre

2013-09-01

The WHO evidence-informed guidelines provide recommendations to Member States and their partners on interventions with vitamins and minerals. Evidence gathered and synthesized through systematic reviews contributes to the development of these guidelines, a process that is dependent on the availability and quality of evidence. Although the guideline development process is stringently governed and supervised to maintain clarity and transparency, the lack of adequacy and specificity of available evidence poses limitations to the formulation of recommendations that can be easily applied for policy and program decision making in diverse contexts. The symposium created a space for dialogue among scientists and public health practitioners to improve the understanding of how evidence fulfills the needs and reflect on mechanisms by which policy and program guidance and priorities for research could be better informed by policy and program needs. Ultimately, programmatic success depends not only on identifying efficacious agents but ensuring effective delivery to those with the potential to respond. To do this, we must understand the rationale for recommending interventions, the biological pathways by which interventions work, delivery systems required to make efficacious interventions work, and other contextual factors that might limit or facilitate successful implementation.

Technology assessment and the drug use process.

PubMed

Solomon, D K; Gourley, D R; Brown, J R; Gourley, G A; Humma, L M

1999-02-01

This activity is designed for pharmacists, physicians, physician assistants, nurses, and other healthcare team members, payers for health services, and healthcare executives. Upon completion of this activity, the participant should be able to: 1. Describe the rationale behind, the development of, and the advantages arising from the formulary process, and discuss the health professionals involved in the creation of formularies. 2. Describe the impact of new drug development and technology on the drug use process. 3. Discuss the functions of the pharmacy and therapeutics committee. 4. Describe the impact of consumers on the drug use process.

Biology Curriculum Guide. Bulletin 1646.

ERIC Educational Resources Information Center

Louisiana State Dept. of Education, Baton Rouge. Div. of Academic Programs.

This curriculum guide, developed to establish statewide curriculum standards for the Louisiana Competency-based Education Program, contains the minimum competencies and process skills that should be included in a biology course. It consists of: (1) a rationale for an effective science program; (2) a list and description of four major goals of…

Physics Curriculum Guide. Bulletin 1661.

ERIC Educational Resources Information Center

Louisiana State Dept. of Education, Baton Rouge. Div. of Academic Programs.

This curriculum guide, developed to establish statewide curriculum standards for the Louisiana Competency-based Education Program, contains the minimum competencies and process skills that should be included in a physics course. It consists of: (1) a rationale for an effective science program; (2) a list and description of four major goals of…

Guide for Multicultural Education: Content and Context.

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento. Bureau of Intergroup Relations.

This guide explores the rationale for multicultural education at the elementary and secondary levels, its needs and goals, the school setting it requires, and the necessary processes of instructional planning and staff preparation. The basic aim of a multicultural instructional program is to help students to accept themselves and other persons as…

Teacher Education and Spaceship Earth.

ERIC Educational Resources Information Center

Raack, Marilyn; Bixler, James

The analogy of "Spaceship Earth" is used to suggest the necessary elements of a teacher education program that is future-oriented and that can be effective in changing and maintaining desired attitudes and behavior, particularly in relation to dealing with significant global issues and processes. Rationales are provided for a global education…

Employee Empowerment in Manufacturing: A Study of Organisations in the UK.

ERIC Educational Resources Information Center

Psoinos, Anna; Smithson, Steve

2002-01-01

Employee empowerment in the United Kingdom manufacturing industry (through total quality management, delayering, and business process reengineering) was examined in a survey of 103 companies. Success factors included a solid business rationale, organizational culture, and staff decision making power. Culture was also the most influential…

Life Science Curriculum Guide. Bulletin 1614.

ERIC Educational Resources Information Center

Louisiana State Dept. of Education, Baton Rouge. Div. of Academic Programs.

This curriculum guide, developed to establish statewide curriculum standards for the Louisiana Competency-based Education Program, contains the minimum competencies and process skills that should be included in a life science course. It consists of: (1) a rationale for an effective science program; (2) a list and description of four major goals of…

Probing the Natural World, Volume 1.

ERIC Educational Resources Information Center

Burkman, Ernest

These materials represent the first third of a coordinated science program for grades seven through nine. The materials have been prepared according to the following Intermediate Science Curriculum Study rationale: (1) science at the junior-high-school level should serve a general education function, and (2) both processes and concepts should be…

Suicide Prevention with Diverse College Students

ERIC Educational Resources Information Center

Shadick, Richard; Akhter, Sarah

2014-01-01

Because of a dearth of experience in preventing suicide in diverse student populations, Pace University developed a multicultural suicide prevention kit. This article details the process used to develop the kit. The rationale for approaching suicide prevention in a culturally competent manner is presented, and methods used to gain culture-specific…

Montage: Improvising in the Land of Action Research

ERIC Educational Resources Information Center

Windle, Sheila; Sefton, Terry

2011-01-01

This paper and its appended multi-media production describe the rationale and process of creating and presenting a "digitally saturated" (Lankshear & Knobel, 2003), multi-layered, synchronous "montage" (Denzin & Lincoln, 2003) of educational Action Research findings. The authors contend that this type of presentation, arising from the fusion of…

The Intent and Processes of a Professional Learning Initiative Seeking to Foster Discussion around Innovative Approaches to Teaching

ERIC Educational Resources Information Center

Sullivan, Peter; Holmes, Marilyn; Ingram, Naomi; Linsell, Chris; Livy, Sharyn; McCormack, Melody

2016-01-01

The following outlines the rationale and structure of a professional learning initiative that seeks to explore teachers' ways of engaging students more actively in building mathematical connections for themselves. An example of one of the suggested experiences is presented.

A Practical Rationale for Classroom Assessment: The SWOT Approach

ERIC Educational Resources Information Center

McLaurin, Sidney E.; Bell, Beulah; Smith, Curtis

2009-01-01

The classroom assessment process can have encouraging results when it begins with "early assessment" that addresses student learning, as well as the social and emotional needs of student(s) in the classroom. This paper presents a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis for classroom assessment. It will review literature…

Embedding Sustainable Development at Cambridge University Engineering Department

ERIC Educational Resources Information Center

Fenner, Richard A.; Ainger, Charles M.; Cruickshank, Heather J.; Guthrie, Peter M.

2005-01-01

Purpose--The paper seeks to examine the latest stage in a process of change aimed at introducing concepts of sustainable development into the activities of the Department of Engineering at Cambridge University, UK. Design/methodology/approach--The rationale behind defining the skills which future engineers require is discussed and vehicles for…

Exposure to concentrated coarse air pollution particles causes mild cardiopulmonary effects in young healthy adults

EPA Science Inventory

Rationale: There is ample epidemiological and toxicological evidence that exposure to fme air pollution particles (PM2.5), which are primarily derived from combustion processes, can result in increased mortality and morbidity. There is less certainty as to the contribution of coa...

Consumer Decision Making in a Global Context.

ERIC Educational Resources Information Center

Lusby, Linda A.

This document examines the underlying rationale for the development of a global approach in consumer studies. The concept of consumer ethics is discussed and the consumer decision-making process is placed within an ecosystem perspective of the marketplace. The model developed introduces educators, marketers, and consumers to a more global…

Academic Learning Revisited: Curriculum Innovation in an Australian University.

ERIC Educational Resources Information Center

Dovey, Ken; Green, Jenny; McQueen, Meryl

2001-01-01

Explores University of Technology, Sydney's process to transform its program in management of third sector organizations because of the profound social change caused by globalization. Analyzes the nature of the crisis, offers a rationale for the strategic action taken, and evaluates the first-phase implementation, including the politics of…

Mainstreaming: Our Current Knowledge Base.

ERIC Educational Resources Information Center

Bates, Percy, Ed.

The nine author contributed chapters are intended to provide a basic introduction to the rationale and processes of mainstreaming handicapped children. The first paper, "The Whys and Hows of Mainstreaming" by T. Tice, provides a philosophical examination of the basic principles of P.L. 94-142, the Education for All Handicapped Children Act, and…

Design and Implementation of Therapist Online Counseling

ERIC Educational Resources Information Center

Thomas, Aaron O.; Lee, Geoff; Ess, Brian

2015-01-01

The following paper describes the rationale for creating an online therapy program of cognitive behavioral therapy, or CBT, for students at the University of Florida who are struggling with stress and anxiety. In addition, the paper discusses the unique challenges of the instructional design process of creating psychoeducational materials through…

Marketing and Distributive Education Curriculum Planning Guide. Revised.

ERIC Educational Resources Information Center

Harris, E. Edward; And Others

This curriculum guide for marketing and distributive education programs in Illinois consists of two sections. In the first section, the rationale for the curriculum is presented, along with the process used to develop it. This presentation is followed by a discussion on articulation in education, especially between high school and postsecondary…

Chemistry Curriculum Guide. Bulletin 1660.

ERIC Educational Resources Information Center

Louisiana State Dept. of Education, Baton Rouge. Div. of Academic Programs.

This curriculum guide, developed to establish statewide curriculum standards for the Louisiana Competency-based Education Program, contains the minimum competencies and process skills that should be included in a chemistry course. It consists of: (1) a rationale for an effective science program; (2) a list and description of four major goals of…

Teaching About War, Peace, Conflict and Change.

ERIC Educational Resources Information Center

New York Friends Group, Inc., New York. Center for War/Peace Studies.

This is a description of the objectives, program activities, and policy of an experimental curriculum development project in the war/peace field. Seven major concepts of content are defined: 1) Identity, 2) Obligation, 3) Change, 4) Power, 5) Conflict, 6) Institutions, 7) Interdependence, 8) Values and the Value Process. Rationale is that…

DIAGNOSIS AND APPRAISAL OF COMMUNICATION DISORDERS. PRENTICE-HALL FOUNDATIONS OF SPEECH PATHOLOGY SERIES.

ERIC Educational Resources Information Center

DARLEY, FREDERIC L.

THIS TEXT GIVES THE STUDENT AN OUTLINE OF THE BASIC PRINCIPLES OF SCIENTIFIC METHODOLOGY WHICH UNDERLIE EVALUATIVE WORK IN SPEECH DISORDERS. RATIONALE AND ASSESSMENT TECHNIQUES ARE GIVEN FOR EXAMINATION OF THE BASIC COMMUNICATION PROCESSES OF SYMBOLIZATION, RESPIRATION, PHONATION, ARTICULATION-RESONANCE, PROSODY, ASSOCIATED SENSORY AND PERCEPTUAL…

Toward Validation of the Genius Discipline-Specific Literacy Model

ERIC Educational Resources Information Center

Ellis, Edwin S.; Wills, Stephen; Deshler, Donald D.

2011-01-01

An analysis of the rationale and theoretical foundations of the Genius Discipline-specific Literacy Model and its use of SMARTvisuals to cue information-processing skills and strategies and focus attention on essential informational elements in high-frequency topics in history and the English language arts are presented. Quantitative data…

Flexibility in Macro-Scripts for Computer-Supported Collaborative Learning

ERIC Educational Resources Information Center

Dillenbourg, P.; Tchounikine, P.

2007-01-01

In the field of computer-supported collaborative learning (CSCL), scripts are designed to support collaboration among distant learners or co-present learners whose interactions are (at least partially) mediated by a computer. The rationale of scripts is to structure collaborative learning processes in order to trigger group interactions that may…

The Effects of Marijuana on Human Cognition.

ERIC Educational Resources Information Center

Pearl, Joseph H.

Investigating the effects of marijuana on human psychological functioning, this study differs from previous research in two ways: 1) it is concerned with relatively complex cognitive processes; 2) it has a theoretical rationale. The general hypothesis of the study states that marijuana will impair its user's ability to form and use abstract…

Identification of the Gifted Redefined with Ethics and Equity in Mind

ERIC Educational Resources Information Center

McCluskey, Ken W.

2017-01-01

Throughout his focus article, Robert Sternberg discusses the theoretical underpinnings and rationale behind his emerging Active Concerned Citizenship and Ethical Leadership (ACCEL) model. In the process, he raises several critically important issues, including the misuse of IQ testing as the major method for identifying gifted students, the need…

Best Instructional Practices for Developing Student Choreographers

ERIC Educational Resources Information Center

Humphreys, Kathryn; Kimbrell, Sinéad

2013-01-01

Drawing on more than two decades of experience refining this teaching process, as well as insights from two consecutive research studies of Hubbard Street Dance Chicago's education work, this article presents best practice strategies for teaching choreography to elementary students in schools. The article outlines the rationale behind the Prepare,…

Construction of an Engineer's Notebook Rubric

ERIC Educational Resources Information Center

Kelley, Todd R.

2014-01-01

It is evident that there is a need for assessment instruments that measure design and engineering design skills, knowledge, and ways of design thinking. These student assessments must be authentic to engineering design practices and measure key elements of the engineering design process. Kelley (2011) presented a rationale to include…

Learning for Resilience? Exploring Learning Opportunities in Biosphere Reserves

ERIC Educational Resources Information Center

Schultz, Lisen; Lundholm, Cecilia

2010-01-01

The interdependence of society and nature, the inherent complexity of social-ecological systems, and the global deterioration of ecosystem services provide the rationale for a growing body of literature focusing on social-ecological resilience--the capacity to cope with, adapt to and shape change--for sustainable development. Processes of…

Comprehensive Career Guidance. Postsecondary & Adult. Programs and Model.

ERIC Educational Resources Information Center

Moore, Earl J.; Miller, Thomas B.

Divided into four parts, this document describes a comprehensive career guidance model for postsecondary and adult programs. In part 1, the rationale for extending career guidance and counseling into the lifelong learning perspective is explained, the Georgia Life Career Development Model is described, and the components of a process model for…

Authenticating Historical Fiction: Rationale and Process

ERIC Educational Resources Information Center

Groce, Eric; Groce, Robin

2005-01-01

In merging social studies education with language arts, classroom teachers are utilizing selections of historical fiction to teach critical literacy skills while also meeting social studies standards. While most of the selections used for teaching history and social studies themes are strong in terms of literary merit, they may be deficient in…

Problem Seeking. New Directions in Architectural Programming.

ERIC Educational Resources Information Center

Pena, William M.; Focke, John W.

The rationale, principles, and methods of pre-design architectural programing are explained for those responsible for overall policy decision-making in the area of facility planning. This programing process provides an orderly framework that aids the architect in defining a client's total problem. A general background is given on data collection,…

Preschool Teachers' Beliefs, Knowledge, and Practices Related to Classroom Management

ERIC Educational Resources Information Center

Drang, Debra Michal

2011-01-01

This study examined preschool teachers' beliefs, knowledge, and practices related to classroom management. The rationale for researching this topic is based on the role of teachers in the special education referral process, the poor success rate for inclusion for children with disabilities who demonstrate problematic classroom behaviors, and the…

The Westminster Eighth Grade World Problems Course (Pilot Project).

ERIC Educational Resources Information Center

Barth, James P.; And Others

The rationale, objectives, and social studies units are provided in this curriculum guide for grade 8. Focus is upon students' assessing, hypothesizing, and synthesizing the world's critical problems. Teaching techniques are process education oriented emphasizing inquiry training, problem solving, and inductive learning in an attempt to prepare…

What Is Comprehensive Sexuality Education? Going WAAAAAY beyond Abstinence and Condoms

ERIC Educational Resources Information Center

Helmich, Joan

2009-01-01

In this article, the author expands our definition of "comprehensive sexuality education," broadening the discourse to something more ideal than what current rhetoric seems to suggest, and in the process presents the rationale for real comprehensive sexuality education. Current definitions of comprehensive sexuality education focus on prevention…

An anthology: Rationale for a US ballistic missile defense (1969 - 1984)

NASA Astrophysics Data System (ADS)

Tircuit, E. C.

1985-04-01

This anthology is a selection and short synopsis of representative articles on the rationale for a US ballistic missile defense (BMD). Unclassified articles and documents were reviewed and analyzed to identify and include nine representative articles in the anthology. The anthology reduces the search for quality material on the subject and documents the fundamental rationale for a BMD. The author concluded that the fundamental rationale for a US BMD is to deter nuclear war. In addition, specific rationale for a US BMD is provided in the anthology. Finally, an extensive bibliography is included in the anthology to enhance further research on the subject.

Tracing the Rationale Behind UML Model Change Through Argumentation

NASA Astrophysics Data System (ADS)

Jureta, Ivan J.; Faulkner, Stéphane

Neglecting traceability—i.e., the ability to describe and follow the life of a requirement—is known to entail misunderstanding and miscommunication, leading to the engineering of poor quality systems. Following the simple principles that (a) changes to UML model instances ought be justified to the stakeholders, (b) justification should proceed in a structured manner to ensure rigor in discussions, critique, and revisions of model instances, and (c) the concept of argument instantiated in a justification process ought to be well defined and understood, the present paper introduces the UML Traceability through Argumentation Method (UML-TAM) to enable the traceability of design rationale in UML while allowing the appropriateness of model changes to be checked by analysis of the structure of the arguments provided to justify such changes.

[Principles of health economic evaluation for use by caregivers].

PubMed

Derumeaux-Burel, Hélène; Derancourt, Christian; Rambhojan, Christine; Branchard, Olivier; Hayes, Nathalie; Bénard, Antoine

2017-01-01

The aim of health economic evaluation is to maximize health gains from limited resources. By definition, health economic evaluation is comparative, based on average costs and outcomes of compared interventions. Incremental costs and outcomes are used to calculate the cost-effectiveness ratio, which represents the average incremental cost per gained unit of effectiveness (i.e.: a year of life) with the evaluated intervention compared to the reference. The health economic rationale applies to all health domains. We cannot spend collective resources (health insurance) without asking ourselves about their potential alternative uses. This reasoning is useful to caregivers for understanding resources allocation decisions and healthcare recommandations. Caregivers should grab this field of expertise because they are central in this strategic reflection for defining the future French healthcare landscape. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Outcome for Children Receiving the Early Start Denver Model Before and After 48 Months.

PubMed

Vivanti, Giacomo; Dissanayake, Cheryl

2016-07-01

The Early Start Denver Model (ESDM) is an intervention program recommended for pre-schoolers with autism ages 12-48 months. The rationale for this recommendation is the potential for intervention to affect developmental trajectories during early sensitive periods. We investigated outcomes of 32 children aged 18-48 months and 28 children aged 48-62 months receiving the ESDM for one year (approximately 20 h per week). Younger children achieved superior verbal DQ gains compared to their older counterparts. There were no group differences with respect to non-verbal DQ and adaptive behavior (with both age-groups undergoing significant change), or ASD severity (with neither age-group showing improvements on the ADOS). The association between verbal DQ gains and age at intake was moderated by baseline verbal level.

Probing Initial Conditions and Outcomes: Star and Planet Formation Programs within the NIRCam GTO Program

NASA Astrophysics Data System (ADS)

Meyer, Michael; NIRCam Star and Planet Formation Theme Team

2017-06-01

With its extraordinary sensitivity, wavelength coverage from < 1 to 5 microns, 2.2x4.4 arc minute field of view, and diversity of observing modes, NIRCam on JWST offers very powerful capabilities to explore the origins of stars and planets. Here we describe programs planned within the NIRCam GTO Program including: i) extinction mapping of pre-stellar cores; ii) massive star formation; iii) embedded clusters and the end of the IMF; iv) imaging and spectroscopy of young stellar objects; and v) excitation of PAH features. We will describe the scope of each program, selection of observing modes and rationale, as well as provide some explicit examples of program design. We will also review the expected outcomes, illustrating the power of NIRCam to answer questions fundamental to understanding the origins of stars and planets.

A Full-Time Nurse for Every School: A Call to Action to Make It Happen.

PubMed

Nikpour, Jacqueline; Hassmiller, Susan

2017-09-01

In June 2016, the American Academy of Pediatrics released its new policy statement recommending a full-time registered nurse in every school building. Indeed, increasing attention is being focused on school nursing, in part due to recent legislation, including the Affordable Care Act, the Healthy Hunger-Free Kids Act, and the Every Student Succeeds Act. Advocating for nursing practice within an education setting presents unique challenges in terms of changing the common perception of school nurses, variances in funding streams for school nursing, and the ability to link health outcomes with educational outcomes. The purpose of this article is to discuss the rationale for a school nurse in every building along with presenting action steps that individual and groups of school nurses can utilize to advocate for a full-time registered nurse in every school.

The effects of amphetamine exposure on outcome-selective Pavlovian-instrumental transfer in rats

PubMed Central

Shiflett, Michael W.

2012-01-01

Rationale Repeated exposure to psychostimulants alters behavioral responses to reward-related cues; however, the motivational underpinnings of this effect have not been fully characterized. Objectives The following study was designed to examine how amphetamine sensitization affects performance in rats on a series of Pavlovian and operant tasks that distinguish between general-incentive and outcome-selective forms of conditioned responses. Methods Adult male rats underwent Pavlovian and instrumental training for food pellet rewards. Following training, rats were sensitized to d-amphetamine (2 mg/kg for 7 days). Rats were subsequently tested on an outcome-selective Pavlovian-instrumental transfer (PIT) task, an outcome-reinstatement task, and an outcome devaluation task. Additionally, in a separate experiment PIT was assessed in amphetamine-sensitized and control rats using a Pavlovian backward-conditioned stimulus. Results Repeated amphetamine exposure sensitized locomotor activity to acute amphetamine challenge. Amphetamine altered responses to CS presentations by increasing conditioned approach. During tests of PIT amphetamine-treated rats showed no outcome-selectivity in their responding, responding to a CS whether or not it shared a common outcome with the instrumental response. No effect of amphetamine sensitization was observed on tests of outcome-selective reinstatement by outcome delivery, or action selection based on outcome value. Amphetamine-sensitized rats showed impaired outcome-selective PIT to a backward CS but were unaltered in conditioned approach. Conclusions Amphetamine sensitization prevents outcome-selective responding during PIT, which is dissociable from amphetamine’s effects on conditioned approach. These data suggest fundamental alterations in how stimuli motivate action in addiction. PMID:22562522

The Physician-as-Stakeholder: An Exploratory Qualitative Analysis of Physicians' Motivations for Using Shared Decision Making in the Emergency Department.

PubMed

Schoenfeld, Elizabeth M; Goff, Sarah L; Elia, Tala R; Khordipour, Errel R; Poronsky, Kye E; Nault, Kelly A; Lindenauer, Peter K; Mazor, Kathleen M

2016-12-01

Shared decision making (SDM) is increasingly recognized as an important facet of patient-centered care. Despite growing interest in SDM in the emergency department (ED), little is known about emergency physicians' (EPs') motivations for using SDM. Understanding current patterns of SDM use and EP's rationale for using SDM is essential for the development of interventions to increase use. Recognizing the EP as an important stakeholder in SDM research, we sought to identify and explore factors that may motivate EPs' engagement in SDM. In this qualitative study, informed by the Theory of Planned Behavior and Social Cognitive Theory, we conducted semistructured interviews with a purposeful sample of EPs. Interviews were recorded and transcribed verbatim. Using a directed qualitative content analysis approach, three members of the research team performed open coding of the transcripts in an iterative process, building a provisional code book as coding progressed. Respondent validation was employed to ensure methodologic rigor. Fifteen EPs, ages 31-65, from both academic and community practice settings, were interviewed. Several had not heard of the specific phrase "shared decision making," but all understood the concept and felt that they used SDM techniques to some degree. Most noted they had often had an agenda when they used SDM, which often motivated them to have the conversation. Agendas described included counteracting an algorithmic or defensive approach to diagnosis and treatment, avoiding harmful tests, or sharing uncertainty. All participants believed that patients benefited from SDM in terms of satisfaction, engagement, or education. Nearly all participants identified research outcomes that they felt would encourage their use of SDM (e.g., improvements in patient engagement, mitigation of risk) and many prioritized patient-centered outcomes over systems outcomes such as improved resource utilization. Little consensus was seen, however, regarding the importance of individual outcomes: of eight potential research outcomes participants endorsed, no single outcome was endorsed by even half of the physicians interviewed. Emergency physicians identified many factors that motivated them to use SDM. This study informs current research on SDM in the ED, particularly regarding the motivations of the physician-as-stakeholder. © 2016 by the Society for Academic Emergency Medicine.

Adhesives: Test Method, Group Assignment, and Categorization Guide for High-Loading Rate Applications - History and Rationale

DTIC Science & Technology

2017-04-20

Categorization Guide for High -Loading- Rate Applications – History and Rationale by Robert Jensen, David Flanagan, Daniel DeSchepper, and Charles...Adhesives: Test Method, Group Assignment, and Categorization Guide for High -Loading- Rate Applications – History and Rationale by Robert Jensen...Categorization Guide for High - Loading-Rate Applications – History and Rationale 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6

Rationale and study protocol of the EASY Minds (Encouraging Activity to Stimulate Young Minds) program: cluster randomized controlled trial of a primary school-based physical activity integration program for mathematics.

PubMed

Riley, Nicholas; Lubans, David R; Holmes, Kathryn; Morgan, Philip J

2014-08-08

Novel strategies are required to increase school-based physical activity levels of children. Integrating physical activity in mathematics lessons may lead to improvements in students' physical activity levels as well as enjoyment, engagement and learning. The primary aim of this study is to evaluate the impact of a curriculum-based physical activity integration program known as EASY Minds (Encouraging Activity to Stimulate Young Minds) on children's daily school time physical activity levels. Secondary aims include exploring the impact of EASY Minds on their engagement and 'on task' behaviour in mathematics. Grade 5/6 classes from eight public schools in New South Wales, Australia will be randomly allocated to intervention (n = 4) or control (n = 4) groups. Teachers from the intervention group will receive one day of professional development, a resource pack and asked to adapt their lessons to embed movement-based learning in their daily mathematics program in at least three lessons per week over a six week period. Intervention support will be provided via a weekly email and three lesson observations. The primary outcomes will be children's physical activity levels (accelerometry) across both the school day and during mathematics lessons (moderate-to-vigorous physical activity and sedentary time). Children's 'on-task' behaviour, enjoyment of mathematics and mathematics attainment will be assessed as secondary outcomes. A detailed process evaluation will be undertaken. EASY Minds is an innovative intervention that has the potential to improve key physical and academic outcomes for primary school aged children and help guide policy and practice regarding the teaching of mathematics. Australian and New Zealand Clinical Trials Register ACTRN12613000637741 13/05/2013.

An intervention to reduce sitting and increase light-intensity physical activity at work: Design and rationale of the 'Stand & Move at Work' group randomized trial.

PubMed

Buman, Matthew P; Mullane, Sarah L; Toledo, Meynard J; Rydell, Sarah A; Gaesser, Glenn A; Crespo, Noe C; Hannan, Peter; Feltes, Linda; Vuong, Brenna; Pereira, Mark A

2017-02-01

American workers spend 70-80% of their time at work being sedentary. Traditional approaches to increase moderate-vigorous physical activity (MVPA) may be perceived to be harmful to productivity. Approaches that target reductions in sedentary behavior and/or increases in standing or light-intensity physical activity [LPA] may not interfere with productivity and may be more feasible to achieve through small changes accumulated throughout the workday METHODS/DESIGN: This group randomized trial (i.e., cluster randomized trial) will test the relative efficacy of two sedentary behavior focused interventions in 24 worksites across two states (N=720 workers). The MOVE+ intervention is a multilevel individual, social, environmental, and organizational intervention targeting increases in light-intensity physical activity in the workplace. The STAND+ intervention is the MOVE+ intervention with the addition of the installation and use of sit-stand workstations to reduce sedentary behavior and enhance light-intensity physical activity opportunities. Our primary outcome will be objectively-measured changes in sedentary behavior and light-intensity physical activity over 12months, with additional process measures at 3months and longer-term sustainability outcomes at 24months. Our secondary outcomes will be a clustered cardiometabolic risk score (comprised of fasting glucose, insulin, triglycerides, HDL-cholesterol, and blood pressure), workplace productivity, and job satisfaction DISCUSSION: This study will determine the efficacy of a multi-level workplace intervention (including the use of a sit-stand workstation) to reduce sedentary behavior and increase LPA and concomitant impact on cardiometabolic health, workplace productivity, and satisfaction. ClinicalTrials.gov Identifier: NCT02566317 (date of registration: 10/1/2015). Copyright © 2016 Elsevier Inc. All rights reserved.

Placement matching of alcohol-dependent patients based on a standardized intake assessment: rationale and design of a randomized controlled trial.

PubMed

Buchholz, Angela; Friedrichs, Anke; Berner, Michael; König, Hans-Helmut; Konnopka, Alexander; Kraus, Ludwig; Kriston, Levente; Küfner, Heinrich; Piontek, Daniela; Rist, Fred; Röhrig, Jeanette

2014-10-14

Despite considerable research on substance-abuse placement matching, evidence is still inconclusive. The aims of this exploratory trial are to evaluate (a) the effects of following matching guidelines on health-care costs and heavy drinking, and (b) factors affecting the implementation of matching guidelines in the treatment of alcohol-dependent patients. A total of 286 alcohol-dependent patients entering one of four participating detoxification units and having no arrangements for further treatment will be recruited. During the first week of treatment, all patients will be administered Measurements in the Addictions for Triage and Evaluation (MATE), European Quality of Life-Five Dimensions health status questionnaire (EQ-5D), and the Client Socio--Demographic and Service Receipt Inventory-European Version (CSSRI-EU). Patients who are randomly allocated to the intervention group will receive feedback regarding their assessment results, including clear recommendations for subsequent treatment. Patients of the control group will receive treatment as usual and, if requested, global feedback regarding their assessment results, but no recommendations for subsequent treatment. At discharge, treatment outcome and referral decisions will be recorded. Six months after discharge, patients will be administered MATE-Outcome, EQ-5D, and CSSRI-EU during a telephone interview. This trial will provide evidence on the effects and costs of using placement-matching guidelines based on a standardized assessment with structured feedback in the treatment of alcohol-dependent patients. A process evaluation will be conducted to facilitate better understanding of the relationship between the use of guidelines, outcomes, and potential mediating variables. German Clinical Trials Register DRKS00005035. Registered 03 June 2013.

Method for appraising model validity of randomised controlled trials of homeopathic treatment: multi-rater concordance study

PubMed Central

2012-01-01

Background A method for assessing the model validity of randomised controlled trials of homeopathy is needed. To date, only conventional standards for assessing intrinsic bias (internal validity) of trials have been invoked, with little recognition of the special characteristics of homeopathy. We aimed to identify relevant judgmental domains to use in assessing the model validity of homeopathic treatment (MVHT). We define MVHT as the extent to which a homeopathic intervention and the main measure of its outcome, as implemented in a randomised controlled trial (RCT), reflect 'state-of-the-art' homeopathic practice. Methods Using an iterative process, an international group of experts developed a set of six judgmental domains, with associated descriptive criteria. The domains address: (I) the rationale for the choice of the particular homeopathic intervention; (II) the homeopathic principles reflected in the intervention; (III) the extent of homeopathic practitioner input; (IV) the nature of the main outcome measure; (V) the capability of the main outcome measure to detect change; (VI) the length of follow-up to the endpoint of the study. Six papers reporting RCTs of homeopathy of varying design were randomly selected from the literature. A standard form was used to record each assessor's independent response per domain, using the optional verdicts 'Yes', 'Unclear', 'No'. Concordance among the eight verdicts per domain, across all six papers, was evaluated using the kappa (κ) statistic. Results The six judgmental domains enabled MVHT to be assessed with 'fair' to 'almost perfect' concordance in each case. For the six RCTs examined, the method allowed MVHT to be classified overall as 'acceptable' in three, 'unclear' in two, and 'inadequate' in one. Conclusion Future systematic reviews of RCTs in homeopathy should adopt the MVHT method as part of a complete appraisal of trial validity. PMID:22510227

Peering into peer-review at GigaScience

PubMed Central

2013-01-01

Fostering and promoting more open and transparent science is one of the goals of GigaScience. One of the ways we have been doing this is by throwing light on the peer-review process and carrying out open peer-review as standard. In this editorial, we provide our rationale for undertaking this policy, give examples of our positive experiences to date, and encourage others to open up the normally opaque publication process. PMID:23587291

Developing family planning nurse practitioner protocols.

PubMed

Hawkins, J W; Roberto, D

1984-01-01

This article focuses on the process of development of protocols for family planning nurse practitioners. A rationale for the use of protocols, a definition of the types and examples, and the pros and cons of practice with protocols are presented. A how-to description for the development process follows, including methods and a suggested tool for critique and evaluation. The aim of the article is to assist nurse practitioners in developing protocols for their practice.

A Diagnostic Marker to Discriminate Childhood Apraxia of Speech from Speech Delay: III. Theoretical Coherence of the Pause Marker with Speech Processing Deficits in Childhood Apraxia of Speech

ERIC Educational Resources Information Center

Shriberg, Lawrence D.; Strand, Edythe A.; Fourakis, Marios; Jakielski, Kathy J.; Hall, Sheryl D.; Karlsson, Heather B.; Mabie, Heather L.; McSweeny, Jane L.; Tilkens, Christie M.; Wilson, David L.

2017-01-01

Purpose: Previous articles in this supplement described rationale for and development of the pause marker (PM), a diagnostic marker of childhood apraxia of speech (CAS), and studies supporting its validity and reliability. The present article assesses the theoretical coherence of the PM with speech processing deficits in CAS. Method: PM and other…

Removing the Taboo on the Surgical Violation (Cut-Through) of Cancer.

PubMed

Robbins, K Thomas; Bradford, Carol R; Rodrigo, Juan P; Suárez, Carlos; de Bree, Remco; Kowalski, Luiz P; Rinaldo, Alessandra; Silver, Carl E; Lund, Valerie J; Nibu, Ken-Ichi; Ferlito, Alfio

2016-10-01

The surgical dictum of en bloc resection without violating cancer tissue has been challenged by novel treatments in head and neck cancer. An analysis of treatment outcomes involving piecemeal removal of sinonasal, laryngeal, oropharyngeal, and hypopharyngeal cancer shows that it did not compromise tumor control. The rationale for the evolution toward use of this technique is outlined. While complete resection with clear margins remains a key end point in surgical oncology, we believe it is time to acknowledge that this time-honored dictum of avoiding tumor violation is no longer valid in selected situations.

Patients with rib fractures: use of incentive spirometry volumes to guide care.

PubMed

Brown, Sheree D; Walters, Madonna R

2012-01-01

Rib fractures pose significant risk to trauma patients. Effective pain control and the ability to take deep breaths are crucial for optimal recovery, and these are key elements in current clinical guidelines. These guidelines use incentive spirometry volumes along with other assessment values to guide patient care. However, despite current guidelines, nurses do not routinely document inspired respiratory volumes. This article provides trauma nurses with the rationale for documenting and tracking incentive spirometry volumes to improve outcomes for patients with rib fractures. This promotes early detection of respiratory decline and early interventions to improve pain control and pulmonary function.

A Systematic Review on the Designs of Clinical Technology: Findings and Recommendations for Future Research

PubMed Central

PhD, Greg Alexander; Staggers, Nancy

2010-01-01

Human factors (HF) studies are increasingly important as technology infuses into clinical settings. No nursing research reviews exist in this area. The authors conducted a systematic review on designs of clinical technology, 34 articles with 50 studies met inclusion criteria. Findings were classified into three categories based on HF research goals. The majority of studies evaluated effectiveness of clinical design; efficiency was fewest. Current research ranges across many interface types examined with no apparent pattern or obvious rationale. Future research should expand types, settings, participants; integrate displays; and expand outcome variables. PMID:19707093

Trials, tribulations, and triumphs of a pilot initiative to optimize the management of wounds complicated by diabetes within the home.

PubMed

Hodgins, Marilyn J; Logan, Susan M; Price, Karla; Thompson, Carol

2014-01-01

To support home health care nurses in their efforts to optimize the management of patients with wounds complicated by diabetes, an initiative was introduced that incorporated a standardized assessment tool, electronic data entry, and the provision of written treatment recommendations with supporting rationale prepared by nurses with expertise in diabetes and wound care. A pilot study was conducted that provided preliminary evidence of the feasibility of this initiative as well as its potential effect on outcomes for patients, nurses, and the home care program.

A modified tensionless gingival grafting technique using acellular dermal matrix.

PubMed

Taylor, John B; Gerlach, Robert C; Herold, Robert W; Bisch, Frederick C; Dixon, Douglas R

2010-10-01

Conventional surgical procedures designed for autogenous tissue material may not be appropriate when using acellular dermal matrix (ADM) for the treatment of gingival recessions. This article describes a new surgical technique that addresses the unique and sensitive aspects of ADM specifically to improve esthetic outcomes and gain increased clinical predictability when treating Miller Class I and II gingival recession defects. In this paper, a root coverage case is described and the specific steps and rationale for this new technique are explained. This technique has been predictable clinically, with results comparable to those achieved using autogenous tissue.

Management of Osseous and Soft-Tissue Ankle Equinus During Total Ankle Replacement.

PubMed

Roukis, Thomas S; Simonson, Devin C

2015-10-01

Obtaining functional alignment of a total ankle replacement, including physiologic sagittal plane range of motion, is paramount for a successful outcome. This article reviews the literature on techniques available for correction of osseous and soft-tissue equinus at the time of index total ankle replacement. These techniques include anterior tibiotalar joint cheilectomy, posterior superficial muscle compartment lengthening, posterior ankle capsule release, and release of the posterior portions of the medial and lateral collateral ligament complexes. The rationale for these procedures and the operative sequence of events for these procedures are presented. Copyright © 2015 Elsevier Inc. All rights reserved.

PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting.

PubMed

Mor, Vincent; Volandes, Angelo E; Gutman, Roee; Gatsonis, Constantine; Mitchell, Susan L

2017-04-01

Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the "real world" application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization prior to recruitment feasible with 100% participation of facilities randomized to the intervention arm. Critical regulatory issues included minimal risk determination, waiver of informed consent, and determination that nursing home providers were not engaged in human subjects research. Intervention training and implementation were initiated on 5 January 2016 using corporate infrastructures for new program roll-out guided by standardized training elements designed by the research team. Video Status Reports in facilities' electronic medical records permitted "real-time" adherence monitoring and corrective actions. The Centers for Medicare and Medicaid Services Virtual Research Data Center allowed for rapid outcomes ascertainment. Conclusion We must rigorously evaluate interventions to deliver more patient-focused care to an increasingly frail nursing home population. Video decision support is a practical approach to improve advance care planning. PRagmatic trial Of Video Education in Nursing homes has the potential to promote goal-directed care among millions of older Americans in nursing homes and establish a methodology for future pragmatic randomized controlled trials in this complex healthcare setting.

Rationale and Description of Right Ventricle-Protective Ventilation in ARDS.

PubMed

Paternot, Alexis; Repessé, Xavier; Vieillard-Baron, Antoine

2016-10-01

Pulmonary vascular dysfunction is associated with ARDS and leads to increased right-ventricular afterload and eventually right-ventricular failure, also called acute cor pulmonale. Interest in acute cor pulmonale and its negative impact on outcome in patients with ARDS has grown in recent years. Right-ventricular function in these patients should be closely monitored, and this is helped by the widespread use of echocardiography in intensive care units. Because mechanical ventilation may worsen right-ventricular failure, the interaction between the lungs and the right ventricle appears to be a key factor in the ventilation strategy. In this review, a rationale for a right ventricle-protective ventilation approach is provided, and such a strategy is described, including the reduction of lung stress (ie, the limitation of plateau pressure and driving pressure), the reduction of PaCO2 , and the improvement of oxygenation. Prone positioning seems to be a crucial part of this strategy by protecting both the lungs and the right ventricle, resulting in increased survival of patients with ARDS. Further studies are required to validate the positive impact on prognosis of right ventricle-protective mechanical ventilation. Copyright © 2016 by Daedalus Enterprises.

Screening for Barrett’s Esophagus and Esophageal Adenocarcinoma: Rationale, Recent Progress, Challenges and Future Directions

PubMed Central

Sami, Sarmed S.; Ragunath, Krish; Iyer, Prasad G.

2014-01-01

As the incidence and mortality of esophageal adenocarcinoma continue to increase, strategies to counter this need to be explored. Screening for Barrett’s esophagus, which is the known precursor of a large majority of adenocarcinomas, has been debated without a firm consensus. Given evidence for and against perceived benefits of screening, the multitude of challenges in the implementation of such a strategy and in the downstream management of subjects with Barrett’s esophagus who could be diagnosed by screening, support for screening has been modest. Recent advances in form of development and initial accuracy of non-invasive tools for screening, risk assessment tools and biomarker panels to risk stratify subjects with BE, have spurred renewed interest in the early detection of Barrett’s esophagus and related neoplasia, particularly with the advent of effective endoscopic therapy. In this review, we explore in depth, the potential rationale for screening for Barrett’s esophagus, recent advances which have the potential of making screening feasible and also highlight some of the challenges which will have to be overcome to develop an effective approach to improve the outcomes of subjects with esophageal adenocarcinoma. PMID:24887058

Personalized Risk Estimator for Rheumatoid Arthritis (PRE-RA) Family Study: rationale and design for a randomized controlled trial evaluating rheumatoid arthritis risk education to first-degree relatives.

PubMed

Sparks, Jeffrey A; Iversen, Maura D; Miller Kroouze, Rachel; Mahmoud, Taysir G; Triedman, Nellie A; Kalia, Sarah S; Atkinson, Michael L; Lu, Bing; Deane, Kevin D; Costenbader, Karen H; Green, Robert C; Karlson, Elizabeth W

2014-09-01

We present the rationale, design features, and protocol of the Personalized Risk Estimator for Rheumatoid Arthritis (PRE-RA) Family Study (ClinicalTrials.gov NCT02046005). The PRE-RA Family Study is an NIH-funded prospective, randomized controlled trial designed to compare the willingness to change behaviors in first-degree relatives of rheumatoid arthritis (RA) patients without RA after exposure to RA risk educational programs. Consented subjects are randomized to receive education concerning their personalized RA risk based on demographics, RA-associated behaviors, genetics, and biomarkers or to receive standard RA information. Four behavioral factors associated with RA risk were identified from prior studies for inclusion in the risk estimate: cigarette smoking, excess body weight, poor oral health, and low fish intake. Personalized RA risk information is presented through an online tool that collects data on an individual's specific age, gender, family history, and risk-related behaviors; presents genetic and biomarker results; displays relative and absolute risk of RA; and provides personalized feedback and education. The trial outcomes will be changes in willingness to alter behaviors from baseline to 6 weeks, 6 months, and 12 months in the three intervention groups. The design and the execution of this trial that targets a special population at risk for RA, while incorporating varied risk factors into a single risk tool, offer distinct challenges. We provide the theoretical rationale for the PRE-RA Family Study and highlight particular design features of this trial that utilize personalized risk education as an intervention. Copyright © 2014 Elsevier Inc. All rights reserved.

Rationale and design of a study using a standardized locally procured macronutrient supplement as adjunctive therapy to HIV treatment in Kenya.

PubMed

Sztam, Kevin A; Ndirangu, Murugi; Sheriff, Muhsin; Arpadi, Stephen M; Hawken, Mark; Rashid, Juma; Deckelbaum, Richard J; El Sadr, Wafaa M

2013-01-01

Poor nutritional status at initiation of antiretroviral therapy (ART) is predictive of mortality. Decreased dietary intake is a major determinant of weight loss in HIV. Despite a biological rationale to treat undernutrition in adults receiving ART, few studies have provided data on feasibility, safety, effectiveness, and sustainability of specific macronutrient supplements with HIV treatment in adults, especially supplements such as a food basket, a supplement approach seldom evaluated in spite of its wide use. We present the rationale and design for a study of a locally procured macronutrient supplement given to HIV-infected patients initiating ART with a body mass index (BMI) ≤20.0 kg/m(2). The objective was to determine feasibility of procurement, distribution, safety and to obtain preliminary effectiveness data for a locally procured supplement. The design was a comparative study for 200 adult participants at two Kenya government-supported clinics. The primary outcome was BMI at 24 weeks. Supplement duration was 24 weeks, total follow-up was 48 weeks, and the study included a comparison site. Novel aspects of this study include use of a standardized macronutrient supplement to protect the participant against household food sharing, and a complementary micronutrient supplement. Comprehensive data collected included dietary intake, HIV-related quality-of-life, food security, neuropsychiatric assessments, laboratory studies, and household geomapping. Assessments were made at baseline, at 24 weeks, and at 48 weeks post-ART initiation. Challenges included establishing a partnership with local millers, distribution from the HIV clinic, food safety, and tracking of participants. These findings will help inform nutrition support programming in Kenya and similar settings, and provide needed data regarding use of macronutrient supplements as an adjunctive intervention with ART.

Social Information Processing and Group-Induced Response Shifts

DTIC Science & Technology

1984-01-01

34). The rationale for not using a standard task attributes measure such as the JDS (Hackman . & Oldham, 1975) or JCI (Sims, Szilagyi , & Keller, 1976...68588 P4-5/B5 LIST 15 (Continued) 452:KD:716:enj 78u452-883 24 June 1981 Dr. H. Wallace Sinaiko Program Director, Manpower Research and