Evaluation of pavement surface friction treatments.

DOT National Transportation Integrated Search

2011-12-01

The implementation of a pavement preservation program involves a learning curve with not only a determination to succeed, but : also the courage to fail. Also, successful implementation of pavement preservation program requires knowledge of the perfo...

Evaluation of pavement surface friction treatments : [technical summary].

DOT National Transportation Integrated Search

2011-01-01

The implementation of a pavement preservation program involves a learning curve with not only a determination to succeed, but also the courage to fail. Successful implementation of pavement preservation program requires knowledge of the performance o...

Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study.

PubMed

Kumar, Sameer; Aldrich, Krista

2010-12-01

An EMR system implementation would significantly reduce clinician workload and medical errors while saving the US healthcare system major expense. Yet, compared to other developed nations, the US lags behind. This article examines EMR system efforts, benefits, and barriers, as well as steps needed to move the US closer to a nationwide EMR system. The analysis includes a blueprint for implementation of EMR, industry comparisons to highlight the differences between successful and non-successful EMR ventures, references to costs and benefit information, and identification of root causes. 'Poka-yokes' (avoid (yokeru) mistakes (poka)) will be inserted to provide insight into how to systematically overcome challenges. Implementation will require upfront costs including patient privacy that must be addressed early in the development process. Government structure, incentives and mandates are required for nationwide EMR system in the US.

Implementing smoking bans in American hospitals: results of a national survey

PubMed Central

Longo, D.; Feldman, M.; Kruse, R.; Brownson, R.; Petroski, G.; Hewett, J.

1998-01-01

OBJECTIVES—To determine how well hospitals complied with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) tobacco control standards, which required banning smoking in hospital buildings; to explore issues involved in developing and implementing smoking bans; and to ascertain the perceived success of the policies.
DESIGN—Postal survey conducted January through June 1994.
PARTICIPANTS—Stratified random sample of American hospitals surveyed by JCAHO (n = 1055).
MAIN OUTCOME MEASURES—Enacting smoking policies more restrictive than the JCAHO standard; the respondent's judgment of the relative success of the hospital's smoking policy.
RESULTS—More than 96% of hospitals complied with the smoking ban standard; 41.4% enacted policies that were more restrictive than required by JCAHO. Several characteristics were associated with exceeding JCAHO requirements: location in a "non-tobacco state"; having fewer than 100 beds; location in a metropolitan statistical area; having unionised employees; and having no psychiatric or substance abuse unit, favour having the same tobacco policy in psychiatry and substance abuse units as the rest of the hospital. More than 95% of respondents viewed their hospital's policy as successful. The JCAHO requirements and concern for employees' health were the major forces influencing hospitals to go smoke-free. Negative employee morale and lack of acceptance by visitors and patients were the most commonly cited barriers to overcome when implementing smoke-free policies.
CONCLUSIONS—Smoking bans were successfully implemented in American hospitals, with many restricting smoking beyond the JCAHO standard. Other industries wishing to follow hospitals' lead would be most likely to succeed in the context of a social norm favouring a smoking ban and regulation by an outside agency.


Keywords: smoke-free worksites; hospitals; United States PMID:9706754

Improved cost monitoring and control through the Earned Value Management System

NASA Astrophysics Data System (ADS)

Hunter, Howard; Fitzgerald, Richard; Barlow, Dewey

2014-01-01

As economic pressure and competition for budget among federal agencies has increased, there has been an increasing need for more granular data and robust management information systems. This is especially true for the execution of major civilian space programs. This need has resulted in new program management requirements being implemented in an attempt to limit cost and schedule growth. In particular, NASA Procedural Requirements (NPR) 7120.5D requires the implementation of an Earned Value Management System (EVMS) compliant with the requirements of American National Standards Institute (ANSI)/Electronic Industries Alliance Standard 748-B. The Radiation Belt Storm Probes (RBSP) program management team at The Johns Hopkins University Applied Physics Laboratory (JHU/APL) made a decision to implement an EVMS on RBSP during Phase B—a year earlier than specified in the contractual Phase C reporting requirement as defined in the NPR. This decision was made so that the project would have the benefit of 12 months of training and hands-on implementation during Phase B. Although there were a number of technical and process hurdles encountered during Phase B and into Phase C, the system was working well when the Integrated Baseline Review (IBR) was held in August 2009. The IBR was a success because it met the review requirements. It was also clear to all IBR participants that the EVMS was providing value to the project management team. Although the IBR pointed out some areas of concern regarding process and ANSI compliance, the system had markedly improved the project's ability to monitor cost and schedule. This, in turn, allowed the project team to foresee problems in advance, formulate corrective actions, and implement course corrections without causing significant adverse impact to the project. Opponents of EVMS systems often communicate the unfavorable opinion that EVMS systems create unnecessary cost and administration. Although it is undeniable that EVMS implementation does not occur without cost, the cost is minimal in comparison to the benefits of successful implementation. This paper will focus on the implementation of EVMS on the RBSP project, explain EV processes and the implementation's cost, and analyze the benefits of EVMS to provide insight into cost/benefit considerations for other projects considering EVMS implementation. This paper will do this by focusing on the following points: (1) RBSP is the first full-up implementation of earned value management (EVM) at JHU/APL; (2) RBSP EVM started in Phase B; (3) RBSP EVM implementation has been working well in Phase C/D; (4) RBSP EVM implementation has been recognized by Goddard Space Flight Center and NASA Headquarters as successful; and (5) an assessment of the benefits of EVMS to the project management team and sponsor shows that the system's benefits outweigh the cost of implementation.

Method of evaluating the impact of ERP implementation critical success factors - a case study in oil and gas industries

NASA Astrophysics Data System (ADS)

Gajic, Gordana; Stankovski, Stevan; Ostojic, Gordana; Tesic, Zdravko; Miladinovic, Ljubomir

2014-01-01

The so far implemented enterprise resource planning (ERP) systems have in many cases failed to meet the requirements regarding the business process control, decrease of business costs and increase of company profit margin. Therefore, there is a real need for an evaluation of the influence of ERP on the company's performance indicators. Proposed in this article is an advanced model for the evaluation of the success of ERP implementation on organisational and operational performance indicators in oil-gas companies. The recommended method establishes a correlation between a process-based method, a scorecard model and ERP critical success factors. The method was verified and tested on two case studies in oil-gas companies using the following procedure: the model was developed, tested and implemented in a pilot gas-oil company, while the results were implemented and verified in another gas-oil company.

Special Topic Interoperability and EHR: Combining openEHR, SNOMED, IHE, and Continua as approaches to interoperability on national eHealth.

PubMed

Beštek, Mate; Stanimirović, Dalibor

2017-08-09

The main aims of the paper comprise the characterization and examination of the potential approaches regarding interoperability. This includes openEHR, SNOMED, IHE, and Continua as combined interoperability approaches, possibilities for their incorporation into the eHealth environment, and identification of the main success factors in the field, which are necessary for achieving required interoperability, and consequently, for the successful implementation of eHealth projects in general. The paper represents an in-depth analysis regarding the potential application of openEHR, SNOMED, IHE and Continua approaches in the development and implementation process of eHealth in Slovenia. The research method used is both exploratory and deductive in nature. The methodological framework is grounded on information retrieval with a special focus on research and charting of existing experience in the field, and sources, both electronic and written, which include interoperability concepts and related implementation issues. The paper will try to answer the following inquiries that are complementing each other: 1. Scrutiny of the potential approaches, which could alleviate the pertinent interoperability issues in the Slovenian eHealth context. 2. Analyzing the possibilities (requirements) for their inclusion in the construction process for individual eHealth solutions. 3. Identification and charting the main success factors in the interoperability field that critically influence development and implementation of eHealth projects in an efficient manner. Provided insights and identified success factors could serve as a constituent of the strategic starting points for continuous integration of interoperability principles into the healthcare domain. Moreover, the general implementation of the identified success factors could facilitate better penetration of ICT into the healthcare environment and enable the eHealth-based transformation of the health system especially in the countries which are still in an early phase of eHealth planning and development and are often confronted with differing interests, requirements, and contending strategies.

Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities.

PubMed

Hartman, D J; Pantanowitz, L; McHugh, J S; Piccoli, A L; OLeary, M J; Lauro, G R

2017-10-01

Digital pathology is becoming technically possible to implement for routine pathology work. At our institution, we have been using digital pathology for second opinion intraoperative consultations for over 10 years. Herein, we describe our experience in converting to a digital pathology platform for primary pathology diagnosis. We implemented an incremental rollout for digital pathology on subspecialty benches, beginning with cases that contained small amounts of tissue (biopsy specimens). We successfully scanned over 40,000 slides through our digital pathology system. Several lessons (both challenges and opportunities) were learned through this implementation. A successful conversion to digital pathology requires pre-imaging adjustments, integrated software and post-imaging evaluations.

1.5 MW RF Load for ITER

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

Ives, Robert Lawrence; Marsden, David; Collins, George

Calabazas Creek Research, Inc. developed a 1.5 MW RF load for the ITER fusion research facility currently under construction in France. This program leveraged technology developed in two previous SBIR programs that successfully developed high power RF loads for fusion research applications. This program specifically focused on modifications required by revised technical performance, materials, and assembly specification for ITER. This program implemented an innovative approach to actively distribute the RF power inside the load to avoid excessive heating or arcing associated with constructive interference. The new design implemented materials and assembly changes required to meet specifications. Critical components were builtmore » and successfully tested during the program.« less

A New Age of Implementation: Guiding Principles for Implementing Performance Assessment Systems

ERIC Educational Resources Information Center

Chapin, Gary; Gagnon, Laurie; Hammonds, Virgel

2017-01-01

In an examination of the conditions required for the successful implementation of performance assessment, the authors draw on a range of personal experience and other insights to guide practitioners and policymakers. Building on the authentic assessment work of the Boston Pilot Schools (CCE 2004), in 2008 the Center for Collaborative Education…

Implementing a Problem-Based Learning Curriculum in an Argentinean Medical School: Implications for Developing Countries.

ERIC Educational Resources Information Center

Carrera, Larisa Ivon; Tellez, Tomas Eduardo; D'Ottavio, Alberto Enrique

2003-01-01

Describes the difficulties Argentina's medical schools are likely to face in implementing a problem-based learning (PBL) curriculum. Outlines the basic requirements for successful implementation of PBL curricula and describes the contradiction in Argentina between a health care system that forces specialization and the efforts of medical schools…

Implementing an Integrated Commitment Management System at the Savannah River Site Tank Farms

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

Blanchard, A.

1999-06-16

Recently, the Savannah River Site Tank Farms have been transitioning from pre-1990 Authorization Basis requirements to new 5480.22/.23 requirements. Implementation of the new Authorization Basis has resulted in more detailed requirements, a completely new set of implementing procedures, and the expectation of even more disciplined operations. Key to the success of this implementation has been the development of an Integrated Commitment Management System (ICMS) by Westinghouse Safety Management Solutions. The ICMS has two elements: the Authorization Commitment Matrix (ACM), and a Procedure Consistency Review methodology. The Authorization Commitment Matrix is a linking database, which ties requirements and implementing documents together.more » The associated Procedure Consistency Review process ensures that the procedures to be credited in the ACM do in fact correctly and completely meet all intended commitments. This Integrated Commitment Management System helps Westinghouse Safety Management Solutions and the facility operations and engineering organizations take ownership in the implementation of the requirements that have been developed.« less

Supports and Concerns for Teacher Professional Growth During the Implementation of a Science Curriculum Innovation

NASA Astrophysics Data System (ADS)

Peers, Cheryl (Shelley) E.; Diezmann, Carmel M.; Watters, James J.

2003-02-01

Internationally, considerable reform in science education is occurring which promotes constructivist philosophies and advocates constructivist-inspired pedagogical strategies that are new to many teachers. This paper reports on the supporting factors necessary for teacher professional growth and the issues of concern that were evident during one primary teacher''s successful implementation of a unit of work based on a draft of a new state-wide science syllabus which proposes such approaches. One researcher (CEP) provided guidance during the writing and implementation of the unit through professional development workshops complemented by ongoing collegial support. The analysis of the teacher''s practice reveals that professional growth required a willingness of the teacher to engage with change and modify his professional practice. The support factors for teacher growth consisted of an appropriate program of professional development, teacher understanding of the elements of the curriculum innovation, and successful experiences in implementing new approaches. In contrast, the issues of concern were: the adequacy of support for planning including the time required to understand the innovation and make changes to teaching practice; science equipment; teacher knowledge; classroom management strategies; and ways to cope with change. Understanding of these support factors and issues of concern is vital for the successful implementation of science curriculum innovations.

Electronic health records: critical success factors in implementation.

PubMed

Safdari, Reza; Ghazisaeidi, Marjan; Jebraeily, Mohamad

2015-04-01

EHR implementation results in the improved quality of care, customer-orientation and timely access to complete information. Despite the potential benefits of EHR, its implementation is a difficult and complex task whose success depends on many factors. The purpose of this research is indeed to identify the key success factors of EHR. This is a cross-sectional survey conducted with participation of 340 work forces from different types of job from Hospitals of TUMS in 2014. Data were collected using a self-structured questionnaire which was estimated as both reliable and valid. The data were analyzed by SPSS software descriptive statistics and analytical statistics. 58.2% of respondents were female and their mean age and work experience were 37.7 and 11.2 years, respectively and most respondents (52.5%) was bachelor. In terms of job, the maximum rate was related to nursing (33 %) and physician (21 %). the main category of critical success factors in Implementation EHRs, the highest rate related to Project Management (4.62) and lowest related to Organizational factors (3.98). success in implementation EHRs requirement more centralization to project management and human factors. Therefore must be Creating to EHR roadmap implementation, establishment teamwork to participation of end-users and select prepare leadership, users obtains sufficient training to use of system and also prepare support from maintain and promotion system.

High Performance Implementation of 3D Convolutional Neural Networks on a GPU.

PubMed

Lan, Qiang; Wang, Zelong; Wen, Mei; Zhang, Chunyuan; Wang, Yijie

2017-01-01

Convolutional neural networks have proven to be highly successful in applications such as image classification, object tracking, and many other tasks based on 2D inputs. Recently, researchers have started to apply convolutional neural networks to video classification, which constitutes a 3D input and requires far larger amounts of memory and much more computation. FFT based methods can reduce the amount of computation, but this generally comes at the cost of an increased memory requirement. On the other hand, the Winograd Minimal Filtering Algorithm (WMFA) can reduce the number of operations required and thus can speed up the computation, without increasing the required memory. This strategy was shown to be successful for 2D neural networks. We implement the algorithm for 3D convolutional neural networks and apply it to a popular 3D convolutional neural network which is used to classify videos and compare it to cuDNN. For our highly optimized implementation of the algorithm, we observe a twofold speedup for most of the 3D convolution layers of our test network compared to the cuDNN version.

High Performance Implementation of 3D Convolutional Neural Networks on a GPU

PubMed Central

Wang, Zelong; Wen, Mei; Zhang, Chunyuan; Wang, Yijie

2017-01-01

Convolutional neural networks have proven to be highly successful in applications such as image classification, object tracking, and many other tasks based on 2D inputs. Recently, researchers have started to apply convolutional neural networks to video classification, which constitutes a 3D input and requires far larger amounts of memory and much more computation. FFT based methods can reduce the amount of computation, but this generally comes at the cost of an increased memory requirement. On the other hand, the Winograd Minimal Filtering Algorithm (WMFA) can reduce the number of operations required and thus can speed up the computation, without increasing the required memory. This strategy was shown to be successful for 2D neural networks. We implement the algorithm for 3D convolutional neural networks and apply it to a popular 3D convolutional neural network which is used to classify videos and compare it to cuDNN. For our highly optimized implementation of the algorithm, we observe a twofold speedup for most of the 3D convolution layers of our test network compared to the cuDNN version. PMID:29250109

Maternity Nurses' Perceptions of Implementation of the Ten Steps to Successful Breastfeeding.

PubMed

Cunningham, Emilie M; Doyle, Eva I; Bowden, Rodney G

The purpose of this study was to determine maternity nurses' perceptions of implementing the Ten Steps to Successful Breastfeeding. An online survey and a focus group were used to evaluate perceptions of maternity nurses of implementing the Ten Steps to Successful Breastfeeding in an urban Texas hospital at the onset of the project initiation. Responses were transcribed and coded using Nvivo software. Thematic analysis was conducted and consensus was reached among the research team to validate themes. Twenty-eight maternity nurses participated. Nurses perceived a number of barriers to implementing the Ten Steps to Successful Breastfeeding including nurse staffing shortages, variations in practice among nurses, different levels of nurse education and knowledge about breastfeeding, lack of parental awareness and knowledge about breastfeeding, culture, and postpartum issues such as maternal fatigue, visitors, and routine required procedures during recovery care that interfered with skin-to-skin positioning. Maternity nurses desired more education about breastfeeding; specifically, a hands-on approach, rather than formal classroom instruction, to be able to promote successful implementation of the Ten Steps. More education on breastfeeding for new mothers, their families, and healthcare providers was recommended. Nurse staffing should be adequate to support nurses in their efforts to promote breastfeeding. Skin-to-skin positioning should be integrated into the recovery period. Hospital leadership support for full implementation and policy adherence is essential. Challenges in implementing the Ten Steps were identified along with potential solutions.

Management considerations to implementing pharmaceutical care.

PubMed

Wichman, K; Hales, B; O'Brodovich, M; Paton, T; Wielenga, J

1993-12-01

Progressing towards the goal of PC requires a fundamental change to pharmacy practice. Strong leadership and management skills will be needed to facilitate this change. Even with enthusiastic and capable staff, implementation of the PC model will require considerable effort. Changes to the department's mission statement and organizational structure will be required. From this beginning, an action plan for the department can be developed. This plan includes the training of individuals and/or recruiting the necessary personnel. An ongoing education program, as well as determining the value of your service, is required. With successful implementation the PC model will lead to the acceptance of the pharmacist's role as the person responsible for identifying, preventing, and resolving drug-related problems.

What drives successful implementation of pollution prevention and cleaner technology strategy? The role of innovative capability.

PubMed

Bhupendra, Kumar Verma; Sangle, Shirish

2015-05-15

Firms that are dynamic and prepared to implement environmental strategies have a potential competitive advantage over their industry counterparts. Therefore, it is important to understand, what capabilities are required to implement proactive environmental strategies. The paper discusses the attributes of innovative capability required by firms in order to adopt pollution prevention and cleaner technology strategies. Empirical results show that process and behavioral innovativeness are required by firms to implement a pollution prevention strategy. In addition to process and behavioral innovativeness, firms need a top management with high risk-taking ability as well as market, product, and strategic innovativeness to implement a cleaner technology strategy. The paper proposes some important managerial implications on the basis of the above research findings. Copyright © 2015 Elsevier Ltd. All rights reserved.

Implementing Innovations in Global Women's, Children's, and Adolescents' Health: Realizing the Potential for Implementation Science.

PubMed

Peterson, Herbert B; Haidar, Joumana; Fixsen, Dean; Ramaswamy, Rohit; Weiner, Bryan J; Leatherman, Sheila

2018-03-01

The launch of the United Nations Sustainable Development Goals and the new Secretary General's Global Strategy for Women's, Children's, and Adolescents' Health are a window of opportunity for improving the health and well-being of women, children, and adolescents in the United States and around the world. Realizing the full potential of this historic moment will require that we improve our ability to successfully implement life-saving and life-enhancing innovations, particularly in low-resource settings. Implementation science, a new and rapidly evolving field that addresses the "how-to" component of providing sustainable quality services at scale, can make an important contribution on this front. A synthesis of the implementation science evidence indicates that three interrelated factors are required for successful, sustainable outcomes at scale: 1) effective innovations, 2) effective implementation, and 3) enabling contexts. Implementation science addresses the interaction among these factors to help make innovations more usable, to build ongoing capacity to assure the effective implementation of these innovations, and to ensure enabling contexts to sustain their full and effective use in practice. Improving access to quality services will require transforming health care systems and, therefore, much of the focus of implementation science in global health is on improving the ability of health systems to serve as enabling contexts. The field of implementation science is inherently interdisciplinary and academe will need to respond by facilitating collaboration among scientists from relevant disciplines, including evaluation, improvement, and systems sciences. Platforms and programs to facilitate collaborations among researchers, practitioners, policymakers, and funders are likewise essential.

For all the right reasons. Approaching CPOE from a patient safety and care quality perspective is the first critical step toward success.

PubMed

Hagland, Mark

2009-09-01

True CPOE success is about facilitating improved patient safety, care quality, and efficiency in a multidisciplinar environment, and on an ongoing basis. CPOE implementation forces clinician leaders to examine and rework long-ingrained care delivery processes, especially as they build or adapt order sets. The likelihood that CPOE will be a requirement of meaningful use could compel a rapid acceleration in implementation.

Implementing a Successful Bilingual Educational Program in Japan: Support for Minority Languages and the Present Climate of Bilingual Education

ERIC Educational Resources Information Center

Cumming, Brett

2011-01-01

Although generally acknowledged as complex and multidimensional, bilingual education, when successful, plays an important role in maintaining and developing bilingualism, resulting in numerous benefits to those who undertake it. This essay will discuss the necessary components and principles of what is required to make a successful bilingual…

Dissemination of psychosocial treatments for anxiety: the importance of taking a broad perspective.

PubMed

Taylor, Steven; Abramowitz, Jonathan S

2013-12-01

Dissemination methods are used to increase the likelihood that a given treatment or form of clinical practice is implemented by clinicians in the community. Therapist training in treatment methods is an important component of dissemination. Successful dissemination also requires that roadblocks to treatment implementation are identified and circumvented, such as misconceptions that clinicians might hold about a given treatment. The present article offers a commentary on the papers included in the special issue on treatment dissemination for anxiety disorders. Most papers focus on issues concerning the training and education of clinicians with regard to exposure therapy. Training and education is an important step but should be part of a broad, multifaceted approach. There are several other important methods of treatment dissemination, including methods developed and implemented with success by the pharmaceutical industry, might also be used to disseminate psychosocial therapies. Optimal dissemination likely requires a broad perspective in which multiple dissemination methods are considered for implementation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Human Behavior Based Exploratory Model for Successful Implementation of Lean Enterprise in Industry

ERIC Educational Resources Information Center

Sawhney, Rupy; Chason, Stewart

2005-01-01

Currently available Lean tools such as Lean Assessments, Value Stream Mapping, and Process Flow Charting focus on system requirements and overlook human behavior. A need is felt for a tool that allows one to baseline personnel, determine personnel requirements and align system requirements with personnel requirements. Our exploratory model--The…

Individualized student advisement for preparation for the national council licensure examination for registered nurses: a community college experience.

PubMed

Anderson, Ruth M

2007-01-01

The success of faculty is, in part, measured by the success of their students. One measurement of student success is passing the National Council Licensure Examination for Registered Nurses. However, some students require assistance beyond routine class work; they require a personalized plan for studying based on individualized areas of weakness. The author reviews the process of implementing a program of individualized student advisement. Included are samples of forms that have been developed to assist in this process.

Twelve tips for implementing whole-task curricula: how to make it work.

PubMed

Dolmans, Diana H J M; Wolfhagen, Ineke H A P; Van Merriënboer, Jeroen J G

2013-10-01

Whole-task models of learning and instructional design, such as problem-based learning, are nowadays very popular. Schools regularly encounter large problems when they implement whole-task curricula. The main aim of this article is to provide 12 tips that may help to make the implementation of a whole-task curriculum successful. Implementing whole-task curricula fails when the implementation is not well prepared. Requirements that must be met to make the implementation of whole task models into a success are described as twelve tips. The tips are organized in four clusters and refer to (1) the infrastructure, (2) the teachers, (3) the students, and (4) the management of the educational organization. Finally, the presented framework will be critically discussed and the importance of shared values and a change of culture is emphasized.

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

PubMed

Werth, S Rose; Sachdeva, Nidhi; Roberts, Andrew W; Garrettson, Mariana; Ringwalt, Chris; Moss, Leslie A; Pikoulas, Theodore; Skinner, Asheley Cockrell

2014-11-01

The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.  To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.  We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.  Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.  Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

Design requirements for SRB production control system. Volume 4: Implementation

NASA Technical Reports Server (NTRS)

1981-01-01

The implementation plan which is presented was developed to provide the means for the successful implementation of the automated production control system. There are three factors which the implementation plan encompasses: detailed planning; phased implementation; and user involvement. The plan is detailed to the task level in terms of necessary activities as the system is developed, refined, installed, and tested. These tasks are scheduled, on a preliminary basis, over a two-and-one-half-year time frame.

Report on the Successful AustLit: Australian Literature Gateway Implementation of the FRBR and INDECS Event Models, and Implications for Other FRBR Implementations.

ERIC Educational Resources Information Center

Ayres, Marie-Louise; Kilner, Kerry; Fitch, Kent; Scarvell, Annette

This paper discusses the first major implementation of two significant new cataloging models: IFLA's FRBR (International Federation of Library Associations' Functional Requirements for Bibliographic Records) and event modeling (INDECS and Harmony). The paper refers briefly to the decision making processes leading to the adoption of these models,…

Commentary: Implementing Interventions: Building a Shared Understanding of Why

ERIC Educational Resources Information Center

Grøver, Vibeke

2016-01-01

This commentary discusses how the articles that comprise this special issue conceptualize what is required for reading interventions to change instruction. Three challenges to successful implementation are addressed: identifying institutional barriers to change, identifying intervention components that are not commonly part of the teachers'…

Implementing a Web-Based Registration and Administration System for Credit-by-Examination: Graduate Education Course Test Case.

ERIC Educational Resources Information Center

Wang, Lih-Ching Chen

2002-01-01

Discusses the problems and successes encountered in implementing a Web-based registration and administration system for credit-by-examination in a required graduate course, detailing the ways in which this system improves upon its paper-based predecessor. (EV)

A Plan for Revolutionary Change in Gas Turbine Engine Control System Architecture

NASA Technical Reports Server (NTRS)

Culley, Dennis E.

2011-01-01

The implementation of Distributed Engine Control technology on the gas turbine engine has been a vexing challenge for the controls community. A successful implementation requires the resolution of multiple technical issues in areas such as network communications, power distribution, and system integration, but especially in the area of high temperature electronics. Impeding the achievement has been the lack of a clearly articulated message about the importance of the distributed control technology to future turbine engine system goals and objectives. To resolve these issues and bring the technology to fruition has, and will continue to require, a broad coalition of resources from government, industry, and academia. This presentation will describe the broad challenges facing the next generation of advanced control systems and the plan which is being put into action to successfully implement the technology on the next generation of gas turbine engine systems.

Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences.

PubMed

Damani, Zaheed; MacKean, Gail; Bohm, Eric; Noseworthy, Tom; Wang, Jenney Meng Han; DeMone, Brie; Wright, Brock; Marshall, Deborah A

2018-02-01

Single-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system's design/implementation; successes, challenges, and unanticipated consequences. On two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings. Respondents indicated that the overarching objectives of the WCIS were being met. Benefits included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations and under-reporting of data by surgeons' offices. Critical success factors for implementation included a requirement for clear communication, robust data collection, physician leadership and patience by all, especially implementation teams. Although successfully implemented, key lessons and critical success factors were learned related to change management, which if considered and applied, can reduce unanticipated consequences, improve uptake and benefit new models of care. Copyright © 2017 Elsevier B.V. All rights reserved.

Implementation of Epic Beaker Anatomic Pathology at an Academic Medical Center.

PubMed

Blau, John Larry; Wilford, Joseph D; Dane, Susan K; Karandikar, Nitin J; Fuller, Emily S; Jacobsmeier, Debbie J; Jans, Melissa A; Horning, Elisabeth A; Krasowski, Matthew D; Ford, Bradley A; Becker, Kent R; Beranek, Jeanine M; Robinson, Robert A

2017-01-01

Beaker is a relatively new laboratory information system (LIS) offered by Epic Systems Corporation as part of its suite of health-care software and bundled with its electronic medical record, EpicCare. It is divided into two modules, Beaker anatomic pathology (Beaker AP) and Beaker Clinical Pathology. In this report, we describe our experience implementing Beaker AP version 2014 at an academic medical center with a go-live date of October 2015. This report covers preimplementation preparations and challenges beginning in September 2014, issues discovered soon after go-live in October 2015, and some post go-live optimizations using data from meetings, debriefings, and the project closure document. We share specific issues that we encountered during implementation, including difficulties with the proposed frozen section workflow, developing a shared specimen source dictionary, and implementation of the standard Beaker workflow in large institution with trainees. We share specific strategies that we used to overcome these issues for a successful Beaker AP implementation. Several areas of the laboratory-required adaptation of the default Beaker build parameters to meet the needs of the workflow in a busy academic medical center. In a few areas, our laboratory was unable to use the Beaker functionality to support our workflow, and we have continued to use paper or have altered our workflow. In spite of several difficulties that required creative solutions before go-live, the implementation has been successful based on satisfaction surveys completed by pathologists and others who use the software. However, optimization of Beaker workflows has continued to be an ongoing process after go-live to the present time. The Beaker AP LIS can be successfully implemented at an academic medical center but requires significant forethought, creative adaptation, and continued shared management of the ongoing product by institutional and departmental information technology staff as well as laboratory managers to meet the needs of the laboratory.

Implementing peer review of teaching: a guide for dental educators.

PubMed

Cunningham, I M; Johnson, I; Lynch, C D

2017-04-07

Peer review of teaching (PRT) is well established and valued within higher education. Increasingly, dental educators involved in undergraduate or postgraduate teaching are required to undertake PRT as part of their teaching development. Despite this, there is a paucity of literature relating to PRT within dental education, and none that considers the implementation of PRT within large dental teaching establishments. This article describes in detail a staged process for the planning and implementation of PRT within a UK dental school. It uses relevant educational literature to supplement the authors' experiences and recommendations. By highlighting aspects of the process which are key to successful implementation, it is a useful guide for all dental educator teams who wish to successfully introduce, restructure or refresh a PRT scheme.

Building Systems for Successful Implementation of Function-Based Support in Schools

ERIC Educational Resources Information Center

Anderson, Cynthia M.; Horner, Robert H.; Rodriguez, Billie Jo; Stiller, Brianna

2013-01-01

Supporting the full range of students with behavioral challenges requires that schools build the capacity to implement evidence-based behavioral interventions. Fortunately, a substantive body of research documents behavioral interventions are available to both decrease problem behavior and enhance prosocial skills. To date, however, this…

A Teacher Proposed Heuristic for ICT Professional Teacher Development and Implementation in the South African Context

ERIC Educational Resources Information Center

du Plessis, Andre; Webb, Paul

2012-01-01

This qualitative interpretive exploratory case study investigated a sample of South African teachers' perceptions of the requirements for successful implementation of Information and Communication Technology (ICT) Professional Teacher Development (PTD) within disadvantaged South African township schools in the Port Elizabeth district in South…

Central State University: Phase III Report

ERIC Educational Resources Information Center

Ohio Board of Regents, 2013

2013-01-01

This document is the final report on Central State University's implementation of Section 371 of Ohio Amended Substitute House Bill 153. Implementation of Phase I action items required that deliverables and timelines be shifted to give Central State the best opportunity for early success. In Phase II, Central State responded aggressively to a…

Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.

PubMed

Alidina, Shehnaz; Goldhaber-Fiebert, Sara N; Hannenberg, Alexander A; Hepner, David L; Singer, Sara J; Neville, Bridget A; Sachetta, James R; Lipsitz, Stuart R; Berry, William R

2018-03-26

Operating room (OR) crises are high-acuity events requiring rapid, coordinated management. Medical judgment and decision-making can be compromised in stressful situations, and clinicians may not experience a crisis for many years. A cognitive aid (e.g., checklist) for the most common types of crises in the OR may improve management during unexpected and rare events. While implementation strategies for innovations such as cognitive aids for routine use are becoming better understood, cognitive aids that are rarely used are not yet well understood. We examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. We conducted a cross-sectional study using a Web-based survey of individuals who had downloaded OR cognitive aids from the websites of Ariadne Labs or Stanford University between January 2013 and January 2016. In this paper, we report on the experience of 368 respondents from US hospitals and ambulatory surgical centers. We analyzed the relationship of more successful implementation (measured as reported regular cognitive aid use during applicable clinical events) with organizational context and with participation in a multi-step implementation process. We used multivariable logistic regression to identify significant predictors of reported, regular OR cognitive aid use during OR crises. In the multivariable logistic regression, small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation (p = 0.0092). Completing more implementation steps was also significantly associated with more successful implementation; each implementation step completed was associated with just over 50% higher odds of more successful implementation (p ≤ 0.0001). More successful implementation was associated with leadership support (p < 0.0001) and dedicated time to train staff (p = 0.0189). Less successful implementation was associated with resistance among clinical providers to using cognitive aids (p < 0.0001), absence of an implementation champion (p = 0.0126), and unsatisfactory content or design of the cognitive aid (p = 0.0112). Successful implementation of cognitive aids in ORs was associated with a supportive organizational context and following a multi-step implementation process. Building strong organizational support and following a well-planned multi-step implementation process will likely increase the use of OR cognitive aids during intraoperative crises, which may improve patient outcomes.

The elimination of fox rabies from Europe: determinants of success and lessons for the future

PubMed Central

Freuling, Conrad M.; Hampson, Katie; Selhorst, Thomas; Schröder, Ronald; Meslin, Francois X.; Mettenleiter, Thomas C.; Müller, Thomas

2013-01-01

Despite perceived challenges to controlling an infectious disease in wildlife, oral rabies vaccination (ORV) of foxes has proved a remarkably successful tool and a prime example of a sophisticated strategy to eliminate disease from wildlife reservoirs. During the past three decades, the implementation of ORV programmes in 24 countries has led to the elimination of fox-mediated rabies from vast areas of Western and Central Europe. In this study, we evaluated the efficiency of 22 European ORV programmes between 1978 and 2010. During this period an area of almost 1.9 million km² was targeted at least once with vaccine baits, with control taking between 5 and 26 years depending upon the country. We examined factors influencing effort required both to control and eliminate fox rabies as well as cost-related issues of these programmes. The proportion of land area ever affected by rabies and an index capturing the size and overlap of successive ORV campaigns were identified as factors having statistically significant effects on the number of campaigns required to both control and eliminate rabies. Repeat comprehensive campaigns that are wholly overlapping much more rapidly eliminate infection and are less costly in the long term. Disproportionally greater effort is required in the final phase of an ORV programme, with a median of 11 additional campaigns required to eliminate disease once incidence has been reduced by 90 per cent. If successive ORV campaigns span the entire affected area, rabies will be eliminated more rapidly than if campaigns are implemented in a less comprehensive manner, therefore reducing ORV expenditure in the longer term. These findings should help improve the planning and implementation of ORV programmes, and facilitate future decision-making by veterinary authorities and policy-makers. PMID:23798690

The elimination of fox rabies from Europe: determinants of success and lessons for the future.

PubMed

Freuling, Conrad M; Hampson, Katie; Selhorst, Thomas; Schröder, Ronald; Meslin, Francois X; Mettenleiter, Thomas C; Müller, Thomas

2013-08-05

Despite perceived challenges to controlling an infectious disease in wildlife, oral rabies vaccination (ORV) of foxes has proved a remarkably successful tool and a prime example of a sophisticated strategy to eliminate disease from wildlife reservoirs. During the past three decades, the implementation of ORV programmes in 24 countries has led to the elimination of fox-mediated rabies from vast areas of Western and Central Europe. In this study, we evaluated the efficiency of 22 European ORV programmes between 1978 and 2010. During this period an area of almost 1.9 million km² was targeted at least once with vaccine baits, with control taking between 5 and 26 years depending upon the country. We examined factors influencing effort required both to control and eliminate fox rabies as well as cost-related issues of these programmes. The proportion of land area ever affected by rabies and an index capturing the size and overlap of successive ORV campaigns were identified as factors having statistically significant effects on the number of campaigns required to both control and eliminate rabies. Repeat comprehensive campaigns that are wholly overlapping much more rapidly eliminate infection and are less costly in the long term. Disproportionally greater effort is required in the final phase of an ORV programme, with a median of 11 additional campaigns required to eliminate disease once incidence has been reduced by 90 per cent. If successive ORV campaigns span the entire affected area, rabies will be eliminated more rapidly than if campaigns are implemented in a less comprehensive manner, therefore reducing ORV expenditure in the longer term. These findings should help improve the planning and implementation of ORV programmes, and facilitate future decision-making by veterinary authorities and policy-makers.

Campus Stories: Three Case Studies. Part C: Putting Experiential Education into Practice--Using Kolb as a Learning Model for Implementing Organizational Change

ERIC Educational Resources Information Center

Johnson, James R.; Kovach, Ronald J.; Roberson, Patricia N.

2010-01-01

This article is the third of three case studies of successful implementation of experiential education at very different types of institutions. This case study discusses the use of David A. Kolb's Experiential Learning Model in the implementation of innovative graduation requirements in experiential education that began in 2008. Purdue University…

Curriculum Mapping in Higher Education: A Case Study and Proposed Content Scope and Sequence Mapping Tool

ERIC Educational Resources Information Center

Arafeh, Sousan

2016-01-01

Best practice in curriculum development and implementation requires that discipline-based standards or requirements embody both curricular and programme scopes and sequences. Ensuring these are present and aligned in course/programme content, activities and assessments to support student success requires formalised and systematised review and…

Implementation of the Enhanced Flight Termination System at National Aeronautics and Space Administration Dryden Flight Research Center

NASA Technical Reports Server (NTRS)

Tow, David

2010-01-01

This paper discusses the methodology, requirements, tests, and results of the implementation of the current operating capability for the Enhanced Flight Termination System (EFTS) at the National Aeronautics and Space Administration (NASA) Dryden Flight Research Center (DFRC). The implementation involves the development of the EFTS at NASA DFRC starting from the requirements to system safety review to full end to end system testing, and concluding with the acceptance of the system as an operational system. The paper discusses the first operational usage and subsequent flight utilizing EFTS successfully.

Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

PubMed

Hoffman, James M; Baker, Donald K; Howard, Scott C; Laver, Joseph H; Shenep, Jerry L

2011-02-01

Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.

A detailed description of the implementation of inpatient insulin orders with a commercial electronic health record system.

PubMed

Neinstein, Aaron; MacMaster, Heidemarie Windham; Sullivan, Mary M; Rushakoff, Robert

2014-07-01

In the setting of Meaningful Use laws and professional society guidelines, hospitals are rapidly implementing electronic glycemic management order sets. There are a number of best practices established in the literature for glycemic management protocols and programs. We believe that this is the first published account of the detailed steps to be taken to design, implement, and optimize glycemic management protocols in a commercial computerized provider order entry (CPOE) system. Prior to CPOE implementation, our hospital already had a mature glycemic management program. To transition to CPOE, we underwent the following 4 steps: (1) preparation and requirements gathering, (2) design and build, (3) implementation and dissemination, and (4) optimization. These steps required more than 2 years of coordinated work between physicians, nurses, pharmacists, and programmers. With the move to CPOE, our complex glycemic management order sets were successfully implemented without any significant interruptions in care. With feedback from users, we have continued to refine the order sets, and this remains an ongoing process. Successful implementation of glycemic management protocols in CPOE is dependent on broad stakeholder input and buy-in. When using a commercial CPOE system, there may be limitations of the system, necessitating workarounds. There should be an upfront plan to apply resources for continuous process improvement and optimization after implementation. © 2014 Diabetes Technology Society.

Lean practices for quality results: a case illustration.

PubMed

Hwang, Pauline; Hwang, David; Hong, Paul

2014-01-01

Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations. The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals. An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices. Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific organisations and inter-organisational networks. Healthcare managers are adopting business practices that improve efficiency and productivity while ensuring their healthcare mission and guaranteeing that customer values are achieved. Shared understanding about complex goals (e.g. reducing waste and enhancing customer value) at the front-end is crucial for implementing successful lean practices. In particular, this study shows that nursing practices, which are both labour intensive and technology enabled, are good candidates for lean practice.

76 FR 12651 - Approval and Promulgation of Implementation Plans; State of Oregon; Regional Haze State...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

... reasonable progress goals and the long term strategy. A. Definition of Regional Haze Regional haze is... Addressing Regional Haze Successful implementation of the Regional Haze Program will require long-term...'s long term strategy for addressing regional haze. The reasonable progress goals in the draft and...

Setting Learning Analytics in Context: Overcoming the Barriers to Large-Scale Adoption

ERIC Educational Resources Information Center

Ferguson, Rebecca; Macfadyen, Leah P.; Clow, Doug; Tynan, Belinda; Alexander, Shirley; Dawson, Shane

2014-01-01

A core goal for most learning analytic projects is to move from small-scale research towards broader institutional implementation, but this introduces a new set of challenges because institutions are stable systems, resistant to change. To avoid failure and maximize success, implementation of learning analytics at scale requires explicit and…

Using Simulation to Explore Lean Manufacturing Implementation Strategies

ERIC Educational Resources Information Center

Shannon, Patrick W.; Krumwiede, Kip R.; Street, Jeffrey N.

2010-01-01

Lean manufacturing, an outgrowth of the Toyota Production System, has spread far beyond the automobile industry and is seen by many leaders as a key management philosophy in the battle to compete on an international scale. Successful implementation of lean requires that managers and employees be educated in the proper application of lean tools and…

Evaluating Evaluation Systems: Policy Levers and Strategies for Studying Implementation of Educator Evaluation. Policy Snapshot

ERIC Educational Resources Information Center

Matlach, Lauren

2015-01-01

Evaluation studies can provide feedback on implementation, support continuous improvement, and increase understanding of evaluation systems' impact on teaching and learning. Despite the importance of educator evaluation studies, states often need support to prioritize and fund them. Successful studies require expertise, time, and a shared…

And Then a Miracle Occurs! Ensuring the Successful Implementation of Enterpisewide EPSS and E-Learning from Day One.

ERIC Educational Resources Information Center

Stone, Deborah L.; Villachica, Steven W.

2003-01-01

Provides suggestions to ensure the success of electronic performance support systems (EPSS) and electronic learning, including creating hybrid solutions; aligning EPSS with business objectives and performance requirements; change management efforts; and rapid application development to lower costs, shrink schedules, and improve quality.…

Success for All? The Role of the School Counselor in Creating and Sustaining Culturally Responsive Positive Behavior Interventions and Supports Programs

ERIC Educational Resources Information Center

Betters-Bubon, Jennifer; Brunner, Todd; Kansteiner, Avery

2016-01-01

Successful implementation of Positive Behavior Interventions and Supports (PBIS) programs should include culturally responsive practices to reduce disproportionality in school discipline referrals and create effective learning environments for all students. Sustaining culturally responsive PBIS programs requires attention to student demographics…

Considerations in change management related to technology.

PubMed

Luo, John S; Hilty, Donald M; Worley, Linda L; Yager, Joel

2006-01-01

The authors describe the complexity of social processes for implementing technological change. Once a new technology is available, information about its availability and benefits must be made available to the community of users, with opportunities to try the innovations and find them worthwhile, despite organizational resistances. The authors reviewed the literature from psychiatry, psychology, sociology, business, and technology to distill common denominators for success and failure related to implementing technology. Beneficial technological innovations that are simple to use and obviously save everyone time and effort are easy to inaugurate. However, innovations that primarily serve management rather than subordinates or front-line utilizers may fail, despite considerable institutional effort. This article reviews and outlines several of the more prominent theoretical models governing successful institutional change. Successful implementation of difficult technological changes requires visionary leadership that has carefully considered the benefits, consulted with influence leaders at all organizational levels to spot unintended consequences and sources of resistance, and developed a detailed plan and continuous quality assurance process to foster implementation over time.

Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries.

PubMed

Horwood, Christiane M; Youngleson, Michele S; Moses, Edward; Stern, Amy F; Barker, Pierre M

2015-07-01

Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care.

Lean Management Systems in Radiology: Elements for Success.

PubMed

Schultz, Stacy R; Ruter, Royce L; Tibor, Laura C

2016-01-01

This article is a review of the literature on Lean and Lean Management Systems and how they have been implemented in healthcare organizations and particularly in radiology departments. The review focuses on the elements required for a successful implementation of Lean by applying the principles of a Lean Management System instead of a Lean tools-only approach. This review shares the successes and failures from healthcare organizations' efforts to improve the quality and safety of the services they provide. There are a limited number of healthcare organizations in the literature who have shared their experiences and additional research is necessary to determine whether a Lean Management System is a viable alternative to the current management structure in healthcare.

Geriatric hip fracture management: keys to providing a successful program.

PubMed

Basu, N; Natour, M; Mounasamy, V; Kates, S L

2016-10-01

Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program. The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital's data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process. To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential-those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.

A Review on Critical Success Factors of Governance towards Sustainable Campus Operations

NASA Astrophysics Data System (ADS)

Halid Abdullah, Abd; Razman, Ruzaimah; Muslim, Rahmat

2017-08-01

Campus Sustainability is an effort that integrates environmentally sustainable practices into institutional practices. A successful transition to a sustainable campus requires the involvement of the university community; the administration, academics departments (faculty and students), researchers and he local community. Our research seeks to identify Critical Success Factors (CSFs) of university governance that contribute to the success in implementing Sustainable Campus Operation (SCO) initiatives. The common CSFs have been identified from 22 published and unpublished articles, conference proceedings, university reports, books, and website documents. The CSFs are mapped and ranked based on the frequency of the identified CSFs. 23 CSFs of SCO have been identified through this research. This research revealed that the CSF that contributes the highest frequency as indicated by most researchers is “developing network with external parties for gaining consensus and commitment”. By identifying these CSFs, this research will help assist universities in successfully plan and implement their SCO initiatives.

Design and Multicentric Implementation of a Generic Software Architecture for Patient Recruitment Systems Re-Using Existing HIS Tools and Routine Patient Data

PubMed Central

Trinczek, B.; Köpcke, F.; Leusch, T.; Majeed, R.W.; Schreiweis, B.; Wenk, J.; Bergh, B.; Ohmann, C.; Röhrig, R.; Prokosch, H.U.; Dugas, M.

2014-01-01

Summary Objective (1) To define features and data items of a Patient Recruitment System (PRS); (2) to design a generic software architecture of such a system covering the requirements; (3) to identify implementation options available within different Hospital Information System (HIS) environments; (4) to implement five PRS following the architecture and utilizing the implementation options as proof of concept. Methods Existing PRS were reviewed and interviews with users and developers conducted. All reported PRS features were collected and prioritized according to their published success and user’s request. Common feature sets were combined into software modules of a generic software architecture. Data items to process and transfer were identified for each of the modules. Each site collected implementation options available within their respective HIS environment for each module, provided a prototypical implementation based on available implementation possibilities and supported the patient recruitment of a clinical trial as a proof of concept. Results 24 commonly reported and requested features of a PRS were identified, 13 of them prioritized as being mandatory. A UML version 2 based software architecture containing 5 software modules covering these features was developed. 13 data item groups processed by the modules, thus required to be available electronically, have been identified. Several implementation options could be identified for each module, most of them being available at multiple sites. Utilizing available tools, a PRS could be implemented in each of the five participating German university hospitals. Conclusion A set of required features and data items of a PRS has been described for the first time. The software architecture covers all features in a clear, well-defined way. The variety of implementation options and the prototypes show that it is possible to implement the given architecture in different HIS environments, thus enabling more sites to successfully support patient recruitment in clinical trials. PMID:24734138

Design and multicentric implementation of a generic software architecture for patient recruitment systems re-using existing HIS tools and routine patient data.

PubMed

Trinczek, B; Köpcke, F; Leusch, T; Majeed, R W; Schreiweis, B; Wenk, J; Bergh, B; Ohmann, C; Röhrig, R; Prokosch, H U; Dugas, M

2014-01-01

(1) To define features and data items of a Patient Recruitment System (PRS); (2) to design a generic software architecture of such a system covering the requirements; (3) to identify implementation options available within different Hospital Information System (HIS) environments; (4) to implement five PRS following the architecture and utilizing the implementation options as proof of concept. Existing PRS were reviewed and interviews with users and developers conducted. All reported PRS features were collected and prioritized according to their published success and user's request. Common feature sets were combined into software modules of a generic software architecture. Data items to process and transfer were identified for each of the modules. Each site collected implementation options available within their respective HIS environment for each module, provided a prototypical implementation based on available implementation possibilities and supported the patient recruitment of a clinical trial as a proof of concept. 24 commonly reported and requested features of a PRS were identified, 13 of them prioritized as being mandatory. A UML version 2 based software architecture containing 5 software modules covering these features was developed. 13 data item groups processed by the modules, thus required to be available electronically, have been identified. Several implementation options could be identified for each module, most of them being available at multiple sites. Utilizing available tools, a PRS could be implemented in each of the five participating German university hospitals. A set of required features and data items of a PRS has been described for the first time. The software architecture covers all features in a clear, well-defined way. The variety of implementation options and the prototypes show that it is possible to implement the given architecture in different HIS environments, thus enabling more sites to successfully support patient recruitment in clinical trials.

Strategic service-line planning. Building competitive advantage.

PubMed

Greenspan, Elizabeth; Krentz, Susanna E; O'Neill, Molly K

2003-12-01

Service-line planning requires a healthcare organization to develop a business plan for each of its service lines. Successful service-line planning requires top leadership support, a willingness to allocate resources, the development of support mechanisms, the active support and involvement of physicians, and management commitment and accountability during implementation.

Implementing guidelines on reporting research using animals (ARRIVE etc.): new requirements for publication in BJP

PubMed Central

McGrath, John C; Lilley, Elliot

2015-01-01

The ARRIVE guidelines have been implemented in BJP for 4 years with the aim of increasing transparency in reporting experiments involving animals. BJP has assessed our success in implementing them and concluded that we could do better. This editorial discusses the issues and explains how we are changing our requirements for authors to report their findings in experiments involving animals. This is one of a series of editorials discussing updates to the BJP Instructions to Authors Video To view the video on the ARRIVE guidelines, visit: https://www.youtube.com/watch?v=DYXoUAnhoPM PMID:25964986

Some Aspects of the Implementation of the Principle of Transparency in Russian Universities: Research, Experience, Perspectives

ERIC Educational Resources Information Center

Egorov, Evgeny Evgenievich; Lebedev?, Tatiana Evgenievna; Bulganina, Svetlana Viktorovna; Vasilyeva, Lyudmila Ivanovna

2015-01-01

The aim of this study is to identify achieved successes, existing gaps and possible prospects of implementing the principle of transparency by Russian universities. It was focused upon the information transparency of educational activities from the perspective of legal requirements and interests of applicants and university students. The analysis…

Preconditions for Sustainable Changes in Didactics Applying Self-Directed Learning in the General Education School

ERIC Educational Resources Information Center

Kazlauskiene, Ausra; Gaucaite, Ramute; Poceviciene, Rasa

2016-01-01

Implementation of the result-oriented (self-)education paradigm in the general education school requires sustainable changes in didactics not only on the strategic document plane but also in educational practice. However, its implementation in practice is complicated. The success of the interaction between theory and practice largely depends on…

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective.

PubMed

Sidek, Yusof Haji; Martins, Jorge Tiago

2017-11-01

Electronic health records (EHR) make health care more efficient. They improve the quality of care by making patients' medical history more accessible. However, little is known about the factors contributing to the successful EHR implementation in dental clinics. This article aims to identify the perceived critical success factors of EHR system implementation in a dental clinic context. We used Grounded Theory to analyse data collected in the context of Brunei's national EHR - the Healthcare Information and Management System (Bru-HIMS). Data analysis followed the stages of open, axial and selective coding. Six perceived critical success factors emerged: usability of the system, emergent behaviours, requirements analysis, training, change management, and project organisation. The study identified a mismatch between end-users and product owner/vendor perspectives. Workflow changes were significant challenges to clinicians' confident use, particularly as the system offered limited modularity and configurability. Recommendations are made for all the parties involved in healthcare information systems implementation to manage the change process by agreeing system goals and functionalities through wider consensual debate, and participated supporting strategies realised through common commitment. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

A Comparison of Two Reading Programs on Third Grade Reading Achievement

ERIC Educational Resources Information Center

Miller, Tawana D.

2008-01-01

Background: The No Child Left Behind Act legislation requires both higher standards and higher success rates at the same time. Failure of students to learn to read adequately as shown by national and state test results and the need for continued school success had prompted education officials to implement two reading programs--Voyager Universal…

A successful model to learn and implement ultrasound-guided venous catheterization in apheresis.

PubMed

Gopalasingam, Nigopan; Thomsen, Anna-Marie Eller; Folkersen, Lars; Juhl-Olsen, Peter; Sloth, Erik

2017-12-01

Apheresis treatments can be performed with peripheral venous catheters (PVC), although central venous catheters (CVC) are inserted when PVCs fail or patient with history of difficult vascular access prior to the apheresis. Ultrasound guidance for PVC has shown promising results in other settings. To investigate if ultrasound guidance for PVC could be implemented among apheresis nurses. Second, how implementation of ultrasound guidance affected the number of CVCs used for apheresis per patient. Apheresis nurses completed a systematic training program for ultrasound-guided vascular access. All independent catheterizations were registered during the implementation stage. The number of CVCs in the pre- and postimplementation stages of the ultrasound guidance was compared. Six nurses completed the training program within a median of 48 days (range 38-83 days). In 77 patients, 485 independent ultrasound-guided PVC placements were performed during the implementation stage. All apheresis treatments (485/485) were accomplished using PVCs without requiring CVC as rescue. During the preimplementation stage, 125 of 273 (45.8%) procedures required a CVC for completion of apheresis procedures; during the postimplementation stage only 30 of 227 (13.2%) procedures required a CVC (p < 0.001). In the postimplementation stage, no CVCs were placed as rescue caused by failed PVCs but were only placed for patients where the ultrasound machine was unavailable. It indicates an effective success rate of 100% for ultrasound-guided PVC use. This study showed that ultrasound guidance could be implemented among apheresis nurses as a routine tool eliminating the need of CVC as a rescue. © 2017 Wiley Periodicals, Inc.

Use of the preconditioned conjugate gradient algorithm as a generic solver for mixed-model equations in animal breeding applications.

PubMed

Tsuruta, S; Misztal, I; Strandén, I

2001-05-01

Utility of the preconditioned conjugate gradient algorithm with a diagonal preconditioner for solving mixed-model equations in animal breeding applications was evaluated with 16 test problems. The problems included single- and multiple-trait analyses, with data on beef, dairy, and swine ranging from small examples to national data sets. Multiple-trait models considered low and high genetic correlations. Convergence was based on relative differences between left- and right-hand sides. The ordering of equations was fixed effects followed by random effects, with no special ordering within random effects. The preconditioned conjugate gradient program implemented with double precision converged for all models. However, when implemented in single precision, the preconditioned conjugate gradient algorithm did not converge for seven large models. The preconditioned conjugate gradient and successive overrelaxation algorithms were subsequently compared for 13 of the test problems. The preconditioned conjugate gradient algorithm was easy to implement with the iteration on data for general models. However, successive overrelaxation requires specific programming for each set of models. On average, the preconditioned conjugate gradient algorithm converged in three times fewer rounds of iteration than successive overrelaxation. With straightforward implementations, programs using the preconditioned conjugate gradient algorithm may be two or more times faster than those using successive overrelaxation. However, programs using the preconditioned conjugate gradient algorithm would use more memory than would comparable implementations using successive overrelaxation. Extensive optimization of either algorithm can influence rankings. The preconditioned conjugate gradient implemented with iteration on data, a diagonal preconditioner, and in double precision may be the algorithm of choice for solving mixed-model equations when sufficient memory is available and ease of implementation is essential.

Project planning, training, measurement and sustainment: the successful implementation of voice recognition.

PubMed

Antiles, S; Couris, J; Schweitzer, A; Rosenthal, D; Da Silva, R Q

2000-01-01

Computerized voice recognition systems (VR) can reduce costs and enhance service. The capital outlay required for conversion to a VR system is significant; therefore, it is incumbent on radiology departments to provide cost and service justifications to administrators. Massachusetts General Hospital (MGH) in Boston implemented VR over a two-year period and achieved annual savings of $530,000 and a 50% decrease in report throughput. Those accomplishments required solid planning and implementation strategies, training and sustainment programs. This article walks through the process, step by step, in the hope of providing a tool set for future implementations. Because VR has dramatic implications for workflow, a solid operational plan is needed when assessing vendors and planning for implementation. The goals for implementation should be to minimize operational disruptions and capitalize on efficiencies of the technology. Senior leadership--the department chair or vice-chair--must select the goals to be accomplished and oversee, manage and direct the VR initiative. The importance of this point cannot be overstated, since implementation will require behavior changes from radiologists and others who may not perceive any personal benefits. Training is the pivotal factor affecting the success of voice recognition, and practice is the only way for radiologists to enhance their skills. Through practice, radiologists will discover shortcuts, and their speed and comfort will improve. Measurement and data analysis are critical to changing and improving the voice recognition application and are vital to decision-making. Some of the issues about which valuable date can be collected are technical and educational problems, VR penetration, report turnaround time and annual cost savings. Sustained effort is indispensable to the maintenance of voice recognition. Finally, all efforts made and gains achieved may prove to be futile without ongoing sustainment of the system through retraining, education and technical support.

Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation

PubMed Central

McAlearney, Ann Scheck; Sieck, Cynthia J; Hefner, Jennifer L; Huerta, Timothy R

2017-01-01

In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer. PMID:28882812

Requirements for company-wide management

NASA Technical Reports Server (NTRS)

Southall, J. W.

1980-01-01

Computing system requirements were developed for company-wide management of information and computer programs in an engineering data processing environment. The requirements are essential to the successful implementation of a computer-based engineering data management system; they exceed the capabilities provided by the commercially available data base management systems. These requirements were derived from a study entitled The Design Process, which was prepared by design engineers experienced in development of aerospace products.

Towards a successful clinical implementation of fluorescence-guided surgery.

PubMed

Snoeks, T J A; van Driel, P B A A; Keereweer, S; Aime, S; Brindle, K M; van Dam, G M; Löwik, C W G M; Ntziachristos, V; Vahrmeijer, A L

2014-04-01

During the European Molecular Imaging Meeting (EMIM) 2013, the fluorescence-guided surgery study group held its inaugural session to discuss the clinical implementation of fluorescence-guided surgery. The general aim of this study group is to discuss and identify the steps required to successfully and safely bring intraoperative fluorescence imaging to the clinics. The focus group intends to use synergies between interested groups as a tool to address regulatory and implementation hurdles in Europe and operates within the intraoperative focus group of the World Molecular Imaging Society (WMIS) that promotes the same interests at the WMIS level. The major topics on the critical path of implementation identified within the study group were quality controls and standards for ensuring accurate imaging and the ability to compare results from different studies, regulatory affairs, and strategies to increase awareness among physicians, regulators, insurance companies, and a broader audience. These hurdles, and the possible actions discussed to overcome them, are summarized in this report. Furthermore, a number of recommendations for the future shape of the fluorescence-guided study group are discussed. A main driving conclusion remains that intraoperative imaging has great clinical potential and that many of the solutions required are best addressed with the community working together to optimally promote and accelerate the clinical implementation of fluorescence imaging towards improving surgical procedures.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.

PubMed

Shah, Hemant; Allard, Raymond D; Enberg, Robert; Krishnan, Ganesh; Williams, Patricia; Nadkarni, Prakash M

2012-03-09

A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts

PubMed Central

2012-01-01

Background A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. Methods In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). Results The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. Conclusions When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies. PMID:22405400

75 FR 32798 - Preparation for International Cooperation on Cosmetic Regulations; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-09

... accommodations due to a disability, please contact Jennifer Haggerty (see Contact Person) at least 7 days in... convergence of regulatory policies and practices. Successful implementation will require input from...

76 FR 18767 - Preparation for International Cooperation on Cosmetics Regulations; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-05

... contact person by April 22, 2011. If you need special accommodations due to a disability, please contact... and seek convergence of regulatory policies and practices. Successful implementation will require...

Software Development With Application Generators: The Naval Aviation Logistics Command Management Information System Case

DTIC Science & Technology

1992-09-01

Aviation Logistics Command Management Information System (NALCOMIS) prototyping development effort, the critical success factors required to implement prototyping with application generators in other areas of DoD.

Does This Really Work? The Keys to Implementing New Technology while Providing Evidence that Technology Is Successful

ERIC Educational Resources Information Center

Sawtelle, Sara

2008-01-01

Proving that technology works is not as simple as proving that a new vendor for art supplies is more cost effective. Technology effectiveness requires both the right software and the right implementation. Just having the software is not enough. Proper planning, training, leadership, support, pedagogy, and software use--along with many other…

The Missing Ingredients in Reflective Supervision: Helping Staff Members Learn about and Fully Participate in the Supervisory Process

ERIC Educational Resources Information Center

Heffron, Mary Claire; Murch, Trudi

2018-01-01

Successful implementation of a reflective supervision (RS) model in an agency or system requires careful attention to the learning needs of supervisees. Although supervisors and managers typically receive orientation and training to help them understand and implement RS, their staff rarely do. In this article, the authors explore supervisees'…

Stratospheric cruise emission reduction program

NASA Technical Reports Server (NTRS)

Diehl, L. A.; Reck, G. M.; Marek, C. J.; Szaniszlo, A. J.

1977-01-01

A recently implemented NASA effort specifically aimed at reducing cruise oxides of nitrogen from high-altitude aircraft is discussed. The desired emission levels and the combustor technology required to achieve them are discussed. A brief overview of the SCERP operating plan is given. Lean premixed-prevaporized combustion and some of the potential difficulties that are associated with applying this technique to gas turbine combustors are examined. Base technology was developed in several key areas. These fundamental studies are viewed as a requirement for successful implementation of the lean premixed combustion technique.

Charge integration successive approximation analog-to-digital converter for focal plane applications using a single amplifier

NASA Technical Reports Server (NTRS)

Zhou, Zhimin (Inventor); Pain, Bedabrata (Inventor)

1999-01-01

An analog-to-digital converter for on-chip focal-plane image sensor applications. The analog-to-digital converter utilizes a single charge integrating amplifier in a charge balancing architecture to implement successive approximation analog-to-digital conversion. This design requires minimal chip area and has high speed and low power dissipation for operation in the 2-10 bit range. The invention is particularly well suited to CMOS on-chip applications requiring many analog-to-digital converters, such as column-parallel focal-plane architectures.

Achieving successful evidence-based practice implementation in juvenile justice: The importance of diagnostic and evaluative capacity.

PubMed

Walker, Sarah Cusworth; Bumbarger, Brian K; Phillippi, Stephen W

2015-10-01

Evidence-based programs (EBPs) are an increasingly visible aspect of the treatment landscape in juvenile justice. Research demonstrates that such programs yield positive returns on investment and are replacing more expensive, less effective options. However, programs are unlikely to produce expected benefits when they are not well-matched to community needs, not sustained and do not reach sufficient reach and scale. We argue that achieving these benchmarks for successful implementation will require states and county governments to invest in data-driven decision infrastructure in order to respond in a rigorous and flexible way to shifting political and funding climates. We conceptualize this infrastructure as diagnostic capacity and evaluative capacity: Diagnostic capacity is defined as the process of selecting appropriate programing and evaluative capacity is defined as the ability to monitor and evaluate progress. Policy analyses of Washington State, Pennsylvania and Louisiana's program implementation successes are used to illustrate the benefits of diagnostic and evaluate capacity as a critical element of EBP implementation. Copyright © 2015 Elsevier Ltd. All rights reserved.

An evaluation of health information technology outsourcing success.

PubMed

Malovec, Shannon N; Borycki, Elizabeth M; Kushniruk, Andre W

2015-01-01

Outsourcing involves contracting out functions performed by an organization to another organization. Many healthcare organizations are exploring outsourcing as a way to address demands for health information technology (HIT). This study researches the success of outsourcing in the health informatics industry in Canada. The study is designed to help understand whether outsourcing four functions of HIT (i.e. development, implementation, operations, and maintenance) can prove successful for an organization. Findings demonstrate that outsourcing these four functions occurs in Canada; however, the research from the semi-structured interviews finds that operations and maintenance may be more commonly outsourced in Canada, over development and implementation functions. Despite this, findings from this research suggest that outsourcing development and implementation may offer more benefits and fewer challenges than outsourcing operations and maintenance. The research also finds that there can be benefits of outsourcing, such as gaining access to expertise and improving service levels. A weakness of outsourcing may be that internal knowledge is lost and having to manage the change required from outsourcing. The study proposes that there are many factors that need to be considered when outsourcing to ensure it is successful.

An Analytic Hierarchy Process-based Method to Rank the Critical Success Factors of Implementing a Pharmacy Barcode System.

PubMed

Alharthi, Hana; Sultana, Nahid; Al-Amoudi, Amjaad; Basudan, Afrah

2015-01-01

Pharmacy barcode scanning is used to reduce errors during the medication dispensing process. However, this technology has rarely been used in hospital pharmacies in Saudi Arabia. This article describes the barriers to successful implementation of a barcode scanning system in Saudi Arabia. A literature review was conducted to identify the relevant critical success factors (CSFs) for a successful dispensing barcode system implementation. Twenty-eight pharmacists from a local hospital in Saudi Arabia were interviewed to obtain their perception of these CSFs. In this study, planning (process flow issues and training requirements), resistance (fear of change, communication issues, and negative perceptions about technology), and technology (software, hardware, and vendor support) were identified as the main barriers. The analytic hierarchy process (AHP), one of the most widely used tools for decision making in the presence of multiple criteria, was used to compare and rank these identified CSFs. The results of this study suggest that resistance barriers have a greater impact than planning and technology barriers. In particular, fear of change is the most critical factor, and training is the least critical factor.

Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals.

PubMed

Edmisten, Catherine; Hall, Charles; Kernizan, Lorna; Korwek, Kimberly; Preston, Aaron; Rhoades, Evan; Shah, Shalin; Spight, Lori; Stradi, Silvia; Wellman, Sonia; Zygadlo, Scott

2017-08-01

Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems.

PubMed

Sujansky, Walter V; Overhage, J Marc; Chang, Sophia; Frohlich, Jonah; Faus, Samuel A

2009-01-01

Electronic laboratory interfaces can significantly increase the value of ambulatory electronic health record (EHR) systems by providing laboratory result data automatically and in a computable form. However, many ambulatory EHRs cannot implement electronic laboratory interfaces despite the existence of messaging standards, such as Health Level 7, version 2 (HL7). Among several barriers to implementing laboratory interfaces is the extensive optionality within the HL7 message standard. This paper describes the rationale for and development of an HL7 implementation guide that seeks to eliminate most of the optionality inherent in HL7, but retain the information content required for reporting outpatient laboratory results. A work group of heterogeneous stakeholders developed the implementation guide based on a set of design principles that emphasized parsimony, practical requirements, and near-term adoption. The resulting implementation guide contains 93% fewer optional data elements than HL7. This guide was successfully implemented by 15 organizations during an initial testing phase and has been approved by the HL7 standards body as an implementation guide for outpatient laboratory reporting. Further testing is required to determine whether widespread adoption of the implementation guide by laboratories and EHR systems can facilitate the implementation of electronic laboratory interfaces.

Understanding effective care management implementation in primary care: a macrocognition perspective analysis.

PubMed

Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A

2015-08-21

Care management in primary care can be effective in helping patients with chronic disease improve their health status. Primary care practices, however, are often challenged with its implementation. Incorporating care management involves more than a simple physical process redesign to existing clinical care routines. It involves changes to who is working with patients, and consequently such things as who is making decisions, who is sharing patient information, and how. Studying the range of such changes in "knowledge work" during implementation requires a perspective and tools designed to do so. We used the macrocognition perspective, which is designed to understand how individuals think in dynamic, messy real-world environments such as care management implementation. To do so, we used cognitive task analysis to understand implementation in terms of such thinking as decision making, knowledge, and communication. Data collection involved semi-structured interviews and observations at baseline and at approximately 9 months into implementation at five practices in one physician-owned administratively connected group of practices in the state of Michigan, USA. Practices were intervention participants in a larger trial of chronic care model implementation. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with macrocognition as a guiding framework. Seventy-four interviews and five observations were completed. There were differences in implementation success across the practices, and these differences in implementation success were well explained by macrocognition. Practices that used more macrocognition functions and used them more often were also more successful in care management implementation. Although care management can introduce many new changes into the delivery of primary care clinical practice, implementing it successfully as a new complex intervention is possible. Macrocognition is a useful perspective for illuminating the elements that facilitate new complex interventions with a view to addressing them during implementation planning.

Multidisciplinary approach to successful implementation of production information system (PRISM)

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

Shariff, M.R.; Gopalakrishnan, S.G.; Francis, N.

1995-12-31

A company wide corporate and regional production database supporting all production areas was envisaged critical to the current expansion within Petronas Carigali Sdn Bhd (PCSB). A multi disciplinary project team was thus formed to analyze the requirements prior to developing, testing, implementing and training users. PCSB has currently evolved into a mature E & P company on par with other E & P companies within the region. This expansion necessitates a common Production Information System for the efficient dissemination of vital Production Information for Production Surveillance, Reservoir Management, Reserve Assessment, Special Studies and Standardized Group-wide Reporting. This paper will discussmore » all the phases involved in the project which includes Systems Requirement Study, Data Migration, System Development, System Implementation and Post-Implementation Plan.« less

FPGA-based Klystron linearization implementations in scope of ILC

DOE PAGES

Omet, M.; Michizono, S.; Matsumoto, T.; ...

2015-01-23

We report the development and implementation of four FPGA-based predistortion-type klystron linearization algorithms. Klystron linearization is essential for the realization of ILC, since it is required to operate the klystrons 7% in power below their saturation. The work presented was performed in international collaborations at the Fermi National Accelerator Laboratory (FNAL), USA and the Deutsches Elektronen Synchrotron (DESY), Germany. With the newly developed algorithms, the generation of correction factors on the FPGA was improved compared to past algorithms, avoiding quantization and decreasing memory requirements. At FNAL, three algorithms were tested at the Advanced Superconducting Test Accelerator (ASTA), demonstrating a successfulmore » implementation for one algorithm and a proof of principle for two algorithms. Furthermore, the functionality of the algorithm implemented at DESY was demonstrated successfully in a simulation.« less

ROLE OF CONTROLLABILITY FOR LONG TERM SUSTAINABILITY

EPA Science Inventory

Successful implementation of sustainability ideas in ecosystem management requires a basic understanding of the often nonlinear and nonintuitive relationships among different dimensions of sustainability, particularly the system-wide implications of human actions. This basic unde...

Machine learning challenges in Mars rover traverse science

NASA Technical Reports Server (NTRS)

Castano, R.; Judd, M.; Anderson, R. C.; Estlin, T.

2003-01-01

The successful implementation of machine learning in autonomous rover traverse science requires addressing challenges that range from the analytical technical realm, to the fuzzy, philosophical domain of entrenched belief systems within scientists and mission managers.

[Success factors in hospital management].

PubMed

Heberer, M

1998-12-01

The hospital environment of most Western countries is currently undergoing dramatic changes. Competition among hospitals is increasing, and economic issues have become decisive factors for the allocation of medical care. Hospitals therefore require management tools to respond to these changes adequately. The balanced scorecard is a method of enabling development and implementation of a business strategy that equally respects the financial requirements, the needs of the customers, process development, and organizational learning. This method was used to derive generally valid success factors for hospital management based on an analysis of an academic hospital in Switzerland. Strategic management, the focus of medical services, customer orientation, and integration of professional groups across the hospital value chain were identified as success factors for hospital management.

Selecting, adapting, and sustaining programs in health care systems

PubMed Central

Zullig, Leah L; Bosworth, Hayden B

2015-01-01

Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA) Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. PMID:25931825

What is needed to implement a web-based audit and feedback intervention with outreach visits to improve care quality: A concept mapping study among cardiac rehabilitation teams.

PubMed

van Engen-Verheul, Mariëtte M; Peek, Niels; Haafkens, Joke A; Joukes, Erik; Vromen, Tom; Jaspers, Monique W M; de Keizer, Nicolette F

2017-01-01

Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation. Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care. Participants included 49 CR professionals from 18 Dutch CR centres who had worked with the A&F system during a RCT. In three focus group sessions participants formulated statements on factors needed to implement QI successfully. Subsequently, participants rated all statements for importance and feasibility and grouped them thematically. Multi dimensional scaling was used to produce a final concept map. Forty-two unique statements were formulated and grouped into five thematic clusters in the concept map. The cluster with the highest importance was QI team commitment, followed by organisational readiness, presence of an adequate A&F system, access to an external quality assessor, and future use and functionalities of the A&F system. Concept mapping appeared efficient and useful to understand contextual factors influencing QI implementation as perceived by healthcare teams. While presence of a web-based A&F system and external quality assessor were seen as instrumental for gaining insight into performance and formulating QI actions, QI team commitment and organisational readiness were perceived as essential to actually implement and carry out these actions. These two sociotechnical factors should be taken into account when implementing and evaluating the success of QI implementations in future research. Copyright © 2016. Published by Elsevier Ireland Ltd.

Ontario's daily physical activity policy for elementary schools: is everything in place for success?

PubMed

Robertson-Wilson, Jennifer E; Lévesque, Lucie

2009-01-01

The development, implementation, and evaluation of policies may play an important role in promoting health behaviours such as physical activity. The Ontario Ministry of Education (OME) recently mandated Memorandum No. 138 requiring daily physical activity (DPA) for Ontario elementary students in grades one through eight. The purpose of this paper is to examine implementation strategies. Hogwood and Gunn's 10 preconditions for "perfect implementation" are used to examine publicly available Ministry DPA policy documents to assess whether these implementation strategies have been considered in the policy documents. Several preconditions (e.g., allocation of resources, task specification) appear to have been considered, however a number of preconditions (e.g., the sustainability of resources, extent to which the policy is valued, and evaluation plans) thought to be important require additional attention to ensure optimal DPA implementation. Additional reflection upon Hogwood and Gunn's implementation preconditions would, in our opinion, assist in facilitating optimal DPA implementation as per Memorandum No. 138.

Community Readiness Within Systems of Care: The Validity and Reliability of the System of Care Readiness and Implementation Measurement Scale (SOC-RIMS).

PubMed

Rosas, Scott R; Behar, Lenore B; Hydaker, William M

2016-01-01

Establishing a system of care requires communities to identify ways to successfully implement strategies and support positive outcomes for children and their families. Such community transformation is complex and communities vary in terms of their readiness for implementing sustainable community interventions. Assessing community readiness and guiding implementation, specifically for the funded communities implementing a system of care, requires a well-designed tool with sound psychometric properties. This scale development study used the results of a previously published concept mapping study to create, administer, and assess the psychometric characteristics of the System of Care Readiness and Implementation Measurement Scale (SOC-RIMS). The results indicate the SOC-RIMS possesses excellent internal consistency characteristics, measures clearly discernible dimensions of community readiness, and demonstrates the target constructs exist within a broad network of content. The SOC-RIMS can be a useful part of a comprehensive assessment in communities where system of care practices, principles, and philosophies are implemented and evaluated.

Implementation and Sustainability of the Russian Federation Ministry of Defense Nuclear Personnel Reliability Program

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

LataPhD, Vasiliy; Coates, Cameron W

2010-01-01

Through a cooperative effort between the US Department of Energy and the Russian Federation (RF) Ministry of Defense (MOD) a Personnel Reliability Program (PRP) for the nuclear handlers within the RF MOD is at the stage of implementation. Sustaining the program is of major significance for long term success. This paper will discuss the elements of the RF PRP and the equipment needs for implementation. Program requirements, documentation needs, training, and assurances of appropriate equipment use will be addressed.

JPL Contamination Control Engineering

NASA Technical Reports Server (NTRS)

Blakkolb, Brian

2013-01-01

JPL has extensive expertise fielding contamination sensitive missions-in house and with our NASA/industry/academic partners.t Development and implementation of performance-driven cleanliness requirements for a wide range missions and payloads - UV-Vis-IR: GALEX, Dawn, Juno, WFPC-II, AIRS, TES, et al - Propulsion, thermal control, robotic sample acquisition systems. Contamination control engineering across the mission life cycle: - System and payload requirements derivation, analysis, and contamination control implementation plans - Hardware Design, Risk trades, Requirements V-V - Assembly, Integration & Test planning and implementation - Launch site operations and launch vehicle/payload integration - Flight ops center dot Personnel on staff have expertise with space materials development and flight experiments. JPL has capabilities and expertise to successfully address contamination issues presented by space and habitable environments. JPL has extensive experience fielding and managing contamination sensitive missions. Excellent working relationship with the aerospace contamination control engineering community/.

Horizons in Learning Innovation through Technology: Prospects for Air Force Education Benefits

DTIC Science & Technology

2010-06-10

prototyping, and implementation. Successfully implementing disruptive innovations requires change management to help steward the identification ...systems and environments for Air Force education benefits goes beyond the identification and analysis of emerging horizons. Processes and methods...scene, a patrol area, or a suspect lineup (“Augmented- reality,” 2010). Connection to Innovation Triangle. The concepts of LVC and AR are quickly

Twelve tips for developing, implementing, and sustaining medical education fellowship programs: Building on new trends and solid foundations.

PubMed

Dewey, Charlene M; Turner, Teri L; Perkowski, Linda; Bailey, Jean; Gruppen, Larry D; Riddle, Janet; Singhal, Geeta; Mullan, Patricia; Poznanski, Ann; Pillow, Tyson; Robins, Lynne S; Rougas, Steven C; Horn, Leora; Ghulyan, Marine V; Simpson, Deborah

2016-01-01

Medical education fellowship programs (MEFPs) are a form of faculty development contributing to an organization's educational mission and participants' career development. Building an MEFP requires a systematic design, implementation, and evaluation approach which aligns institutional and individual faculty goals. Implementing an MEFP requires a team of committed individuals who provide expertise, guidance, and mentoring. Qualified MEFP directors should utilize instructional methods that promote individual and institutional short and long term growth. Directors must balance the use of traditional design, implementation, and evaluation methodologies with advancing trends that may support or threaten the acceptability and sustainability of the program. Drawing on the expertise of 28 MEFP directors, we provide twelve tips as a guide to those implementing, sustaining, and/or growing a successful MEFP whose value is demonstrated by its impacts on participants, learners, patients, teaching faculty, institutions, the greater medical education community, and the population's health.

The human side of lean teams.

PubMed

Wackerbarth, Sarah B; Strawser-Srinath, Jamie R; Conigliaro, Joseph C

2015-05-01

Organizations use lean principles to increase quality and decrease costs. Lean projects require an understanding of systems-wide processes and utilize interdisciplinary teams. Most lean tools are straightforward, and the biggest barrier to successful implementation is often development of the team aspect of the lean approach. The purpose of this article is to share challenges experienced by a lean team charged with improving a hospital discharge process. Reflection on the experience provides an opportunity to highlight lessons from The Team Handbook by Peter Scholtes and colleagues. To improve the likelihood that process improvement initiatives, including lean projects, will be successful, organizations should consider providing training in organizational change principles and team building. The authors' lean team learned these lessons the hard way. Despite the challenges, the team successfully implemented changes throughout the organization that have had a positive impact. Training to understand the psychology of change might have decreased the resistance faced in implementing these changes. © 2014 by the American College of Medical Quality.

Controllability of complex networks for sustainable system dynamics

EPA Science Inventory

Successful implementation of sustainability ideas in ecosystem management requires a basic understanding of the often non-linear and non-intuitive relationships among different dimensions of sustainability, particularly the system-wide implications of human actions. This basic un...

Guidance on the Management of Remediation Waste Under the Resource Conservation and Recovery Act (RCRA)

EPA Pesticide Factsheets

To assist regulators in successfully implementing RCRA requirements for remediation waste, this memorandum consolidates existing guidance on the RCRA regulations and policies that most often affect remediation waste management.

Optimization and experimental realization of the quantum permutation algorithm

NASA Astrophysics Data System (ADS)

Yalçınkaya, I.; Gedik, Z.

2017-12-01

The quantum permutation algorithm provides computational speed-up over classical algorithms for determining the parity of a given cyclic permutation. For its n -qubit implementations, the number of required quantum gates scales quadratically with n due to the quantum Fourier transforms included. We show here for the n -qubit case that the algorithm can be simplified so that it requires only O (n ) quantum gates, which theoretically reduces the complexity of the implementation. To test our results experimentally, we utilize IBM's 5-qubit quantum processor to realize the algorithm by using the original and simplified recipes for the 2-qubit case. It turns out that the latter results in a significantly higher success probability which allows us to verify the algorithm more precisely than the previous experimental realizations. We also verify the algorithm for the first time for the 3-qubit case with a considerable success probability by taking the advantage of our simplified scheme.

Process control systems: integrated for future process technologies

NASA Astrophysics Data System (ADS)

Botros, Youssry; Hajj, Hazem M.

2003-06-01

Process Control Systems (PCS) are becoming more crucial to the success of Integrated Circuit makers due to their direct impact on product quality, cost, and Fab output. The primary objective of PCS is to minimize variability by detecting and correcting non optimal performance. Current PCS implementations are considered disparate, where each PCS application is designed, deployed and supported separately. Each implementation targets a specific area of control such as equipment performance, wafer manufacturing, and process health monitoring. With Intel entering the nanometer technology era, tighter process specifications are required for higher yields and lower cost. This requires areas of control to be tightly coupled and integrated to achieve the optimal performance. This requirement can be achieved via consistent design and deployment of the integrated PCS. PCS integration will result in several benefits such as leveraging commonalities, avoiding redundancy, and facilitating sharing between implementations. This paper will address PCS implementations and focus on benefits and requirements of the integrated PCS. Intel integrated PCS Architecture will be then presented and its components will be briefly discussed. Finally, industry direction and efforts to standardize PCS interfaces that enable PCS integration will be presented.

Health workers' views of a program to facilitate physical health care in mental health settings: implications for implementation and training.

PubMed

Baker, Wendy; Harris, Melanie; Battersby, Malcolm

2014-12-01

Physical comorbidities shorten the lifespan of people with severe mental illness therefore mental health clinicians need to support service users in risk factor-related behaviour change. We investigated mental health care workers' views of a physical health self-management support program in order to identify implementation requirements. Qualitative interviews were conducted with workers who had differing levels of experience with a self-management support program. Themes were identified using interpretive descriptive analysis and then matched against domains used in implementation models to draw implications for successful practice change. Three main themes emerged related to: (1) understandings of disease management within job roles; (2) requirements for putting self-management support into practice; and (3) challenges of coordination in disease management. Priority domains from implementation models were inner and outer health service settings. While staff training is required, practice change for care which takes account of both mental and physical health also requires changes in organisational frameworks. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Is Sustainability Achievable? Exploring the Limits of Sustainability with Model Systems

EPA Science Inventory

Successful implementation of sustainability ideas in ecosystem management requires a basic understanding of the often nonlinear and non-intuitive relationships amongst different dimensions of sustainability, particularly the systemwide implications of human actions. This basic un...

Establishing a competitive advantage through quality management.

PubMed

George, R J

1996-06-01

The successful dentist of the future will establish a sustainable competitive advantage in the marketplace by recognising that patients undergoing dental treatment cannot see the result before purchase, and that they therefore look for signs of service quality to reduce uncertainty. Thus the successful dentist will implement a quality programme that recognises not only that quality is defined by meeting patients' needs and expectations, but also that quality service is fundamental to successful business strategy. Finally, the successful dentist of the future will realise that the pursuit of quality is a never-ending process which requires leadership by example.

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

Omet, M.; Michizono, S.; Matsumoto, T.

We report the development and implementation of four FPGA-based predistortion-type klystron linearization algorithms. Klystron linearization is essential for the realization of ILC, since it is required to operate the klystrons 7% in power below their saturation. The work presented was performed in international collaborations at the Fermi National Accelerator Laboratory (FNAL), USA and the Deutsches Elektronen Synchrotron (DESY), Germany. With the newly developed algorithms, the generation of correction factors on the FPGA was improved compared to past algorithms, avoiding quantization and decreasing memory requirements. At FNAL, three algorithms were tested at the Advanced Superconducting Test Accelerator (ASTA), demonstrating a successfulmore » implementation for one algorithm and a proof of principle for two algorithms. Furthermore, the functionality of the algorithm implemented at DESY was demonstrated successfully in a simulation.« less

Formal specification and mechanical verification of SIFT - A fault-tolerant flight control system

NASA Technical Reports Server (NTRS)

Melliar-Smith, P. M.; Schwartz, R. L.

1982-01-01

The paper describes the methodology being employed to demonstrate rigorously that the SIFT (software-implemented fault-tolerant) computer meets its requirements. The methodology uses a hierarchy of design specifications, expressed in the mathematical domain of multisorted first-order predicate calculus. The most abstract of these, from which almost all details of mechanization have been removed, represents the requirements on the system for reliability and intended functionality. Successive specifications in the hierarchy add design and implementation detail until the PASCAL programs implementing the SIFT executive are reached. A formal proof that a SIFT system in a 'safe' state operates correctly despite the presence of arbitrary faults has been completed all the way from the most abstract specifications to the PASCAL program.

Devising, Implementing, and Evaluating Interventions to Eliminate Health Care Disparities in Minority Children

PubMed Central

Flores, Glenn

2010-01-01

Despite an accumulating body of literature addressing racial/ethnic disparities in children’s health and health care, there have been few published studies of interventions that have been successful in eliminating these disparities. The objectives of this article, therefore, are to (1) describe 3 interventions that have been successful in eliminating racial/ethnic disparities in children’s health and health care, (2) high-light tips and pitfalls regarding devising, implementing, and evaluating pediatric disparities interventions, and (3) propose a research agenda for pediatric disparities interventions. Key characteristics of the 3 successful interventions include rigorous study designs; large sample sizes; appropriate comparison groups; community-based interventions that are culturally and linguistically sensitive and involve collaboration with participants; research staff from the same community as the participants; appropriate blinding of outcomes assessors; and statistical adjustment of outcomes for relevant covariates. On the basis of these characteristics, I propose tips, pitfalls, an approach, and a research agenda for devising, implementing, and evaluating successful pediatric disparities interventions. Examination of 3 successful interventions indicates that pediatric health care disparities can be eliminated. Achievement of this goal requires an intervention that is rigorous, evidence-based, and culturally and linguistically appropriate. The intervention must also include community collaboration, minimize attrition, adjust for potential confounders, and incorporate mechanisms for sustainability. PMID:19861473

Devising, implementing, and evaluating interventions to eliminate health care disparities in minority children.

PubMed

Flores, Glenn

2009-11-01

Despite an accumulating body of literature addressing racial/ethnic disparities in children's health and health care, there have been few published studies of interventions that have been successful in eliminating these disparities. The objectives of this article, therefore, are to (1) describe 3 interventions that have been successful in eliminating racial/ethnic disparities in children's health and health care, (2) highlight tips and pitfalls regarding devising, implementing, and evaluating pediatric disparities interventions, and (3) propose a research agenda for pediatric disparities interventions. Key characteristics of the 3 successful interventions include rigorous study designs; large sample sizes; appropriate comparison groups; community-based interventions that are culturally and linguistically sensitive and involve collaboration with participants; research staff from the same community as the participants; appropriate blinding of outcomes assessors; and statistical adjustment of outcomes for relevant covariates. On the basis of these characteristics, I propose tips, pitfalls, an approach, and a research agenda for devising, implementing, and evaluating successful pediatric disparities interventions. Examination of 3 successful interventions indicates that pediatric health care disparities can be eliminated. Achievement of this goal requires an intervention that is rigorous, evidence-based, and culturally and linguistically appropriate. The intervention must also include community collaboration, minimize attrition, adjust for potential confounders, and incorporate mechanisms for sustainability.

Manned Spacecraft Requirements for Materials and Processes

NASA Technical Reports Server (NTRS)

Vaughn, Timothy P.

2006-01-01

A major cause of project failure can be attributed to an emphasized focus on end products and inadequate attention to resolving development risks during the initial phases of a project. The initial phases of a project, which we will call the "study period", are critical to determining project scope and costs, and can make or break most projects. If the requirements are not defined adequately, how can the scope be adequately determined, also how can the costs of the entire project be effectively estimated, and how can the risk of project success be accurately assessed? Using the proper material specifications and standards and incorporating these specifications and standards in the design process should be considered inherently crucial to the technical success of a project as just as importantly, crucial to the cost and schedule success. This paper will intertwine several important aspects or considerations for project success: 1) Characteristics of a "Good Material Requirement"; 2) Linking material requirements to the implementation of "Design for Manufacturing"; techniques and 3) The importance of decomposing materials requirements during the study phase/development phase to mitigate project risk for the maturation of technologies before the building of hardware.

Conditions of Formation of Social Successfulness of Students with Disabilities in the System of Continuous Inclusive Education on the Basis of Value Approach

ERIC Educational Resources Information Center

Nasibullov, Ramis R.; Kashapova, L??l?? M.; Shavaliyeva, Zulfiya Sh.

2015-01-01

The thematic justification is due to the fact that the problem of inclusive education implementation in the modern period is very popular and requires close examination. Object of the article is to determine the conditions of formation of social successfulness of students with disabilities in the system of continuous inclusive education on the…

Implementation of a community-based secondhand smoke reduction intervention for caregivers of urban children with asthma: process evaluation, successes and challenges

PubMed Central

Blaakman, Susan; Tremblay, Paul J.; Halterman, Jill S.; Fagnano, Maria; Borrelli, Belinda

2013-01-01

Many children, including those with asthma, remain exposed to secondhand smoke. This manuscript evaluates the process of implementing a secondhand smoke reduction counseling intervention using motivational interviewing (MI) for caregivers of urban children with asthma, including reach, dose delivered, dose received and fidelity. Challenges, strategies and successes in applying MI are highlighted. Data for 140 children (3–10 years) enrolled in the School Based Asthma Therapy trial, randomized to the treatment condition and living with one or more smoker, were analyzed. Summary statistics describe the sample, process measures related to intervention implementation, and primary caregiver (PCG) satisfaction with the intervention. The full intervention was completed by 79% of PCGs, but only 17% of other smoking caregivers. Nearly all (98%) PCGs were satisfied with the care study nurses provided and felt the program might be helpful to others. Despite challenges, this intervention was feasible and well received reaching caregivers who were not actively seeking treatment for smoking cessation or secondhand smoke reduction. Anticipating the strategies required to implement such an intervention may help promote participant engagement and retention to enhance the program’s ultimate success. PMID:22717938

The Practitioner View

NASA Astrophysics Data System (ADS)

Smart, Ian; Bestwick, Stuart; Jarrett, Neil; O'Conner, Richard; Gurnett, John

On paper, plans are most often technically "correct". But a large percentage of implementations fail - due to delay, missed targets or lack of sustainability. The most common pitfall is neglect of the "soft" side of change. All implementation projects imply change, and successful change requires leadership. What separates leaders from managers is the ability to engage and excite stakeholders, to lead by example and to drive the change agenda. In my opinion most people will be part of change if they understand the need for change, have the adequate competences to perform in their new role and have the right incentives. Therefore leaders that are able to communicate the need for change, provide for adequate training and aligned incentives will be most successful. In addition, leaders that engage and motivate their employees through role modelling and personal involvement will not only succeed in implementation - they will thrive.

Euclid Cosmological Simulations Requirements and Implementation Plan

NASA Technical Reports Server (NTRS)

Kiessling, Alina

2012-01-01

Simulations are essential for the successful undertaking of the Euclid mission. The simulations requirements for the Euclid mission are vast ! It is an enormous undertaking that includes development of software and acquisition of hardware facilities. The simulations requirements are currently being finalised - please contact myself or Elisabetta Semboloni if you would like to add/modify any r equi r ements (or if you would like to be involved in the development of the simulations).

Establishment and Implementation of a Required Medication Therapy Management Advanced Pharmacy Practice Experience

PubMed Central

Gilliam, Eric; Thompson, Megan; Vande Griend, Joseph

2017-01-01

Objective. To develop a community pharmacy-based medication therapy management (MTM) advanced pharmacy practice experience (APPE) that provides students with skills and knowledge to deliver entry-level pharmacy MTM services. Design. The University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences (SSPPS) partnered with three community pharmacy chains to establish this three-week, required MTM APPE. Students completed the American Pharmacists Association MTM Certificate Course prior to entering the APPE. Students were expected to spend 90% or more of their time at this experience working on MTM interventions, using store MTM platforms. Assessment. All 151 students successfully completed this MTM APPE, and each received a passing evaluation from their preceptor. Preceptor evaluations of students averaged above four (entry-level practice) on a five-point Likert scale. The majority of students reported engagement in MTM services for more than 80% of the time on site. Students’ self-reporting of their ability to perform MTM interventions improved after participation in the APPE. Conclusion. The SSPPS successfully implemented a required MTM APPE, preparing students for entry-level delivery of MTM services. PMID:28381896

Stakeholder perspectives on implementing a universal Lynch syndrome screening program: a qualitative study of early barriers and facilitators.

PubMed

Schneider, Jennifer L; Davis, James; Kauffman, Tia L; Reiss, Jacob A; McGinley, Cheryl; Arnold, Kathleen; Zepp, Jamilyn; Gilmore, Marian; Muessig, Kristin R; Syngal, Sapna; Acheson, Louise; Wiesner, Georgia L; Peterson, Susan K; Goddard, Katrina A B

2016-02-01

Evidence-based guidelines recommend that all newly diagnosed colon cancer be screened for Lynch syndrome (LS), but best practices for implementing universal tumor screening have not been extensively studied. We interviewed a range of stakeholders in an integrated health-care system to identify initial factors that might promote or hinder the successful implementation of a universal LS screening program. We conducted interviews with health-plan leaders, managers, and staff. Interviews were audio-recorded and transcribed. Thematic analysis began with a grounded approach and was also guided by the Practical Robust Implementation and Sustainability Model (PRISM). We completed 14 interviews with leaders/managers and staff representing involved clinical and health-plan departments. Although stakeholders supported the concept of universal screening, they identified several internal (organizational) and external (environment) factors that promote or hinder implementation. Facilitating factors included perceived benefits of screening for patients and organization, collaboration between departments, and availability of organizational resources. Barriers were also identified, including: lack of awareness of guidelines, lack of guideline clarity, staffing and program "ownership" concerns, and cost uncertainties. Analysis also revealed nine important infrastructure-type considerations for successful implementation. We found that clinical, laboratory, and administrative departments supported universal tumor screening for LS. Requirements for successful implementation may include interdepartmental collaboration and communication, patient and provider/staff education, and significant infrastructure and resource support related to laboratory processing and systems for electronic ordering and tracking.

Toward Successful Implementation of Prefabricated Deck Panels to Accelerate the Bridge Construction Process

DOT National Transportation Integrated Search

2016-08-01

The development of accelerated bridge construction (ABC) techniques and connection details has become a national research focus. With the aging of the interstate system and many bridges on key routes requiring extensive rehabilitation or replacement,...

Mastery Based Homework in Introductory Physics at the University of Illinois

NASA Astrophysics Data System (ADS)

Stelzer, Tim; Gutmann, Brianne; Gladding, Gary; Lundsgaard, Morten; Schroeder, Noah

2017-01-01

The successful implementation of mastery-style online homework into our preparatory mechanics course has been a long-term project, currently in its second year. By requiring students to perfect a single unit of defined competencies before moving on to its successive unit (with intervening narrated animated solutions for instructional support), this homework delivery method replaced traditional immediate feedback online homework for the class of about 500 students. After the first year of data collection and analysis, significant revisions were made to the system's delivery, content, and messaging. The impact of these changes and second year data will be presented, as well as data from implementation in our introductory electricity and magnetism course. NSF DUE 16-08002.

Global health diplomacy investments in Afghanistan: adaptations and outcomes of global fund malaria programs.

PubMed

Kevany, Sebastian; Sahak, Omar; Workneh, Nibretie Gobezie; Saeedzai, Sayed Ataullah

2014-01-01

Global health programmes require extensive adaptation for implementation in conflict and post-conflict settings. Without such adaptations, both implementation success and diplomatic, international relations and other indirect outcomes may be threatened. Conversely, diplomatic successes may be made through flexible and responsive programmes. We examine adaptations and associated outcomes for malaria treatment and prevention programmes in Afghanistan. In conjunction with the completion of monitoring and evaluation activities for the Global Fund to Fight AIDS, Tuberculosis and Malaria, we reviewed adaptations to the structure, design, selection, content and delivery of malaria-related interventions in Afghanistan. Interviews were conducted with programme implementers, service delivery providers, government representatives and local stakeholders, and site visits to service delivery points were completed. Programmes for malaria treatment and prevention require a range of adaptations for successful implementation in Afghanistan. These include (1) amendment of educational materials for rural populations, (2) religious awareness in gender groupings for health educational interventions, (3) recruitment of local staff, educated in languages and customs, for both quality assurance and service delivery, (4) alignment with diplomatic principles and, thereby, avoidance of confusion with broader strategic and military initiatives and (5) amendments to programme 'branding' procedures. The absence of provision for these adaptations made service delivery excessively challenging and increased the risk of tension between narrow programmatic and broader diplomatic goals. Conversely, adapted global health programmes displayed a unique capacity to access potentially extremist populations and groups in remote regions otherwise isolated from international activities. A range of diplomatic considerations when delivering global health programmes in conflict and post-conflict settings are required in order to ensure that health gains are not offset by broader international relations losses through challenges to local cultural, religious and social norms, as well as in order to ensure the security of programme staff. Conversely, when global health programmes are delivered with international relations considerations in mind, they have the potential to generate unquantified diplomatic outcomes.

The factors affecting Nigeria's success toward implementation of global public health priorities.

PubMed

Echebiri, Vitalis C

2015-06-01

This paper examines the challenges facing the Nigerian government toward the implementation of global public health priories. The Nigerian government recognizes the need to implement these priorities by putting in place the necessary policy framework, but political instability, poor infrastructural development and inadequate funding have remained barriers toward the achievement of success in implementing these priorities. The rest of the paper elucidates the fact that despite leadership and influence from the World Health Organization and other United Nations agencies, and some responses from the Nigerian government, tackling these public health problems requires much more fundamental reform to primary health services and a reduction in poverty. Although the government has shown enough political will to tackle these problems, it is expected that a better result will be achieved through injecting more funds into the Nigerian health sector, and deploying astute health administrators to manage the sector rather than pure health professionals without managerial acumen. © The Author(s) 2014.

Implementing enhanced recovery in gynaecology oncology.

PubMed

Rooth, Carolyn; Sidhu, Amar

Enhanced recovery involves the adoption of a selected number of evidence-based interventions used together and implemented in a 'fast track' care pathway during preoperative management, surgery itself and throughout the immediate postoperative period. Aimed at promoting effective patient recovery after surgery, this has been shown to improve the patient experience and facilitate early patient discharge following major surgery in some clinical areas (Department of Health, 2010). Applied to the clinical management and nursing care of women affected by gynaecological malignancies in one London tertiary referral centre hospital, enhanced recovery has been seen to improve patient experience and shorten the length of overall hospital stay. Implementation requires careful planning, appointment of key practitioners and commitment of the multidisciplinary team to realise successful outcomes. The authors' experience suggests that challenges are associated with changing practice and that while careful planning is essential, successes are to be gained, which significantly benefit patients, staff and the NHS Trust. In sharing this experience of implementing enhanced recovery, the authors hope to encourage others to consider application of this innovative strategy.

Strong Leadership for RTI Success

ERIC Educational Resources Information Center

Mellard, Daryl F.; Prewett, Sara; Deshler, Donald D.

2012-01-01

During the past decade, thousands of schools have adopted response to intervention (RTI) frameworks as the means of improving educational outcomes for all students, including those with disabilities. Planning, implementing, and sustaining those frameworks requires organizational changes that affect staff members and underlying school structures…

Software Prototyping: Designing Systems for Users.

ERIC Educational Resources Information Center

Spies, Phyllis Bova

1983-01-01

Reports on major change in computer software development process--the prototype model, i.e., implementation of skeletal system that is enhanced during interaction with users. Expensive and unreliable software, software design errors, traditional development approach, resources required for prototyping, success stories, and systems designer's role…

An overview of knowledge management (KM) issues for implementation in consultant firms in Malaysian construction industry

NASA Astrophysics Data System (ADS)

Othman, Azlan; Ismail, Syuhaida; Yahya, Khairulzan

2017-12-01

In the past few years, there has been a growing interest in treating knowledge as a significant organisational resource. Thus, effective development and implementation of KM requires a foundation in several rich literatures. As a preparation for the competitive industrial nation, KM is an important countenance that should be the point of convergence for the industry players. This paper wishes to draw the attention on the current situation of KM practice, focusing on consultant firms in Malaysian construction industry. Questionnaires were distributed to about 200 respondents working in the industry, with the objective of appraising the KM implementation amongst consultant firms working in construction industry in Malaysia. This paper also gives the overview on KM definition, process, understanding and challenges in construction industry, besides the critical success factor of KM implementation. The literature is restricted on the recent KM study of 17 years research from 2000 to 2017. Finally, this paper proposes the conceptual ideas of relationship between KM process, KM understanding and KM challenges with critical success factor of KM implementation.

Implementing an Intervention to Assist Certificate IV Students to Transition Successfully to Undergraduate Study within an AAQF Contextualisation: A Case Study

ERIC Educational Resources Information Center

McNaught, Keith

2013-01-01

In response to the poor performance of students in 2007 who had used a Certificate IV to meet minimum entry requirements, The University of Notre Dame Australia, Fremantle campus, developed a specific intervention. A compulsorily-required "primer" course was developed and taught by a staff member with extensive experience in both…

Implementing and Sustaining School Improvement. Principal's Research Review: Supporting the Principal's Data-Informed Decisions. Vol. 6, No. 2

ERIC Educational Resources Information Center

Protheroe, Nancy

2011-01-01

School improvement can be a complex, messy business. At its most basic, school improvement is change--change that might require people to abandon long-held beliefs and practices, shift roles, and learn new skills. Kilgore and Reynolds (2011) suggested that successful change requires that people change their perceptions as well as their actions.…

Using career ladders to motivate and retain employees: an implementation success story.

PubMed

Garletts, Joseph A

2002-01-01

In October 2000, Phoenix-based Sonora Quest Laboratories, LLC (SQL), commissioned The Gelfond Group to survey SQL employees. Responding to negative survey scores, SQL developed and implemented an entry-level career ladder for line staff of the specimen management/referral testing department. The program was piloted in February 2001, and was implemented fully shortly thereafter. The ladder was designed to provide job enrichment opportunities through company-conducted training and advancement provisions. It contained requirements for productivity and quality of work performed in addition to increasingly rigorous training and competency documentation. Employees were accountable for their own advancement and for ensuring that all documentation was complete. Advancement was automatic once requirements were completed. Pay increases accompanied each advancement on a predetermined scale. At the end of 12 months, employee turnover dropped from 39% to less than 20% annually. Both productivity and morale improved, and results on a second employee survey indicated dramatic improvement in five key areas. The career ladder concept has been replicated successfully in several other departments, including phlebotomy, and a six-tiered ladder is under development for the clinical laboratory. It will encompass CLA, MLT, and MT positions from entry level to technical coordinator.

Multiple models guide strategies for agricultural nutrient reductions

USGS Publications Warehouse

Scavia, Donald; Kalcic, Margaret; Muenich, Rebecca Logsdon; Read, Jennifer; Aloysius, Noel; Bertani, Isabella; Boles, Chelsie; Confesor, Remegio; DePinto, Joseph; Gildow, Marie; Martin, Jay; Redder, Todd; Robertson, Dale M.; Sowa, Scott P.; Wang, Yu-Chen; Yen, Haw

2017-01-01

In response to degraded water quality, federal policy makers in the US and Canada called for a 40% reduction in phosphorus (P) loads to Lake Erie, and state and provincial policy makers in the Great Lakes region set a load-reduction target for the year 2025. Here, we configured five separate SWAT (US Department of Agriculture's Soil and Water Assessment Tool) models to assess load reduction strategies for the agriculturally dominated Maumee River watershed, the largest P source contributing to toxic algal blooms in Lake Erie. Although several potential pathways may achieve the target loads, our results show that any successful pathway will require large-scale implementation of multiple practices. For example, one successful pathway involved targeting 50% of row cropland that has the highest P loss in the watershed with a combination of three practices: subsurface application of P fertilizers, planting cereal rye as a winter cover crop, and installing buffer strips. Achieving these levels of implementation will require local, state/provincial, and federal agencies to collaborate with the private sector to set shared implementation goals and to demand innovation and honest assessments of water quality-related programs, policies, and partnerships.

Going above and beyond for implementation: the development and validity testing of the Implementation Citizenship Behavior Scale (ICBS).

PubMed

Ehrhart, Mark G; Aarons, Gregory A; Farahnak, Lauren R

2015-05-07

In line with recent research on the role of the inner context of organizations in implementation effectiveness, this study extends research on organizational citizenship behavior (OCB) to the domain of evidence-based practice (EBP) implementation. OCB encompasses those behaviors that go beyond what is required for a given job that contribute to greater organizational effectiveness. The goal of this study was to develop and test a measure of implementation citizenship behavior (ICB) or those behaviors that employees perform that go above and beyond what is required in order to support EBP implementation. The primary participants were 68 supervisors from ten mental health agencies throughout California. Items measuring ICB were developed based on past research on OCB and in consultation with experts on EBP implementation in mental health settings. Supervisors rated 357 of their subordinates on ICB and implementation success. In addition, 292 of the subordinates provided data on self-rated performance, attitudes towards EBPs, work experience, and full-time status. The supervisor sample was randomly split, with half used for exploratory factor analyses and the other half for confirmatory factor analyses. The entire sample of supervisors and subordinates was utilized for analyses assessing the reliability and construct validity of the measure. Exploratory factor analyses supported the proposed two-factor structure of the Implementation Citizenship Behavior Scale (ICBS): (1) Helping Others and (2) Keeping Informed. Confirmatory factor analyses with the other half of the sample supported the factor structure. Additional analyses supported the reliability and construct validity for the ICBS. The ICBS is a pragmatic brief measure (six items) that captures critical behaviors employees perform to go above and beyond the call of duty to support EBP implementation, including helping their fellow employees on implementation-related activities and keeping informed about issues related to EBP and implementation efforts. The ICBS can be used by researchers to better understand the outcomes of improved organizational support for implementation (i.e., implementation climate) and the proximal predictors of implementation effectiveness. The ICBS can also provide insight for organizations, practitioners, and managers by focusing on key employee behaviors that should increase the probability of implementation success.

Implementing corporate wellness programs: a business approach to program planning.

PubMed

Helmer, D C; Dunn, L M; Eaton, K; Macedonio, C; Lubritz, L

1995-11-01

1. Support of key decision makers is critical to the successful implementation of a corporate wellness program. Therefore, the program implementation plan must be communicated in a format and language readily understood by business people. 2. A business approach to corporate wellness program planning provides a standardized way to communicate the implementation plan. 3. A business approach incorporates the program planning components in a format that ranges from general to specific. This approach allows for flexibility and responsiveness to changes in program planning. 4. Components of the business approach are the executive summary, purpose, background, ground rules, approach, requirements, scope of work, schedule, and financials.

Implementing Audio Digital Feedback Loop Using the National Instruments RIO System

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

Huang, G.; Byrd, J. M.

2006-11-20

Development of system for high precision RF distribution and laser synchronization at Berkeley Lab has been ongoing for several years. Successful operation of these systems requires multiple audio bandwidth feedback loops running at relatively high gains. Stable operation of the feedback loops requires careful design of the feedback transfer function. To allow for flexible and compact implementation, we have developed digital feedback loops on the National Instruments Reconfigurable Input/Output (RIO) platform. This platform uses an FPGA and multiple I/Os that can provide eight parallel channels running different filters. We present the design and preliminary experimental results of this system.

An approach to the implementation of ISO 14000 at a shipping company

NASA Astrophysics Data System (ADS)

Panaitescu, F. V.; Panaitescu, M.

2015-11-01

We present here a successful implementation of the Environmental Management System (EMS) in a shipping company. The EMS of the each company must be revised and expanded and new analytical requirements included in it. This new EMS concept is available to everyone on board and must be studied by every seafarer. All environmental requirements to be strictly followed all over the world. The main points of new EMS are: new open reporting system, environmental tag system (ETS) which introduce non re-usable numbered seals, pollution prevention equipment (OWS, OCM, Incinerator and Sewage Treatment Plant), the environmental defect reports system - extraordinary E/R operations and leakages log book.

[Evidence-based clinical oral healthcare guidelines 4. Adherence requires an implementation strategy].

PubMed

Braspenning, J C C; Mettes, T G P H; van der Sanden, W J M; Wensing, M J P

2015-03-01

Adherence to clinical guidelines requires support in practice. However, systematic implementation of evidence-based guidelines is not common practice in oral healthcare. The Knowledge Institute Oral Care (KiMo) offers the opportunity to take into account potential barriers and facilitators during the development of evidence-based clinical practice guidelines. These factors which are relevant to the guideline and the oral healthcare practice provide the ingredients for a tailor-made programme of implementation that has a scientific basis. Elements of any implementation programme are the quality indicators derived from the oral healthcare guidelines. These indicators should fit, on the one hand, the specific goals of the guidelines (patient safety, effectiveness, efficiency, patient-centred, timeliness, accessibility) and, onthe other hand, the various perspectives of the different stakeholders, such as patients, caregivers, health insurers and inspectorate. These quality indicators provide information on adherence to the guidelines, the results of a certain treatment and the success of the implementation strategy, all with the aim to improve the quality of oral healthcare.

A palette of desired leadership competencies: painting the picture for successful regionalization.

PubMed

Hall, Lee

2004-01-01

Regionalization is occurring across the country in an attempt to improve accessibility and services to populations with increased expectations and significant budget pressures. A successful reorganization requires strong and effective leadership, equipped with an array of knowledge, skills and abilities known as competencies. The model of leadership competencies presented in this article will become an essential tool for organizations in their pursuit of leaders to implement and drive successful change. This leadership competency model, discussed within a framework of change management process, will ensure that essential steps of change are followed and provide organizations with a blueprint for success. Is your organization ready?

Requirements for Successful Adoption of a Glucose Measurement System Into a Hospital POC Program.

PubMed

Füzéry, Anna K; Cembrowski, George S

2016-07-01

Widespread and successful implementation of any glucose measurement system in a hospital point-of-care (POC) program requires a number of features in addition to accurate and reliable analytical performance. Such features include, but are not limited to, a system's glucose-hematocrit dependence, durability, information technology capabilities, and battery capacity and battery life. While the study of Ottiger et al in this issue supports the analytical accuracy and reliability of Bayer's CONTOUR XT® blood glucose monitoring system, the suitability of other features of this system for a hospital POC program remains to be established. © 2016 Diabetes Technology Society.

Concepts, requirements, and design approaches for building successful planning and scheduling systems

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller; Willoughby, John K.

1991-01-01

Traditional practice of systems engineering management assumes requirements can be precisely determined and unambiguously defined prior to system design and implementation; practice further assumes requirements are held static during implementation. Human-computer decision support systems for service planning and scheduling applications do not conform well to these assumptions. Adaptation to the traditional practice of systems engineering management are required. Basic technology exists to support these adaptations. Additional innovations must be encouraged and nutured. Continued partnership between the programmatic and technical perspective assures proper balance of the impossible with the possible. Past problems have the following origins: not recognizing the unusual and perverse nature of the requirements for planning and scheduling; not recognizing the best starting point assumptions for the design; not understanding the type of system that being built; and not understanding the design consequences of the operations concept selected.

An empirical study of multidimensional fidelity of COMPASS consultation.

PubMed

Wong, Venus; Ruble, Lisa A; McGrew, John H; Yu, Yue

2018-06-01

Consultation is essential to the daily practice of school psychologists (National Association of School Psychologist, 2010). Successful consultation requires fidelity at both the consultant (implementation) and consultee (intervention) levels. We applied a multidimensional, multilevel conception of fidelity (Dunst, Trivette, & Raab, 2013) to a consultative intervention called the Collaborative Model for Promoting Competence and Success (COMPASS) for students with autism. The study provided 3 main findings. First, multidimensional, multilevel fidelity is a stable construct and increases over time with consultation support. Second, mediation analyses revealed that implementation-level fidelity components had distant, indirect effects on student Individualized Education Program (IEP) outcomes. Third, 3 fidelity components correlated with IEP outcomes: teacher coaching responsiveness at the implementation level, and teacher quality of delivery and student responsiveness at the intervention levels. Implications and future directions are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation.

PubMed

Yen, Po-Yin; McAlearney, Ann Scheck; Sieck, Cynthia J; Hefner, Jennifer L; Huerta, Timothy R

2017-09-07

In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer. ©Po-Yin Yen, Ann Scheck McAlearney, Cynthia J Sieck, Jennifer L Hefner, Timothy R Huerta. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 07.09.2017.

78 FR 46117 - National Tunnel Inspection Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-30

... based on roadway enclosure and length: ``Any combination of structures that creates a structure that is... this SNPRM apply to all structures defined as highway tunnels on all public roads, on and off Federal... describes the organizational requirements associated with successful implementation of the proposed NTIS...

Implementing Community Engagement for Combination Prevention: Lessons Learnt From the First Year of the HPTN 071 (PopART) Community-Randomized Study.

PubMed

Simwinga, Musonda; Bond, Virginia; Makola, Nozizwe; Hoddinott, Graeme; Belemu, Steve; White, Rhonda; Shanaube, Kwame; Seeley, Janet; Moore, Ayana

2016-08-01

Key to the success of a HIV combination prevention strategy, including galvanizing the current push to roll out universal test and treat (UTT), is the involvement and buy-in of the populations that the strategy aims to reach. Drawing on the experiences of engaging with 21 communities in Zambia and South Africa in the design and implementation of a community-randomized study of combination HIV prevention including UTT, this paper reflects on the commitment to, approaches for and benefits of involving communities. Key lessons learnt include that all communities require continuous community engagement (CE) and engagement needs to be adapted to diverse local contexts. Intrinsic goals of CE, such as building trusting relationships between study stakeholders, are necessary precursors to instrumental goals which strengthen the research quality. Engaging the community for combination prevention requires that CE successfully bridges science and real life, paying attention to influences in the wider social landscape.

Radiographer-led plan selection for bladder cancer radiotherapy: initiating a training programme and maintaining competency.

PubMed

McNair, H A; Hafeez, S; Taylor, H; Lalondrelle, S; McDonald, F; Hansen, V N; Huddart, R

2015-04-01

The implementation of plan of the day selection for patients receiving radiotherapy (RT) for bladder cancer requires efficient and confident decision-making. This article describes the development of a training programme and maintenance of competency. Cone beam CT (CBCT) images acquired on patients receiving RT for bladder cancer were assessed to establish baseline competency and training needs. A training programme was implemented, and observers were asked to select planning target volumes (PTVs) on two groups of 20 patients' images. After clinical implementation, the PTVs chosen were reviewed offline, and an audit performed after 3 years. A mean of 73% (range, 53-93%) concordance rate was achieved prior to training. Subsequent to training, the mean score decreased to 66% (Round 1), then increased to 76% (Round 2). Six radiographers and two clinicians successfully completed the training programme. An independent observer reviewed the images offline after clinical implementation, and a 91% (126/139) concordance rate was achieved. During the audit, 125 CBCT images from 13 patients were reviewed by a single observer and concordance was 92%. Radiographer-led selection of plan of the day was implemented successfully with the use of a training programme and continual assessment. Quality has been maintained over a period of 3 years. The training programme was successful in achieving and maintaining competency for a plan of the day technique.

Mass Customization and Personalization Prospects in Developing Country: Indonesian Context

NASA Astrophysics Data System (ADS)

Risdiyono; Djati Widodo, Imam; Mahtarami, Affan

2016-01-01

The advancement of information technology (IT) has changed many modes and ways for people in doing their businesses. Mass Customization and Personalization (MCP) is one example of business modes that has been dramatically evolve, mainly due to the currently very fast IT development. MCP has enabled people to involve in adjusting some design parameters of a product to meet their personal requirements before purchased. The advancement of IT has made MCP more successful as it makes the process faster, easier, simpler and more joyful. The success stories of MCP are easily found in many developed countries, where the IT infrastructure has firmly been established. For developing countries, there are very few industries have implemented the MCP concept, including Indonesia. This paper discusses a descriptive study to depict what people think about MCP implementation in Indonesia especially in Small and Medium Enterprises (SMEs). Kano model was used to see the perception of both producers and consumers in relation with MCP implementation. Five dummy MCP prototypes were developed for five creative products including plaques, hats, invitation card, t-shirts and leather bags. Based on the KANO questionnaire analyses, it is clear that there are big opportunities to implement MCP in Indonesia especially for creative products produced by SMEs. Identifying the correct product features is an important key for successful MCP implementation in developing countries.

Evaluation of the learning curve for external cephalic version using cumulative sum analysis.

PubMed

Kim, So Yun; Han, Jung Yeol; Chang, Eun Hye; Kwak, Dong Wook; Ahn, Hyun Kyung; Ryu, Hyun Mi; Kim, Moon Young

2017-07-01

We evaluated the learning curve for external cephalic version (ECV) using learning curve-cumulative sum (LC-CUSUM) analysis. This was a retrospective study involving 290 consecutive cases between October 2013 and March 2017. We evaluated the learning curve for ECV on nulli and over para 1 group using LC-CUSUM analysis on the assumption that 50% and 70% of ECV procedures succeeded by description a trend-line of quadratic function with reliable R 2 values. The overall success rate for ECV was 64.8% (188/290), while the success rate for nullipara and over para 1 groups was 56.2% (100/178) and 78.6% (88/112), respectively. 'H' value, that the actual failure rate does not differ from the acceptable failure rate, was -3.27 and -1.635 when considering ECV success rates of 50% and 70%, respectively. Consequently, in order to obtain a consistent 50% success rate, we would require 57 nullipara cases, and in order to obtain a consistent 70% success rate, we would require 130 nullipara cases. In contrast, 8 to 10 over para 1 cases would be required for an expected success rate of 50% and 70% on over para 1 group. Even a relatively inexperienced physician can experience success with multipara and after accumulating experience, they will manage nullipara cases. Further research is required for LC-CUSUM involving several practitioners instead of a single practitioner. This will lead to the gradual implementation of standard learning curve guidelines for ECV.

A qualitative analysis of success stories from Michiana Coordinated School Health Leadership institute participants.

PubMed

Dewitt, Natalie; Lohrmann, David K; O'Neill, James; Clark, Jeffrey K

2011-12-01

The purpose of this study was to detect and document common themes among success stories, along with challenges, as related by participants in the Michiana Coordinated School Health Leadership Institute. Four-member teams from 18 Michigan and Indiana school districts participated in semiannual Institute workshops over a 3-year period and were tasked with implementing Coordinated School Health Programs (CSHPs). Qualitative methods were used to generate themes from interviews. Data were gathered through a combined survey/interview process related to programmatic successes, evidence of success, and implementation challenges. One participant from 11 of 18 participating school districts completed the survey/interview. Each participant reported at least 1 success that had a positive effect on students and/or staff, many of which were related to the federally mandated wellness policy. With some notable exceptions, success was based on subjective judgments rather than systematically collected data. Unanimous expression of time constraints and being overworked in their current positions constituted major challenges. Although the Institute required only process evaluation, some participants collected outcome data, a task that is important in validating the benefits of CSHPs. Most districts were not able to hire the recommended coordinator to ensure implementation of health program planning initially developed during the institute. Encouragingly, at the time of data collection many teams were still acting to ensure health programming remained a priority. Nevertheless, without the network of social support provided by the Institute, some respondents struggled to maintain momentum. © 2011, American School Health Association.

WE-E-304-00: Implementing SBRT Protocols

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

NONE

2015-06-15

SBRT is having a dramatic impact on radiation therapy of early-stage, locally advanced cancers. A number of national protocols have been and are being developed to assess the clinical efficacy of SBRT for various anatomical sites, such as lung and spine. Physics credentialing for participating and implementation of trial protocols involve a broad spectrum of requirements from image guidance, motion management, to planning technology and dosimetric constrains. For radiation facilities that do not have extensive experiences in SBRT treatment and protocol credentialing, these complex processes of credentialing and implementation could be very challenging and, sometimes, may lead to ineffective evenmore » unsuccessful execution of these processes. In this proposal, we will provide comprehensive review of some current SBRT protocols, explain the requirements and their underline rationales, illustrate representative failed and successful experiences, related to SBRT credentialing, and discuss strategies for effective SBRT credentialing and implementation. Learning Objectives: Understand requirements and challenges of SBRT credentailing and implentation Discuss processes and strategies of effective SBRT credentailing Discuss practical considerations, potential pitfalls and solutions of SBRT implentation.« less

WE-E-304-02: Implementing SBRT Protocols: A NRG CIRO Perspective

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

Xiao, Y.

2015-06-15

SBRT is having a dramatic impact on radiation therapy of early-stage, locally advanced cancers. A number of national protocols have been and are being developed to assess the clinical efficacy of SBRT for various anatomical sites, such as lung and spine. Physics credentialing for participating and implementation of trial protocols involve a broad spectrum of requirements from image guidance, motion management, to planning technology and dosimetric constrains. For radiation facilities that do not have extensive experiences in SBRT treatment and protocol credentialing, these complex processes of credentialing and implementation could be very challenging and, sometimes, may lead to ineffective evenmore » unsuccessful execution of these processes. In this proposal, we will provide comprehensive review of some current SBRT protocols, explain the requirements and their underline rationales, illustrate representative failed and successful experiences, related to SBRT credentialing, and discuss strategies for effective SBRT credentialing and implementation. Learning Objectives: Understand requirements and challenges of SBRT credentailing and implentation Discuss processes and strategies of effective SBRT credentailing Discuss practical considerations, potential pitfalls and solutions of SBRT implentation.« less

Research Required for the Effective Implementation of the Framework Convention on Tobacco Control, Articles 9 and 10

PubMed Central

2013-01-01

This paper is part of a series of articles intended to set out the research questions that are relevant to the successful implementation of the various provisions of the Framework Convention on Tobacco Control (FCTC). This paper focuses on issues affecting Articles 9 and 10 of the FCTC. This paper focuses on the research that is most important for most countries, rather than on what is desirable in countries with high levels of research capacity. Articles 9 and 10 of the FCTC address the regulation of contents and emissions of tobacco products and regulation of tobacco product disclosure. Such regulation will be essential if the long-term objective of reducing the danger of tobacco products is to be achieved. There are many components of tobacco and tobacco smoke that are excessively toxic and dangerous to the user. Many of these components are carcinogenic and addictive and can be removed or reduced substantially with current known technology. The fact that these components remain in tobacco and tobacco smoke at levels that are unnecessarily dangerous is precisely the reason why the successful implementation of Articles 9 and 10 of the FCTC is important to tobacco control. This paper discusses the scientific challenges involved in successfully implementing Articles 9 and 10 of the FCTC, which focuses on regulating carcinogens and toxins in tobacco and tobacco smoke, the abuse liability of tobacco products, and the additives and engineering features in tobacco products that make tobacco products appealing to future consumers. The research issues we focus on are those required to support the early stages of regulation. As regulation proceeds, new and more sophisticated research questions will undoubtedly emerge. PMID:23024247

Exploring faculty perceptions towards electronic health records for nursing education.

PubMed

Kowitlawakul, Y; Chan, S W C; Wang, L; Wang, W

2014-12-01

The use of electronic health records in nursing education is rapidly increasing worldwide. The successful implementation of electronic health records for nursing education software program relies on students as well as nursing faculty members. This study aimed to explore the experiences and perceptions of nursing faculty members using electronic health records for nursing education software program, and to identify the influential factors for successful implementation of this technology. This exploratory qualitative study was conducted using in-depth individual interviews at a university in Singapore. Seven faculty members participated in the study. The data were gathered and analysed at the end of the semester in the 2012/2013 academic year. The participants' perceptions of the software program were organized into three main categories: innovation, transition and integration. The participants perceived this technology as innovative, with both values and challenges for the users. In addition, using the new software program was perceived as transitional process. The integration of this technology required time from faculty members and students, as well as support from administrators. The software program had only been implemented for 2-3 months at the time of the interviews. Consequently, the participants might have lacked the necessary skill and competence and confidence to implement it successfully. In addition, the unequal exposure to the software program might have had an impact on participants' perceptions. The findings show that the integration of electronic health records into nursing education curricula is dependent on the faculty members' experiences with the new technology, as well as their perceptions of it. Hence, cultivating a positive attitude towards the use of new technologies is important. Electronic health records are significant applications of health information technology. Health informatics competency should be included as a required competency component in faculty professional development policy and programmes. © 2014 International Council of Nurses.

Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness.

PubMed

Windle, E M; Beddow, D; Hall, E; Wright, J; Sundar, N

2010-02-01

Artificial nutrition support is required to optimise nutritional status in many patients. Traditional methods of placing feeding tubes may incur clinical risk and financial costs. A technique facilitating placement of nasogastric and post-pyloric tubes via electromagnetic visual guidance may reduce the need for X-ray exposure, endoscopy time and the use of parenteral nutrition. The present study aimed to audit use of such a system at initial implementation in patients within an acute NHS Trust. A retrospective review was undertaken of dietetic and medical records for the first 14 months of using the Cortrak system. Data were collected on referral origin, preparation of the patient prior to insertion, placement success rates and need for X-ray. Cost analysis was also performed. Referrals were received from primary consultants or consultant intensivists, often on the advice of the dietitian. Fifty-nine percent of patients received prokinetic therapy at the time of placement. Thirty-nine tube placements were attempted. Sixty-nine percent of referrals for post-pyloric tube placement resulted in successful placement. X-ray films were requested for 22% of all attempted post-pyloric placements. Less than half of nasogastric tubes were successfully passed, although none of these required X-ray confirmation. The mean cost per tube insertion attempt was 111 pounds. This system confers advantages, particularly in terms of post-pyloric tube placement, even at this early stage of implementation. A reduction in clinical risk and cost avoidance related to X-ray exposure, the need for endoscopic tube placement and parenteral nutrition have been achieved. The implementation of this system should be considered in other centres.

Using the nursing process to implement a Y2K computer application.

PubMed

Hobbs, C F; Hardinge, T T

2000-01-01

Because of the coming year 2000, the need was assessed to upgrade the order entry system at many hospitals. At Somerset Medical Center, a training team divided the transition into phases and used a modified version of the nursing process to implement the new program. The entire process required fewer than 6 months and was relatively problem-free. This successful transition was aided by the nursing process, training team, and innovative educational techniques.

Teaching with Videogames: How Experience Impacts Classroom Integration

ERIC Educational Resources Information Center

Bell, Amanda; Gresalfi, Melissa

2017-01-01

Digital games have demonstrated great potential for supporting students' learning across disciplines. But integrating games into instruction is challenging and requires teachers to shift instructional practices. One factor that contributes to the successful use of games in a classroom is teachers' experience implementing the technologies. But how…

Cost Framework for Teacher Preparation and Professional Development.

ERIC Educational Resources Information Center

Rice, Jennifer King

In 2000, the Finance Project received a planning grant to launch a new initiative on financing professional development in education. This report contributes to the understanding of resources required to successfully implement, replicate, or scale up professional development initiatives. The first section examines what preservice and inservice…

Blended Learning: A Dangerous Idea?

ERIC Educational Resources Information Center

Moskal, Patsy; Dziuban, Charles; Hartman, Joel

2013-01-01

The authors make the case that implementation of a successful blended learning program requires alignment of institutional, faculty, and student goals. Reliable and robust infrastructure must be in place to support students and faculty. Continuous evaluation can effectively track the impact of blended learning on students, faculty, and the…

Improved outcomes after successful implementation of a pediatric early warning system (PEWS) in a resource-limited pediatric oncology hospital.

PubMed

Agulnik, Asya; Mora Robles, Lupe Nataly; Forbes, Peter W; Soberanis Vasquez, Doris Judith; Mack, Ricardo; Antillon-Klussmann, Federico; Kleinman, Monica; Rodriguez-Galindo, Carlos

2017-08-01

Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in resource-limited settings. Pediatric early warning systems (PEWS) aid in the early identification of clinical deterioration; however, there are limited data regarding their feasibility or impact in low-resource settings. This study describes the successful implementation of PEWS at the Unidad Nacional de Oncología Pediátrica (UNOP), a pediatric oncology hospital in Guatemala, resulting in improved inpatient outcomes. A modified PEWS was implemented at UNOP with systems to track errors, transfers to a higher level of care, and high scores. A retrospective cohort study was used to evaluate clinical deterioration events in the year before and after PEWS implementation. After PEWS implementation at UNOP, there was 100% compliance with PEWS documentation and an error rate of <10%. Implementation resulted in 5 high PEWS per week, with 30% of patients transferring to a higher level of care. Among patients requiring transfer to the pediatric intensive care unit (PICU), 93% had an abnormal PEWS before transfer. The rate of clinical deterioration events decreased after PEWS implementation (9.3 vs 6.5 per 1000-hospitalpatient-days, p = .003). Despite an 18% increase in total hospital patient-days, PICU utilization for inpatient transfers decreased from 1376 to 1088 PICU patient-days per year (21% decrease; P<.001). This study describes the successful implementation of PEWS in a pediatric oncology hospital in Guatemala, resulting in decreased inpatient clinical deterioration events and PICU utilization. This work demonstrates that PEWS is a feasible and effective quality improvement measure to improve hospital care for children with cancer in hospitals with limited resources. Cancer 2017;123:2965-74. © 2017 American Cancer Society. © 2017 American Cancer Society.

Comparative case study of two biomedical research collaboratories.

PubMed

Schleyer, Titus K L; Teasley, Stephanie D; Bhatnagar, Rishi

2005-10-25

Working together efficiently and effectively presents a significant challenge in large-scale, complex, interdisciplinary research projects. Collaboratories are a nascent method to help meet this challenge. However, formal collaboratories in biomedical research centers are the exception rather than the rule. The main purpose of this paper is to compare and describe two collaboratories that used off-the-shelf tools and relatively modest resources to support the scientific activity of two biomedical research centers. The two centers were the Great Lakes Regional Center for AIDS Research (HIV/AIDS Center) and the New York University Oral Cancer Research for Adolescent and Adult Health Promotion Center (Oral Cancer Center). In each collaboratory, we used semistructured interviews, surveys, and contextual inquiry to assess user needs and define the technology requirements. We evaluated and selected commercial software applications by comparing their feature sets with requirements and then pilot-testing the applications. Local and remote support staff cooperated in the implementation and end user training for the collaborative tools. Collaboratory staff evaluated each implementation by analyzing utilization data, administering user surveys, and functioning as participant observers. The HIV/AIDS Center primarily required real-time interaction for developing projects and attracting new participants to the center; the Oral Cancer Center, on the other hand, mainly needed tools to support distributed and asynchronous work in small research groups. The HIV/AIDS Center's collaboratory included a center-wide website that also served as the launch point for collaboratory applications, such as NetMeeting, Timbuktu Conference, PlaceWare Auditorium, and iVisit. The collaboratory of the Oral Cancer Center used Groove and Genesys Web conferencing. The HIV/AIDS Center was successful in attracting new scientists to HIV/AIDS research, and members used the collaboratory for developing and implementing new research studies. The Oral Cancer Center successfully supported highly distributed and asynchronous research, and the collaboratory facilitated real-time interaction for analyzing data and preparing publications. The two collaboratory implementations demonstrated the feasibility of supporting biomedical research centers using off-the-shelf commercial tools, but they also identified several barriers to successful collaboration. These barriers included computing platform incompatibilities, network infrastructure complexity, variable availability of local versus remote IT support, low computer and collaborative software literacy, and insufficient maturity of available collaborative software. Factors enabling collaboratory use included collaboration incentives through funding mechanism, a collaborative versus competitive relationship of researchers, leadership by example, and tools well matched to tasks and technical progress. Integrating electronic collaborative tools into routine scientific practice can be successful but requires further research on the technical, social, and behavioral factors influencing the adoption and use of collaboratories.

Strategies from a nationwide health information technology implementation: the VA CART story.

PubMed

Box, Tamára L; McDonell, Mary; Helfrich, Christian D; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S

2010-01-01

The VA Cardiovascular Assessment, Reporting, and Tracking (CART) system is a customized electronic medical record system which provides standardized report generation for cardiac catheterization procedures, serves as a national data repository, and is the centerpiece of a national quality improvement program. Like many health information technology projects, CART implementation did not proceed without some barriers and resistance. We describe the nationwide implementation of CART at the 77 VA hospitals which perform cardiac catheterizations in three phases: (1) strategic collaborations; (2) installation; and (3) adoption. Throughout implementation, success required a careful balance of technical, clinical, and organizational factors. We offer strategies developed through CART implementation which are broadly applicable to technology projects aimed at improving the quality, reliability, and efficiency of health care.

A real time microcomputer implementation of sensor failure detection for turbofan engines

NASA Technical Reports Server (NTRS)

Delaat, John C.; Merrill, Walter C.

1989-01-01

An algorithm was developed which detects, isolates, and accommodates sensor failures using analytical redundancy. The performance of this algorithm was demonstrated on a full-scale F100 turbofan engine. The algorithm was implemented in real-time on a microprocessor-based controls computer which includes parallel processing and high order language programming. Parallel processing was used to achieve the required computational power for the real-time implementation. High order language programming was used in order to reduce the programming and maintenance costs of the algorithm implementation software. The sensor failure algorithm was combined with an existing multivariable control algorithm to give a complete control implementation with sensor analytical redundancy. The real-time microprocessor implementation of the algorithm which resulted in the successful completion of the algorithm engine demonstration, is described.

A multi-institutional study of the perceived barriers and facilitators to implementing evidence-based practice.

PubMed

Duncombe, Daphne C

2018-03-01

To examine perceived barriers and facilitators to implementing evidence-based practice among nurses working in psychiatric, geriatric, hospital and community settings in The Bahamas. It is evident from previous studies that a number of factors exist which either obstruct or promote the utilisation of research evidence in nursing practice. Identifying these factors is vital to the successful uptake of evidence-based practice in nursing. Descriptive, comparative study. Data were collected using self-administered questionnaires. A stratified random sample (n = 100) of registered nurses participated; 5-point Likert-like scales were used to examine nurses' perceptions of barriers and facilitators of evidence-based practice. Descriptive statistics were used to describe demographic characteristics and to compare responses of nurses. Participants were predominantly female (98.4%), in the 25 to <35 years age group (45.9%). Of nurses surveyed, 72.1% had never tried to implement evidence-based practice previously. The greatest barriers identified were as follows: "Inadequate resources for implementing research findings" (85.2%; n = 52) and "Inadequate training in research methods" (83.6%; n = 51). The top facilitators identified were as follows: "Training in research methods" (88.5%; n = 54) and "Organisational policies and protocols that are evidence-based" (86.9%; n = 53). Nurses generally expressed that they required additional training in research and evidence-based practice concepts. Although some nurses had a desire to implement evidence-based practice to provide quality care and improve patient outcomes, many expressed that they lacked the required resources. The study draws attention to the need for prioritisation of evidence-based practice both at institutional and governmental levels. Successful adoption of evidence-based practice implies combined efforts of nurses, healthcare providers and policymakers. Further research is needed to determine the best method for successfully incorporating evidence-based practice into nursing practice in The Bahamas. © 2017 John Wiley & Sons Ltd.

Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health

PubMed Central

Bergström, Anna; Hoa, Dinh Thi Phuong; Nga, Nguyen Thu; Eldh, Ann Catrine

2017-01-01

Background In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial. Methods In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis. Results To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital–prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking. Conclusions The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond the project lifetime, and engagement of key stakeholders, in order to promote and sustain knowledge implementation. PMID:28806744

Evidence implementation: Development of an online methodology from the knowledge-to-action model of knowledge translation.

PubMed

Lockwood, Craig; Stephenson, Matthew; Lizarondo, Lucylynn; van Den Hoek, Joan; Harrison, Margaret

2016-08-01

This paper describes an online facilitation for operationalizing the knowledge-to-action (KTA) model. The KTA model incorporates implementation planning that is optimally suited to the information needs of clinicians. The can-implement(©) is an evidence implementation process informed by the KTA model. An online counterpart, the can-implement.pro(©) , was developed to enable greater dissemination and utilization of the can-implement(©) process. The driver for this work was health professionals' need for facilitation that is iterative, informed by context and localized to the specific needs of users. The literature supporting this paper includes evaluation studies and theoretical concepts relevant to KTA model, evidence implementation and facilitation. Nursing and other health disciplines require a skill set and resources to successfully navigate the complexity of organizational requirements, inter-professional leadership and day-to-day practical management to implement evidence into clinical practice. The can-implement.pro(©) provides an accessible, inclusive system for evidence implementation projects. There is empirical support for evidence implementation informed by the KTA model, which in this phase of work has been developed for online uptake. Nurses and other clinicians seeking to implement evidence could benefit from the directed actions, planning advice and information embedded in the phases and steps of can-implement.pro(©) . © 2016 John Wiley & Sons Australia, Ltd.

Exploration Requirements Development Utilizing the Strategy-to-Task-to-Technology Development Approach

NASA Technical Reports Server (NTRS)

Drake, Bret G.; Josten, B. Kent; Monell, Donald W.

2004-01-01

The Vision for Space Exploration provides direction for the National Aeronautics and Space Administration to embark on a robust space exploration program that will advance the Nation s scientific, security, and economic interests. This plan calls for a progressive expansion of human capabilities beyond low earth orbit seeking to answer profound scientific and philosophical questions while responding to discoveries along the way. In addition, the Vision articulates the strategy for developing the revolutionary new technologies and capabilities required for the future exploration of the solar system. The National Aeronautics and Space Administration faces new challenges in successfully implementing the Vision. In order to implement a sustained and affordable exploration endeavor it is vital for NASA to do business differently. This paper provides an overview of the strategy-to-task-to-technology process being used by NASA s Exploration Systems Mission Directorate to develop the requirements and system acquisition details necessary for implementing a sustainable exploration vision.

Design and implementation of organic LED-based displays for signage application

NASA Astrophysics Data System (ADS)

Sharma, Pratibha; Kwok, Harry

2006-06-01

Organic light-emitting diodes (OLEDs) have been utilized successfully for various applications such as microdisplays in cell-phones and digital cameras. However, the application of OLEDs for large area signage displays has not yet been established. This paper presents novel design techniques for implementing OLEDs as light sources for signage application. The designs are examined on the basis of signage uniformity, cost and manufacturing complexity. Advantages and limitations of each design are described. It is determined that a trade-off is required to choose a design for implementation. After evaluation and comparison of the designs, the most optimal design is chosen and implemented. Measurement results with the optimal design are described.

What happened to the no-wait hospital? A case study of implementation of operational plans for reduced waits.

PubMed

Hansson, Johan; Tolf, Sara; Øvretveit, John; Carlsson, Jan; Brommels, Mats

2012-01-01

Both research and practice show that waiting lists are hard to reduce. Implementing complex interventions for reduced waits is an intricate and challenging process that requires special attention for surrounding factors helping and hindering the implementation. This article reports a case study of a hospital implementation of operational plans for reduced waits, with an emphasis on the process of change. A case study research design, theoretically informed by the Pettigrew and Whipp model of strategic change, was applied. Data were gathered from individual and focus group interviews with informants from different organizational levels at different times and from documents and plans. The findings revealed arrangements both helping and hindering the implementation work. Helping factors were the hospital's contemporary savings requirements and experiences from similar change initiatives. Those hindering the actions to plan and agree the changes were unclear support functions and unclear task prioritization. One contribution of this study is to demonstrate the advantages, disadvantages, and challenges of a contextualized case study for increased understanding of factors influencing organizational change implementation. One lesson for current policy is to regard context factors that are critical for successful implementation.

Paraphrasing Strategy Instruction in Content Area Text

ERIC Educational Resources Information Center

Hagaman, Jessica L.; Casey, Kathryn J.

2017-01-01

Reading comprehension is important for academic success and is a skill required for many activities in school and beyond. With the implementation of the Common Core State Standards (CCSS), many teachers have reported feeling overwhelmed by the expectations that reading and writing skills should be emphasized, taught, and supported in the content…

Organizational Culture: Technology Integration. Review of Literature and Data Gathering

ERIC Educational Resources Information Center

Simpson, Selena E.

2008-01-01

Background: Communities of practice and technology integration within such communities requires much attention in the future of education and developing organizations. Purpose: To examine the effectiveness of technology integration and how communities of practice plays a role in the successful implementation of technology integration for teacher…

Agricultural Extension Services and the Issue of Equity in Agricultural Development.

ERIC Educational Resources Information Center

Monu, Erasmus D.

1981-01-01

Reviews experiments in Kenya and Nigeria attempting to modify the progressive-farmer strategy. Success requires that extension services recognize small farmers' ability to make their own rational decisions and involve farmers in planning and implementing extension programs. Available from: Rural Sociological Society, 325 Morgan Hall, University of…

Principal Preservice Education for Leadership in Inclusive Schools

ERIC Educational Resources Information Center

Lyons, Wanda

2016-01-01

Principal leadership has been identified as the key to successful implementation of inclusive education for students with disabilities. Prospective principals require knowledge, skills, and dispositions to equip them to work with key stakeholders to initiate and sustain inclusive practices within their schools. The purpose of this action research…

Inclusive Classes in Physical Education: Teachers' Difficulties

ERIC Educational Resources Information Center

Toloi, Gabriela Gallucci; Manzini, Eduardo José; Spoldaro, Diego Machado; Zacarias, Lucas Ventura

2016-01-01

The successful inclusion of students with special needs in physical education classes requires much planning and preparation. Lack of preparation of physical education teachers working in inclusive settings in Brazil has demonstrated the need for specialized training in strategies for implementing inclusion. The goal of this study was to identify,…

Moving to the National Curriculum.

ERIC Educational Resources Information Center

O'Shaughnessy, Martin

1994-01-01

Reflects the experience of teachers who attended a course on managing change. They used their new knowledge to introduce change in their own teaching or their own departments. Successful change implementation requires agreement on the change target(s), starting with a small, manageable target, and monitoring of the resulting change. (one…

AADE position statement: education for continuous subcutaneous insulin infusion pump users. American Association of Diabetes Educators.

PubMed

1997-01-01

Successful implementation of CSII requires a motivated patient with a range of technical skills and self-management capabilities. Patients develop this expertise through an ongoing program of education and the support that a healthcare team knowledgeable in insulin pump therapy can provide.

Building a Culture of Reading

ERIC Educational Resources Information Center

Makatche, Kathryn; Oberlin, Jessica Urick

2011-01-01

Building a culture of reading in a school requires the participation of the entire school community--students, teachers, administrators, staff, parents, and patrons. To be successful, the whole community must be on board with books--not just the helpful librarian in the school library. Implementing library programs to encourage students to read…

Attention to Intentions--How to Stimulate Strong Intentions to Change

ERIC Educational Resources Information Center

Dam, M.; Janssen, F. J. J. M.; van Driel, J. H.

2018-01-01

The implementation of educational reforms requires behavioral changes from the teachers involved. Theories on successful behavioral change prescribe the following conditions: teachers need to possess the necessary knowledge and skills, form strong positive intentions to perform the new behavior, and have a supporting environment for change.…

Revenue Forecasting to Integrate CCC Planning and Resource Allocation for Transformative Leadership

ERIC Educational Resources Information Center

Hovey, Ann

2012-01-01

In recent years the majority of California community colleges evaluated for re-accreditation received sanctions requiring documented improvement in the integration of college planning and budgeting processes. This study explores the challenges colleges face and the best practices utilized by successful colleges in implementing integrated…

Coding Skills as a Success Factor for a Society

ERIC Educational Resources Information Center

Tuomi, Pauliina; Multisilta, Jari Antero; Saarikoski, Petri; Suominen, Jaakko

2018-01-01

Digitalization is one of the most promising ways to increase productivity in the public sector and is needed to reform the economy by creating new innovation related jobs. The implementation of digital services requires problem solving, design skills, logical thinking, an understanding of how computers and networks operate, and programming…

How to Use Historical Approach to Teach Nature of Science in Chemistry Education?

ERIC Educational Resources Information Center

Tolvanen, Simo; Jansson, Jan; Vesterinen, Veli-Matti; Aksela, Maija

2014-01-01

Successful implementation of historical approach to teach nature of science (NOS) requires suitable curriculum material. Several research and development projects have produced lesson plans for science teachers. 25 lesson plans from four different projects involved in creating curriculum material utilizing historical approach in chemistry…

Vending Reimbursable Lunches to High School Students: A Study of Two Successes

ERIC Educational Resources Information Center

Carr, Deborah H.; Cross, Evelina W.

2008-01-01

Objectives: The objectives were to investigate the operational requirements for offering healthful vended reimbursable lunches to students and to identify barriers to implementation. Methods: A descriptive case study method was utilized to explore the operations of two school nutrition programs offering vended reimbursable lunches. Two school…

Multilingual Education in South Africa: The Role of Publishers

ERIC Educational Resources Information Center

Edwards, Viv; Ngwaru, Jacob Marriote

2011-01-01

The South African constitution and related legislative tools provide a supportive framework for multilingual education. Successful implementation, however, requires appropriate learning materials and questions remain as to the vision and commitment of publishers to producing them. Based on an analysis of currently available books for children and…

Digital Stories: Overview

ERIC Educational Resources Information Center

Oskoz, Ana; Elola, Idoia

2016-01-01

This article provides an overview of how digital stories (DSs)--storylines that integrate text, images, and sound--have been used in second-language (L2) contexts. The article first reviews the methodical and planned, albeit non-linear, steps required for successful implementation of DSs in the L2 classroom and then assesses the observed…

Integrating New Technologies in UK Classrooms: Lessons for Teachers from Early Years Practitioners.

ERIC Educational Resources Information Center

Brooker, Liz

2003-01-01

Notes that rapid introduction of information and communication technologies in United Kingdom schools, along with government-mandated curriculum requirements, has not been matched by growth in practitioners' understanding of appropriate ways to use the technology. Examines the successful implementation of technology in early childhood settings…

Management Planning for Workplace Automation.

ERIC Educational Resources Information Center

McDole, Thomas L.

Several factors must be considered when implementing office automation. Included among these are whether or not to automate at all, the effects of automation on employees, requirements imposed by automation on the physical environment, effects of automation on the total organization, and effects on clientele. The reasons behind the success or…

Computer-Aided Corrosion Program Management

NASA Technical Reports Server (NTRS)

MacDowell, Louis

2010-01-01

This viewgraph presentation reviews Computer-Aided Corrosion Program Management at John F. Kennedy Space Center. The contents include: 1) Corrosion at the Kennedy Space Center (KSC); 2) Requirements and Objectives; 3) Program Description, Background and History; 4) Approach and Implementation; 5) Challenges; 6) Lessons Learned; 7) Successes and Benefits; and 8) Summary and Conclusions.

Proactive Strategies to Safeguard Young Adolescents in the Cyberage

ERIC Educational Resources Information Center

Miller, Nicole C.; Thompson, Nicole L.; Franz, Dana Pomykal

2009-01-01

Schools should be proactive rather than reactive to issues of technology safety, and this requires careful planning and policy implementation. In this article, the authors provide information and recommendations that will help middle grades educators, students, and parents to safely and successfully manage the many technologies they encounter and…

Non-standard equipment for construction of vertical shafts

NASA Astrophysics Data System (ADS)

Yagodkin, F. I.; Prokopov, A. Y.; Pleshko, M. S.; Pankratenko, A. N.

2017-10-01

The article deals with the modern problems of construction and reconstruction of vertical shafts of mines, which require innovative technical solutions in the mechanization of mining operations. The examples developed by the authors of the original equipment and technologies, are successfully implemented for the mining industry in Russia.

Learning to Teach: Pedagogical Content Knowledge in Adventure-Based Learning

ERIC Educational Resources Information Center

Sutherland, Sue; Stuhr, Paul T.; Ayvazo, Shiri

2016-01-01

Background: Many alternative curricular models exist in physical education to better meet the needs of students than the multi-activity team sports curriculum that dominates in the USA. These alternative curricular models typically require different content knowledge (CK) and pedagogical CK (PCK) to implement successfully. One of the complexities…

CP&P Reports: Part Two--The Placement Survey Report.

ERIC Educational Resources Information Center

Hannah, Larry K.; Mattox, Robert J.

1989-01-01

Outlines the Emporia State University methodology for developing and implementing a placement survey focusing on employment situation, salary, and geographic location as these are the most commonly asked questions by students and are federal requirements. Demonstrates how to successfully collect annual post-graduation follow-up information.…

Evaluation of a Complex, Multisite, Multilevel Grants Initiative

ERIC Educational Resources Information Center

Rollison, Julia; Hill, Gary; Yu, Ping; Murray, Stephen; Mannix, Danyelle; Mathews-Younes, Anne; Wells, Michael E.

2012-01-01

The Safe Schools/Healthy Students (SS/HS) national evaluation seeks to assess both the implementation process and the results of the SS/HS initiative, exploring factors that have contributed to or detracted from grantee success. Each site is required to forge partnerships with representatives from education, mental health, juvenile justice, and…

SETTING DATA QUALITY OBJECTIVES FOR THERMALLY ENHANCED, IN SITU REMEDIATION PROJECTS

EPA Science Inventory

The design and implementation of an in-situ technology requires an up-front and clear understanding of the remedial objectives of the technology application and the data that will be collected to track the progress of remediation and to assess the ultimate success of in-sit...

Experiment requirements and implementation plan (Erip) for semiconductor materials growth in low-G environment

NASA Technical Reports Server (NTRS)

Crouch, R. K.; Fripp, A. L.; Debnam, W. J.; Clark, I. O.

1983-01-01

The MEA-2 A facility was used to test the effect of the low gravity environment on suppressing convective mixing in the growth of Pb(1-x)Sn(x)Te crystals. The need to eliminate convection, the furnace characteristics and operation that will be required for successful experimental implementation, and to the level that is presently known, the measured physical properties of the Pb(1-x)Sn(x)Te system were discussed. In addition, a brief background of the present and potential utilization of Pb(1-x)Sn(x)Te is given. Additional experiments are anticipated in future MEA-A, improved MEA and other dedicated materials processing in space flight apparatus.

Top Down Implementation Plan for system performance test software

NASA Technical Reports Server (NTRS)

Jacobson, G. N.; Spinak, A.

1982-01-01

The top down implementation plan used for the development of system performance test software during the Mark IV-A era is described. The plan is based upon the identification of the hierarchical relationship of the individual elements of the software design, the development of a sequence of functionally oriented demonstrable steps, the allocation of subroutines to the specific step where they are first required, and objective status reporting. The results are: determination of milestones, improved managerial visibility, better project control, and a successful software development.

Hazard detection and avoidance sensor for NASA's planetary landers

NASA Technical Reports Server (NTRS)

Lau, Brian; Chao, Tien-Hsin

1992-01-01

An optical terrain analysis based sensor system specifically designed for landing hazard detection as required for NASA's autonomous planetary landers is introduced. This optical hazard detection and avoidance (HDA) sensor utilizes an optoelectronic wedge-and-ting (WRD) filter for Fourier transformed feature extraction and an electronic neural network processor for pattern classification. A fully implemented optical HDA sensor would assure safe landing of the planetary landers. Computer simulation results of a successful feasibility study is reported. Future research for hardware system implementation is also provided.

Policy Driven Development: Flexible Policy Insertion for Large Scale Systems.

PubMed

Demchak, Barry; Krüger, Ingolf

2012-07-01

The success of a software system depends critically on how well it reflects and adapts to stakeholder requirements. Traditional development methods often frustrate stakeholders by creating long latencies between requirement articulation and system deployment, especially in large scale systems. One source of latency is the maintenance of policy decisions encoded directly into system workflows at development time, including those involving access control and feature set selection. We created the Policy Driven Development (PDD) methodology to address these development latencies by enabling the flexible injection of decision points into existing workflows at runtime , thus enabling policy composition that integrates requirements furnished by multiple, oblivious stakeholder groups. Using PDD, we designed and implemented a production cyberinfrastructure that demonstrates policy and workflow injection that quickly implements stakeholder requirements, including features not contemplated in the original system design. PDD provides a path to quickly and cost effectively evolve such applications over a long lifetime.

Modeling a distributed environment for a petroleum reservoir engineering application with software product line

NASA Astrophysics Data System (ADS)

de Faria Scheidt, Rafael; Vilain, Patrícia; Dantas, M. A. R.

2014-10-01

Petroleum reservoir engineering is a complex and interesting field that requires large amount of computational facilities to achieve successful results. Usually, software environments for this field are developed without taking care out of possible interactions and extensibilities required by reservoir engineers. In this paper, we present a research work which it is characterized by the design and implementation based on a software product line model for a real distributed reservoir engineering environment. Experimental results indicate successfully the utilization of this approach for the design of distributed software architecture. In addition, all components from the proposal provided greater visibility of the organization and processes for the reservoir engineers.

Building a global business continuity programme.

PubMed

Lazcano, Michael

2014-01-01

Business continuity programmes provide an important function within organisations, especially when aligned with and supportive of the organisation's goals, objectives and organisational culture. Continuity programmes for large, complex international organisations, unlike those for compact national companies, are more difficult to design, build, implement and maintain. Programmes for international organisations require attention to structural design, support across organisational leadership and hierarchy, seamless integration with the organisation's culture, measured success and demonstrated value. This paper details practical, but sometimes overlooked considerations for building successful global business continuity programmes.

User's manual for the Simulated Life Analysis of Vehicle Elements (SLAVE) model

NASA Technical Reports Server (NTRS)

Paul, D. D., Jr.

1972-01-01

The simulated life analysis of vehicle elements model was designed to perform statistical simulation studies for any constant loss rate. The outputs of the model consist of the total number of stages required, stages successfully completing their lifetime, and average stage flight life. This report contains a complete description of the model. Users' instructions and interpretation of input and output data are presented such that a user with little or no prior programming knowledge can successfully implement the program.

Implementing a province-wide mandatory vaccinate-or-mask policy at healthcare facilities in British Columbia, Canada.

PubMed

Nunn, Alexandra; Campbell, Audrey C; Naus, Monika; Kwong, Jeffrey C; Puddicombe, David; Quach, Susan; Henry, Bonnie

2018-01-08

In 2012, British Columbia (BC) became the first Canadian province to implement an influenza prevention policy requiring healthcare workers (HCW) to either be vaccinated annually against influenza or wear a mask in patient care areas during the influenza season. This study describes an evaluation of influenza policy implementation processes and identifies supports and challenges related to successful policy implementation at the level of healthcare facilities, during the second policy year (2013/14). Implementation leaders from 262 long-term care (LTC) and acute care facilities, mostly in three of BC's five regional Health Authorities, were invited to participate in an online survey following the 2013/14 influenza season. Descriptive quantitative and qualitative analyses identified common and effective strategies for improving vaccination coverage and policy compliance. A total of 127 respondents completed the survey on behalf of 33 acute care and 99 LTC facilities, representing 36% of acute care and 27% of LTC facilities in BC. Respondents agreed that the policy was successfully implemented at 89% of facilities, and implementation was reported to be easy at 52% of facilities. The findings elaborate on communication and leadership strategies, campaign logistics and enforcement approaches involved in policy implementation. Implementation of a vaccinate-or-mask influenza policy is complex. This study provides insight for other jurisdictions considering implementing such a policy and offers practical recommendations for facilities and health authorities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Challenges of Implementing a Communication-and-Resolution Program Where Multiple Organizations Must Cooperate.

PubMed

Mello, Michelle M; Armstrong, Sarah J; Greenberg, Yelena; McCotter, Patricia I; Gallagher, Thomas H

2016-12-01

To implement a communication-and-resolution program (CRP) in a setting in which liability insurers and health care facilities must collaborate to resolve incidents involving a facility and separately insured clinicians. Six hospitals and clinics and a liability insurer in Washington State. Sites designed and implemented CRPs and contributed information about cases and operational challenges over 20 months. Data were qualitatively analyzed. Data from interviews with personnel responsible for CRP implementation were triangulated with data on program cases collected by sites and notes recorded during meetings with sites and among project team members. Sites experienced small victories in resolving particular cases and streamlining some working relationships, but they were unable to successfully implement a collaborative CRP. Barriers included the insurer's distance from the point of care, passive rather than active support from top leaders, coordinating across departments and organizations, workload, nonparticipation by some physicians, and overcoming distrust. Operating CRPs where multiple organizations must collaborate can be highly challenging. Success likely requires several preconditions, including preexisting trust among organizations, active leadership engagement, physicians' commitment to participate, mechanisms for quickly transmitting information to insurers, tolerance for missteps, and clear protocols for joint investigations and resolutions. © Health Research and Educational Trust.

A primer for effective organization of professional conferences.

PubMed

Werner, Susan E; Kenefick, Colleen

2005-01-01

The challenge of organizing a successful conference is a tremendous commitment requiring extensive preparation and teamwork. It is tempting but dangerous to underestimate the details needed to coordinate an outstanding event. Conferences follow a natural life cycle from proposal, gaining administrative support, planning, implementing, and then finally evaluating outcomes. These guidelines identify the tasks and areas of responsibilities required including setting objectives, budgeting, selecting a venue, publicity, programming, and working with vendors.

Nickel-hydrogen battery state of charge during low rate trickle charging

NASA Technical Reports Server (NTRS)

Lurie, C.; Foroozan, S.; Brewer, J.; Jackson, L.

1996-01-01

The NASA AXAF-I program requires high battery state of charge at launch. Traditional approaches to providing high state of charge, during prelaunch operations, require significant battery cooling. The use of active cooling, in the AXAF-I prelaunch environment, was considered and proved to be difficult to implement and very expensive. Accordingly alternate approaches were considered. An approach utilizing adiabatic charging and low rate trickle charge, was investigated and proved successful.

SU-F-P-04: Implementation of Dose Monitoring Software: Successes and Pitfalls

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

Och, J

2016-06-15

Purpose: to successfully install a dose monitoring software (DMS) application to assist in CT protocol and dose management. Methods: Upon selecting the DMS, we began our implementation of the application. A working group composed of Medical Physics, Radiology Administration, Information Technology, and CT technologists was formed. On-site training in the application was supplied by the vendor. The decision was made to apply the process for all the CT protocols on all platforms at all facilities. Protocols were painstakingly mapped to the correct masters, and the system went ‘live’. Results: We are routinely using DMS as a tool in our Clinicalmore » Performance CT QA program. It is useful in determining the effectiveness of revisions to existing protocols, and establishing performance baselines for new units. However, the implementation was not without difficulty. We identified several pitfalls and obstacles which frustrated progress. Including: Training deficiencies, Nomenclature problems, Communication, DICOM variability. Conclusion: Dose monitoring software can be a potent tool for QA. However, implementation of the program can be problematic and requires planning, organization and commitment.« less

Evaluation of the learning curve for external cephalic version using cumulative sum analysis

PubMed Central

Kim, So Yun; Chang, Eun Hye; Kwak, Dong Wook; Ahn, Hyun Kyung; Ryu, Hyun Mi; Kim, Moon Young

2017-01-01

Objective We evaluated the learning curve for external cephalic version (ECV) using learning curve-cumulative sum (LC-CUSUM) analysis. Methods This was a retrospective study involving 290 consecutive cases between October 2013 and March 2017. We evaluated the learning curve for ECV on nulli and over para 1 group using LC-CUSUM analysis on the assumption that 50% and 70% of ECV procedures succeeded by description a trend-line of quadratic function with reliable R2 values. Results The overall success rate for ECV was 64.8% (188/290), while the success rate for nullipara and over para 1 groups was 56.2% (100/178) and 78.6% (88/112), respectively. ‘H’ value, that the actual failure rate does not differ from the acceptable failure rate, was −3.27 and −1.635 when considering ECV success rates of 50% and 70%, respectively. Consequently, in order to obtain a consistent 50% success rate, we would require 57 nullipara cases, and in order to obtain a consistent 70% success rate, we would require 130 nullipara cases. In contrast, 8 to 10 over para 1 cases would be required for an expected success rate of 50% and 70% on over para 1 group. Conclusion Even a relatively inexperienced physician can experience success with multipara and after accumulating experience, they will manage nullipara cases. Further research is required for LC-CUSUM involving several practitioners instead of a single practitioner. This will lead to the gradual implementation of standard learning curve guidelines for ECV. PMID:28791265

Critical dosimetry measures and surrogate tools that can facilitate clinical success in PDT (Conference Presentation)

NASA Astrophysics Data System (ADS)

Pogue, Brian W.; Davis, Scott C.; Kanick, Stephen C.; Maytin, Edward V.; Pereira, Stephen P.; Palanisami, Akilan; Hasan, Tayyaba

2016-03-01

Photodynamic therapy can be a highly complex treatment with more than one parameter to control, or in some cases it is easily implemented with little control other than prescribed drug and light values. The role of measured dosimetry as related to clinical adoption has not been as successful as it could have been, and part of this may be from the conflicting goals of advocating for as many measurements as possible for accurate control, versus companies and clinical adopters advocating for as few measurements as possible, to keep it simple. An organized approach to dosimetry selection is required, which shifts from mechanistic measurements in pre-clinical and early phase I trials, towards just those essential dose limiting measurements and a focus on possible surrogate measures in phase II/III trials. This essential and surrogate approach to dosimetry should help successful adoption of clinical PDT if successful. The examples of essential dosimetry points and surrogate dosimetry tools which might be implemented in phase II and higher trials are discussed for solid tissue PDT with verteporfin and skin lesion treatment with aminolevulinc acid.

Solving a Health Information Management Problem. An international success story.

PubMed

Hannan, Terry J

2015-01-01

The management of health care delivery requires the availability of effective 'information management' tools based on e-technologies [eHealth]. In developed economies many of these 'tools' are readily available whereas in Low and Middle Income Countries (LMIC) there is limited access to eHealth technologies and this has been defined as the "digital divide". This paper provides a short introduction to the fundamental understanding of what is meant by information management in health care and how it applies to all social economies. The core of the paper describes the successful implementation of appropriate information management tools in a resource poor environment to manage the HIV/AIDS epidemic and other disease states, in sub-Saharan Africa and how the system has evolved to become the largest open source eHealth project in the world and become the health information infrastructure for several national eHealth economies. The system is known as Open MRS [www.openmrs.org). The continuing successful evolution of the OpenMRS project has permitted its key implementers to define core factors that are the foundations for successful eHealth projects.

Minimum intervention dentistry and the management of tooth wear in general practice.

PubMed

Meyers, I A

2013-06-01

The incidence of tooth wear, or non-carious tooth surface loss (NCTSL), is increasing and oral rehabilitation of patients with non-carious tooth loss requires strategies that address all the factors relevant to the aetiology and pathogenesis of the condition. The multifactorial nature of tooth wear and the variability in its clinical presentation provides treatment challenges for the clinician and successful management must be more than just restoration. Management must include an appropriate mix of preventive and restorative strategies and an understanding that long-term restorative success is affected by the patient's oral environment, and how diet, lifestyle and medical status can modify this environment. Ultimately, the success of any restorative intervention is very dependent on the stability of the oral environment and the condition of the remaining tooth structure. Minimum intervention dentistry (MID) philosophies are ideally suited to tooth wear cases and an overall MID strategy involving diagnosis, recognition and control of predisposing factors, stabilization of the oral environment, remineralization and restoration of the tooth structure, and ongoing maintenance can be implemented. When restorative treatment is required, contemporary materials and techniques are available that can provide cost-effective and conservative restorative alternatives for patients unable to undergo the complex indirect restorative techniques that are both costly and time consuming to implement. These minimally invasive approaches are not only an economically viable solution, but can provide aesthetic and functional rehabilitation and maintain tooth structure as a precursor to more complex restorative options when required. © 2013 Australian Dental Association.

A Pharmacy Blueprint for Electronic Medical Record Implementation Success

PubMed Central

Bach, David S.; Risko, Kenneth R.; Farber, Margo S.; Polk, Gregory J.

2015-01-01

Objective: Implementation of an integrated, electronic medical record (EMR) has been promoted as a means of improving patient safety and quality. While there are a few reports of such processes that incorporate computerized prescriber order entry, pharmacy verification, an electronic medication administration record (eMAR), point-of-care barcode scanning, and clinical decision support, there are no published reports on how a pharmacy department can best participate in implementing such a process across a multihospital health care system. Method: This article relates the experience of the design, build, deployment, and maintenance of an integrated EMR solution from the pharmacy perspective. It describes a 9-month planning and build phase and the subsequent rollout at 8 hospitals over the following 13 months. Results: Key components to success are identified, as well as a set of guiding principles that proved invaluable in decision making and dispute resolution. Labor/personnel requirements for the various stages of the process are discussed, as are issues involving medication workflow analysis, drug database considerations, the development of clinical order sets, and incorporation of bar-code scanning of medications. Recommended implementation and maintenance strategies are presented, and the impact of EMR implementation on the pharmacy practice model and revenue analysis are examined. Conclusion: Adherence to the principles and practices outlined in this article can assist pharmacy administrators and clinicians during all medication-related phases of the development, implementation, and maintenance of an EMR solution. Furthermore, review and incorporation of some or all of practices presented may help ease the process and ensure its success. PMID:26405340

Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT.

PubMed

Luker, Julie A; Craig, Louise E; Bennett, Leanne; Ellery, Fiona; Langhorne, Peter; Wu, Olivia; Bernhardt, Julie

2016-05-10

The implementation of multidisciplinary stroke rehabilitation interventions is challenging, even when the intervention is evidence-based. Very little is known about the implementation of complex interventions in rehabilitation clinical trials. The aim of study was to better understand how the implementation of a rehabilitation intervention in a clinical trial within acute stroke units is experienced by the staff involved. This qualitative process evaluation was part of a large Phase III stroke rehabilitation trial (AVERT). A descriptive qualitative approach was used. We purposively sampled 53 allied health and nursing staff from 19 acute stroke units in Australia, New Zealand and Scotland. Semi-structured interviews were conducted by phone, voice-internet, or face to face. Digitally recorded interviews were transcribed and analysed by two researchers using rigorous thematic analysis. Our analysis uncovered ten important themes that provide insight into the challenges of implementing complex new rehabilitation practices within complex care settings, plus factors and strategies that assisted implementation. Themes were grouped into three main categories: staff experience of implementing the trial intervention, barriers to implementation, and overcoming the barriers. Participation in the trial was challenging but had personal rewards and improved teamwork at some sites. Over the years that the trial ran some staff perceived a change in usual care. Barriers to trial implementation at some sites included poor teamwork, inadequate staffing, various organisational barriers, staff attitudes and beliefs, and patient-related barriers. Participants described successful implementation strategies that were built on interdisciplinary teamwork, education and strong leadership to 'get staff on board', and developing different ways of working. The AVERT stroke rehabilitation trial required commitment to deliver an intervention that needed strong collaboration between nurses and physiotherapists and was different to current care models. This qualitative process evaluation contributes unique insights into factors that may be critical to successful trials teams, and as AVERT was a pragmatic trial, success factors to delivering complex intervention in clinical practice. AVERT registered with Australian New Zealand Clinical Trials Registry ACTRN12606000185561 .

Designing, implementing and monitoring social impact mitigation strategies: Lessons from Forest Industry Structural Adjustment Packages

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

Loxton, Edwina A., E-mail: Edwina.Loxton@anu.edu.au; Schirmer, Jacki, E-mail: Jacki.Schirmer@canberra.edu.au; Cooperative Research Centre for Forestry, Hobart, 7001

2013-09-15

Social impact mitigation strategies are implemented by the proponents of policies and projects with the intent of reducing the negative, and increasing the positive social impacts of their activities, and facilitating the achievement of policy/project goals. Evaluation of mitigation strategies is critical to improving their future success and cost-effectiveness. This paper evaluates two Forest Industry Structural Adjustment Packages (FISAP) implemented in Australia in the 1990s to 2000s as part of broader policy changes that reduced access to timber from publicly owned native forests. It assesses the effectiveness of the structure, design, implementation and monitoring of the FISAPs, and highlights themore » interactions between these four elements and their influence on social impacts. The two FISAPs were found to be effective in terms of reducing negative impacts, encouraging positive impacts and contributing towards policy goals, although they did not mitigate negative impacts in all cases, and sometimes interacted with external factors and additional policy changes to contribute to significant short and long term negative impacts. -- Highlights: ► Mitigation strategies aim to reduce negative and enhance positive social impacts ► Mitigation strategy design, implementation, and monitoring are critical to success ► Effective mitigation enhanced the capacity of recipients to respond to change ► Mitigation strategies influenced multiple interacting positive and negative impacts ► Success required good communication, transparency, support, resources and timing.« less

Nurse-Led Programs to Facilitate Enrollment to Children's Oncology Group Cancer Control Trials.

PubMed

Haugen, Maureen; Kelly, Katherine Patterson; Leonard, Marcia; Mills, Denise; Sung, Lillian; Mowbray, Catriona; Landier, Wendy

2016-09-01

The progress made over the past 50 years in disease-directed clinical trials has significantly increased cure rates for children and adolescents with cancer. The Children's Oncology Group (COG) is now conducting more studies that emphasize improving quality of life for young people with cancer. These types of clinical trials are classified as cancer control (CCL) studies by the National Cancer Institute and require different resources and approaches to facilitate adequate accrual and implementation at COG institutions. Several COG institutions that had previously experienced problems with low accruals to CCL trials have successfully implemented local nursing leadership for these types of studies. Successful models of nurses as institutional leaders and "champions" of CCL trials are described. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

Managing change: an overview.

PubMed

Lorenzi, N M; Riley, R T

2000-01-01

As increasingly powerful informatics systems are designed, developed, and implemented, they inevitably affect larger, more heterogeneous groups of people and more organizational areas. In turn, the major challenges to system success are often more behavioral than technical. Successfully introducing such systems into complex health care organizations requires an effective blend of good technical and good organizational skills. People who have low psychological ownership in a system and who vigorously resist its implementation can bring a "technically best" system to its knees. However, effective leadership can sharply reduce the behavioral resistance to change-including to new technologies-to achieve a more rapid and productive introduction of informatics technology. This paper looks at four major areas-why information system failures occur, the core theories supporting change management, the practical applications of change management, and the change management efforts in informatics.

Interdisciplinary curriculum to train internal medicine and obstetrics-gynecology residents in ambulatory women's health: adapting problem-based learning to residency education.

PubMed

Spencer, Abby L; McNeil, Melissa

2009-09-01

Although residents in internal medicine (IM) and obstetrics-gynecology (OG) must provide primary care for women, studies indicate that both groups require more skills and training in women's health. Our goals were to assess the needs of residents at our academic medical center and to design an interdisciplinary curriculum that addresses these needs utilizing a modified problem-based learning (PBL) format. The aim of this article is to report on the development, logistics, and successful implementation of our innovative curriculum. Based on results from a targeted needs-assessment, we designed a curriculum for both IM and OG residents to address curricular deficiencies in an efficient and effective manner. Procurement of support was achieved by reviewing overlapping competency requirements and results of the needs-assessment with the program directors. The curriculum consists of six ambulatory clinical cases which lead residents through a discussion of screening, diagnosis, prevention, and management within a modified PBL format. Residents select one learning objective each week which allows them to serve as content experts during case discussions, applying what they learned from their literature review to guide the group as they decide upon the next step for the case. This format helps accommodate different experience levels of learners, encourages discussion from less-vocal residents, and utilizes theories of adult learning. Sixty-five residents have participated in the curriculum since it was successfully implemented. IM residents report that the cases were their first opportunity to discuss the health concerns of younger women; OG residents felt similarly about cases related to older women. Implementation challenges included resident accountability. Residents identified the timing of the sessions and clinical coverage requirements as barriers to conference attendance. Interdisciplinary modified PBL conferences focusing on shared curricular needs in ambulatory women's health are well-received by both IM and OG residents. This format utilizes theories of adult learning and maximizes limited time and resources by teaching IM and OG residents concurrently, and can be successfully implemented at a large academic medical center.

A system management methodology for building successful resource management systems

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller; Willoughby, John K.

1989-01-01

This paper presents a system management methodology for building successful resource management systems that possess lifecycle effectiveness. This methodology is based on an analysis of the traditional practice of Systems Engineering Management as it applies to the development of resource management systems. The analysis produced fifteen significant findings presented as recommended adaptations to the traditional practice of Systems Engineering Management to accommodate system development when the requirements are incomplete, unquantifiable, ambiguous and dynamic. Ten recommended adaptations to achieve operational effectiveness when requirements are incomplete, unquantifiable or ambiguous are presented and discussed. Five recommended adaptations to achieve system extensibility when requirements are dynamic are also presented and discussed. The authors conclude that the recommended adaptations to the traditional practice of Systems Engineering Management should be implemented for future resource management systems and that the technology exists to build these systems extensibly.

SMSaúde: Design, Development, and Implementation of a Remote/Mobile Patient Management System to Improve Retention in Care for HIV/AIDS and Tuberculosis Patients.

PubMed

Nhavoto, José António; Grönlund, Åke; Chaquilla, Walter Ponce

2015-03-09

The widespread and low cost of mobile phones and the convenience of short message service (SMS) text messaging suggest potential suitability for use with alternative strategies for supporting retention in care and adherence to the treatment of various chronic diseases, such as HIV and tuberculosis (TB). Despite the growing body of literature reporting positive outcomes of SMS text message-based communication with patients, there is yet very little research about the integration of communication technologies and electronic medical records or electronic patient tracking systems. To design, develop, and implement an integrated mobile phone text messaging system used to follow up with patients with HIV and TB in treatment in Mozambique. Following the design science research methodology, we developed a Web-based system that provides support to patients. A case study involving three health care sites in Mozambique was a basis for discussing design issues for this kind of system. We used brainstorming techniques to solicit usability requirements, focus group meetings to discuss and define system architecture, and prototyping to test in real environments and to improve the system. We found six sets of system requirements that need to be addressed for success: data collection, telecommunication costs, privacy and data security, text message content, connectivity, and system scalability. A text messaging system was designed and implemented in three health facilities. These sites feed data into a central data repository, which can be used for analysis of operations and decision support. Based on the treatment schedule, the system automatically sent SMS text message appointment reminders, medication reminders, as well as motivational and educational messages to patients enrolled in antiretroviral therapy and TB treatment programs. We successfully defined the requirements for, designed, and implemented a mobile phone text messaging system to support HIV and TB treatments. Implementation of this system could improve patients' self-management skills and strengthen communication between patients and health care providers.

A multi-disciplinary approach to implementation science: the NIH-PEPFAR PMTCT implementation science alliance.

PubMed

Sturke, Rachel; Harmston, Christine; Simonds, R J; Mofenson, Lynne M; Siberry, George K; Watts, D Heather; McIntyre, James; Anand, Nalini; Guay, Laura; Castor, Delivette; Brouwers, Pim; Nagel, Joan D

2014-11-01

In resource-limited countries, interventions to prevent mother-to-child HIV transmission (PMTCT) have not yet realized their full potential health impact, illustrating the common gap between the scientific proof of an intervention's efficacy and effectiveness and its successful implementation at scale into routine health services. For PMTCT, this gap results, in part, from inadequate adaptation of PMTCT interventions to the realities of the implementation environment, including client and health care worker behaviors and preferences, health care policies and systems, and infrastructure and resource constraints. Elimination of mother-to-child HIV transmission can only be achieved through understanding of key implementation barriers and successful adaptation of scientifically proven interventions to the local environment. Central to such efforts is implementation science (IS), which aims to investigate and address major bottlenecks that impede effective implementation and to test new approaches to identifying, understanding, and overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions. Advancing IS will require deliberate and strategic efforts to facilitate collaboration, communication, and relationship-building among researchers, implementers, and policy-makers. To speed the translation of effective PMTCT interventions into practice and advance IS more broadly, the US National Institutes of Health, in collaboration with the President's Emergency Plan for AIDS Relief launched the National Institutes of Health/President's Emergency Plan for AIDS Relief PMTCT IS Alliance, comprised of IS researchers, PMTCT program implementers, and policy-makers as an innovative platform for interaction and coordination.

USDA Snack Policy Implementation: Best Practices From the Front Lines, United States, 2013-2014.

PubMed

Asada, Yuka; Chriqui, Jamie; Chavez, Noel; Odoms-Young, Angela; Handler, Arden

2016-06-16

The Smart Snacks in Schools interim final rule was promulgated by the US Department of Agriculture (USDA) as authorized by the Healthy, Hunger-Free Kids Act of 2010 (PL 111-296) and implementation commenced beginning July 1, 2014; however, in the years leading up to this deadline, national studies suggested that most schools were far from meeting the USDA standards. Evidence to guide successful implementation of the standards is needed. This study examined snack policy implementation in exemplary high schools to learn best practices for implementation. Guided by a multiple case study approach, school professionals (n = 37) from 9 high schools across 8 states were recruited to be interviewed about perceptions of school snack implementation; schools were selected using criterion sampling on the basis of the HealthierUS Schools Challenge: Smarter Lunchrooms (HUSSC: SL) database. Interview transcripts and internal documents were organized and coded in ATLAS.Ti v7; 2 researchers coded and analyzed data using a constant comparative analysis method to identify best practice themes. Best practices for snack policy implementation included incorporating the HUSSC: SL award's comprehensive wellness approach; leveraging state laws or district policies to reinforce snack reform initiatives; creating strong internal and external partnerships; and crafting positive and strategic communications. Implementation of snack policies requires evidence of successful experiences from those on the front lines. As federal, state, and local technical assistance entities work to ensure implementation of the Smart Snacks standards, these best practices provide strategies to facilitate the process.

Physicians' accounts of frontline tensions when implementing pilot projects to improve primary care.

PubMed

Mansfield, Elizabeth; Bhattacharyya, Onil; Christian, Jennifer; Naglie, Gary; Steriopoulos, Vicky; Webster, Fiona

2018-03-19

Purpose Canada's primary care system has been described as "a culture of pilot projects" with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Antimicrobial stewardship programs: how to start and steer a successful program.

PubMed

Drew, Richard H

2009-03-01

Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials by selecting the appropriate dose, duration, and route of administration. The appropriate use of antimicrobials has the potential to improve efficacy, reduce treatment-related costs, minimize drug-related adverse events, and limit the potential for emergence of antimicrobial resistance. To summarize ASP tactics that can improve the appropriate use of antimicrobials in the hospital setting. Several measures can be used to implement such programs and gain multidisciplinary support while addressing common barriers. Implementation of an ASP requires a multidisciplinary approach with an infectious diseases physician and a clinical pharmacist with infectious diseases training as its core team members. As identified by recently published guidelines, 2 proactive strategies for promoting antimicrobial stewardship include: (1) formulary restriction and pre-authorization, and (2) prospective audit with intervention and feedback. Other supplemental strategies involve education, guidelines and clinical pathways, antimicrobial order forms, de-escalation of therapy, intravenous-to-oral (IV-to-PO) switch therapy, and dose optimization. Several barriers exist to successful implementation of ASPs. These include obtaining adequate administrative support and compensation for team members. Gaining physician acceptance can also be challenging if there is a perceived loss of autonomy in clinical decision making. ASPs have the potential to reduce antimicrobial resistance, health care costs, and drug-related adverse events while improving clinical outcomes. The efforts and expense required to implement and maintain ASPs are more than justified given their potential benefits to both the hospital and the patient.

A Bitslice Implementation of Anderson's Attack on A5/1

NASA Astrophysics Data System (ADS)

Bulavintsev, Vadim; Semenov, Alexander; Zaikin, Oleg; Kochemazov, Stepan

2018-03-01

The A5/1 keystream generator is a part of Global System for Mobile Communications (GSM) protocol, employed in cellular networks all over the world. Its cryptographic resistance was extensively analyzed in dozens of papers. However, almost all corresponding methods either employ a specific hardware or require an extensive preprocessing stage and significant amounts of memory. In the present study, a bitslice variant of Anderson's Attack on A5/1 is implemented. It requires very little computer memory and no preprocessing. Moreover, the attack can be made even more efficient by harnessing the computing power of modern Graphics Processing Units (GPUs). As a result, using commonly available GPUs this method can quite efficiently recover the secret key using only 64 bits of keystream. To test the performance of the implementation, a volunteer computing project was launched. 10 instances of A5/1 cryptanalysis have been successfully solved in this project in a single week.

Assessment and Verification of SLS Block 1-B Exploration Upper Stage and Stage Disposal Performance

NASA Technical Reports Server (NTRS)

Patrick, Sean; Oliver, T. Emerson; Anzalone, Evan J.

2018-01-01

Delta-v allocation to correct for insertion errors caused by state uncertainty is one of the key performance requirements imposed on the SLS Navigation System. Additionally, SLS mission requirements include the need for the Exploration Up-per Stage (EUS) to be disposed of successfully. To assess these requirements, the SLS navigation team has developed and implemented a series of analysis methods. Here the authors detail the Delta-Delta-V approach to assessing delta-v allocation as well as the EUS disposal optimization approach.

Successful implementation of cooperative handling eliminates the need for restraint in a complex nonhuman primate disease model

PubMed Central

Graham, Melanie L; Rieke, Eric F; Mutch, Lucas A; Zolondek, Elizabeth K; Faig, Aaron W; DuFour, Theresa A; Munson, James W; Kittredge, Jessica A; Schuurman, Henk-Jan

2011-01-01

Introduction Streptozotocin-induced diabetic nonhuman primates are used to study efficacy and safety of innovative immunosuppression after islet transplantation. We implemented a training program for medical management of a chronic disease state. Methods Cooperation with hand feeding and drinking; shifting; and limb presentation were trained utilizing predominately positive but also negative reinforcement in 52 animals compared with 28 macaques subjected to conventional physical and/or chemical restraint. The success of and timing of behavior acquisition was evaluated in a representative subset of 14 animals. Results Over 90% of animals were successful in behavior acquisition. Programmatically this resulted in complete elimination of chair restraint and negligible requirement for sedation. About half of trained animals had no to moderate thymic involution, indicative of a substantial reduction in stress. Conclusion Cooperative handling enhances animal well-being. This contributes to validity of scientific results and eliminates model-induced confounding that can obstruct interpretation of safety and efficacy data. PMID:22150842

Factors Influencing the Selection of the Systems Integration Organizational Model Type for Planning and Implementing Government High-Technology Programs

NASA Technical Reports Server (NTRS)

Thomas, Leann; Utley, Dawn

2006-01-01

While there has been extensive research in defining project organizational structures for traditional projects, little research exists to support high technology government project s organizational structure definition. High-Technology Government projects differ from traditional projects in that they are non-profit, span across Government-Industry organizations, typically require significant integration effort, and are strongly susceptible to a volatile external environment. Systems Integration implementation has been identified as a major contributor to both project success and failure. The literature research bridges program management organizational planning, systems integration, organizational theory, and independent project reports, in order to assess Systems Integration (SI) organizational structure selection for improving the high-technology government project s probability of success. This paper will describe the methodology used to 1) Identify and assess SI organizational structures and their success rate, and 2) Identify key factors to be used in the selection of these SI organizational structures during the acquisition strategy process.

Implementation Pearls from a New Guidebook on Improving Medication Use and Outcomes with Clinical Decision Support

PubMed Central

Sirajuddin, Anwar M; Osheroff, Jerome A.; Sittig, Dean F.; Chuo, John; Velasco, Ferdinand; Collins, David A.

2012-01-01

Effective clinical decision support (CDS) is essential for addressing healthcare performance improvement imperatives, but care delivery organizations (CDO) typically struggle with CDS deployment. Ensuring safe and effective medication delivery to patients is a central focus of CDO performance improvement efforts, and this article provides an overview of best-practice strategies for applying CDS to these goals. The strategies discussed are drawn from a new guidebook, co-published and co-sponsored by more than a dozen leading organizations. Developed by scores of CDS implementers and experts, the guidebook outlines key steps and success factors for applying CDS to medication management. A central thesis is that improving outcomes with CDS interventions requires that the CDS five rights be addressed successfully. That is, the interventions must deliver the right information, to the right person, in the right format, through the right channel, at the right point in workflow. This paper provides further details about these CDS five rights, and highlights other important strategies for successful CDS programs. PMID:19894486

Using the "customer service framework" to successfully implement patient- and family-centered care.

PubMed

Rangachari, Pavani; Bhat, Anita; Seol, Yoon-Ho

2011-01-01

Despite the growing momentum toward patient- and family-centered care at the federal policy level, the organizational literature remains divided on its effectiveness, especially in regard to its key dimension of involving patients and families in treatment decisions and safety practices. Although some have argued for the universal adoption of patient involvement, others have questioned both the effectiveness and feasibility of patient involvement. In this article, we apply a well-established theoretical perspective, that is, the Service Quality Model (SQM) (also known as the "customer service framework") to the health care context, to reconcile the debate related to patient involvement. The application helps support the case for universal adoption of patient involvement and also question the arguments against it. A key contribution of the SQM lies in highlighting a set of fundamental service quality determinants emanating from basic consumer service needs. It also provides a simple framework for understanding how gaps between consumer expectations and management perceptions of those expectations can affect the gap between "expected" and "perceived" service quality from a consumer's perspective. Simultaneously, the SQM also outlines "management requirements" for the successful implementation of a customer service strategy. Applying the SQM to the health care context therefore, in addition to reconciling the debate on patient involvement, helps identify specific steps health care managers could take to successfully implement patient- and family-centered care. Correspondingly, the application also provides insights into strategies for the successful implementation of policy recommendations related to patient- and family-centered care in health care organizations.

Using technology to prevent adverse drug events in the intensive care unit.

PubMed

Hassan, Erkan; Badawi, Omar; Weber, Robert J; Cohen, Henry

2010-06-01

Critically ill patients are particularly susceptible to adverse drug events (ADEs) due to their rapidly changing and unstable physiology, complex therapeutic regimens, and large percentage of medications administered intravenously. There are a wide variety of technologies that can help prevent the points of failure commonly associated with ADEs (i.e., the five "Rights": right patient; right drug; right route; right dose; right frequency). These technologies are often categorized by their degree of complexity to design and engineer and the type of error they are designed to prevent. Focusing solely on the software and hardware design of technology may over- or underestimate the degree of difficulty to avoid ADEs at the bedside. Alternatively, we propose categorizing technological solutions by identifying the factors essential for success. The two major critical success factors are: 1) the degree of clinical assessment required by the clinician to appropriately evaluate and disposition the issue identified by a technology; and 2) the complexity associated with effective implementation. This classification provides a way of determining how ADE-preventing technologies in the intensive care unit can be successfully integrated into clinical practice. Although there are limited data on the effectiveness of many technologies in reducing ADEs, we will review the technologies currently available in the intensive care unit environment. We will also discuss critical success factors for implementation, common errors made during implementation, and the potential errors using these systems.

Conversion from Tree to Graph Representation of Requirements

NASA Technical Reports Server (NTRS)

Mayank, Vimal; Everett, David Frank; Shmunis, Natalya; Austin, Mark

2009-01-01

A procedure and software to implement the procedure have been devised to enable conversion from a tree representation to a graph representation of the requirements governing the development and design of an engineering system. The need for this procedure and software and for other requirements-management tools arises as follows: In systems-engineering circles, it is well known that requirements- management capability improves the likelihood of success in the team-based development of complex systems involving multiple technological disciplines. It is especially desirable to be able to visualize (in order to identify and manage) requirements early in the system- design process, when errors can be corrected most easily and inexpensively.

75 FR 41685 - Implementation of the National HIV/AIDS Strategy

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

.... The actions we take now will build upon a legacy of global leadership, national commitment, and... our national response to HIV/AIDS. Today I am releasing a National HIV/AIDS Strategy for the United..., moreover, is not enough. Success will require the commitment of all parts of society, including businesses...

Universal Design for Learning: A Blueprint for Success for All Learners

ERIC Educational Resources Information Center

Brand, Susan Trostle; Favazza, Antoinette E.; Dalton, Elizabeth M.

2012-01-01

The Center for Applied Special Technology, Inc. (CAST), an educational research organization, introduced Universal Design for Learning (UDL) in its earliest form nearly 25 years ago. According to Orkwis and McLane (1998), UDL is a tangible means by which educators implement the special education requirements and sustain the gains that were…

A Comprehensive, Competency-Based Education Framework Using Medium-Sized ERP Systems

ERIC Educational Resources Information Center

Scholtz, Brenda; Cilliers, Charmain; Calitz, Andre

2012-01-01

Graduates with industry-relevant ERP competencies are highly sought after. This requirement is due to a dominance of Enterprise Resource Planning (ERP) systems and the positive affect which good quality ERP specialists have on the success rate of ERP system implementation projects. Universities are therefore increasingly pressurised to supply…

Teachers' Perceptions of Teaching in Workplace Simulations in Vocational Education

ERIC Educational Resources Information Center

Jossberger, Helen; Brand-Gruwel, Saskia; van de Wiel, Margje W.; Boshuizen, Henny P.

2015-01-01

In a large-scale top-down innovation operation in the Netherlands, workplace simulations have been implemented in vocational schools, where students are required to work independently and self-direct their learning. However, research has shown that the success of such large-scale top-down innovations depends on how well their execution in schools…

Computer-Based Assessment of Complex Problem Solving: Concept, Implementation, and Application

ERIC Educational Resources Information Center

Greiff, Samuel; Wustenberg, Sascha; Holt, Daniel V.; Goldhammer, Frank; Funke, Joachim

2013-01-01

Complex Problem Solving (CPS) skills are essential to successfully deal with environments that change dynamically and involve a large number of interconnected and partially unknown causal influences. The increasing importance of such skills in the 21st century requires appropriate assessment and intervention methods, which in turn rely on adequate…

Accepting the Utopian Challenge: A Student Perspective

ERIC Educational Resources Information Center

Carman, Breanna R.

2013-01-01

The scholarship of teaching and learning (SoTL) allows institutions to achieve the goals required for student learning and success. The purpose of this paper is to address recommendations for the implementation of SoTL that should have relevant input from students. These include, but are not limited to, better communication, evaluation, continuing…

Coaching: an effective leadership intervention.

PubMed

Karsten, Margo A

2010-03-01

Organizations are transitioning from a management industrial era to a humanistic era. This transition will require a different set of leadership competencies. Competencies that reflect relationships, connections with employees, and having the skill to unleash the human capability at all levels of an organization are essential. Similar to when a sports team needs a different play book to be successful, leaders need a new play book. Coaches within the sports team are the ones who assist players in learning how to adapt to a different set of rules. They teach the players how to show up differently and how to implement different plays, with the overall goal of being a successful team. New competencies are being required to reflect a humanistic approach to leadership. It is critical that organizations offer coaching as an intervention to all levels of leadership. This actual case study demonstrates that coaching not only assisted leaders in learning a new way of leading but also improved overall organizational effectiveness. The results that have been accomplished through the use of implementing a 360-degree feedback system, with coaching, reaped overall organization improvement. Copyright 2010 Elsevier Inc. All rights reserved.

Decision support at home (DS@HOME) – system architectures and requirements

PubMed Central

2012-01-01

Background Demographic change with its consequences of an aging society and an increase in the demand for care in the home environment has triggered intensive research activities in sensor devices and smart home technologies. While many advanced technologies are already available, there is still a lack of decision support systems (DSS) for the interpretation of data generated in home environments. The aim of the research for this paper is to present the state-of-the-art in DSS for these data, to define characteristic properties of such systems, and to define the requirements for successful home care DSS implementations. Methods A literature review was performed along with the analysis of cross-references. Characteristic properties are proposed and requirements are derived from the available body of literature. Results 79 papers were identified and analyzed, of which 20 describe implementations of decision components. Most authors mention server-based decision support components, but only few papers provide details about the system architecture or the knowledge base. A list of requirements derived from the analysis is presented. Among the primary drawbacks of current systems are the missing integration of DSS in current health information system architectures including interfaces, the missing agreement among developers with regard to the formalization and customization of medical knowledge and a lack of intelligent algorithms to interpret data from multiple sources including clinical application systems. Conclusions Future research needs to address these issues in order to provide useful information – and not only large amounts of data – for both the patient and the caregiver. Furthermore, there is a need for outcome studies allowing for identifying successful implementation concepts. PMID:22640470

Significance of User Participation in a Hospital Information System Success: Insights From a Case Study.

PubMed

Saleem, Naveed; Steel, Douglas; Gercek, Gokhan; Chandra, Ashish

User participation in the development of a system is universally prescribed as an effective strategy to ensure the success of the resultant system. However, the existing literature on the merits of user participation only provides equivocal evidence. Various analyses of this literature point out that this equivocal evidence may be due to inconsistent operational measures of the user participation and system success constructs. Planned organizational change and participative decision making, the underlying paradigms of user participation construct, suggest that the development of some information systems may require blending of users' system-related functional expertise and developers' technical expertise to ensure system success. These paradigms also maintain that in case of well-defined, structured information systems user participation should enhance the likelihood of system success through better user understanding of the need for the system and system content and objectives, user trust, and a sense of system ownership. This research also described a case study involving the development and implementation of a medical records system for a neonatal intensive care unit in a large hospital in Texas. The case study provides evidence that in systems that require incorporation of user functional expertise user participation will enhance the likelihood of system success.

Supportability Issues and Approaches for Exploration Missions

NASA Technical Reports Server (NTRS)

Watson, J. K.; Ivins, M. S.; Cunningham, R. A.

2006-01-01

Maintaining and repairing spacecraft systems hardware to achieve required levels of operational availability during long-duration exploration missions will be challenged by limited resupply opportunities, constraints on the mass and volume available for spares and other maintenance-related provisions, and extended communications times. These factors will force the adoption of new approaches to the integrated logistics support of spacecraft systems hardware. For missions beyond the Moon, all spares, equipment, and supplies must either be prepositioned prior to departure from Earth of human crews or carried with the crews. The mass and volume of spares must be minimized by enabling repair at the lowest hardware levels, imposing commonality and standardization across all mission elements at all hardware levels, and providing the capability to fabricate structural and mechanical spares as required. Long round-trip communications times will require increasing levels of autonomy by the crews for most operations including spacecraft maintenance. Effective implementation of these approaches will only be possible when their need is recognized at the earliest stages of the program, when they are incorporated in operational concepts and programmatic requirements, and when diligence is applied in enforcing these requirements throughout system design in an integrated way across all contractors and suppliers. These approaches will be essential for the success of missions to Mars. Although limited duration lunar missions may be successfully accomplished with more traditional approaches to supportability, those missions will offer an opportunity to refine these concepts, associated technologies, and programmatic implementation methodologies so that they can be most effectively applied to later missions.

Hazardous Materials Pharmacies - A Vital Component of a Robust P2 Program

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

McCarter, S.

2006-07-01

Integrating pollution prevention (P2) into the Department of Energy Integrated Safety Management (ISM) - Environmental Management System (EMS) approach, required by DOE Order 450.1, leads to an enhanced ISM program at large and complex installations and facilities. One of the building blocks to integrating P2 into a comprehensive environmental and safety program is the control and tracking of the amounts, types, and flow of hazardous materials used on a facility. Hazardous materials pharmacies (typically called HazMarts) provide a solid approach to resolving this issue through business practice changes that reduce use, avoid excess, and redistribute surplus. If understood from conceptmore » to implementation, the HazMart is a powerful tool for reducing pollution at the source, tracking inventory storage, controlling usage and flow, and summarizing data for reporting requirements. Pharmacy options can range from a strict, single control point for all hazardous materials to a virtual system, where the inventory is user controlled and reported over a common system. Designing and implementing HazMarts on large, diverse installations or facilities present a unique set of issues. This is especially true of research and development (R and D) facilities where the chemical use requirements are extensive and often classified. There are often multiple sources of supply; a wide variety of chemical requirements; a mix of containers ranging from small ampoules to large bulk storage tanks; and a wide range of tools used to track hazardous materials, ranging from simple purchase inventories to sophisticated tracking software. Computer systems are often not uniform in capacity, capability, or operating systems, making it difficult to use a server-based unified tracking system software. Each of these issues has a solution or set of solutions tied to fundamental business practices. Each requires an understanding of the problem at hand, which, in turn, requires good communication among all potential users. A key attribute to a successful HazMart is that everybody must use the same program. That requirement often runs directly into the biggest issue of all... institutional resistance to change. To be successful, the program has to be both a top-down and bottom-up driven process. The installation or facility must set the policy and the requirement, but all of the players have to buy in and participate in building and implementing the program. Dynamac's years of experience assessing hazardous materials programs, providing business case analyses, and recommending and implementing pharmacy approaches for federal agencies has provided us with key insights into the issues, problems, and the array of solutions available. This paper presents the key steps required to implement a HazMart, explores the advantages and pitfalls associated with a HazMart, and presents some options for implementing a pharmacy or HazMart on complex installations and R and D facilities. (authors)« less

Information technology for brain banking.

PubMed

Schmitz, Peer

2018-01-01

Implementing and maintaining the information technology (IT) infrastructure of a brain bank can be a daunting task for any brain bank coordinator, particularly when access to both funds and IT professionals is limited. Many questions arise when attempting to determine which IT products are most suitable for a brain bank. The requirements of each brain bank must be assessed carefully to ensure that the chosen IT infrastructure will be able to meet those requirements successfully and will be able to expand and adapt as the size of the brain bank increases. This chapter provides some valuable insights to be considered when implementing the IT infrastructure for a brain bank and discusses the pros and cons of various approaches and products. Copyright © 2018 Elsevier B.V. All rights reserved.

Medical Data Transmission Using Cell Phone Networks

NASA Astrophysics Data System (ADS)

Voos, J.; Centeno, C.; Riva, G.; Zerbini, C.; Gonzalez, E.

2011-12-01

A big challenge in telemedicine systems is related to have the technical requirements needed for a successful implementation in remote locations where the available hardware and communication infrastructure is not adequate for a good medical data transmission. Despite of the wide standards availability, methodologies, applications and systems integration facilities in telemedicine, in many cases the implementation requirements are not achievable to allow the system execution in remote areas of our country. Therefore, this paper presents an alternative for the messages transmission related to medical studies using the cellular network and the standard HL7 V3 [1] for data modeling. The messages are transmitted to a web server and stored in a centralized database which allows data sharing with other specialists.

Repeat-until-success cubic phase gate for universal continuous-variable quantum computation

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

Marshall, Kevin; Pooser, Raphael; Siopsis, George

2015-03-24

We report that to achieve universal quantum computation using continuous variables, one needs to jump out of the set of Gaussian operations and have a non-Gaussian element, such as the cubic phase gate. However, such a gate is currently very difficult to implement in practice. Here we introduce an experimentally viable “repeat-until-success” approach to generating the cubic phase gate, which is achieved using sequential photon subtractions and Gaussian operations. Ultimately, we find that our scheme offers benefits in terms of the expected time until success, as well as the fact that we do not require any complex off-line resource state,more » although we require a primitive quantum memory.« less

Implementing quality initiatives in healthcare organizations: drivers and challenges.

PubMed

Abdallah, Abdallah

2014-01-01

Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results. Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers. This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation. PRACTICAL IMPLICATIONs: This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided. This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

AMCC casting development, volume 2

NASA Technical Reports Server (NTRS)

1995-01-01

PCC successfully cast and performed nondestructive testing, FPI and x-ray, on seventeen AMCC castings. Destructive testing, lab analysis and chemical milling, was performed on eleven of the castings and the remaining six castings were shipped to NASA or Aerojet. Two of the six castings shipped, lots 015 and 016, were fully processed per blueprint requirements. PCC has fully developed the gating and processing parameters of this part and feels the part could be implemented into production, after four more castings have been completed to ensure the repeatability of the process. The AMCC casting has been a technically challenging part due to its size, configuration, and alloy type. The height and weight of the wax pattern assembly necessitated the development of a hollow gating system to ensure structural integrity of the shell throughout the investment process. The complexity in the jacket area of the casting required the development of an innovative casting technology that PCC has termed 'TGC' or thermal gradient control. This method of setting up thermal gradients in the casting during solidification represents a significant process improvement for PCC and has been successfully implemented on other programs. The alloy, JBK75, is a relatively new alloy in the investment casting arena and required our engineering staff to learn the gating, processing, and dimensional characteristics of the material.

Comparative Case Study of Two Biomedical Research Collaboratories

PubMed Central

Teasley, Stephanie D; Bhatnagar, Rishi

2005-01-01

Background Working together efficiently and effectively presents a significant challenge in large-scale, complex, interdisciplinary research projects. Collaboratories are a nascent method to help meet this challenge. However, formal collaboratories in biomedical research centers are the exception rather than the rule. Objective The main purpose of this paper is to compare and describe two collaboratories that used off-the-shelf tools and relatively modest resources to support the scientific activity of two biomedical research centers. The two centers were the Great Lakes Regional Center for AIDS Research (HIV/AIDS Center) and the New York University Oral Cancer Research for Adolescent and Adult Health Promotion Center (Oral Cancer Center). Methods In each collaboratory, we used semistructured interviews, surveys, and contextual inquiry to assess user needs and define the technology requirements. We evaluated and selected commercial software applications by comparing their feature sets with requirements and then pilot-testing the applications. Local and remote support staff cooperated in the implementation and end user training for the collaborative tools. Collaboratory staff evaluated each implementation by analyzing utilization data, administering user surveys, and functioning as participant observers. Results The HIV/AIDS Center primarily required real-time interaction for developing projects and attracting new participants to the center; the Oral Cancer Center, on the other hand, mainly needed tools to support distributed and asynchronous work in small research groups. The HIV/AIDS Center’s collaboratory included a center-wide website that also served as the launch point for collaboratory applications, such as NetMeeting, Timbuktu Conference, PlaceWare Auditorium, and iVisit. The collaboratory of the Oral Cancer Center used Groove and Genesys Web conferencing. The HIV/AIDS Center was successful in attracting new scientists to HIV/AIDS research, and members used the collaboratory for developing and implementing new research studies. The Oral Cancer Center successfully supported highly distributed and asynchronous research, and the collaboratory facilitated real-time interaction for analyzing data and preparing publications. Conclusions The two collaboratory implementations demonstrated the feasibility of supporting biomedical research centers using off-the-shelf commercial tools, but they also identified several barriers to successful collaboration. These barriers included computing platform incompatibilities, network infrastructure complexity, variable availability of local versus remote IT support, low computer and collaborative software literacy, and insufficient maturity of available collaborative software. Factors enabling collaboratory use included collaboration incentives through funding mechanism, a collaborative versus competitive relationship of researchers, leadership by example, and tools well matched to tasks and technical progress. Integrating electronic collaborative tools into routine scientific practice can be successful but requires further research on the technical, social, and behavioral factors influencing the adoption and use of collaboratories. PMID:16403717

The TQM Coordinator as Change Agent in Implementing Total Quality Management

DTIC Science & Technology

1989-06-01

Quality Management involves a major change, a paradigm shift, in management philosophy. Implementing TQM requires the use of a change agent to act as a catalyst to change the organization. Interviews with TQM coordinators, and a survey of 143 organizations were done to examine the role of the TQM coordinator. Research identified criteria for selection, and location in the organizational structure. Use of an external consultant in a tem concept is examined. Resistance to change and overcoming that resistance are explored. Ways to measure success are discussed. Keywords:

Neural implementation of operations used in quantum cognition.

PubMed

Busemeyer, Jerome R; Fakhari, Pegah; Kvam, Peter

2017-11-01

Quantum probability theory has been successfully applied outside of physics to account for numerous findings from psychology regarding human judgement and decision making behavior. However, the researchers who have made these applications do not rely on the hypothesis that the brain is some type of quantum computer. This raises the question of how could the brain implement quantum algorithms other than quantum physical operations. This article outlines one way that a neural based system could perform the computations required by applications of quantum probability to human behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluation of user interface and workflow design of a bedside nursing clinical decision support system.

PubMed

Yuan, Michael Juntao; Finley, George Mike; Long, Ju; Mills, Christy; Johnson, Ron Kim

2013-01-31

Clinical decision support systems (CDSS) are important tools to improve health care outcomes and reduce preventable medical adverse events. However, the effectiveness and success of CDSS depend on their implementation context and usability in complex health care settings. As a result, usability design and validation, especially in real world clinical settings, are crucial aspects of successful CDSS implementations. Our objective was to develop a novel CDSS to help frontline nurses better manage critical symptom changes in hospitalized patients, hence reducing preventable failure to rescue cases. A robust user interface and implementation strategy that fit into existing workflows was key for the success of the CDSS. Guided by a formal usability evaluation framework, UFuRT (user, function, representation, and task analysis), we developed a high-level specification of the product that captures key usability requirements and is flexible to implement. We interviewed users of the proposed CDSS to identify requirements, listed functions, and operations the system must perform. We then designed visual and workflow representations of the product to perform the operations. The user interface and workflow design were evaluated via heuristic and end user performance evaluation. The heuristic evaluation was done after the first prototype, and its results were incorporated into the product before the end user evaluation was conducted. First, we recruited 4 evaluators with strong domain expertise to study the initial prototype. Heuristic violations were coded and rated for severity. Second, after development of the system, we assembled a panel of nurses, consisting of 3 licensed vocational nurses and 7 registered nurses, to evaluate the user interface and workflow via simulated use cases. We recorded whether each session was successfully completed and its completion time. Each nurse was asked to use the National Aeronautics and Space Administration (NASA) Task Load Index to self-evaluate the amount of cognitive and physical burden associated with using the device. A total of 83 heuristic violations were identified in the studies. The distribution of the heuristic violations and their average severity are reported. The nurse evaluators successfully completed all 30 sessions of the performance evaluations. All nurses were able to use the device after a single training session. On average, the nurses took 111 seconds (SD 30 seconds) to complete the simulated task. The NASA Task Load Index results indicated that the work overhead on the nurses was low. In fact, most of the burden measures were consistent with zero. The only potentially significant burden was temporal demand, which was consistent with the primary use case of the tool. The evaluation has shown that our design was functional and met the requirements demanded by the nurses' tight schedules and heavy workloads. The user interface embedded in the tool provided compelling utility to the nurse with minimal distraction.

Water safety plans: bridges and barriers to implementation in North Carolina.

PubMed

Amjad, Urooj Quezon; Luh, Jeanne; Baum, Rachel; Bartram, Jamie

2016-10-01

First developed by the World Health Organization, and now used in several countries, water safety plans (WSPs) are a multi-step, preventive process for managing drinking water hazards. While the beneficial impacts of WSPs have been documented in diverse countries, how to successfully implement WSPs in the United States remains a challenge. We examine the willingness and ability of water utility leaders to implement WSPs in the US state of North Carolina. Our findings show that water utilities have more of a reactive than preventive organizational culture, that implementation requires prioritization of time and resources, perceived comparative advantage to other hazard management plans, leadership in implementation, and identification of how WSPs can be embedded in existing work practices. Future research could focus on whether WSP implementation provides benefits such as decreases in operational costs, and improved organization of records and communication.

Testing some major determinants for hospital innovation success.

PubMed

Caccia-Bava, Maria do Carmo; Guimaraes, Valerie C K; Guimaraes, Tor

2009-01-01

Hospitals have adopted new policies, methods and technologies to change their processes, improve services, and support other organizational changes necessary for better performance. The literature regarding the four major areas of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the organization's change process propose their importance in successfully implementing organization innovation. While these factors may indeed be important to enhance hospital performance, the existing literature contains limited empirical evidence supporting their relationship to successfully implementing innovation in hospitals. This study aims to empirically test these relationships proposed in the literature by researchers in separate knowledge areas. A survey of 223 hospitals has been used to test an integrated model of these relationships. The response rate and the representativeness of the sample in terms of hospital size and geographical location were found satisfactory. The quality assurance/compliance managers for each hospital were the target respondents to questions, which require a corporate perspective while reducing the chance of bias for questions regarding top management leadership abilities. The results provide clear evidence about the importance of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the hospital's change process to the hospitals success in implementing innovation. Given the importance of hospitals to change their processes, improve services, and support other organizational changes necessary for better performance, a great benefit is that the main factors for successful innovation have been brought together from scattered literature and tested among hospitals. Further, the items used for measuring the main constructs provide further insights into how hospital administrators should go about developing these areas within their organizations. This study is a first attempt at empirically testing the importance of strategic leadership, competitive intelligence, management of technology, and specific characteristics of the hospital's change process for the success of innovation efforts.

Effects of people-centred factors on enterprise resource planning implementation project success: empirical evidence from Sri Lanka

NASA Astrophysics Data System (ADS)

Wickramasinghe, Vathsala; Gunawardena, Vathsala

2010-08-01

Extant literature suggests people-centred factors as one of the major areas influencing enterprise resource planning (ERP) implementation project success. Yet, to date, few empirical studies attempted to validate the link between people-centred factors and ERP implementation project success. The purpose of this study is to empirically identify people-centred factors that are critical to ERP implementation projects in Sri Lanka. The study develops and empirically validates a framework for people-centred factors that influence the success of ERP implementation projects. Survey research methodology was used and collected data from 74 ERP implementation projects in Sri Lanka. The people-centred factors of 'project team competence', 'rewards' and 'communication and change' were found to predict significantly the ERP implementation project success.

Standardized network order sets in rural Ontario: a follow-up report on successes and sustainability.

PubMed

Rawn, Andrea; Wilson, Katrina

2011-01-01

Unifying, implementing and sustaining a large order set project requires strategic placement of key organizational professionals to provide ongoing user education, communication and support. This article will outline the successful strategies implemented by the Grey Bruce Health Network, Evidence-Based Care Program to reduce length of stay, increase patient satisfaction and increase the use of best practices resulting in quality outcomes, safer practice and better allocation of resources by using standardized Order Sets within a network of 11 hospital sites. Audits conducted in 2007 and again in 2008 revealed a reduced length of stay of 0.96 in-patient days when order sets were used on admission and readmission for the same or a related diagnosis within one month decreased from 5.5% without order sets to 3.5% with order sets.

A generic, web-based clinical information system architecture using HL7 CDA: successful implementation in dermatological routine care.

PubMed

Schuler, Thilo; Boeker, Martin; Klar, Rüdiger; Müller, Marcel

2007-01-01

The requirements of highly specialized clinical domains are often underrepresented in hospital information systems (HIS). Common consequences are that documentation remains to be paper-based or external systems with insufficient HIS integration are used. This paper presents a solution to overcome this deficiency in the form of a generic framework based on the HL7 Clinical Document Architecture. The central architectural idea is the definition of customized forms using a schema-controlled XML language. These flexible form definitions drive the user interface, the data storage, and standardized data exchange. A successful proof-of-concept application in a dermatologic outpatient wound care department has been implemented, and is well accepted by the clinicians. Our work with HL7 CDA revealed the need for further practical research in the health information standards realm.

Encoding qubits into oscillators with atomic ensembles and squeezed light

NASA Astrophysics Data System (ADS)

Motes, Keith R.; Baragiola, Ben Q.; Gilchrist, Alexei; Menicucci, Nicolas C.

2017-05-01

The Gottesman-Kitaev-Preskill (GKP) encoding of a qubit within an oscillator provides a number of advantages when used in a fault-tolerant architecture for quantum computing, most notably that Gaussian operations suffice to implement all single- and two-qubit Clifford gates. The main drawback of the encoding is that the logical states themselves are challenging to produce. Here we present a method for generating optical GKP-encoded qubits by coupling an atomic ensemble to a squeezed state of light. Particular outcomes of a subsequent spin measurement of the ensemble herald successful generation of the resource state in the optical mode. We analyze the method in terms of the resources required (total spin and amount of squeezing) and the probability of success. We propose a physical implementation using a Faraday-based quantum nondemolition interaction.

WE-E-304-01: SBRT Credentialing: Understanding the Process From Inquiry to Approval

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

Followill, D.

SBRT is having a dramatic impact on radiation therapy of early-stage, locally advanced cancers. A number of national protocols have been and are being developed to assess the clinical efficacy of SBRT for various anatomical sites, such as lung and spine. Physics credentialing for participating and implementation of trial protocols involve a broad spectrum of requirements from image guidance, motion management, to planning technology and dosimetric constrains. For radiation facilities that do not have extensive experiences in SBRT treatment and protocol credentialing, these complex processes of credentialing and implementation could be very challenging and, sometimes, may lead to ineffective evenmore » unsuccessful execution of these processes. In this proposal, we will provide comprehensive review of some current SBRT protocols, explain the requirements and their underline rationales, illustrate representative failed and successful experiences, related to SBRT credentialing, and discuss strategies for effective SBRT credentialing and implementation. Learning Objectives: Understand requirements and challenges of SBRT credentailing and implentation Discuss processes and strategies of effective SBRT credentailing Discuss practical considerations, potential pitfalls and solutions of SBRT implentation.« less

Eight critical factors in creating and implementing a successful simulation program.

PubMed

Lazzara, Elizabeth H; Benishek, Lauren E; Dietz, Aaron S; Salas, Eduardo; Adriansen, David J

2014-01-01

Recognizing the need to minimize human error and adverse events, clinicians, researchers, administrators, and educators have strived to enhance clinicians' knowledge, skills, and attitudes through training. Given the risks inherent in learning new skills or advancing underdeveloped skills on actual patients, simulation-based training (SBT) has become an invaluable tool across the medical education spectrum. The large simulation, training, and learning literature was used to provide a synthesized yet innovative and "memorable" heuristic of the important facets of simulation program creation and implementation, as represented by eight critical "S" factors-science, staff, supplies, space, support, systems, success, and sustainability. These critical factors advance earlier work that primarily focused on the science of SBT success, to also include more practical, perhaps even seemingly obvious but significantly challenging components of SBT, such as resources, space, and supplies. SYSTEMS: One of the eight critical factors-systems-refers to the need to match fidelity requirements to training needs and ensure that technological infrastructure is in place. The type of learning objectives that the training is intended to address should determine these requirements. For example, some simulators emphasize physical fidelity to enable clinicians to practice technical and nontechnical skills in a safe environment that mirrors real-world conditions. Such simulators are most appropriate when trainees are learning how to use specific equipment or conduct specific procedures. The eight factors-science, staff, supplies, space, support, systems, success, and sustainability-represent a synthesis of the most critical elements necessary for successful simulation programs. The order of the factors does not represent a deliberate prioritization or sequence, and the factors' relative importance may change as the program evolves.

Complying with the Occupational Safety and Health Administration's Bloodborne Pathogens Standard: implementing needleless systems and intravenous safety devices.

PubMed

Marini, Michelle A; Giangregorio, Maeve; Kraskinski, Joanna C

2004-03-01

Preventing the transmission of bloodborne pathogens to healthcare workers has been a mission and a challenge of the healthcare industry for over 20 years. The development of the Occupational Safety and Health Administration Bloodborne Pathogens Standard in 1991 and the passing of the Needlestick Safety Act in 2000 mandated hospitals to develop an Exposure Control Plan to protect workers from these pathogens. Children's Hospital Boston began implementation of a needleless system in 1993. Employees readily accepted these systems into practice, because they were convenient and easy to use. A marked decrease in exposures to bloodborne pathogens naturally followed, which is consistent with the national data. The transition to intravenous (i.v.) safety devices at Children's Hospital began in 2000 and proved to be more of a challenge. First, the clinicians must choose a safety product, which requires developing and implementing a trial plan with potential catheters. This selection process is especially difficult in pediatrics where successful placement of the smallest-gauge catheter, no. 24, is imperative. After choosing an i.v. safety product, successful transition is dependent upon the thoroughness of i.v. safety device training and a commitment by the clinicians to the use of these products. Although the number of needlestick injuries and subsequent transmission of bloodborne pathogens have been further reduced with the use of i.v. safety devices, needlestick injuries still occur. This results from a lack of familiarity with the engineering of the device and therefore poor technique or a failure to activate the safety mechanism. Staff resistance due to loss of expertise with the new device and patient care concerns are additional barriers to the use of these new products. Addressing these obstacles and providing adequate training for all clinicians were required for successful implementation of these i.v. safety devices.

How change management can prevent the failure of information systems implementation among Malaysian government hospitals?

NASA Astrophysics Data System (ADS)

ChePa, Noraziah; Jasin, Noorhayati Md; Bakar, Nur Azzah Abu

2017-10-01

Fail to prevent or control challenges of Information System (IS) implementation have led to the failure of its implementation. Successful implementation of IS has been a challenging task to any organization including government hospitals. Government has invested a big amount of money on information system (IS) projects to improve service delivery in healthcare. However, several of them failed to be implemented successfully due to several factors. This article proposes a prevention model which incorporated Change Management (CM) concepts to avoid the failure of IS implementation, hence ensuring the success of it. Challenges of IS implementation in government hospitals have been discovered. Extensive literature review and deep interview approaches were employed to discover these challenges. A prevention model has been designed to cater the challenges. The model caters three main phases of implementation; pre-implementation, during implementation, and post-implementation by adopting CM practices of Lewin's, Kotter's and Prosci's CM model. Six elements of CM comprising thirteen sub-elements adopted from the three CM models have been used to handle CFFs of Human and Support issues; guiding team, resistance avoidance, IS adoption, enforcement, monitoring, and IS sustainability. Successful practice of the proposed mapping is expected to prevent CFFs to occur, hence ensuring a successful implementation of IS in the hospitals. The proposed model has been presented and successfully evaluated by the domain experts from the selected hospitals. The proposed model is believed to be beneficial for top management, IT practitioners and medical practitioners in preventing IS implementation failure among government hospitals towards ensuring the success implementation.

Data inversion algorithm development for the hologen occultation experiment

NASA Technical Reports Server (NTRS)

Gordley, Larry L.; Mlynczak, Martin G.

1986-01-01

The successful retrieval of atmospheric parameters from radiometric measurement requires not only the ability to do ideal radiometric calculations, but also a detailed understanding of instrument characteristics. Therefore a considerable amount of time was spent in instrument characterization in the form of test data analysis and mathematical formulation. Analyses of solar-to-reference interference (electrical cross-talk), detector nonuniformity, instrument balance error, electronic filter time-constants and noise character were conducted. A second area of effort was the development of techniques for the ideal radiometric calculations required for the Halogen Occultation Experiment (HALOE) data reduction. The computer code for these calculations must be extremely complex and fast. A scheme for meeting these requirements was defined and the algorithms needed form implementation are currently under development. A third area of work included consulting on the implementation of the Emissivity Growth Approximation (EGA) method of absorption calculation into a HALOE broadband radiometer channel retrieval algorithm.

What makes an automated teller machine usable by blind users?

PubMed

Manzke, J M; Egan, D H; Felix, D; Krueger, H

1998-07-01

Fifteen blind and sighted subjects, who featured as a control group for acceptance, were asked for their requirements for automated teller machines (ATMs). Both groups also tested the usability of a partially operational ATM mock-up. This machine was based on an existing cash dispenser, providing natural speech output, different function menus and different key arrangements. Performance and subjective evaluation data of blind and sighted subjects were collected. All blind subjects were able to operate the ATM successfully. The implemented speech output was the main usability factor for them. The different interface designs did not significantly affect performance and subjective evaluation. Nevertheless, design recommendations can be derived from the requirement assessment. The sighted subjects were rather open for design modifications, especially the implementation of speech output. However, there was also a mismatch of the requirements of the two subject groups, mainly concerning the key arrangement.

The Collier Chautauqua program: A formative evaluation of the implementation of the Iowa Chautauqua model of professional development and its effectiveness in improving science teaching

NASA Astrophysics Data System (ADS)

Dass, Pradeep Maxwell

1997-11-01

A formative evaluation of the implementation of the Iowa Chautauqua model of professional development in Collier County, Florida, was conducted during 1995-97, focusing on implementation issues and teacher enhancement. Major findings are as follows: Implementation issues. (1) Development of a shared vision through collaborative interaction between teachers, school administrators, and district administrators is critical to successful program implementation. (2) When a new program is implemented on a district-wide basis, the success of implementation depends upon how well the program matches local goals and needs and how ready the district and teachers are to make changes necessary for implementing the tenets of the program. (3) Development of proper understanding of desired pedagogical approaches requires modeling of these approaches in program activities, with explicit attention drawn to the modeling. (4) Successful implementation of desired pedagogical approaches in the classroom is critically influenced by the support and continual feedback teachers receive from district administrators, building administrators, and their peers. (5) Unwavering commitment of district and school administrators is essential for encouraging more teachers to participate in the program, leading to district-wide implementation without making it mandatory. Teacher Enhancement. (1) Participants developed leadership skills in mentorship, teamwork, presenting at professional meetings, and assuming responsibility within the program. (2) Participants learned to focus more on student questions and concerns, value prior conceptions of students, and develop instructional activities accordingly. They grew in their understanding and use of the constructivist pedagogy. (3) Participants attitude toward teaching in general and science in particular improved markedly, leading to new excitement and enthusiasm toward their profession. (4) Participants became more confident about teaching science. Elementary teachers reported spending more time on science activities and integrating science topics more with other curricular areas. (5) Participants collaborated more with their peers, administrators, and local community resources in improving instructional activities, providing more meaningful learning experiences for their students. (6) Participants integrated more technological resources than they did formerly, helping students explore avenues otherwise inaccessible. This investigation reveals that teacher enhancement is closely related to changed practice, which is critically influenced by implementation issues at broader levels.

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients.

PubMed

Mudge, Alison M; Banks, Merrilyn D; Barnett, Adrian G; Blackberry, Irene; Graves, Nicholas; Green, Theresa; Harvey, Gillian; Hubbard, Ruth E; Inouye, Sharon K; Kurrle, Sue; Lim, Kwang; McRae, Prue; Peel, Nancye M; Suna, Jessica; Young, Adrienne M

2017-01-09

Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention. A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards. Using a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation. ACTRN12615000879561 registered prospectively 21/8/2015.

Implementation of a web-based national child health-care programme in a local context: A complex facilitator role.

PubMed

Tell, Johanna; Olander, Ewy; Anderberg, Peter; Berglund, Johan Sanmartin

2018-02-01

The aim of this study was to investigate child health-care coordinators' experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme 'Being a facilitator: a complex role' was formed to express the child health-care coordinators' experiences. Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.

Implementation of Hydrodynamic Simulation Code in Shock Experiment Design for Alkali Metals

NASA Astrophysics Data System (ADS)

Coleman, A. L.; Briggs, R.; Gorman, M. G.; Ali, S.; Lazicki, A.; Swift, D. C.; Stubley, P. G.; McBride, E. E.; Collins, G.; Wark, J. S.; McMahon, M. I.

2017-10-01

Shock compression techniques enable the investigation of extreme P-T states. In order to probe off-Hugoniot regions of P-T space, target makeup and laser pulse parameters must be carefully designed. HYADES is a hydrodynamic simulation code which has been successfully utilised to simulate shock compression events and refine the experimental parameters required in order to explore new P-T states in alkali metals. Here we describe simulations and experiments on potassium, along with the techniques required to access off-Hugoniot states.

Implementation of the TOMS contamination control requirements in the former USSR

NASA Technical Reports Server (NTRS)

Abrams, Eve M.

1992-01-01

The American Total Ozone Mapping Spectrometer (TOMS) was integrated with the Russian Meteor-3 spacecraft and launched on August 15, 1991. Although the TOMS instrument was sensitive to both particulate and molecular contamination, the program for Meteor-3 had not formerly addressed contamination control in ground operations. In order to accommodate the TOMS cleanliness requirements, a contamination control program was successfully established from inception at both the Meteor-3 spacecraft plant near Moscow and at the launch site in Plesetsk.

Housing First and the Risk of Failure: A Comment on Westermeyer and Lee (2013).

PubMed

Kertesz, Stefan G; Austin, Erika Laine; Holmes, Sally K; Pollio, David E; VanDeusen Lukas, Carol

2015-07-01

Over the last 5 years, community policies in response to homelessness have shifted toward offering permanent housing accompanied by treatment supports, without requiring treatment success as a precondition. The US Department of Veterans Affairs (VA) has embraced this "Housing First" approach. A 2013 report sounds a contrarian note. In a 16-person quasi-experimental study, 8 veterans who entered VA's permanent supportive housing did poorly, whereas 8 veterans who remained in more traditional treatment did well. In this commentary, we suggest that the report was problematic in the conceptualization of the matters it sought to address and in its science. Nonetheless, it highlights challenges that must not be ignored. From this report and other research, we now know that even more attention is required to support clinical recovery for Housing First clients. Successful implementation of Housing First requires guidance from agency leaders, and their support for clinical staff when individual clients fare poorly.

Embracing change: practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke

PubMed Central

2012-01-01

Background Rehabilitation technology for upper limb training of stroke patients may play an important role as therapy tool in future, in order to meet the increasing therapy demand. Currently, implementation of this technology in the clinic remains low. This study aimed at identifying criteria and conditions that people, involved in development of such technology, should take into account to achieve a (more) successful implementation of the technology in the clinic. Methods A literature search was performed in PubMed and IEEE databases, and semi-structured interviews with therapists in stroke rehabilitation were held, to identify criteria and conditions technology should meet to facilitate (implementation of) technology-assisted arm-hand skills training in rehabilitation therapy of stroke patients. In addition, an implementation strategy frequently applied in general health care was used to compose a stepwise guidance to facilitate successful implementation of this technology in therapy of stroke patients. Implementation-related criteria mentioned by therapists during the interviews were integrated in this guidance. Results Results indicate that, related to therapy content, technology should facilitate repetition of task-related movements, tailored to the patient and patient’s goals, in a meaningful context. Variability and increasing levels of difficulty in exercises should be on offer. Regarding hardware and software design of technology, the system should facilitate quick familiarisation and be easily adjustable to individual patients during therapy by therapists (and assistants). The system should facilitate adaptation to individual patients’ needs and their progression over time, should be adjustable as to various task-related variables, should be able to provide instructions and feedback, and should be able to document patient’s progression. The implementation process of technology in the clinic is provided as a stepwise guidance that consists of five phases therapists have to go through. The guidance includes criteria and conditions that motivate therapists, and make it possible for them, to actually use technology in their daily clinical practice. Conclusions The reported requirements are important as guidance for people involved in the development of rehabilitation technology for arm-hand therapy of stroke patients. The stepwise guide provides a tool for facilitating successful implementation of technology in clinical practice, thus meeting future therapy demand. PMID:22856548

Promote the Vocational Education Program. Competency-Based Vocational Education Administrator Module Series. Leadership and Training Series No. 58B-9.

ERIC Educational Resources Information Center

Quinn, Karen M.; And Others

Designed to provide pre- and inservice administrators with the skills necessary to select appropriate program development and implementation, and monitor and evaluate their success, this competency-based learning module consists of an introduction and four sequential learning experiences. Each learning experience contains an overview, required and…

Characteristics of Successful Co-Teaching Experiences in Classrooms with General and Special Education Students

ERIC Educational Resources Information Center

Abbye-Taylor, Sonya

2014-01-01

Co-teaching, an instructional model serving students with special education needs in the general education classroom, has been proliferating in response to federal requirements and because it has potential in reaching all students. Implementation of co-teaching has been inconsistent and there has been little evidence co-teaching has positively…

Inquiry Guided Learning Projects for the Development of Critical Thinking in the College Classroom: A Pilot Study

ERIC Educational Resources Information Center

Bentley, Danielle C.

2014-01-01

This paper describes the inaugural success of implementing Inquiry Guided Learning Projects within a college-level human anatomy and physiology course. In this context, scientific inquiry was used as a means of developing skills required for critical thinking among students. The projects were loosely designed using the Information Search Process…

Project Risk Management in Educational Organizations: A Case from the Czech Republic

ERIC Educational Resources Information Center

Eger, Ludvík; Egerová, Dana

2016-01-01

The past 20 years have been a period of reforms for school systems in Visegrad countries. However, the successful implementation of educational reforms requires effective leaders and managers and, to produce effective leaders, changes in the system of leadership and management programmes need to be adopted. From 2004, the Czech Republic saw a…

A CIS (Clinical Information System) Quality Evaluation Tool for Nursing Care Services

ERIC Educational Resources Information Center

Lee, Seon Ah

2010-01-01

The purpose of this study was to develop a tool to evaluate the quality of a clinical information system (CIS) conceived by nurses and conduct a pilot test with the developed tool as an initial assessment. CIS quality is required for successful implementation in information technology (IT) environments. The study started with the realization that…

The Soldier Fitness Tracker: Global Delivery of Comprehensive Soldier Fitness

ERIC Educational Resources Information Center

Fravell, Mike; Nasser, Katherine; Cornum, Rhonda

2011-01-01

Carefully implemented technology strategies are vital to the success of large-scale initiatives such as the U.S. Army's Comprehensive Soldier Fitness (CSF) program. Achieving the U.S. Army's vision for CSF required a robust information technology platform that was scaled to millions of users and that leveraged the Internet to enable global reach.…

Identifying and Meeting Training Needs for Public Participation Responsibilities in Water Resources Planning. Publication No. 107.

ERIC Educational Resources Information Center

Ertel, Madge O.

This project surveyed planners in coastal zone management and 208 programs in New England to determine what type of skills and/or experience were required for planners to implement successful public participation programs. The research indicated that prior experience is more directly related to perceived adequacy than either academic or…

Does Implementing an Emotional Intelligence Program Guarantee Student Achievement?

ERIC Educational Resources Information Center

Wilkens, Coral L.; Wilmore, Elaine

2015-01-01

Being a 21st century learner may require a shift in the education paradigm. To be successful students may need to possess a different type of intelligence. Cherniss (2001), Goleman (1995), and O'Neil (1996), suggest that the key to positive life outcomes might consider emotional intelligence as more important than intellectual quotient (IQ).…

Selected Outcomes Related to Tech Prep Implementation by Illinois Consortia, 2001-2005

ERIC Educational Resources Information Center

Bragg, Debra D.; Kirby, Catherine; Zhu, Rongchun

2006-01-01

This report is the summary of key aspects of Tech Prep in Illinois over the five year period of 2001-2005 during which all Tech Prep consortia provided annual data based on federal legislative requirements and state-determined essential elements of successful programs. These annual Tech Prep reports enable local educators to monitor student…

Unraveling the Administrative Tangles in JMU's Speech Communication and General Education Programs.

ERIC Educational Resources Information Center

Emmert, Philip; Smilowitz, Michael

What has transpired at James Madison University provides a model for the successful implementation of a basic communication education program required of all first-year students. This paper provides an accounting of the efforts that made possible the commitment to the development of the program. The paper is first divided into two columns. One…

Counterfeit Compliance with the HIPAA Security Rule: A Study of Information System Success

ERIC Educational Resources Information Center

Johnson, James R.

2013-01-01

The intent of the security standards adopted by the Department of Health and Human Services (DHS) implementing some of the requirements of the Administrative Simplification (AS) subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was to improve Federal and private health care programs and to improve the…

No Child Left Behind: Where Do We Go from Here? Backgrounder No. 1775

ERIC Educational Resources Information Center

Kafer, Krista

2004-01-01

This publication raises several points of discussion concerning the No Child Left Behind (NCLB) Act and its future. Two years after its enactment, NCLB implementation proceeds by trial and error. Its ultimate success or failure remains unclear. Adequate Yearly Progress (AYP) and teacher quality requirements are not always compatible with existing…

Improving Undergraduate Online Retention through Gated Advisement and Redundant Communication

ERIC Educational Resources Information Center

Clay, Melanie N.; Rowland, Stacey; Packard, Abbot

2009-01-01

The University of West Georgia implemented a successful research-based initiative, Project DEW (Developing eCore Winners) to improve retention in its eCore courses. eCore courses are those offered through a collaborative University System of Georgia program, and includes courses required to complete the first two years of an undergraduate degree.…

State forestry agency perspectives on carbon management and carbon market assistance to family forest owners

Treesearch

Kristell A. Miller; Stephanie A. Snyder; Michael A. Kilgore

2015-01-01

Family forest owners within the United States could potentially make significant contributions to sequestration efforts. However, we expect that landowners will need assistance if they are to successfully implement carbon management techniques and/or navigate through complex carbon market requirements. State forestry agencies were surveyed to gather their perspectives...

SOA Governance: A Critical SOA Success Factor

DTIC Science & Technology

2010-04-01

Software Perspective Service Consumer Service Providers Interface Optimize tomorrow today. ® Building Blocks...of a SOA Service – Software implemented capability that is well-defined, self contained and does not depend on context or state of other services ... Service Consumer – Service , application or other software component that requires a specific service . – Located through registry – Initiates service

Program of Adaptation Assistance in Foster Families and Particular Features of Its Implementation

ERIC Educational Resources Information Center

Zakirova, Venera G.; Gaysina, Guzel I.; Zhumabaeva, Asia

2015-01-01

Relevance of the problem stated in the article, conditioned by the fact that the successful adaptation of orphans in a foster family requires specialized knowledge and skills, as well as the need of professional support. Therefore, this article aims at substantiation of the effectiveness of the developed pilot program psycho-pedagogical support of…

Current scientific literature on tarnished plant bug, Lygus lineolaris (Palisot de Beauvois) ecology in Mississippi, and critical information needs

USDA-ARS?s Scientific Manuscript database

Understanding the basic ecological patterns of the tarnished plant bug, Lygus lineolaris (Palisot de Beauvois), is required for implementing a successful integrated pest management program. As the primary pest of cotton in Mississippi and across the mid-south, L. lineolaris is a highly polyphagous m...

Measuring Perceived School Support for Inclusive Education in Bangladesh: The Development of a Context-Specific Scale

ERIC Educational Resources Information Center

Ahmmed, Masud

2013-01-01

International studies have identified that teachers require adequate support, including human and material resources, if they are to successfully implement inclusive education (IE) in regular classes. Past research shows that the level of support teachers feel they are receiving, from members of the school community and in the provision of…

Implementing an Innovative Educational Program Delivery Strategy to Teach 2014 Farm Bill Changes to Ohio Farmers and Landowners

ERIC Educational Resources Information Center

Bruynis, Chris L.; Shoemaker, Dianne E.; Ward, Barry; Custer, Sam G.

2016-01-01

The timing and complexity of the 2014 Farm Bill required quick dissemination of technical information to allow participants to make decisions affecting risk management strategies for their farms. Using existing organizational structures and incorporating a team approach allowed Ohio State University Extension educators to successfully meet the…

Early growth of planted longleaf pine seedlings in relation to light, soil moisture, and soil temperature

Treesearch

Benjamin O. Knapp; G. Geoff Wang; Joan L. Walker

2006-01-01

Drastic reductions in longleaf pine (Pinus palustris Mill.) acreage have led to an increased focus on regeneration of the longleaf pine ecosystem. Many areas require artificial regeneration for establishment, and site preparation techniques may be implemented to increase regeneration success. The objectives of this study were to determine differences...

Holistic Admissions in Nursing: We Can Do This

PubMed Central

GLAZER, GREER; CLARK, ANGELA; BANKSTON, KAREN; DANEK, JENNIFER; FAIR, MALIKA; MICHAELS, JULIA

2016-01-01

Research shows that holistic admissions review practices can increase diversity across students without decreasing the workforce preparedness and academic success of students. Therefore, many disciplines have readily adopted the widespread use of holistic admissions review. Despite its proven effectiveness in addressing student diversity, nursing has been slow to implement holistic admissions review. The purpose of this study was to gain a better understanding of the barriers to implementing holistic admissions review in nursing and the feasibility of adopting holistic admissions review across nursing programs. A biphasic qualitative research study was conducted with nursing deans from across the United States. Qualitative data collection consisted of two phases of focus group discussions conducted over a 3-month period. The qualitative data were analyzed using content analysis. The categories and subcategories identified in Phase 1 informed the discussion in Phase 2. One overarching category from Phase 1 was identified, which was the lack of nursing schools’ knowledge regarding holistic admissions review. Four subcategories also identified in Phase 1 included the need for better dissemination of evidence, the need for additional support from university leaders and administrators, the need for legal guidance to facilitate implementation of holistic admissions review, and ensuring appropriate resources to support the holistic admissions review process. Three categories emerged in Phase 2, which included everyone’s buy-in is required, the need for a model, and a need for training. The adoption of holistic admissions review in nursing may be feasible. However, certain barriers need to be overcome so that nursing schools can successfully take on this process. Therefore, five recommendations have been developed to assist nursing schools in the implementation of holistic admissions review. These recommendations include increasing knowledge and understanding of holistic admissions review among nursing deans; obtaining buy-in and support for holistic admissions review and conducting a self-assessment of current admissions practices; providing nursing administrators, faculty, and staff with diversity training; and conducting further research to identify factors most critical for success in nursing. Although the transition to a holistic admissions process requires some effort, arming ourselves with the appropriate tools will mitigate barriers during implementation. PMID:27424931

Holistic Admissions in Nursing: We Can Do This.

PubMed

Glazer, Greer; Clark, Angela; Bankston, Karen; Danek, Jennifer; Fair, Malika; Michaels, Julia

2016-01-01

Research shows that holistic admissions review practices can increase diversity across students without decreasing the workforce preparedness and academic success of students. Therefore, many disciplines have readily adopted the widespread use of holistic admissions review. Despite its proven effectiveness in addressing student diversity, nursing has been slow to implement holistic admissions review. The purpose of this study was to gain a better understanding of the barriers to implementing holistic admissions review in nursing and the feasibility of adopting holistic admissions review across nursing programs. A biphasic qualitative research study was conducted with nursing deans from across the United States. Qualitative data collection consisted of two phases of focus group discussions conducted over a 3-month period. The qualitative data were analyzed using content analysis. The categories and subcategories identified in Phase 1 informed the discussion in Phase 2. One overarching category from Phase 1 was identified, which was the lack of nursing schools' knowledge regarding holistic admissions review. Four subcategories also identified in Phase 1 included the need for better dissemination of evidence, the need for additional support from university leaders and administrators, the need for legal guidance to facilitate implementation of holistic admissions review, and ensuring appropriate resources to support the holistic admissions review process. Three categories emerged in Phase 2, which included everyone's buy-in is required, the need for a model, and a need for training. The adoption of holistic admissions review in nursing may be feasible. However, certain barriers need to be overcome so that nursing schools can successfully take on this process. Therefore, five recommendations have been developed to assist nursing schools in the implementation of holistic admissions review. These recommendations include increasing knowledge and understanding of holistic admissions review among nursing deans; obtaining buy-in and support for holistic admissions review and conducting a self-assessment of current admissions practices; providing nursing administrators, faculty, and staff with diversity training; and conducting further research to identify factors most critical for success in nursing. Although the transition to a holistic admissions process requires some effort, arming ourselves with the appropriate tools will mitigate barriers during implementation. Copyright © 2016 Elsevier Inc. All rights reserved.

Technology requirements for an orbiting fuel depot - A necessary element of a space infrastructure

NASA Technical Reports Server (NTRS)

Stubbs, R. M.; Corban, R. R.; Willoughby, A. J.

1988-01-01

Advanced planning within NASA has identified several bold space exploration initiatives. The successful implementation of these missions will require a supporting space infrastructure which would include a fuel depot, an orbiting facility to store, transfer and process large quantities of cryogenic fluids. In order to adequately plan the technology development programs required to enable the construction and operation of a fuel depot, a multidisciplinary workshop was convened to assess critical technologies and their state of maturity. Since technology requirements depend strongly on the depot design assumptions, several depot concepts are presented with their effect of criticality ratings. Over 70 depot-related technology areas are addressed.

Technology requirements for an orbiting fuel depot: A necessary element of a space infrastructure

NASA Technical Reports Server (NTRS)

Stubbs, R. M.; Corban, R. R.; Willoughby, A. J.

1988-01-01

Advanced planning within NASA has identified several bold space exploration initiatives. The successful implementation of these missions will require a supporting space infrastructure which would include a fuel depot, an orbiting facility to store, transfer and process large quantities of cryogenic fluids. In order to adequately plan the technology development programs required to enable the construction and operation of a fuel depot, a multidisciplinary workshop was convened to assess critical technologies and their state of maturity. Since technology requirements depend strongly on the depot design assumptions, several depot concepts are presented with their effect on criticality ratings. Over 70 depot-related technology areas are addressed.

New patient-centered care standards from the commission on cancer: opportunities and challenges.

PubMed

Fashoyin-Aje, Lola A; Martinez, Kathryn A; Dy, Sydney M

2012-01-01

The Commission on Cancer of the American College of Surgeons publishes accreditation standards that hospitals and cancer treatment centers implement to ensure quality care to cancer patients. These standards address the full spectrum of cancer care, from cancer prevention to survivorship and end-of-life care. The most recent revisions of these standards included new standards in "patient-centered areas," including the provision of palliative care services, treatment and survivorship plans, psychological distress screening, and patient navigation programs. Unified by their emphasis on the early identification of patients at risk of receiving suboptimal care and the importance of ensuring that issues arising during and after completion of cancer treatment are addressed, they are a welcome expansion of the standards guiding cancer care. As with all standards, however, the next steps will be to further define how they will be implemented and to determine how success will be assessed. This will require ongoing critical evaluation of the standards and their implementation, including the need for member institutions to define successful implementation methods and measurable outcomes and identification of areas most in need of further research. Copyright © 2012 Elsevier Inc. All rights reserved.

Implementing a Lean Management System in Primary Care: Facilitators and Barriers From the Front Lines.

PubMed

Hung, Dorothy; Martinez, Meghan; Yakir, Maayan; Gray, Caroline

2015-01-01

Although Lean management techniques are increasingly used in health care to improve quality and reduce costs, lessons about how to successfully implement this approach on the front lines of care delivery are not well documented. In this study, we highlight key facilitators and barriers to implementing Lean among frontline primary care providers. This case study took place at a large, ambulatory care delivery system serving nearly 1 million patients. In-depth interviews were conducted with primary care physicians, staff, and administrators to identify key factors impacting Lean redesigns in primary care. Overall, staff engagement and performance management, sensitivity to the professional values and culture of medicine, and perceived adequacy of organizational resources were critical when introducing Lean changes. Specific drivers of change included empowerment of staff at all levels, visual display of performance metrics, and a culture of innovation and collaboration. Barriers included physician resistance to standardized work, difficulty transferring management responsibilities to non-physician staff, and time and staffing required for participating in improvement efforts. Although Lean offers a new approach to delivering care, the implementation process itself is both complex and crucial to success. Understanding early facilitators and barriers can maximize Lean's, potential to improve health care delivery.

Inter-organizational collaboration in the implementation of evidence-based practices among public agencies serving abused and neglected youth.

PubMed

Palinkas, Lawrence A; Fuentes, Dahlia; Finno, Megan; Garcia, Antonio R; Holloway, Ian W; Chamberlain, Patricia

2014-01-01

This study examined the role of inter-organizational collaboration in implementing new evidence-based practices for addressing problem behaviors in at-risk youth. Semi-structured interviews were conducted with 38 systems leaders of probation, mental health, and child welfare departments of 12 California counties participating in a large randomized controlled trial to scale-up the use of Multidimensional Treatment Foster Care. Three sets of collaboration characteristics were identified: (1) characteristics of collaboration process, (2) characteristics of the external environment, and (3) characteristics of participating organizations and individuals. Inter-organizational collaboration enables an exchange of information and advice and a pooling of resources individual agencies may require for successful implementation.

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

Strong advocacy led to successful implementation of smokefree Mexico City.

PubMed

Crosbie, Eric; Sebrié, Ernesto M; Glantz, Stanton A

2011-01-01

To describe the approval process and implementation of the 100% smokefree law in Mexico City and a competing federal law between 2007 and 2010. Reviewed smokefree legislation, published newspaper articles and interviewed key informants. Strong efforts by tobacco control advocacy groups and key policymakers in Mexico City in 2008 prompted the approval of a 100% smokefree law following the WHO FCTC. As elsewhere, the tobacco industry utilised the hospitality sector to block smokefree legislation, challenged the City law before the Supreme Court and promoted the passage of a federal law that required designated smoking areas. These tactics disrupted implementation of the City law by causing confusion over which law applied in Mexico City. Despite interference, the City law increased public support for 100% smokefree policies and decreased the social acceptability of smoking. In September 2009, the Supreme Court ruled in favour of the City law, giving it the authority to go beyond the federal law to protect the fundamental right of health for all citizens. Early education and enforcement efforts by tobacco control advocates promoted the City law in 2008 but advocates should still anticipate continuing opposition from the tobacco industry, which will require continued pressure on the government. Advocates should utilise the Supreme Court's ruling to promote 100% smokefree policies outside Mexico City. Strong advocacy for the City law could be used as a model of success throughout Mexico and other Latin American countries.

Prognostic modelling options for remaining useful life estimation by industry

NASA Astrophysics Data System (ADS)

Sikorska, J. Z.; Hodkiewicz, M.; Ma, L.

2011-07-01

Over recent years a significant amount of research has been undertaken to develop prognostic models that can be used to predict the remaining useful life of engineering assets. Implementations by industry have only had limited success. By design, models are subject to specific assumptions and approximations, some of which are mathematical, while others relate to practical implementation issues such as the amount of data required to validate and verify a proposed model. Therefore, appropriate model selection for successful practical implementation requires not only a mathematical understanding of each model type, but also an appreciation of how a particular business intends to utilise a model and its outputs. This paper discusses business issues that need to be considered when selecting an appropriate modelling approach for trial. It also presents classification tables and process flow diagrams to assist industry and research personnel select appropriate prognostic models for predicting the remaining useful life of engineering assets within their specific business environment. The paper then explores the strengths and weaknesses of the main prognostics model classes to establish what makes them better suited to certain applications than to others and summarises how each have been applied to engineering prognostics. Consequently, this paper should provide a starting point for young researchers first considering options for remaining useful life prediction. The models described in this paper are Knowledge-based (expert and fuzzy), Life expectancy (stochastic and statistical), Artificial Neural Networks, and Physical models.

Implementation of a Collision Probability Prediction Technique for Constellation Maneuver Planning

NASA Technical Reports Server (NTRS)

Concha, Marco a.

2007-01-01

On March 22, 2006, the Space Technology 5 (ST5) constellation spacecraft were successfully delivered to orbit by a Pegasus XI, launch vehicle. An unexpected relative motion experienced by the constellation after orbit insertion brought about a problem. Soon after launch the observed relative position of the inert rocket body was between the leading and the middle spacecraft within the constellation. The successful planning and execution of an orbit maneuver that would create a fly-by of the rocket body was required to establish the.formation. This maneuver would create a close approach that needed to conform to predefined collision probability requirements. On April 21, 2006, the ST5 "155" spacecraft performed a large orbit maneuver and successfully passed the inert Pegasus 3rd Stage Rocket Body on April 30, 2006 15:20 UTC at a distance of 2.55 km with a Probability of Collision of less than 1.0E-06. This paper will outline the technique that was implemented to establish the safe planning and execution of the fly-by maneuver. The method makes use of Gaussian distribution models of state covariance to determine underlying probabilities of collision that arise under low velocity encounters. Specific numerical examples used for this analysis are discussed in detail. The mechanics of this technique are explained to foster deeper understanding of the concepts presented and to improve existing processes for use in future constellation maneuver planning.

USDA Snack Policy Implementation: Best Practices From the Front Lines, United States, 2013–2014

PubMed Central

Chriqui, Jamie; Chavez, Noel; Odoms-Young, Angela; Handler, Arden

2016-01-01

Introduction The Smart Snacks in Schools interim final rule was promulgated by the US Department of Agriculture (USDA) as authorized by the Healthy, Hunger-Free Kids Act of 2010 (PL 111–296) and implementation commenced beginning July 1, 2014; however, in the years leading up to this deadline, national studies suggested that most schools were far from meeting the USDA standards. Evidence to guide successful implementation of the standards is needed. This study examined snack policy implementation in exemplary high schools to learn best practices for implementation. Methods Guided by a multiple case study approach, school professionals (n = 37) from 9 high schools across 8 states were recruited to be interviewed about perceptions of school snack implementation; schools were selected using criterion sampling on the basis of the HealthierUS Schools Challenge: Smarter Lunchrooms (HUSSC: SL) database. Interview transcripts and internal documents were organized and coded in ATLAS.Ti v7; 2 researchers coded and analyzed data using a constant comparative analysis method to identify best practice themes. Results Best practices for snack policy implementation included incorporating the HUSSC: SL award’s comprehensive wellness approach; leveraging state laws or district policies to reinforce snack reform initiatives; creating strong internal and external partnerships; and crafting positive and strategic communications. Conclusion Implementation of snack policies requires evidence of successful experiences from those on the front lines. As federal, state, and local technical assistance entities work to ensure implementation of the Smart Snacks standards, these best practices provide strategies to facilitate the process. PMID:27309416

Implementation of a successful on-call system in clinical chemistry.

PubMed

Hobbs, G A; Jortani, S A; Valdes, R

1997-11-01

Successful practice of clinical pathology depends on a wide variety of laboratory, clinical, and managerial decisions. The skills needed to make these decisions can most effectively be learned by residents and fellows in pathology using a service-oriented on-call approach. We report our experience implementing an on-call system in the clinical chemistry laboratory at the University of Louisville Hospital (Ky). We detail the guidelines used to establish this system and the elements required for its successful implementation. The system emphasizes a laboratory-initiated approach to linking laboratory results to patient care. From inception of the program during late 1990 through 1995, the number of beeper calls (including clinician contacts) steadily increased and is currently 8 to 20 per week. The on-call system is active 24 hours per day, 7 days per week, thus representing activity on all three laboratory shifts. Types of responses were separated into administrative (12%), analytical (42%), clinical (63%), quality control or quality assurance (12%), and consultation (13%) categories. We also present 6 case reports as examples demonstrating multiple elements in these categories. In 23% of the calls, clinician contact was required and achieved by the fellow or resident on call for the laboratory. The on-call reports are documented and presented informally at weekly on-call report sessions. Emphasis is placed on learning and refinement of investigative skills needed to function as an effective laboratory director. Educational emphasis for the medical staff is in establishing awareness of the presence of the laboratory as an important interactive component of patient care. In addition, we found this program to be beneficial to the hospital and to the department of pathology in fulfilling its clinical service and teaching missions. Our experience may be helpful to other institutions establishing such a program.

Evaluating an HIV and AIDS Community Training Partnership Program in five diamond mining communities in South Africa.

PubMed

Rispel, L C; Peltzer, K; Nkomo, N; Molomo, B

2010-11-01

In 2006, De Beers Consolidated Diamond Mines in South Africa entered into a partnership with the Soul City Institute for Health and Development Communications to implement an HIV and AIDS Community Training Partnership Program (CTPP), initially in five diamond mining areas in three provinces of South Africa. The aim of CTPP was to improve HIV knowledge and to contribute to positive behavior changes in the targeted populations. This paper describes the evaluation of the CTPP, one year after implementation. The evaluation combined qualitative interviews with key informants and trainers and a post-intervention survey of 142 community members. The successes of the CTPP included capacity building of trainers through an innovative training approach and HIV and AIDS knowledge transfer to community trainers and targeted communities in remote mining towns. The Soul City edutainment brand is popular and emerged as a major reason for success. Challenges included insufficient attention paid to contextual factors, resource constraints and the lack of a monitoring and evaluation framework. Independent evaluations are useful to strengthen program implementation. In remote areas and resource constraint settings, partnerships between non-governmental organisations and corporations may be required for successful community HIV and AIDS initiatives. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

[Endoscopic treatment of gastroduodenal digestive hemorrhage].

PubMed

Llanos, J; Valdés, E; Cofré, C; Tapia, A; Denegri, E

1992-12-01

Endoscopy is extremely useful for the diagnosis of upper gastrointestinal bleeding. At the present time, therapeutic measures are been used during the endoscopy to stop bleeding. This paper reports the experience of hospital de Talca in the endoscopic treatment of upper gastrointestinal bleeding. Thirty four patients (22 male) with bleeding not originating from esophageal or gastric varices were treated with direct absolute alcohol injection into the bleeding lesions. The procedure was successful in 31 patients. Three of the 34 patients required surgery, but only one of those successfully sclerosed (97% success). There were no complications attributable to the procedure. It is concluded that this therapeutic modality must be implemented in places were gastrointestinal endoscopy is performed.

ORM-Based Semantics of B2B Transactions

NASA Astrophysics Data System (ADS)

Balsters, H.; van Blommestein, F.

After widespread implementation of Enterprise Resource Planning and Personal Information Management, the next wave in the application of ICT is headed towards business to business (B2B) communication. B2B has a number of specific aspects, one of them being negotiation. This aspect has been largely neglected by present implementations of standard EDI- or XML-messaging and by B2B webservice implementations. In this paper a precise model is given of the negotiation process. The requirements of a potential Buyer and the offer of a potential Seller are matched and, if the negotiation is successful, a contract is concluded. The negotiation process model is represented in ORM, extended with dynamic constraints. Our model may be implemented in the databases of the trading partners and in message- or service definitions.

Implementing Obstetric Early Warning Systems.

PubMed

Friedman, Alexander M; Campbell, Mary L; Kline, Carolyn R; Wiesner, Suzanne; D'Alton, Mary E; Shields, Laurence E

2018-04-01

Severe maternal morbidity and mortality are often preventable and obstetric early warning systems that alert care providers of potential impending critical illness may improve maternal safety. While literature on outcomes and test characteristics of maternal early warning systems is evolving, there is limited guidance on implementation. Given current interest in early warning systems and their potential role in care, the 2017 Society for Maternal-Fetal Medicine (SMFM) Annual Meeting dedicated a session to exploring early warning implementation across a wide range of hospital settings. This manuscript reports on key points from this session. While implementation experiences varied based on factors specific to individual sites, common themes relevant to all hospitals presenting were identified. Successful implementation of early warnings systems requires administrative and leadership support, dedication of resources, improved coordination between nurses, providers, and ancillary staff, optimization of information technology, effective education, evaluation of and change in hospital culture and practices, and support in provider decision-making. Evolving data on outcomes on early warning systems suggest that maternal risk may be reduced. To effectively reduce maternal, risk early warning systems that capture deterioration from a broad range of conditions may be required in addition to bundles tailored to specific conditions such as hemorrhage, thromboembolism, and hypertension.

Barriers to Implementing the Response to Intervention Framework in Secondary Schools: Interviews with Secondary Principals

ERIC Educational Resources Information Center

Bartholomew, Mitch; De Jong, David

2017-01-01

Despite the successful implementation of the Response to Intervention (RtI) framework in many elementary schools, there is little evidence of successful implementation in high school settings. Several themes emerged from the interviews of nine secondary principals, including a lack of knowledge and training for successful implementation, the…

Improving the Nuclear Reform Implementation for Success

DTIC Science & Technology

2016-09-15

IMPROVING THE NUCLEAR REFORM IMPLEMENTATION FOR SUCCESS GRADUATE RESEARCH PAPER Allen Y. Agnes...United States. AFIT-ENS-MS-16-S-023 IMPROVING THE NUCLEAR REFORM IMPLMENTATION FOR SUCCESS GRADUATE RESEARCH PAPER Presented to the...AFIT-ENS-MS-16-S-023 IMPROVING THE NUCLEAR REFORM IMPLEMENTATION FOR SUCCESS Allen Y. Agnes, BS, MS Major, USAF

Successful clinical and organisational change in endodontic practice: a qualitative study.

PubMed

Koch, M; Englander, M; Tegelberg, Å; Wolf, E

2014-08-01

The aim of this study was to explicate and describe the qualitative meaning of successful clinical and organizational change in endodontic practice, following a comprehensive implementation program, including the integration of the nickel-titanium-rotary-technique. After an educational intervention in the Public Dental Service in a Swedish county, thematic in-depth interviews were conducted, with special reference to the participants' experience of the successful change. Interviews with four participants, were purposively selected on the basis of occupation (dentist, dental assistant, receptionist, clinical manager), for a phenomenological human scientific analysis. Four constituents were identified as necessary for the invariant, general structure of the phenomenon: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. The perceived requirements for achieving successful clinical and organizational change in endodontic practice were clinical relevance, an atmosphere which facilitated discussion and allowance for individual learning patterns. The qualities required in the educator were acknowledged competence with respect to scientific knowledge and clinical expertise, as well as familiarity with conditions at the dental clinics. The results indicate a complex interelationship among various aspects of the successful change process. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Best practice strategies to safeguard drug prescribing and drug administration: an anthology of expert views and opinions.

PubMed

Seidling, Hanna M; Stützle, Marion; Hoppe-Tichy, Torsten; Allenet, Benoît; Bedouch, Pierrick; Bonnabry, Pascal; Coleman, Jamie J; Fernandez-Llimos, Fernando; Lovis, Christian; Rei, Maria Jose; Störzinger, Dominic; Taylor, Lenka A; Pontefract, Sarah K; van den Bemt, Patricia M L A; van der Sijs, Heleen; Haefeli, Walter E

2016-04-01

While evidence on implementation of medication safety strategies is increasing, reasons for selecting and relinquishing distinct strategies and details on implementation are typically not shared in published literature. We aimed to collect and structure expert information resulting from implementing medication safety strategies to provide advice for decision-makers. Medication safety experts with clinical expertise from thirteen hospitals throughout twelve European and North American countries shared their experience in workshop meetings, on-site-visits and remote structured interviews. We performed an expert-based, in-depth assessment of implementation of best-practice strategies to improve drug prescribing and drug administration. Workflow, variability and recommended medication safety strategies in drug prescribing and drug administration processes. According to the experts, institutions chose strategies that targeted process steps known to be particularly error-prone in the respective setting. Often, the selection was channeled by local constraints such as the e-health equipment and critically modulated by national context factors. In our study, the experts favored electronic prescribing with clinical decision support and medication reconciliation as most promising interventions. They agreed that self-assessment and introduction of medication safety boards were crucial to satisfy the setting-specific differences and foster successful implementation. While general evidence for implementation of strategies to improve medication safety exists, successful selection and adaptation of a distinct strategy requires a thorough knowledge of the institute-specific constraints and an ongoing monitoring and adjustment of the implemented measures.

Lessons Learned by Community Stakeholders in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Project, 2013–2014

PubMed Central

Ganter, Claudia; Aftosmes-Tobio, Alyssa; Chuang, Emmeline; Kwass, Jo-Ann; Land, Thomas

2017-01-01

Introduction Childhood obesity is a multifaceted disease that requires sustainable, multidimensional approaches that support change at the individual, community, and systems levels. The Massachusetts Childhood Obesity Research Demonstration project addressed this need by using clinical and public health evidence-based methods to prevent childhood obesity. To date, little information is known about successes and lessons learned from implementing such large-scale interventions. To address this gap, we examined perspectives of community stakeholders from various sectors on successes achieved and lessons learned during the implementation process. Methods We conducted 39 semistructured interviews with key stakeholders from 6 community sectors in 2 low-income communities from November 2013 through April 2014, during project implementation. Interviews were audio-recorded, transcribed, and analyzed by using the constant comparative method. Data were analyzed by using QSR NVivo 10. Results Successes included increased parental involvement in children’s health and education, increased connections within participating organizations and within the broader community, changes in organizational policies and environments to better support healthy living, and improvements in health behaviors in children, parents, and stakeholders. Lessons learned included the importance of obtaining administrative and leadership support, involving key stakeholders early in the program planning process, creating buffers that allow for unexpected changes, and establishing opportunities for regular communication within and across sectors. Conclusion Study findings indicate that multidisciplinary approaches support health behavior change and provide insight into key issues to consider in developing and implementing such approaches in low-income communities. PMID:28125400

Methods to Succeed in Effective Knowledge Translation in Clinical Practice.

PubMed

Kitson, Alison L; Harvey, Gillian

2016-05-01

To explore the evidence around facilitation as an intervention for the successful implementation of new knowledge into clinical practice. The revised version of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, called the integrated or i-PARIHS framework, is used as the explanatory framework. This framework posits that evidence is a multidimensional construct embedded within innovation and operationalized by clinicians (individuals and within teams), working across multiple layers of context. Facilitation is the active ingredient that promotes successful implementation. An emerging body of evidence supports facilitation as a mechanism to getting new knowledge into clinical practice. Facilitation roles are divided into beginner, experienced, and expert facilitators. Facilitators can be internal or external to the organization they work in, and their skills and attributes complement other knowledge translation (KT) roles. Complex KT projects require facilitators who are experienced in implementation methods. Facilitation is positioned as the active ingredient to effectively introduce new knowledge into a clinical setting. Levels of facilitation experience are assessed in relation to the complexity of the KT task. Three core facilitation roles are identified, and structured interventions are established taking into account the nature and novelty of the evidence, the receptiveness of the clinicians, and the context or setting where the new evidence is to be introduced. Roles such as novice, experienced, and expert facilitators have important and complementary parts to play in enabling the successful translation of evidence into everyday practice in order to provide effective care for patients. © 2016 Sigma Theta Tau International.

"Alcohol and nicotine"--Concept and evaluation of an interdisciplinary elective course with OSPE in preclinical medical education.

PubMed

Bergelt, Corinna; Lauke, Heidrun; Petersen-Ewert, Corinna; Jücker, Manfred; Bauer, Christiane K

2014-01-01

In the last decade, increasing interest has been paid to interdisciplinary and practical courses in the medical education in Germany. This report describes the implementation and outcome of a preclinical interdisciplinary elective course with a team-teaching concept developed by lecturers in medical psychology, anatomy, physiology and biochemistry. The practical orientation of the course led to the implementation of a final interdisciplinary OSPE to ensure fair consideration of the different disciplines involved in grading. Individual OSPE results correlate well with the fact that different skills are required in medical psychology compared to those required in anatomy, physiology and biochemistry. Student course evaluation and lecturers` experience indicate the success of this elective course. Its concept can be well adapted to other interdisciplinary courses.

Adapting the Quebecois method for assessing implementation to the French National Alzheimer Plan 2008–2012: lessons for gerontological services integration

PubMed Central

Somme, Dominique; Trouvé, Hélène; Perisset, Catherine; Corvol, Aline; Ankri, Joël; Saint-Jean, Olivier; de Stampa, Matthieu

2014-01-01

Introduction Many countries face ageing-related demographic and epidemiological challenges, notably neurodegenerative disorders, due to the multiple care services they require, thereby pleading for a more integrated system of care. The integrated Quebecois method issued from the Programme of Research to Integrate Services for the Maintenance of Autonomy inspired a French pilot experiment and the National Alzheimer Plan 2008–2012. Programme of Research to Integrate Services for the Maintenance of Autonomy method implementation was rated with an evaluation grid adapted to assess its successive degrees of completion. Discussion The approaching end of the president's term led to the method's institutionalization (2011–2012), before the implementation study ended. When the government changed, the study was interrupted. The results extracted from that ‘lost’ study (presented herein) have, nonetheless, ‘found’ some key lessons. Key lessons/conclusion It was possible to implement a Quebecois integrated-care method in France. We describe the lessons and pitfalls encountered in adapting this evaluation tool. This process is necessarily multidisciplinary and requires a test phase. A simple tool for quantitative assessment of integration was obtained. The first assessment of the tool was unsatisfactory but requires further studies. In the meantime, we recommend using mixed methodologies to assess the services integration level. PMID:24959112

Surgical model-view-controller simulation software framework for local and collaborative applications

PubMed Central

Sankaranarayanan, Ganesh; Halic, Tansel; Arikatla, Venkata Sreekanth; Lu, Zhonghua; De, Suvranu

2010-01-01

Purpose Surgical simulations require haptic interactions and collaboration in a shared virtual environment. A software framework for decoupled surgical simulation based on a multi-controller and multi-viewer model-view-controller (MVC) pattern was developed and tested. Methods A software framework for multimodal virtual environments was designed, supporting both visual interactions and haptic feedback while providing developers with an integration tool for heterogeneous architectures maintaining high performance, simplicity of implementation, and straightforward extension. The framework uses decoupled simulation with updates of over 1,000 Hz for haptics and accommodates networked simulation with delays of over 1,000 ms without performance penalty. Results The simulation software framework was implemented and was used to support the design of virtual reality-based surgery simulation systems. The framework supports the high level of complexity of such applications and the fast response required for interaction with haptics. The efficacy of the framework was tested by implementation of a minimally invasive surgery simulator. Conclusion A decoupled simulation approach can be implemented as a framework to handle simultaneous processes of the system at the various frame rates each process requires. The framework was successfully used to develop collaborative virtual environments (VEs) involving geographically distributed users connected through a network, with the results comparable to VEs for local users. PMID:20714933

Surgical model-view-controller simulation software framework for local and collaborative applications.

PubMed

Maciel, Anderson; Sankaranarayanan, Ganesh; Halic, Tansel; Arikatla, Venkata Sreekanth; Lu, Zhonghua; De, Suvranu

2011-07-01

Surgical simulations require haptic interactions and collaboration in a shared virtual environment. A software framework for decoupled surgical simulation based on a multi-controller and multi-viewer model-view-controller (MVC) pattern was developed and tested. A software framework for multimodal virtual environments was designed, supporting both visual interactions and haptic feedback while providing developers with an integration tool for heterogeneous architectures maintaining high performance, simplicity of implementation, and straightforward extension. The framework uses decoupled simulation with updates of over 1,000 Hz for haptics and accommodates networked simulation with delays of over 1,000 ms without performance penalty. The simulation software framework was implemented and was used to support the design of virtual reality-based surgery simulation systems. The framework supports the high level of complexity of such applications and the fast response required for interaction with haptics. The efficacy of the framework was tested by implementation of a minimally invasive surgery simulator. A decoupled simulation approach can be implemented as a framework to handle simultaneous processes of the system at the various frame rates each process requires. The framework was successfully used to develop collaborative virtual environments (VEs) involving geographically distributed users connected through a network, with the results comparable to VEs for local users.

Mars Science Laboratory Propulsive Maneuver Design and Execution

NASA Technical Reports Server (NTRS)

Wong, Mau C.; Kangas, Julie A.; Ballard, Christopher G.; Gustafson, Eric D.; Martin-Mur, Tomas J.

2012-01-01

The NASA Mars Science Laboratory (MSL) rover, Curiosity, was launched on November 26, 2011 and successfully landed at the Gale Crater on Mars. For the 8-month interplanetary trajectory from Earth to Mars, five nominal and two contingency trajectory correction maneuvers (TCM) were planned. The goal of these TCMs was to accurately deliver the spacecraft to the desired atmospheric entry aimpoint in Martian atmosphere so as to ensure a high probability of successful landing on the Mars surface. The primary mission requirements on maneuver performance were the total mission propellant usage and the entry flight path angle (EFPA) delivery accuracy. They were comfortably met in this mission. In this paper we will describe the spacecraft propulsion system, TCM constraints and requirements, TCM design processes, and their implementation and verification.

Fracture Mechanics for Composites: State of the Art and Challenges

NASA Technical Reports Server (NTRS)

Krueger, Ronald; Krueger, Ronald

2006-01-01

Interlaminar fracture mechanics has proven useful for characterizing the onset of delaminations in composites and has been used with limited success primarily to investigate onset in fracture toughness specimens and laboratory size coupon type specimens. Future acceptance of the methodology by industry and certification authorities however, requires the successful demonstration of the methodology on the structural level. In this paper, the state-of-the-art in fracture toughness characterization, and interlaminar fracture mechanics analysis tools are described. To demonstrate the application on the structural level, a panel was selected which is reinforced with stringers. Full implementation of interlaminar fracture mechanics in design however remains a challenge and requires a continuing development effort of codes to calculate energy release rates and advancements in delamination onset and growth criteria under mixed mode conditions.

Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience.

PubMed

Hoyme, Derek B; Atkins, Dianne L

2017-02-01

To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was <$1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience

PubMed Central

Hoyme, Derek B.; Atkins, Dianne L.

2017-01-01

Objective To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Study design Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Results Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was <$1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. Conclusions Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations. PMID:27852456

Open modular architecture controls at GM Powertrain: technology and implementation

NASA Astrophysics Data System (ADS)

Bailo, Clark P.; Yen, C. J.

1997-01-01

General Motors Powertrain Group (GMPTG) has been the leader in implementing open, modular architecture controller (OMAC) technologies in its manufacturing applications since 1986. The interest in OMAC has been greatly expanded for the past two years because of the advancement of personal computer technologies and the publishing of the OMAC whitepaper by the US automotive companies stating the requirements of OMAC technologies in automotive applications. The purpose of this paper is to describe the current OMAC projects and the future direction of implementation at GMPTG. An overview of the OMAC project and the definition of the OMAC concept are described first. The rationale of pursuing open technologies is explained from the perspective of GMPTG in lieu of its agile manufacturing strategy. Examples of existing PC-based control applications are listed to demonstrate the extensive commitment to PC-based technologies that has already been put in place. A migration plan form PC-based to OMAC-based systems with the thorough approach of validation are presented next to convey the direction that GMPTG is taking in implementing OMAC technologies. Leveraged technology development projects are described to illustrate the philosophy and approaches toward the development of OMAC technologies at GMPTG. Finally, certain implementation issues are discussed to emphasize efforts that are still required to have successful implementations of OMAC systems.

A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia.

PubMed

Psaila, Kim; Fowler, Cathrine; Kruske, Sue; Schmied, Virginia

2014-12-01

The transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services. This paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations. Data reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis. The range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively. Improving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.

PubMed

Hofler, Lisa G; Cordes, Sarah; Cwiak, Carrie A; Goedken, Peggy; Jamieson, Denise J; Kottke, Melissa

2017-01-01

To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences. At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed. Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

Views of practice managers and general practitioners on implementing NHS Health Checks.

PubMed

Krska, Janet; du Plessis, Ruth; Chellaswamy, Hannah

2016-03-01

As part of an evaluation of a contract with general practices to deliver the national NHS Health Checks programme in Sefton, North West England, we surveyed general practitioners (GPs) and practice managers (PMs) in all 55 practices. The contract required practices to identify individuals from their practice registers with potentially high cardiovascular disease risk, and provide annual reviews. Responses were obtained from 43/178 GPs and 40/55 PMs representing 56 and 73% of practices, respectively. There was variation in many aspects of implementation. Time and software were viewed as barriers to implementation, the increased nurse workload impacted on other services and payments were insufficient to cover costs. The main enabler for successful implementation was IT support. Fewer than half the respondents viewed the programme as beneficial to their practice. Findings have been used to address many issues raised. Practices need more support from commissioners to help implement NHS Health Checks.

Measuring the success of electronic medical record implementation using electronic and survey data.

PubMed Central

Keshavjee, K.; Troyan, S.; Holbrook, A. M.; VanderMolen, D.

2001-01-01

Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically. PMID:11825201

Health Reforms as Examples of Multilevel Interventions in Cancer Care

PubMed Central

Fennell, Mary L.; Devers, Kelly J.

2012-01-01

To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation’s health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform. PMID:22623600

Health reforms as examples of multilevel interventions in cancer care.

PubMed

Flood, Ann B; Fennell, Mary L; Devers, Kelly J

2012-05-01

To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

Computer-based physician order entry: the state of the art.

PubMed Central

Sittig, D F; Stead, W W

1994-01-01

Direct computer-based physician order entry has been the subject of debate for over 20 years. Many sites have implemented systems successfully. Others have failed outright or flirted with disaster, incurring substantial delays, cost overruns, and threatened work actions. The rationale for physician order entry includes process improvement, support of cost-conscious decision making, clinical decision support, and optimization of physicians' time. Barriers to physician order entry result from the changes required in practice patterns, roles within the care team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and easy to use, the user interface must behave consistently in all situations, the institution must have broad and committed involvement and direction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to present the current state of the art of computer-based physician order entry. PMID:7719793

Efficient state initialization by a quantum spectral filtering algorithm

NASA Astrophysics Data System (ADS)

Fillion-Gourdeau, François; MacLean, Steve; Laflamme, Raymond

2017-04-01

An algorithm that initializes a quantum register to a state with a specified energy range is given, corresponding to a quantum implementation of the celebrated Feit-Fleck method. This is performed by introducing a nondeterministic quantum implementation of a standard spectral filtering procedure combined with an apodization technique, allowing for accurate state initialization. It is shown that the implementation requires only two ancilla qubits. A lower bound for the total probability of success of this algorithm is derived, showing that this scheme can be realized using a finite, relatively low number of trials. Assuming the time evolution can be performed efficiently and using a trial state polynomially close to the desired states, it is demonstrated that the number of operations required scales polynomially with the number of qubits. Tradeoffs between accuracy and performance are demonstrated in a simple example: the harmonic oscillator. This algorithm would be useful for the initialization phase of the simulation of quantum systems on digital quantum computers.

E-learning implementation in superior technical educational system

NASA Astrophysics Data System (ADS)

Musca, Gavril; Mihalache, Andrei; Musca, Elena

2016-11-01

E-learning methods apply to most modern and various domains but also represent a great tool for the mechanical educational system where there are a lot of sustained efforts for its implementation. Using, administrating and maintaining an e-learning system for a certain field of study requires knowledge related to computation system's utilization but also the understanding the working mechanisms behind it that allows the system to be fully customized in order to be perfect fitted to the user's needs and requirements. A Moodle based test is evaluated from several points of views such as coherence clarity, concise content, information synthesis capacity and the presentation mode which makes the difference between clear or fuzzy graphical representations or terms. The authors appreciate that the ability of managing information in real time by the professor is a decisive decision in order to successfully implement an e-learning web platform. Updating information and structuring trainee's activities from thoroughgoing study up to their individual proposals for conceived applications leads to a better understanding and practical knowledge of theory.

Evaluation of alternative approaches for landscape-scale biomass estimation in a mixed-species northern forest

Treesearch

Coeli M. Hoover; Mark J. Ducey; R. Andy Colter; Mariko Yamasaki

2018-01-01

There is growing interest in estimating and mapping biomass and carbon content of forests across large landscapes. LiDAR-based inventory methods are increasingly common and have been successfully implemented in multiple forest types. Asner et al. (2011) developed a simple universal forest carbon estimation method for tropical forests that reduces the amount of required...

The Degree of Implementing ISTE Standards in Technical Education Colleges of Palestine

ERIC Educational Resources Information Center

Ayad, Fuad Ismail; Ajrami, Sameh Jamil

2017-01-01

In light of this successive technological change, there has been an ongoing need for the development of technical education, so that the graduate is able to keep up with the requirements of the labor market on the one hand, and has a continuing education skills on the other. International Society for Technology in Education (ISTE) standards are…

Adolescents' Comprehension about Sustainable Development as a Device to Study Socio-Economic Knowledge Related to Citizenship

ERIC Educational Resources Information Center

Diez-Martinez, Evelyn

2013-01-01

Environmental education has been included in the school curricula of many countries in the last 15 years. Implementation has been not as successful as expected due to various constraints reported in several research projects. Its achievement remains uncertain and more research is required in all areas of education. In order to propose a curriculum…

Strategies for integrating computer-based activities into your educational environment: a practical guide.

PubMed Central

Miller, J G; Wolf, F M

1996-01-01

Strategies for implementing instructional technology are based on recent experiences at the University of Michigan Medical Center. The issues covered include 1) addressing facilities, hardware, and staffing needs, 2) determining learners' skill requirements and appropriate training activities, and 3) selecting and customizing educational software. Many examples are provided, and nine key points for success are emphasized. PMID:8653447

On Adopting Solutions to Improve Population Health: Do We Have the Political Will?

ERIC Educational Resources Information Center

Galea, Sandro

2016-01-01

In this column, Sandro Galea addresses what would be required to identify and implement solutions that can improve the health of populations. Galea suggests that two perspectives need to inform solutions that might prove successful. First, solutions that aim to improve the health of populations need to be grounded in clarity of purpose, aiming to…

An Evidence-Based Project Demonstrating Increased School Immunization Compliance Following a School Nurse-Initiated Vaccine Compliance Strategy

ERIC Educational Resources Information Center

Swallow, Wendy; Roberts, Jill C.

2016-01-01

During the 2012-2013 school year, only 66% of students at a Northern Indiana High School were in compliance with school immunization requirements. We report here successful implementation of evidence-based, time, and cost-effective methods aimed at increasing school immunization compliance. A three-stage strategy initiated by the school nurse was…

Comparing Student and Teacher Perceptions of the Importance of Social Skills in a Self-Contained Setting

ERIC Educational Resources Information Center

Morgan, Joseph John; Dobbins, Nicole; Hsiao, Yun-Ju; Brown, Nancy; Higgins, Kyle

2015-01-01

Implementation of social skills deemed appropriate for use in school is important for student success. Students with emotional and behavioral disorders often fail to use these social skills, requiring intervention to facilitate their use. Results related to social skills interventions have been mixed; one suggested reason for this is the lack of…

Implementing Education Reforms in New Zealand, 1987-97: A Case Study. The Education Reform and Management Series, Vol. 1, No. 1.

ERIC Educational Resources Information Center

Perris, Lyall

In 1987 New Zealand faced multiple economic problems and high unemployment. A flexible and responsive education system was needed to produce the skills, attitudes, and learning required for New Zealand's future. The primary objective was decentralizing authority to school level. This book emphasizes the process of successful reform, rather than…

Agriculture and food systems in sub-Saharan Africa in a 4°C+ world.

PubMed

Thornton, Philip K; Jones, Peter G; Ericksen, Polly J; Challinor, Andrew J

2011-01-13

Agricultural development in sub-Saharan Africa faces daunting challenges, which climate change and increasing climate variability will compound in vulnerable areas. The impacts of a changing climate on agricultural production in a world that warms by 4°C or more are likely to be severe in places. The livelihoods of many croppers and livestock keepers in Africa are associated with diversity of options. The changes in crop and livestock production that are likely to result in a 4°C+ world will diminish the options available to most smallholders. In such a world, current crop and livestock varieties and agricultural practices will often be inadequate, and food security will be more difficult to achieve because of commodity price increases and local production shortfalls. While adaptation strategies exist, considerable institutional and policy support will be needed to implement them successfully on the scale required. Even in the 2°C+ world that appears inevitable, planning for and implementing successful adaptation strategies are critical if agricultural growth in the region is to occur, food security be achieved and household livelihoods be enhanced. As part of this effort, better understanding of the critical thresholds in global and African food systems requires urgent research.

The impact of middle manager affective commitment on perceived improvement program implementation success.

PubMed

Fryer, Ashley-Kay; Tucker, Anita L; Singer, Sara J

Recent literature suggests that middle manager affective commitment (emotional attachment, identification, and involvement) to an improvement program may influence implementation success. However, less is known about the interplay between middle manager affective commitment and frontline worker commitment, another important driver of implementation success. We contribute to this research by surveying middle managers who directly manage frontline workers on nursing units. We assess how middle manager affective commitment is related to their perceptions of implementation success and whether their perceptions of frontline worker support mediate this relationship. We also test whether a set of organizational support factors foster middle manager affective commitment. We adapt survey measures of manager affective commitment to our research context of hospitals. We surveyed 67 nurse managers from 19 U.S. hospitals. We use hierarchical linear regression to assess relationships among middle manager affective commitment to their units' falls reduction program and their perceptions of three constructs related to the program: frontline worker support, organizational support, and implementation success. Middle manager affective commitment to their unit's falls reduction program is positively associated with their perception of implementation success. This relationship is mediated by their perception of frontline worker support for the falls program. Moreover, middle managers' affective commitment to their unit's falls program mediates the relationship between perceived organizational support for the program and perceived implementation success. We, through this research, offer an important contribution by providing empirical support of factors that may influence successful implementation of an improvement program: middle manager affective commitment, frontline worker support, and organizational support for an improvement program. Increasing levels of middle manager affective commitment to an improvement program could strengthen program implementation success by facilitating frontline worker support for the program. Furthermore, providing the organizational support items in our survey construct may bolster middle manager affective commitment.

Electronic Chemotherapy Order Entry: A Major Cancer Center's Implementation

PubMed Central

Sklarin, Nancy T.; Granovsky, Svetlana; O'Reilly, Eileen M.; Zelenetz, Andrew D.

2011-01-01

Implementation of a computerized provider order entry system for complex chemotherapy regimens at a large cancer center required intense effort from a multidisciplinary team of clinical and systems experts with experience in all facets of the chemotherapy process. The online tools had to resemble the paper forms used at the time and parallel the successful established process as well as add new functionality. Close collaboration between the institution and the vendor was necessary. This article summarizes the institutional efforts, challenges, and collaborative processes that facilitated universal chemotherapy computerized electronic order entry across multiple sites during a period of several years. PMID:22043182

Electronic Chemotherapy Order Entry: A Major Cancer Center's Implementation.

PubMed

Sklarin, Nancy T; Granovsky, Svetlana; O'Reilly, Eileen M; Zelenetz, Andrew D

2011-07-01

Implementation of a computerized provider order entry system for complex chemotherapy regimens at a large cancer center required intense effort from a multidisciplinary team of clinical and systems experts with experience in all facets of the chemotherapy process. The online tools had to resemble the paper forms used at the time and parallel the successful established process as well as add new functionality. Close collaboration between the institution and the vendor was necessary. This article summarizes the institutional efforts, challenges, and collaborative processes that facilitated universal chemotherapy computerized electronic order entry across multiple sites during a period of several years.

The South African Tuberculosis Care Cascade: Estimated Losses and Methodological Challenges

PubMed Central

Naidoo, Pren; Theron, Grant; Rangaka, Molebogeng X; Chihota, Violet N; Vaughan, Louise; Brey, Zameer O; Pillay, Yogan

2017-01-01

Abstract Background While tuberculosis incidence and mortality are declining in South Africa, meeting the goals of the End TB Strategy requires an invigorated programmatic response informed by accurate data. Enumerating the losses at each step in the care cascade enables appropriate targeting of interventions and resources. Methods We estimated the tuberculosis burden; the number and proportion of individuals with tuberculosis who accessed tests, had tuberculosis diagnosed, initiated treatment, and successfully completed treatment for all tuberculosis cases, for those with drug-susceptible tuberculosis (including human immunodeficiency virus (HIV)–coinfected cases) and rifampicin-resistant tuberculosis. Estimates were derived from national electronic tuberculosis register data, laboratory data, and published studies. Results The overall tuberculosis burden was estimated to be 532005 cases (range, 333760–764480 cases), with successful completion of treatment in 53% of cases. Losses occurred at multiple steps: 5% at test access, 13% at diagnosis, 12% at treatment initiation, and 17% at successful treatment completion. Overall losses were similar among all drug-susceptible cases and those with HIV coinfection (54% and 52%, respectively, successfully completed treatment). Losses were substantially higher among rifampicin- resistant cases, with only 22% successfully completing treatment. Conclusion Although the vast majority of individuals with tuberculosis engaged the public health system, just over half were successfully treated. Urgent efforts are required to improve implementation of existing policies and protocols to close gaps in tuberculosis diagnosis, treatment initiation, and successful treatment completion. PMID:29117342

[Guideline implementation study on asthma: Results of a pragmatic implementation approach].

PubMed

Redaèlli, Marcus; Vollmar, Horst Christian; Simic, Dusan; Maly-Schürer, Cornelia; Löscher, Susanne; Koneczny, Nikolaus

2015-01-01

Knowledge transfer from theory to practice in healthcare systems poses a challenge worldwide. Typical examples include national disease management guidelines. The present study contributes towards improving implementation strategies for an asthma guideline. A guideline implementation strategy was examined in a four-armed, non-randomised, controlled intervention study with an additional control group. The study participants were general practitioners and paediatricians recruited from primary care quality circles. All study participants attended an interactive seminar on the evidence-based recommendations for patients with asthma. In addition, the participants were asked to choose among the following options: no further intervention, additional e-learning, training of their practice nurses, or e-learning and training of their practice nurses. The success of the intervention was measured by questionnaire (and the success rate expressed as a percentage). About one third of all participants (n=313) opted for the combination of an interactive seminar and a training of practice nurses; two third preferred the classic way of continuing medical education with an interactive seminar without a further intervention. Just 10 % of the physicians participated in e-learning. Independently of their choice for continuing medical education, all participants demonstrated an increase in knowledge about asthma and an improvement in the management of asthma. The physicians exhibited an average increase in both categories of about 10 % of the percentage values, compared to an increase of about 28 % among the practice nurses without continuing medical education. The physicians' free choice of the educative modules might be an integral part of successful implementation strategies. However, this will require a change of focus from general continuing medical education packages to a more individualised culture of continuing professional development in Germany. Copyright © 2015. Published by Elsevier GmbH.

Prospective implementation of an algorithm for bedside intravascular ultrasound-guided filter placement in critically ill patients.

PubMed

Killingsworth, Christopher D; Taylor, Steven M; Patterson, Mark A; Weinberg, Jordan A; McGwin, Gerald; Melton, Sherry M; Reiff, Donald A; Kerby, Jeffrey D; Rue, Loring W; Jordan, William D; Passman, Marc A

2010-05-01

Although contrast venography is the standard imaging method for inferior vena cava (IVC) filter insertion, intravascular ultrasound (IVUS) imaging is a safe and effective option that allows for bedside filter placement and is especially advantageous for immobilized critically ill patients by limiting resource use, risk of transportation, and cost. This study reviewed the effectiveness of a prospectively implemented algorithm for IVUS-guided IVC filter placement in this high-risk population. Current evidence-based guidelines were used to create a clinical decision algorithm for IVUS-guided IVC filter placement in critically ill patients. After a defined lead-in phase to allow dissemination of techniques, the algorithm was prospectively implemented on January 1, 2008. Data were collected for 1 year using accepted reporting standards and a quality assurance review performed based on intent-to-treat at 6, 12, and 18 months. As defined in the prospectively implemented algorithm, 109 patients met criteria for IVUS-directed bedside IVC filter placement. Technical feasibility was 98.1%. Only 2 patients had inadequate IVUS visualization for bedside filter placement and required subsequent placement in the endovascular suite. Technical success, defined as proper deployment in an infrarenal position, was achieved in 104 of the remaining 107 patients (97.2%). The filter was permanent in 21 (19.6%) and retrievable in 86 (80.3%). The single-puncture technique was used in 101 (94.4%), with additional dual access required in 6 (5.6%). Periprocedural complications were rare but included malpositioning requiring retrieval and repositioning in three patients, filter tilt >/=15 degrees in two, and arteriovenous fistula in one. The 30-day mortality rate for the bedside group was 5.5%, with no filter-related deaths. Successful placement of IVC filters using IVUS-guided imaging at the bedside in critically ill patients can be established through an evidence-based prospectively implemented algorithm, thereby limiting the need for transport in this high-risk population. Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Conditions for successfully implementing resident-oriented care in nursing homes.

PubMed

Berkhout, Afke J M B; Boumans, Nicolle P G; Mur, Ingrid; Nijhuis, Frans J N

2009-06-01

This study reports an investigation of the conditions for a successful introduction of a resident-oriented care model on six somatic and psychogeriatric intervention wards in three Dutch nursing homes. This study aims to answer the following research question: 'What are the conditions for successfully implementing resident-oriented care?' To answer the research question, the organisational change process was monitored by using the '7-S' model of Peters and Waterman as a diagnostic framework. Based on this model, the following change characteristics were studied: structure, strategy, systems, staff, skills, style and shared values. Our study involved a one group pretest/post-test design. To measure the conditions for change, we operationalised the factors of the 7-S model serving as a diagnostic framework and studied their presence and nature on the intervention wards. For this purpose qualitative interviews were held with the change agents of the nursing homes and the wards' supervisors. To determine the degree of 'success' of the implementation, we measured the extent to which resident-oriented care was implemented. For this purpose a quantitative questionnaire was filled in by the nurses of the intervention wards. By relating the extent to which resident-oriented care was implemented to the differences in change conditions, we were able to distinguish the 'most' from the 'least' successful intervention ward and so, pointing out the conditions contributing to a successful implementation of resident-oriented care. The results showed that, in contrast to the least successful intervention ward, the most successful intervention ward was characterised by success conditions related to the 7-S model factors strategy, systems, staff and skills. The factor structure did not contribute to the success of the implementation. Success conditions appeared to be related to the ward level and not to the organisational or project level. Especially the supervisors' role appeared to be crucial for a successful implementation.

Evaluation of a countrywide implementation of the world health organisation surgical safety checklist in Madagascar

PubMed Central

White, Michelle C.; Baxter, Linden S.; Close, Kristin L.; Ravelojaona, Vaonandianina A.; Rakotoarison, Hasiniaina N.; Bruno, Emily; Herbert, Alison; Andean, Vanessa; Callahan, James; Andriamanjato, Hery H.; Shrime, Mark G.

2018-01-01

Background The 2009 World Health Organisation (WHO) surgical safety checklist significantly reduces surgical mortality and morbidity (up to 47%). Yet in 2016, only 25% of East African anesthetists regularly use the checklist. Nationwide implementation of the checklist is reported in high-income countries, but in low- and middle-income countries (LMICs) reports of successful implementations are sparse, limited to single institutions and require intensive support. Since checklist use leads to the biggest improvements in outcomes in LMICs, methods of wide-scale implementation are needed. We hypothesized that, using a three-day course, successful wide-scale implementation of the checklist could be achieved, as measured by at least 50% compliance with six basic safety processes at three to four months. We also aimed to determine predictors for checklist utilization. Materials and methods Using a blended educational implementation strategy based on prior pilot studies we designed a three-day dynamic educational course to facilitate widespread implementation of the WHO checklist. The course utilized lectures, film, small group breakouts, participant feedback and simulation to teach the knowledge, skills and behavior changes needed to implement the checklist. In collaboration with the Ministry of Health and local hospital leadership, the course was delivered to 427 multi-disciplinary staff at 21 hospitals located in 19 of 22 regions of Madagascar between September 2015 and March 2016. We evaluated implementation at three to four months using questionnaires (with a 5-point Likert scale) and focus groups. Multivariate linear regression was used to test predictors of checklist utilization. Results At three to four months, 65% of respondents reported always using the checklist, with another 13% using it in part. Participant’s years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with counting instruments (p< 0.05), but not with verifying: patient identity, difficult intubation risk, risk of blood loss, prophylactic antibiotic administration, or counting needles and sponges. Conclusion Use of a multi-disciplinary three-day course for checklist implementation resulted in 78% of participants using the checklist, at three months; and an increase in counting surgical instruments. Successful checklist implementation was not predicted by participant length of medical service, hospital size or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility. PMID:29401465

Evaluation of a countrywide implementation of the world health organisation surgical safety checklist in Madagascar.

PubMed

White, Michelle C; Baxter, Linden S; Close, Kristin L; Ravelojaona, Vaonandianina A; Rakotoarison, Hasiniaina N; Bruno, Emily; Herbert, Alison; Andean, Vanessa; Callahan, James; Andriamanjato, Hery H; Shrime, Mark G

2018-01-01

The 2009 World Health Organisation (WHO) surgical safety checklist significantly reduces surgical mortality and morbidity (up to 47%). Yet in 2016, only 25% of East African anesthetists regularly use the checklist. Nationwide implementation of the checklist is reported in high-income countries, but in low- and middle-income countries (LMICs) reports of successful implementations are sparse, limited to single institutions and require intensive support. Since checklist use leads to the biggest improvements in outcomes in LMICs, methods of wide-scale implementation are needed. We hypothesized that, using a three-day course, successful wide-scale implementation of the checklist could be achieved, as measured by at least 50% compliance with six basic safety processes at three to four months. We also aimed to determine predictors for checklist utilization. Using a blended educational implementation strategy based on prior pilot studies we designed a three-day dynamic educational course to facilitate widespread implementation of the WHO checklist. The course utilized lectures, film, small group breakouts, participant feedback and simulation to teach the knowledge, skills and behavior changes needed to implement the checklist. In collaboration with the Ministry of Health and local hospital leadership, the course was delivered to 427 multi-disciplinary staff at 21 hospitals located in 19 of 22 regions of Madagascar between September 2015 and March 2016. We evaluated implementation at three to four months using questionnaires (with a 5-point Likert scale) and focus groups. Multivariate linear regression was used to test predictors of checklist utilization. At three to four months, 65% of respondents reported always using the checklist, with another 13% using it in part. Participant's years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with counting instruments (p< 0.05), but not with verifying: patient identity, difficult intubation risk, risk of blood loss, prophylactic antibiotic administration, or counting needles and sponges. Use of a multi-disciplinary three-day course for checklist implementation resulted in 78% of participants using the checklist, at three months; and an increase in counting surgical instruments. Successful checklist implementation was not predicted by participant length of medical service, hospital size or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility.

The successful implementation of a licensed data management interface between a Sunquest(®) laboratory information system and an AB SCIEX™ mass spectrometer.

PubMed

French, Deborah; Terrazas, Enrique

2013-01-01

Interfacing complex laboratory equipment to laboratory information systems (LIS) has become a more commonly encountered problem in clinical laboratories, especially for instruments that do not have an interface provided by the vendor. Liquid chromatography-tandem mass spectrometry is a great example of such complex equipment, and has become a frequent addition to clinical laboratories. As the testing volume on such instruments can be significant, manual data entry will also be considerable and the potential for concomitant transcription errors arises. Due to this potential issue, our aim was to interface an AB SCIEX™ mass spectrometer to our Sunquest(®) LIS. WE LICENSED SOFTWARE FOR THE DATA MANAGEMENT INTERFACE FROM THE UNIVERSITY OF PITTSBURGH, BUT EXTENDED THIS WORK AS FOLLOWS: The interface was designed so that it would accept a text file exported from the AB SCIEX™ × 5500 QTrap(®) mass spectrometer, pre-process the file (using newly written code) into the correct format and upload it into Sunquest(®) via file transfer protocol. The licensed software handled the majority of the interface tasks with the exception of converting the output from the Analyst(®) software to the required Sunquest(®) import format. This required writing of a "pre-processor" by one of the authors which was easily integrated with the supplied software. We successfully implemented the data management interface licensed from the University of Pittsburgh. Given the coding that was required to write the pre-processor, and alterations to the source code that were performed when debugging the software, we would suggest that before a laboratory decides to implement such an interface, it would be necessary to have a competent computer programmer available.

Instituting a Sugar-Sweetened Beverage Ban: Experience From a Children’s Hospital

PubMed Central

Eneli, Ihuoma U.; Grover, Kathryn; Miller, Rick; Kelleher, Kelly

2014-01-01

Sugar-sweetened beverage (SSB) consumption is linked to increased weight and obesity in children and remains the major source of added sugar in the typical US diet across all age groups. In an effort to improve the nutritional offerings for patients and employees within our institution, Nationwide Children’s Hospital in Columbus, Ohio, implemented an SSB ban in 2011 in all food establishments within the hospital. In this report, we describe how the ban was implemented. We found that an institutional SSB ban altered beverage sales without revenue loss at nonvending food locations. From a process perspective, we found that successful implementation requires excellent communication and bold leadership at several levels throughout the hospital environment. PMID:25121811

A Study to Identify the Critical Success Factors for ERP Implementation in an Indian SME: A Case Based Approach

NASA Astrophysics Data System (ADS)

Upadhyay, Parijat; Dan, Pranab K.

To achieve synergy across product lines, businesses are implementing a set of standard business applications and consistent data definitions across all business units. ERP packages are extremely useful in integrating a global company and provide a "common language" throughout the company. Companies are not only implementing a standardized application but is also moving to a common architecture and infrastructure. For many companies, a standardized software rollout is a good time to do some consolidation of their IT infrastructure across various locations. Companies are also finding that the ERP solutions help them get rid of their legacy systems, most of which may not be compliant with the modern day business requirements.

Methodical bases of selection and evaluation of the effectiveness of the projects of the urban territory renovation

NASA Astrophysics Data System (ADS)

Sizova, Evgeniya; Zhutaeva, Evgeniya; Chugunov, Andrei

2018-03-01

The article highlights features of processes of urban territory renovation from the perspective of a commercial entity participating in the implementation of a project. The requirements of high-rise construction projects to the entities, that carry out them, are considered. The advantages of large enterprises as participants in renovation projects are systematized, contributing to their most efficient implementation. The factors, which influence the success of the renovation projects, are presented. A method for selecting projects for implementation based on criteria grouped by qualitative characteristics and contributing to the most complete and comprehensive evaluation of the project is suggested. Patterns to prioritize and harmonize renovation projects in terms of multi-project activity of the enterprise are considered.

Use of the Theoretical Domains Framework to evaluate factors driving successful implementation of the Accelerated Chest pain Risk Evaluation (ACRE) project.

PubMed

Skoien, Wade; Page, Katie; Parsonage, William; Ashover, Sarah; Milburn, Tanya; Cullen, Louise

2016-10-12

The translation of healthcare research into practice is typically challenging and limited in effectiveness. The Theoretical Domains Framework (TDF) identifies 12 domains of behaviour determinants which can be used to understand the principles of behavioural change, a key factor influencing implementation. The Accelerated Chest pain Risk Evaluation (ACRE) project has successfully translated research into practice, by implementing an intervention to improve the assessment of low to intermediate risk patients presenting to emergency departments (EDs) with chest pain. The aims of this paper are to describe use of the TDF to determine which factors successfully influenced implementation and to describe use of the TDF as a tool to evaluate implementation efforts and which domains are most relevant to successful implementation. A 30-item questionnaire targeting clinicians was developed using the TDF as a guide. Questions encompassed ten of the domains of the TDF: Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Optimism; Beliefs about consequences; Intentions; Memory, attention and decision processes; Environmental context and resources; and Social influences. Sixty-three of 176 stakeholders (36 %) responded to the questionnaire. Responses for all scales showed that respondents were highly favourable to all aspects of the implementation. Scales with the highest mean responses were Intentions, Knowledge, and Optimism, suggesting that initial education and awareness strategies around the ACRE project were effective. Scales with the lowest mean responses were Environmental context and resources, and Social influences, perhaps highlighting that implementation planning could have benefitted from further consideration of the factors underlying these scales. The ACRE project was successful, and therefore, a perfect case study for understanding factors which drive implementation success. The overwhelmingly positive response suggests that it was a successful programme and likely that each of these domains was important for the implementation. However, a lack of variance in the responses hampered us from concluding which factors were most influential in driving the success of the implementation. The TDF offers a useful framework to conceptualise and evaluate factors impacting on implementation success. However, its broad scope makes it necessary to tailor the framework to allow evaluation of specific projects.

Digital Holographic Demonstration Systems by Stanford University and Siros Technologies

NASA Astrophysics Data System (ADS)

Hesselink, L.

Its useful capacity, transfer rate and access time measure the performance of a holographic data storage system (HDSS). Data should never be lost, requiring a corrected bit error rate (BER) of 10-12 to 10-15. To compete successfully in the large storage marketplace, an HDS drive should be cost-competitive with improved performance over other drives. The exception could be certain niche markets, where unique HDS attributes — all-solid-state implementation with extremely short access times or associative retrieval — are attractive or required.

Electronic dental records: start taking the steps.

PubMed

Bergoff, Jana

2011-01-01

Converting paper patient records charts into their electronic counterparts (EDRs) not only has many advantages, but also could become a legal requirement in the future. Several steps key to a successful transition includes assessing the needs of the dental team and what they require as a part of the implementation Existing software and hardware must be evaluated for continued use and expansion. Proper protocols for information transfer must be established to ensure complete records while maintaining HIPAA regulations regarding patient privacy. Reduce anxiety by setting realistic dead-lines and using trusted back-up methods.

Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

PubMed

Tappen, Ruth M; Wolf, David G; Rahemi, Zahra; Engstrom, Gabriella; Rojido, Carolina; Shutes, Jill M; Ouslander, Joseph G

Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

Evaluation of User Interface and Workflow Design of a Bedside Nursing Clinical Decision Support System

PubMed Central

Yuan, Michael Juntao; Finley, George Mike; Mills, Christy; Johnson, Ron Kim

2013-01-01

Background Clinical decision support systems (CDSS) are important tools to improve health care outcomes and reduce preventable medical adverse events. However, the effectiveness and success of CDSS depend on their implementation context and usability in complex health care settings. As a result, usability design and validation, especially in real world clinical settings, are crucial aspects of successful CDSS implementations. Objective Our objective was to develop a novel CDSS to help frontline nurses better manage critical symptom changes in hospitalized patients, hence reducing preventable failure to rescue cases. A robust user interface and implementation strategy that fit into existing workflows was key for the success of the CDSS. Methods Guided by a formal usability evaluation framework, UFuRT (user, function, representation, and task analysis), we developed a high-level specification of the product that captures key usability requirements and is flexible to implement. We interviewed users of the proposed CDSS to identify requirements, listed functions, and operations the system must perform. We then designed visual and workflow representations of the product to perform the operations. The user interface and workflow design were evaluated via heuristic and end user performance evaluation. The heuristic evaluation was done after the first prototype, and its results were incorporated into the product before the end user evaluation was conducted. First, we recruited 4 evaluators with strong domain expertise to study the initial prototype. Heuristic violations were coded and rated for severity. Second, after development of the system, we assembled a panel of nurses, consisting of 3 licensed vocational nurses and 7 registered nurses, to evaluate the user interface and workflow via simulated use cases. We recorded whether each session was successfully completed and its completion time. Each nurse was asked to use the National Aeronautics and Space Administration (NASA) Task Load Index to self-evaluate the amount of cognitive and physical burden associated with using the device. Results A total of 83 heuristic violations were identified in the studies. The distribution of the heuristic violations and their average severity are reported. The nurse evaluators successfully completed all 30 sessions of the performance evaluations. All nurses were able to use the device after a single training session. On average, the nurses took 111 seconds (SD 30 seconds) to complete the simulated task. The NASA Task Load Index results indicated that the work overhead on the nurses was low. In fact, most of the burden measures were consistent with zero. The only potentially significant burden was temporal demand, which was consistent with the primary use case of the tool. Conclusions The evaluation has shown that our design was functional and met the requirements demanded by the nurses’ tight schedules and heavy workloads. The user interface embedded in the tool provided compelling utility to the nurse with minimal distraction. PMID:23612350

Should consultation recording use be a practice standard? A systematic review of the effectiveness and implementation of consultation recordings.

PubMed

Rieger, Kendra L; Hack, Thomas F; Beaver, Kinta; Schofield, Penelope

2018-04-01

To conduct a systematic review of the effectiveness of consultation recordings and identify factors contributing to their successful implementation in health-care settings. A systematic review was conducted for quantitative studies examining the effectiveness of consultation recordings in health care. Two independent reviewers assessed the relevance and quality of retrieved quantitative studies by using standardized criteria. Study findings were examined to determine consultation recording effectiveness and to identify barriers and facilitators to implementation. A supplementary review of qualitative evidence was performed to further explicate implementation factors. Of the 3373 articles retrieved in the quantitative search, 26 satisfied the standardized inclusion criteria (12 randomized controlled trials, 1 quasi-experiment, and 13 cross-sectional studies). Most patients found consultation recordings beneficial. Statistically significant evidentiary support was found for the beneficial impact of consultation recordings on the following patient reported outcomes: knowledge, perception of being informed, information recall, decision-making factors, anxiety, and depression. Implementation barriers included strength of evidence concerns, patient distress, impact of the recording on consultation quality, clinic procedures, medico-legal issues, and resource costs. Facilitators included comfort with being recorded, clinical champions, legal strategies, efficient recording procedures, and a positive consultation recording experience. Consultation recordings are valuable to patients and positively associated with patient-reported outcomes. Successful integration of consultation recording use into clinical practice requires an administratively supported, systematic approach to addressing implementation factors. Copyright © 2017 John Wiley & Sons, Ltd.

Physical and organizational provision for installation, regulatory requirements and implementation of a simultaneous hybrid PET/MR-imaging system in an integrated research and clinical setting.

PubMed

Sattler, Bernhard; Jochimsen, Thies; Barthel, Henryk; Sommerfeld, Kerstin; Stumpp, Patrick; Hoffmann, Karl-Titus; Gutberlet, Matthias; Villringer, Arno; Kahn, Thomas; Sabri, Osama

2013-02-01

The implementation of hybrid imaging systems requires thorough and anticipatory planning at local and regional levels. For installation of combined positron emission and magnetic resonance imaging systems (PET/MRI), a number of physical and constructional provisions concerning shielding of electromagnetic fields (RF- and high-field) as well as handling of radionuclides have to be met, the latter of which includes shielding for the emitted 511 keV gamma rays. Based on our experiences with a SIEMENS Biograph mMR system, a step-by-step approach is required to allow a trouble-free installation. In this article, we present a proposal for a standardized step-by-step plan to accomplish the installation of a combined PET/MRI system. Moreover, guidelines for the smooth operation of combined PET/MRI in an integrated research and clinical setting will be proposed. Overall, the most important preconditions for the successful implementation of PET/MRI in an integrated research and clinical setting is the interdisciplinary target-oriented cooperation between nuclear medicine, radiology, and all referring and collaborating institutions at all levels of interaction (personnel, imaging protocols, reporting, selection of the data transfer and communication methods).

A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa.

PubMed

Silumbwe, Adam; Zulu, Joseph Mumba; Halwindi, Hikabasa; Jacobs, Choolwe; Zgambo, Jessy; Dambe, Rosalia; Chola, Mumbi; Chongwe, Gershom; Michelo, Charles

2017-05-22

Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.

Qualitative evaluation of Rhode Island’s healthcare worker influenza vaccination regulations

PubMed Central

Lindley, Megan C.; Dube, Donna; Kalayil, Elizabeth J.; Kim, Hanna; Paiva, Kristi; Raymond, Patricia

2015-01-01

Objective To evaluate Rhode Island’s revised vaccination regulations requiring healthcare workers (HCWs) to receive annual influenza vaccination or wear a mask during patient care when influenza is widespread. Design Semi-structured telephone interviews conducted in a random sample of healthcare facilities. Setting Rhode Island healthcare facilities covered by the HCW regulations, including hospitals, nursing homes, community health centers, nursing service agencies, and home nursing care providers. Participants Staff responsible for collecting and/or reporting facility-level HCW influenza vaccination data to comply with Rhode Island HCW regulations. Methods Interviews were transcribed and individually coded by interviewers to identify themes; consensus on coding differences was reached through discussion. Common themes and illustrative quotes are presented. Results Many facilities perceived the revised regulations as extending their existing influenza vaccination policies and practices. Despite variations in implementation, nearly all facilities implemented policies that complied with the minimum requirements of the regulations. The primary barrier to implementing the HCW regulations was enforcement of masking among unvaccinated HCWs, which required timely tracking of vaccination status and additional time and effort by supervisors. Factors facilitating implementation included early and regular communication from the state health department and facilities’ ability to adapt existing influenza vaccination programs to incorporate provisions of the revised regulations. Conclusions Overall, facilities successfully implemented the revised HCW regulations during the 2012–2013 influenza season. Continued maintenance of the regulations is likely to reduce transmission of influenza and resulting morbidity and mortality in Rhode Island’s healthcare facilities. PMID:25192807

Hippocampus and Retrosplenial Cortex Combine Path Integration Signals for Successful Navigation

PubMed Central

Erdem, Uğur M.; Ross, Robert S.; Brown, Thackery I.; Hasselmo, Michael E.; Stern, Chantal E.

2013-01-01

The current study used fMRI in humans to examine goal-directed navigation in an open field environment. We designed a task that required participants to encode survey-level spatial information and subsequently navigate to a goal location in either first person, third person, or survey perspectives. Critically, no distinguishing landmarks or goal location markers were present in the environment, thereby requiring participants to rely on path integration mechanisms for successful navigation. We focused our analysis on mechanisms related to navigation and mechanisms tracking linear distance to the goal location. Successful navigation required translation of encoded survey-level map information for orientation and implementation of a planned route to the goal. Our results demonstrate that successful first and third person navigation trials recruited the anterior hippocampus more than trials when the goal location was not successfully reached. When examining only successful trials, the retrosplenial and posterior parietal cortices were recruited for goal-directed navigation in both first person and third person perspectives. Unique to first person perspective navigation, the hippocampus was recruited to path integrate self-motion cues with location computations toward the goal location. Last, our results demonstrate that the hippocampus supports goal-directed navigation by actively tracking proximity to the goal throughout navigation. When using path integration mechanisms in first person and third person perspective navigation, the posterior hippocampus was more strongly recruited as participants approach the goal. These findings provide critical insight into the neural mechanisms by which we are able to use map-level representations of our environment to reach our navigational goals. PMID:24305826

Strong advocacy led to successful implementation of smokefree Mexico City

PubMed Central

Crosbie, Eric; Sebrié, Ernesto M; Glantz, Stanton A

2011-01-01

Objective To describe the approval process and implementation of the 100% smokefree law in Mexico City and a competing federal law between 2007 and 2010. Methods Reviewed smokefree legislation, published newspaper articles and interviewed key informants. Results Strong efforts by tobacco control advocacy groups and key policymakers in Mexico City in 2008 prompted the approval of a 100% smokefree law following the WHO FCTC. As elsewhere, the tobacco industry utilised the hospitality sector to block smokefree legislation, challenged the City law before the Supreme Court and promoted the passage of a federal law that required designated smoking areas. These tactics disrupted implementation of the City law by causing confusion over which law applied in Mexico City. Despite interference, the City law increased public support for 100% smokefree policies and decreased the social acceptability of smoking. In September 2009, the Supreme Court ruled in favour of the City law, giving it the authority to go beyond the federal law to protect the fundamental right of health for all citizens. Conclusions Early education and enforcement efforts by tobacco control advocates promoted the City law in 2008 but advocates should still anticipate continuing opposition from the tobacco industry, which will require continued pressure on the government. Advocates should utilise the Supreme Court’s ruling to promote 100% smokefree policies outside Mexico City. Strong advocacy for the City law could be used as a model of success throughout Mexico and other Latin American countries. PMID:21059606

Time to audit.

PubMed

Smyth, L G; Martin, Z; Hall, B; Collins, D; Mealy, K

2012-09-01

Public and political pressures are increasing on doctors and in particular surgeons to demonstrate competence assurance. While surgical audit is an integral part of surgical practice, its implementation and delivery at a national level in Ireland is poorly developed. Limits to successful audit systems relate to lack of funding and administrative support. In Wexford General Hospital, we have a comprehensive audit system which is based on the Lothian Surgical Audit system. We wished to analyse the amount of time required by the Consultant, NCHDs and clerical staff on one surgical team to run a successful audit system. Data were collected over a calendar month. This included time spent coding and typing endoscopy procedures, coding and typing operative procedures, and typing and signing discharge letters. The total amount of time spent to run the audit system for one Consultant surgeon for one calendar month was 5,168 min or 86.1 h. Greater than 50% of this time related to work performed by administrative staff. Only the intern and administrative staff spent more than 5% of their working week attending to work related to the audit. An integrated comprehensive audit system requires a very little time input by Consultant surgeons. Greater than 90% of the workload in running the audit was performed by the junior house doctors and administrative staff. The main financial implications for national audit implementation would relate to software and administrative staff recruitment. Implementation of the European Working Time Directive in Ireland may limit the time available for NCHD's to participate in clinical audit.

The NatCarb geoportal: Linking distributed data from the Carbon Sequestration Regional Partnerships

USGS Publications Warehouse

Carr, T.R.; Rich, P.M.; Bartley, J.D.

2007-01-01

The Department of Energy (DOE) Carbon Sequestration Regional Partnerships are generating the data for a "carbon atlas" of key geospatial data (carbon sources, potential sinks, etc.) required for rapid implementation of carbon sequestration on a broad scale. The NATional CARBon Sequestration Database and Geographic Information System (NatCarb) provides Web-based, nation-wide data access. Distributed computing solutions link partnerships and other publicly accessible repositories of geological, geophysical, natural resource, infrastructure, and environmental data. Data are maintained and enhanced locally, but assembled and accessed through a single geoportal. NatCarb, as a first attempt at a national carbon cyberinfrastructure (NCCI), assembles the data required to address technical and policy challenges of carbon capture and storage. We present a path forward to design and implement a comprehensive and successful NCCI. ?? 2007 The Haworth Press, Inc. All rights reserved.

Formulation for Simultaneous Aerodynamic Analysis and Design Optimization

NASA Technical Reports Server (NTRS)

Hou, G. W.; Taylor, A. C., III; Mani, S. V.; Newman, P. A.

1993-01-01

An efficient approach for simultaneous aerodynamic analysis and design optimization is presented. This approach does not require the performance of many flow analyses at each design optimization step, which can be an expensive procedure. Thus, this approach brings us one step closer to meeting the challenge of incorporating computational fluid dynamic codes into gradient-based optimization techniques for aerodynamic design. An adjoint-variable method is introduced to nullify the effect of the increased number of design variables in the problem formulation. The method has been successfully tested on one-dimensional nozzle flow problems, including a sample problem with a normal shock. Implementations of the above algorithm are also presented that incorporate Newton iterations to secure a high-quality flow solution at the end of the design process. Implementations with iterative flow solvers are possible and will be required for large, multidimensional flow problems.

Foundations of planetary quarantine.

NASA Technical Reports Server (NTRS)

Hall, L. B.; Lyle, R. G.

1971-01-01

Discussion of some of the problems in microbiology and engineering involved in the implementation of planetary quarantine. It is shown that the solutions require new knowledge in both disciplines for success at low cost in terms of both monetary outlay and man's further exploration of the planets. A related problem exists in that engineers are not accustomed to the wide variation of biological data and microbiologists must learn to work and think in more exact terms. Those responsible for formulating or influencing national and international policies must walk a tightrope with delicate balance between unnecessarily stringent requirements for planetary quarantine on the one hand and prevention of contamination on the other. The success of planetary quarantine measures can be assured only by rigorous measures, each checked, rechecked, and triple-checked to make sure that no errors have been made and that no factor has been overlooked.

Planning for growth in satellite systems - The Intelsat experience

NASA Astrophysics Data System (ADS)

Nadkarni, P.; Perillan, L.; Chasia, H.

It is thought that the increase in conventional voice traffic will result primarily from growth on existing links rather than the establishment of new links. A steady growth of approximately 15% per annum is forecast over the next decade, for a requirement of more than 125,000 circuits, worldwide, by the early 1990s. It is noted that the transfer of services from a satellite to its successor is becoming increasingly complex with successive generations. Increases in the number of beams and beam interconnections, together with differences in coverages between successive satellites, have required totally new frequency plans and carrier assignments to be implemented as part of the operation transition. Attention is also given to the way that the investment in resources, technologies, and installed plant already in use exerts a strong influence on the alternatives for growth.

Implementation and evaluation of a community-based interprofessional learning activity.

PubMed

Luebbers, Ellen L; Dolansky, Mary A; Vehovec, Anton; Petty, Gayle

2017-01-01

Implementation of large-scale, meaningful interprofessional learning activities for pre-licensure students has significant barriers and requires novel approaches to ensure success. To accomplish this goal, faculty at Case Western Reserve University, Ohio, USA, used the Ottawa Model of Research Use (OMRU) framework to create, improve, and sustain a community-based interprofessional learning activity for large numbers of medical students (N = 177) and nursing students (N = 154). The model guided the process and included identification of context-specific barriers and facilitators, continual monitoring and improvement using data, and evaluation of student learning outcomes as well as programme outcomes. First year Case Western Reserve University medical students and undergraduate nursing students participated in team-structured prevention screening clinics in the Cleveland Metropolitan Public School District. Identification of barriers and facilitators assisted with overcoming logistic and scheduling issues, large class size, differing ages and skill levels of students and creating sustainability. Continual monitoring led to three distinct phases of improvement and resulted in the creation of an authentic team structure, role clarification, and relevance for students. Evaluation of student learning included both qualitative and quantitative methods, resulting in statistically significant findings and qualitative themes of learner outcomes. The OMRU implementation model provided a useful framework for successful implementation resulting in a sustainable interprofessional learning activity.

A Communications Network for Cislunar Operations

NASA Technical Reports Server (NTRS)

Burleigh, Scott

2012-01-01

Reliable and efficient communications will be critical to the success of commercial flight operations in cislunar space. The Internet is not well-suited to meeting this requirement. But the Delay-Tolerant Networking (DTN) architecture is. The DTN protocols are well-documented and implementations are mature. We think DTN will be ready to support low-cost, low-risk cislunar networking by the time the vehicles are in place.

Beyond Minimum Technology Requirements: Course Characteristics for the Instructional Design of Virtual Programs at the Elementary Grade Levels

ERIC Educational Resources Information Center

Vytlacil, Kerrie A.

2013-01-01

With virtual public school initiatives in each of the 50 states, there is an impetus to develop and implement online programs for the elementary grades (Cavanaugh, 2004, pp. 262-266; Oliver et al., p. 56). Yet, learner usability characteristics for successful online schooling for the elementary grades are unknown and/or unspecified. The purpose of…

Instructional Practice for Students with Autism Spectrum and Related Disorders: Exploring the Teaching of Writing in Two Self-Contained Classrooms

ERIC Educational Resources Information Center

Asaro-Saddler, Kristie; Arcidiacono, Mary Beth; Morris Deyoe, Meghan

2017-01-01

Writing is an important skill that pervades all subjects and is required for postschool success. Many students with autism spectrum disorders (ASD) struggle with writing, yet it has been an underresearched area. To determine what writing practices are being implemented with students with ASD, we observed the practices of two teachers who instruct…

A Juvenile Drug Court Model in Southern Arizona: Substance Abuse, Delinquency, and Sexual Risk Outcomes by Gender and Race/Ethnicity

ERIC Educational Resources Information Center

Ruiz, Bridget S.; Stevens, Sally J.; Fuhriman, Janet; Bogart, John G.; Korchmaros, Josephine D.

2009-01-01

Alcohol and drug use related crimes continue to be processed in juvenile courts at high rates. One approach for addressing substance related issues has been the implementation of juvenile drug courts. Juvenile drug courts were established given the wide-spread success of adult drug courts. However, juvenile drug courts require different components…

Genetic tools for advancement of Synechococcus sp. PCC 7002 as a cyanobacterial chassis

DOE PAGES

Ruffing, Anne M.; Jensen, Travis J.; Strickland, Lucas M.

2016-11-10

Successful implementation of modified cyanobacteria as hosts for industrial applications requires the development of a cyanobacterial chassis. The cyanobacterium Synechococcus sp. PCC 7002 embodies key attributes for an industrial host, including a fast growth rate and high salt, light, and temperature tolerances. Here, this study addresses key limitations in the advancement of Synechococcus sp. PCC 7002 as an industrial chassis.

Genetic tools for advancement of Synechococcus sp. PCC 7002 as a cyanobacterial chassis

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

Ruffing, Anne M.; Jensen, Travis J.; Strickland, Lucas M.

Successful implementation of modified cyanobacteria as hosts for industrial applications requires the development of a cyanobacterial chassis. The cyanobacterium Synechococcus sp. PCC 7002 embodies key attributes for an industrial host, including a fast growth rate and high salt, light, and temperature tolerances. Here, this study addresses key limitations in the advancement of Synechococcus sp. PCC 7002 as an industrial chassis.

Transition II in Alabama: A Profile of Commitment. Proceedings of the Annual Statewide Conference on Transition( (2nd, Auburn, Alabama, January 1993).

ERIC Educational Resources Information Center

Browning, Philip, Ed.

This proceedings document provides the texts of 12 presentations given at a 2-day conference in 1992 which focused on policies, materials, programs, and activities being implemented in Alabama to foster the successful transition of youth with disabilities to adult life. Two papers address the national scene: "Transition Services Requirement:…

Design and Implementation of the Boundary Layer Transition Flight Experiment on Space Shuttle Discovery

NASA Technical Reports Server (NTRS)

Spanos, Theodoros A.; Micklos, Ann

2010-01-01

In an effort to better the understanding of high speed aerodynamics, a series of flight experiments were installed on Space Shuttle Discovery during the STS-119 and STS-128 missions. This experiment, known as the Boundary Layer Transition Flight Experiment (BLTFE), provided the technical community with actual entry flight data from a known height protuberance at Mach numbers at and above Mach 15. Any such data above Mach 15 is irreproducible in a laboratory setting. Years of effort have been invested in obtaining this valuable data, and many obstacles had to be overcome in order to ensure the success of implementing an Orbiter modification. Many Space Shuttle systems were involved in the installation of appropriate components that revealed 'concurrent engineering' was a key integration tool. This allowed the coordination of all various parts and pieces which had to be sequenced appropriately and installed at the right time. Several issues encountered include Orbiter configuration and access, design requirements versus current layout, implementing the modification versus typical processing timelines, and optimizing the engineering design cycles and changes. Open lines of communication within the entire modification team were essential to project success as the team was spread out across the United States, from NASA Kennedy Space Center in Florida, to NASA Johnson Space Center in Texas, to Boeing Huntington Beach, California among others. The forum permits the discussion of processing concerns from the design phase to the implementation phase, which eventually saw the successful flights and data acquisition on STS-119 in March 2009 and on STS-128 in September 2009.

Designing and implementing an authentic science research program

NASA Astrophysics Data System (ADS)

Rosvally, Harry Edward, Jr.

Science research programs have become a popular elective course in high schools around the country. As the popularity of these programs grows, school districts need a guide by which to implement science research in their own schools. This study sought to provide this information by answering the following questions: (1) What are the most important features in existing research program models? (2) How do schools that have an existing research program define "success"? (3) How do different factors (i.e., budget, professional development, scheduling, recruitment effort, curriculum, and mentors) affect the scope and implementation of a research program? (4) Which features and factors support inclusiveness as a goal for a research program? (5) What kinds of indicators are appropriate for assessing the progress toward an inclusive science research program? After reviewing the literature, six sites with existing research programs were selected for participation in the study. Interviews with teachers and students were conducted during site visits. Interviews with mentors were conducted by telephone. Although the six models in this study were different from one another, there were common characteristics. Students conducted their own review of the literature. Upon completion of the actual research, students published or otherwise communicated their findings to the larger scientific community through regional and national competitions and non-competitive science symposia. This study was also able to identify significant elements that contribute to successful programs. These included: teacher selection; budget requirements; mentor qualities; recruitment and retention practices; and overall structure. As a result of the findings during the research, this study makes recommendations for the successful implementation of a research program.

Lean healthcare from a change management perspective.

PubMed

van Rossum, Lisa; Aij, Kjeld Harald; Simons, Frederique Elisabeth; van der Eng, Niels; Ten Have, Wouter Dirk

2016-05-16

Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

Understanding a Successful Implementation of Organizational Social Media: A Multi-Site Case Study

ERIC Educational Resources Information Center

Lahman, Caroline D.

2017-01-01

The purpose of this dissertation was to examine the successful implementation of social media strategies in multiple organizations. Examining the factors an organization used to implement social media can provide the understanding of the benefits and risks associated with this technology. Some businesses are considered successful using social…

Impacts of EHR Certification and Meaningful Use Implementation on an Integrated Delivery Network.

PubMed

Bowes, Watson A

2014-01-01

Three years ago Intermountain Healthcare made the decision to participate in the Medicare and Medicaid Electronic Heath Record (EHR) Incentive Program which required that hospitals and providers use a certified EHR in a meaningful way. At that time, the barriers to enhance our home grown system, and change clinician workflows were numerous and large. This paper describes the time and effort required to enhance our legacy systems in order to pass certification, including filling 47 gaps in (EHR) functionality. We also describe the processes and resources that resulted in successful changes to many clinical workflows required by clinicians to meet meaningful use requirements. In 2011 we set meaningful use targets of 75% of employed physicians and 75% of our hospitals to meet Stage 1 of meaningful use by 2013. By the end of 2013, 87% of 696 employed eligible professionals and 100% of 22 Intermountain hospitals had successfully attested for Stage 1. This paper describes documented and perceived costs to Intermountain including time, effort, resources, postponement of other projects, as well as documented and perceived benefits of attainment of meaningful use.

An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator.

PubMed

Hendy, Jane; Chrysanthaki, Theopisti; Barlow, James; Knapp, Martin; Rogers, Anne; Sanders, Caroline; Bower, Peter; Bowen, Robert; Fitzpatrick, Ray; Bardsley, Martin; Newman, Stanton

2012-11-15

To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Case-studies of three sites forming the UK Department of Health's Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised.

Implementing an organised cervical screening programme in the Republic of Moldova-Stakeholder identification and engagement.

PubMed

Davies, Philip; Valuta, Diana; Cojohari, Natalia; Sancho-Garnier, Helene

2017-10-01

Successfully implementing cervical screening programmes requires them to be adapted to the local context and have broad stakeholder support. This can be achieved by actively engaging local stakeholders in planning as well as implementing the programmes. The Moldovan government started implementing an organised cervical screening programme in 2010 with the first step being stakeholder identification and engagement. This process started by contacting easily identified stakeholders with each asked to recommend others and the process continued until no new ones were identified. Stakeholders were then involved in a series of individual and group meetings over a 2-year period to build confidence and encourage progressively greater engagement. In total, 87 individuals from 46 organisations were identified. Over the 2-year process, the individual and group meetings facilitated a change in stakeholder attitudes from disinterest, to acceptance and finally to active cooperation in designing the screening programme and preparing an implementation plan that were both well adapted to the Moldovan context. Developing the broad support needed to implement cervical screening programmes required ongoing interaction with stakeholders over an extended period. This interaction allowed stakeholder concerns to be identified and addressed, progress to be demonstrated, and stakeholders to be educated about organised screening programmes so they had the knowledge to progressively take greater responsibility and ownership. Copyright © 2017 Elsevier Ltd. All rights reserved.

Health impact assessment in a network of European cities.

PubMed

Ison, Erica

2013-10-01

The methodology of health impact assessment (HIA) was introduced as one of four core themes for Phase IV (2003-2008) of the World Health Organization European Healthy Cities Network (WHO-EHCN). Four objectives for HIA were set at the beginning of the phase. We report on the results of the evaluation of introducing and implementing this methodology in cities from countries across Europe with widely differing economies and sociopolitical contexts. Two main sources of data were used: a general questionnaire designed for the Phase IV evaluation and the annual reporting template for 2007-2008. Sources of bias included the proportion of non-responders and the requirement to communicate in English. Main barriers to the introduction and implementation of HIA were a lack of skill, knowledge and experience of HIA, the newness of the concept, the lack of a legal basis for implementation and a lack of political support. Main facilitating factors were political support, training in HIA, collaboration with an academic/public health institution or local health agency, a pre-existing culture of intersectoral working, a supportive national policy context, access to WHO materials about or expertise in HIA and membership of the WHO-EHCN, HIA Sub-Network or a National Network. The majority of respondents did not feel that they had had the resources, knowledge or experience to achieve all of the objectives set for HIA in Phase IV. The cities that appear to have been most successful at introducing and implementing HIA had pre-existing experience of HIA, came from a country with a history of applying HIA, were HIA Sub-Network members or had made a commitment to implementing HIA during successive years of Phase IV. Although HIA was recognised as an important component of Healthy Cities' work, the experience in the WHO-EHCN underscores the need for political buy-in, capacity building and adequate resourcing for the introduction and implementation of HIA to be successful.

Managing protected areas under climate change: challenges and priorities.

PubMed

Rannow, Sven; Macgregor, Nicholas A; Albrecht, Juliane; Crick, Humphrey Q P; Förster, Michael; Heiland, Stefan; Janauer, Georg; Morecroft, Mike D; Neubert, Marco; Sarbu, Anca; Sienkiewicz, Jadwiga

2014-10-01

The implementation of adaptation actions in local conservation management is a new and complex task with multiple facets, influenced by factors differing from site to site. A transdisciplinary perspective is therefore required to identify and implement effective solutions. To address this, the International Conference on Managing Protected Areas under Climate Change brought together international scientists, conservation managers, and decision-makers to discuss current experiences with local adaptation of conservation management. This paper summarizes the main issues for implementing adaptation that emerged from the conference. These include a series of conclusions and recommendations on monitoring, sensitivity assessment, current and future management practices, and legal and policy aspects. A range of spatial and temporal scales must be considered in the implementation of climate-adapted management. The adaptation process must be area-specific and consider the ecosystem and the social and economic conditions within and beyond protected area boundaries. However, a strategic overview is also needed: management at each site should be informed by conservation priorities and likely impacts of climate change at regional or even wider scales. Acting across these levels will be a long and continuous process, requiring coordination with actors outside the "traditional" conservation sector. To achieve this, a range of research, communication, and policy/legal actions is required. We identify a series of important actions that need to be taken at different scales to enable managers of protected sites to adapt successfully to a changing climate.

Primer on the Implementation of a Pharmacy Intranet Site to Improve Department Communication

PubMed Central

Hale, Holly J.

2013-01-01

Purpose: The purpose of the article is to describe the experience of selecting, developing, and implementing a pharmacy department intranet site with commentary regarding application to other institutions. Clinical practitioners and supporting staff need an effective, efficient, organized, and user-friendly communication tool to utilize and relay information required to optimize patient care. Summary: To create a functional and user-friendly department intranet site, department leadership and staff should be involved in the process from selection of product through implementation. A product that supports both document storage management and communication delivery and has the capability to be customized to provide varied levels of site access is desirable. The designation of an intranet site owner/developer within the department will facilitate purposeful site design and site maintenance execution. A well-designed and up-to-date site along with formal end-user training are essential for staff adoption and continued utilization. Conclusion: Development of a department intranet site requires a considerable time investment by several members of the department. The implementation of an intranet site can be an important step toward achieving improved communications. Staff utilization of this resource is key to its success. PMID:24421523

Primer on the implementation of a pharmacy intranet site to improve department communication.

PubMed

Hale, Holly J

2013-07-01

The purpose of the article is to describe the experience of selecting, developing, and implementing a pharmacy department intranet site with commentary regarding application to other institutions. Clinical practitioners and supporting staff need an effective, efficient, organized, and user-friendly communication tool to utilize and relay information required to optimize patient care. To create a functional and user-friendly department intranet site, department leadership and staff should be involved in the process from selection of product through implementation. A product that supports both document storage management and communication delivery and has the capability to be customized to provide varied levels of site access is desirable. The designation of an intranet site owner/developer within the department will facilitate purposeful site design and site maintenance execution. A well-designed and up-to-date site along with formal end-user training are essential for staff adoption and continued utilization. Development of a department intranet site requires a considerable time investment by several members of the department. The implementation of an intranet site can be an important step toward achieving improved communications. Staff utilization of this resource is key to its success.

An implementation framework for wastewater treatment models requiring a minimum programming expertise.

PubMed

Rodríguez, J; Premier, G C; Dinsdale, R; Guwy, A J

2009-01-01

Mathematical modelling in environmental biotechnology has been a traditionally difficult resource to access for researchers and students without programming expertise. The great degree of flexibility required from model implementation platforms to be suitable for research applications restricts their use to programming expert users. More user friendly software packages however do not normally incorporate the necessary flexibility for most research applications. This work presents a methodology based on Excel and Matlab-Simulink for both flexible and accessible implementation of mathematical models by researchers with and without programming expertise. The models are almost fully defined in an Excel file in which the names and values of the state variables and parameters are easily created. This information is automatically processed in Matlab to create the model structure and almost immediate model simulation, after only a minimum Matlab code definition, is possible. The framework proposed also provides programming expert researchers with a highly flexible and modifiable platform on which to base more complex model implementations. The method takes advantage of structural generalities in most mathematical models of environmental bioprocesses while enabling the integration of advanced elements (e.g. heuristic functions, correlations). The methodology has already been successfully used in a number of research studies.

Ethnographic process evaluation in primary care: explaining the complexity of implementation.

PubMed

Bunce, Arwen E; Gold, Rachel; Davis, James V; McMullen, Carmit K; Jaworski, Victoria; Mercer, MaryBeth; Nelson, Christine

2014-12-05

The recent growth of implementation research in care delivery systems has led to a renewed interest in methodological approaches that deliver not only intervention outcome data but also deep understanding of the complex dynamics underlying the implementation process. We suggest that an ethnographic approach to process evaluation, when informed by and integrated with quantitative data, can provide this nuanced insight into intervention outcomes. The specific methods used in such ethnographic process evaluations are rarely presented in detail; our objective is to stimulate a conversation around the successes and challenges of specific data collection methods in health care settings. We use the example of a translational clinical trial among 11 community clinics in Portland, OR that are implementing an evidence-based, health-information technology (HIT)-based intervention focused on patients with diabetes. Our ethnographic process evaluation employed weekly diaries by clinic-based study employees, observation, informal and formal interviews, document review, surveys, and group discussions to identify barriers and facilitators to implementation success, provide insight into the quantitative study outcomes, and uncover lessons potentially transferable to other implementation projects. These methods captured the depth and breadth of factors contributing to intervention uptake, while minimizing disruption to clinic work and supporting mid-stream shifts in implementation strategies. A major challenge is the amount of dedicated researcher time required. The deep understanding of the 'how' and 'why' behind intervention outcomes that can be gained through an ethnographic approach improves the credibility and transferability of study findings. We encourage others to share their own experiences with ethnography in implementation evaluation and health services research, and to consider adapting the methods and tools described here for their own research.

Critical success factors for physical activity promotion through community partnerships.

PubMed

Lucidarme, Steffie; Marlier, Mathieu; Cardon, Greet; De Bourdeaudhuij, Ilse; Willem, Annick

2014-02-01

To define key factors of effective evidence-based policy implementation for physical activity promotion by use of a partnership approach. Using Parent and Harvey's model for sport and physical activity community-based partnerships, we defined determinants of implementation based on 13 face-to-face interviews with network organisations and 39 telephone interviews with partner organisations. Furthermore, two quantitative data-sets (n = 991 and n = 965) were used to measure implementation. In total, nine variables were found to influence implementation. Personal contact was the most powerful variable since its presence contributed to success while its absence led to a negative outcome. Four contributed directly to success: political motive, absence of a metropolis, high commitment and more qualified staff. Four others resulted in a less successful implementation: absence of positive merger effects, exposure motive and governance, and dispersed leadership. Community networks are a promising instrument for the implementation of evidence-based policies. However, determinants of both formation and management of partnerships influence the implementation success. During partnership formation, special attention should be given to partnership motives while social skills are of utmost importance for the management.

Improving Health Care for Critically Ill Patients Using an Evidence-Based Collaborative Approach to ABCDEF Bundle Dissemination and Implementation.

PubMed

Barnes-Daly, Mary Ann; Pun, Brenda T; Harmon, Lori A; Byrum, Diane G; Kumar, Vishakha K; Devlin, John W; Stollings, Joanna L; Puntillo, Kathleen A; Engel, Heidi J; Posa, Patricia J; Barr, Juliana; Schweickert, William D; Esbrook, Cheryl L; Hargett, Ken D; Carson, Shannon S; Aldrich, J Matthew; Ely, E Wesley; Balas, Michele C

2018-06-01

Patients admitted to intensive care units (ICUs) often experience pain, oversedation, prolonged mechanical ventilation, delirium, and weakness. These conditions are important in that they often lead to protracted physical, neurocognitive, and mental health sequelae now termed postintensive care syndrome. Changing current ICU practice will not only require the adoption of evidence-based interventions but the development of effective and reliable teams to support these new practices. To build on the success of bundled care and bridge an ongoing evidence-practice gap, the Society of Critical Care Medicine (SCCM) recently launched the ICU Liberation ABCDEF Bundle Improvement Collaborative. The Collaborative aimed to foster the bedside application of the SCCM's Pain, Agitation, and Delirium Guidelines via the ABCDEF bundle. The purpose of this paper is to describe the history of the Collaborative, the evidence-based implementation strategies used to foster change and teamwork, and the performance and outcome metrics used to monitor progress. Collaborative participants were required to attend four in-person meetings, monthly colearning calls, database training sessions, an e-Community listserv, and select in-person site visits. Teams submitted patient-level data and completed pre- and postimplementation questionnaires focused on the assessment of teamwork and collaboration, work environment, and overall ICU care. Faculty shared the evidence used to derive each bundle element as well as team-based implementation strategies for improvement and sustainment. Retention in the Collaborative was high, with 67 of 69 adult and eight of nine pediatric ICUs fully completing the program. Baseline and prospective data were collected on over 17,000 critically ill patients. A variety of evidence-based professional behavioral change interventions and novel implementation techniques were utilized and shared among Collaborative members. Hospitals and health systems can use the Collaborative structure, strategies, and tools described in this paper to help successfully implement the ABCDEF bundle in their ICUs. © 2018 Sigma Theta Tau International.

Implementation of a School-wide Clinical Intervention Documentation System

PubMed Central

Stevenson, T. Lynn; Fox, Brent I.; Andrus, Miranda; Carroll, Dana

2011-01-01

Objective. To evaluate the effectiveness and impact of a customized Web-based software program implemented in 2006 for school-wide documentation of clinical interventions by pharmacy practice faculty members, pharmacy residents, and student pharmacists. Methods. The implementation process, directed by a committee of faculty members and school administrators, included preparation and refinement of the software, user training, development of forms and reports, and integration of the documentation process within the curriculum. Results. Use of the documentation tool consistently increased from May 2007 to December 2010. Over 187,000 interventions were documented with over $6.2 million in associated cost avoidance. Conclusions. Successful implementation of a school-wide documentation tool required considerable time from the oversight committee and a comprehensive training program for all users, with ongoing monitoring of data collection practices. Data collected proved to be useful to show the impact of faculty members, residents, and student pharmacists at affiliated training sites. PMID:21829264

MRP (materiel requirements planning) II implementation: a case study.

PubMed

Sheldon, D

1994-05-01

Manufacturing resource planning (MRP II) is a powerful and effective business planning template on which to build a continuous improvement culture. MRP II, when successfully implemented, encourages a disciplined yet nonthreatening environment centered on measurement and accountability. From the education that accompanies an MRP II implementation, the employees can better understand the vision and mission of the organization. This common goal keeps everyone's energy directed toward the same final objective. The Raymond Corporation is a major materiels handling equipment manufacturer headquartered in Greene, New York, with class "A" MRP II manufacturing facilities in Greene and Brantford, Ontario and an aftermark distribution facility in East Syracuse, New York. Prior to the implementation of MRP II in its Greene plant (from 1988 through 1990) good intentions and hard work were proving to be less than necessary to compete in the global market. Certified class "A" in February 1990. The Raymond Corporation has built a world-class organization from these foundations.

A Culturally Responsive Approach to Improving Replication of a Youth Sexual Health Program.

PubMed

Mwaria, Mercy; Chen, ChiaChing; Coppola, Nanci; Maurice, Ingrid; Phifer, Mary

2016-11-01

Youth-serving agencies continually turn to evidence-based interventions that have been empirically assessed for effectiveness in influencing young people's lives, particularly those living in communities with considerable health inequities. Replicating promising evidence-based interventions requires thoughtful adaptation and modification to better fit participants' sociocultural context and to enhance their learning experiences. Due to the restrictive nature of a replication model, adaptations to the intervention curriculum must be minimized during full implementation. Implementers must find innovative ways to ensure content is relevant and engaging to participants without altering core elements of the curriculum. This article describes practical best practice strategies used in implementing a sexual health education program among socioculturally diverse youth in a northeastern city in the United States. The implementing agency applied Richard, Brown and Forde's framework for culturally responsive pedagogy as a heuristic approach to describe the application of implementation practices across three dimensions: institutional, personal, and instructional. The results not only highlight successful culturally responsive practices that enhanced the implementation process but also acknowledge areas in which such practices proved daunting to implement. © 2016 Society for Public Health Education.

A Qualitative Phenomenology of Christian Middle School Implementation of Inquiry-based Science Instruction

NASA Astrophysics Data System (ADS)

Ferrin, Patricia Ann

The purpose of this qualitative phenomenology study will be to explore curriculum coordinators, teachers, and principals' implementation of Inquiry-Based Instruction (IBI) in Christian middle school science classes in the central Virginia area. IBI will be referred to as "a teaching method that combines the curiosity of students and the scientific method to enhance the development of critical thinking skills while learning science" (Warner & Myers, 2008, p.3). A qualitative phenomenology study will be made to consider the requirements and implementation of IBI in the Christian middle schools as compared to the requirements and implementation of IBI in the National Science Education Standard (NSES). Curriculum coordinators, teachers, and principals, and participated in this study from five Christian middle schools in the central Virginia area. The guiding theories include John Dewey's (1948) Constructivism, Lev Vygotsky's (1998) Social Constructivism, and William Glasser's (2005) Choice Theory as they relate to the beliefs curriculum coordinators, teachers, and principals have regarding the implementation of IBI. A primary research question for this study is, "If research supports successful outcomes of IBI, then how and why do Christian CMSST, principals, and curriculum coordinators implement or not implement IBI?" Interviews, classroom observations, and document reviews were used for triangulation and data collection. The data analysis used in this study were completed by using Moustakas' (1994) seven step thematic coding derived from the observations, interview transcriptions, and school documents in the form of lesson plans and objectives (Merriam, 2009; Moustakas, 1994).

Noise reduction in optically controlled quantum memory

NASA Astrophysics Data System (ADS)

Ma, Lijun; Slattery, Oliver; Tang, Xiao

2018-05-01

Quantum memory is an essential tool for quantum communications systems and quantum computers. An important category of quantum memory, called optically controlled quantum memory, uses a strong classical beam to control the storage and re-emission of a single-photon signal through an atomic ensemble. In this type of memory, the residual light from the strong classical control beam can cause severe noise and degrade the system performance significantly. Efficiently suppressing this noise is a requirement for the successful implementation of optically controlled quantum memories. In this paper, we briefly introduce the latest and most common approaches to quantum memory and review the various noise-reduction techniques used in implementing them.

Defining community readiness for the implementation of a system of care.

PubMed

Behar, Lenore B; Hydaker, William M

2009-11-01

Developing systems of care for children with emotional disorders requires changes in the organization and delivery of services. Using concept mapping, the authors conducted a study to define factors of a community's readiness to make such changes. Participants were from 25 of 27 federally-funded, advanced sites, plus a panel of experts. The participants completed three tasks: brainstorming, rating, and sorting. This process produced eight factors: Leadership, Network of Local Partners, Shared Goals, Collaboration, Families and Youth as Partners, Accountability, Evaluation, and Plans to Expand Services. Understanding factors that contribute to successful implementation should help communities identify and make needed changes.

Implementation of COTs Hardware in Non-Critical Space Applications: A Brief Tutorial

NASA Technical Reports Server (NTRS)

Yoder, Geoffrey L.

2004-01-01

Approaches used for manned applications include limited items such as CD-players evaluated for safety to high criticality applications where the COTs hardware is evaluated on a case-by-case basis for the application and commensurate screening and qualification testing. COTS hardware is successfully implemented in both the International Space Station and Space Shuttle but requires evaluation and modifications for the application. Screening and qualification of COTs hardware used in critical applications may need to be more extensive and stringent than traditional military screening. Evaluation for: a) Suitability for the application; b) Safety; c) Reliability and maintainability; and d) Workmanship.

A Successful Collaborative: Scientists and Middle School Teachers!

NASA Astrophysics Data System (ADS)

Walker, S. H.; Brown, S. A.; Culipher-Ross, S.; Spranger, M.; Dindo, J.; Tinnin, R.; Kastler, J.; Brook, R. D.; Bishop, T.; Tuddenham, P.

2004-12-01

This NSF/ONR-NOPP/NOAA-Sea Grant funded Center for Ocean Sciences Education Excellence:Central Gulf Of Mexico (COSEE:CGOM) presentation will review "best practices" and lessons learned in a successful ocean sciences and science education based graduate course, offered in a face-to-face and online format. Implementation strategies which will be discussed include: participant recruitment, the "face to face" and online graduate course infrastructure, as well as teachers-to-sea, website development, and cognitive and affective formation and summative evaluations. This COSEE:CGOM effort is helping research scientists meet the "broader impact" requirement being mandated by many funding agencies. Various URLs will also be provided to attendees.

An open source toolkit for medical imaging de-identification.

PubMed

González, David Rodríguez; Carpenter, Trevor; van Hemert, Jano I; Wardlaw, Joanna

2010-08-01

Medical imaging acquired for clinical purposes can have several legitimate secondary uses in research projects and teaching libraries. No commonly accepted solution for anonymising these images exists because the amount of personal data that should be preserved varies case by case. Our objective is to provide a flexible mechanism for anonymising Digital Imaging and Communications in Medicine (DICOM) data that meets the requirements for deployment in multicentre trials. We reviewed our current de-identification practices and defined the relevant use cases to extract the requirements for the de-identification process. We then used these requirements in the design and implementation of the toolkit. Finally, we tested the toolkit taking as a reference those requirements, including a multicentre deployment. The toolkit successfully anonymised DICOM data from various sources. Furthermore, it was shown that it could forward anonymous data to remote destinations, remove burned-in annotations, and add tracking information to the header. The toolkit also implements the DICOM standard confidentiality mechanism. A DICOM de-identification toolkit that facilitates the enforcement of privacy policies was developed. It is highly extensible, provides the necessary flexibility to account for different de-identification requirements and has a low adoption barrier for new users.

Using Design Capability Indices to Satisfy Ranged Sets of Design Requirements

NASA Technical Reports Server (NTRS)

Chen, Wei; Allen, Janet K.; Simpson, Timothy W.; Mistree, Farrokh

1996-01-01

For robust design it is desirable to allow the design requirements to vary within a certain range rather than setting point targets. This is particularly important during the early stages of design when little is known about the system and its requirements. Toward this end, design capability indices are developed in this paper to assess the capability of a family of designs, represented by a range of top-level design specifications, to satisfy a ranged set of design requirements. Design capability indices are based on process capability indices from statistical process control and provide a single objective, alternate approach to the use of Taguchi's signal-to- noise ratio which is often used for robust design. Successful implementation of design capability indices ensures that a family of designs conforms to a given ranged set of design requirements. To demonstrate an application and the usefulness of design capability indices, the design of a solar powered irrigation system is presented. Our focus in this paper is on the development and implementation of design capability indices as an alternate approach to the use of the signal-to-noise ratio and not on the results of the example problem, per se.

Systems approach used in the Gas Centrifuge Enrichment Plant

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

Rooks, W.A. Jr.

A requirement exists for effective and efficient transfer of technical knowledge from the design engineering team to the production work force. Performance-Based Training (PBT) is a systematic approach to the design, development, and implementation of technical training. This approach has been successfully used by the US Armed Forces, industry, and other organizations. The advantages of the PBT approach are: cost-effectiveness (lowest life-cycle training cost), learning effectiveness, reduced implementation time, and ease of administration. The PBT process comprises five distinctive and rigorous phases: Analysis of Job Performance, Design of Instructional Strategy, Development of Training Materials and Instructional Media, Validation of Materialsmore » and Media, and Implementation of the Instructional Program. Examples from the Gas Centrifuge Enrichment Plant (GCEP) are used to illustrate the application of PBT.« less

What characterizes the work culture at a hospital unit that successfully implements change - a correlation study.

PubMed

André, Beate; Sjøvold, Endre

2017-07-14

To successfully achieve change in healthcare, a balance between technology and "people ware", the human recourses, is necessary. However, the human aspect of the change implementation process has received less attention than the technological issues. The aim was to explore the factors that characterize the work culture in a hospital unit that successfully implemented change compared with the factors that characterize the work culture of a hospital unit with unsuccessful implementation. The Systematizing Person-Group Relations method was used for gathering and analyzing data to explore what dominate the behavior in a particular work environment identifying challenges, limitations and opportunities. This method applied six different dimensions, each representing different behavior in a work culture: Synergy, Withdrawal, Opposition, Dependence, Control and Nurture. We compared two different units at the same hospital, one that successfully implemented change and one that was unsuccessful. There were significant statistical differences between healthcare personnel working at a unit that successfully implemented change contrasted with the unit with unsuccessful implementation. These significant differences were found in both the synergy and control dimensions, which are important positive qualities in a work culture. The results of this study show that healthcare personnel at a unit with a successful implementation of change have a working environment with many positive qualities. This indicates that a work environment with a high focus on goal achievement and task orientation can handle the challenges of implementing changes.

The South African Tuberculosis Care Cascade: Estimated Losses and Methodological Challenges.

PubMed

Naidoo, Pren; Theron, Grant; Rangaka, Molebogeng X; Chihota, Violet N; Vaughan, Louise; Brey, Zameer O; Pillay, Yogan

2017-11-06

While tuberculosis incidence and mortality are declining in South Africa, meeting the goals of the End TB Strategy requires an invigorated programmatic response informed by accurate data. Enumerating the losses at each step in the care cascade enables appropriate targeting of interventions and resources. We estimated the tuberculosis burden; the number and proportion of individuals with tuberculosis who accessed tests, had tuberculosis diagnosed, initiated treatment, and successfully completed treatment for all tuberculosis cases, for those with drug-susceptible tuberculosis (including human immunodeficiency virus (HIV)-coinfected cases) and rifampicin-resistant tuberculosis. Estimates were derived from national electronic tuberculosis register data, laboratory data, and published studies. The overall tuberculosis burden was estimated to be 532005 cases (range, 333760-764480 cases), with successful completion of treatment in 53% of cases. Losses occurred at multiple steps: 5% at test access, 13% at diagnosis, 12% at treatment initiation, and 17% at successful treatment completion. Overall losses were similar among all drug-susceptible cases and those with HIV coinfection (54% and 52%, respectively, successfully completed treatment). Losses were substantially higher among rifampicin- resistant cases, with only 22% successfully completing treatment. Although the vast majority of individuals with tuberculosis engaged the public health system, just over half were successfully treated. Urgent efforts are required to improve implementation of existing policies and protocols to close gaps in tuberculosis diagnosis, treatment initiation, and successful treatment completion. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

2014-07-01

While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

How organizational escalation prevention potential affects success of implementation of innovations: electronic medical records in hospitals.

PubMed

Lambooij, Mattijs S; Koster, Ferry

2016-05-20

Escalation of commitment is the tendency that (innovation) projects continue, even if it is clear that they will not be successful and/or become extremely costly. Escalation prevention potential (EPP), the capability of an organization to stop or steer implementation processes that do not meet their expectations, may prevent an organization of losing time and money on unsuccessful projects. EPP consists of a set of checks and balances incorporated in managerial practices that safeguard management against irrational (but very human) decisions and may limit the escalation of implementation projects. We study whether successful implementation of electronic medical records (EMRs) relates to EPP and investigate the organizational factors accounting for this relationship. Structural equation modelling (SEM), using questionnaire data of 427 doctors and 631 nurses who had experience with implementation and use of EMRs in hospitals, was applied to study whether formal governance and organizational culture mediate the relationship between EPP and the perceived added value of EMRs. Doctors and nurses in hospitals with more EPP report more successful implementation of EMR (in terms of perceived added value of the EMR). Formal governance mediates the relation between EPP and implementation success. We found no evidence that open or innovative culture explains the relationship between EPP and implementation success. There is a positive relationship between the level of EPP and perceived added value of EMRs. This relationship is explained by formal governance mechanisms of organizations. This means that management has a set of tangible tools to positively affect the success of innovation processes. However, it also means that management needs to be able to critically reflect on its (previous) actions and decisions and is willing to change plans if elements of EPP signal that the implementation process is hampered.

Moving Past Exploration and Adoption: Considering Priorities for Implementing Mobile Learning by Nurses.

PubMed

Mather, Carey; Cummings, Elizabeth

2017-01-01

Successful implementation of mobile technology for informal learning and continuing professional development within healthcare settings cannot be achieved or sustained, until end-users recognise that the benefits of using this innovation, outweigh the issues of non-use. At a systems level there is a need for standards, guidelines and codes of conduct to support deployment of mobile technology at an individual level. The aim of this research was to explore findings of a previous focus group study to elucidate priorities for action, provide evidence and focus impetus for advocating progression of the installation of standards and guidelines at an organisation level. The study confirms nurse supervisors' preparedness and readiness to employ mobile learning at point of care. However, successful implementation requires organisations engaging with, and embracing the evolving digital landscape, and supporting this new andragogy. Organisational level commitment will promote contemporary nursing practice, support the best clinical outcomes for patients, and provide educational support for nurses. Nurse leaders and professional bodies must drive and guide development of robust standards, guidelines, and codes of conduct to prioritise mobile learning as a component of digital professionalism within healthcare organisations.

Navigation of military and space unmanned ground vehicles in unstructured terrains

NASA Technical Reports Server (NTRS)

Lescoe, Paul; Lavery, David; Bedard, Roger

1991-01-01

Development of unmanned vehicles for local navigation in terrains unstructured by humans is reviewed. Modes of navigation include teleoperation or remote control, computer assisted remote driving (CARD), and semiautonomous navigation (SAN). A first implementation of a CARD system was successfully tested using the Robotic Technology Test Vehicle developed by Jet Propulsion Laboratory. Stereo pictures were transmitted to a remotely located human operator, who performed the sensing, perception, and planning functions of navigation. A computer provided range and angle measurements and the path plan was transmitted to the vehicle which autonomously executed the path. This implementation is to be enhanced by providing passive stereo vision and a reflex control system for autonomously stopping the vehicle if blocked by an obstacle. SAN achievements include implementation of a navigation testbed on a six wheel, three-body articulated rover vehicle, development of SAN algorithms and code, integration of SAN software onto the vehicle, and a successful feasibility demonstration that represents a step forward towards the technology required for long-range exploration of the lunar or Martian surface. The vehicle includes a passive stereo vision system with real-time area-based stereo image correlation, a terrain matcher, a path planner, and a path execution planner.

An in situ trap capacitance measurement and ion-trapping detection scheme for a Penning ion trap facility.

PubMed

Reza, Ashif; Banerjee, Kumardeb; Das, Parnika; Ray, Kalyankumar; Bandyopadhyay, Subhankar; Dam, Bivas

2017-03-01

This paper presents the design and implementation of an in situ measurement setup for the capacitance of a five electrode Penning ion trap (PIT) facility at room temperature. For implementing a high Q resonant circuit for the detection of trapped electrons/ions in a PIT, the value of the capacitance of the trap assembly is of prime importance. A tunable Colpitts oscillator followed by a unity gain buffer and a low pass filter is designed and successfully implemented for a two-fold purpose: in situ measurement of the trap capacitance when the electric and magnetic fields are turned off and also providing RF power at the desired frequency to the PIT for exciting the trapped ions and subsequent detection. The setup is tested for the in situ measurement of trap capacitance at room temperature and the results are found to comply with those obtained from measurements using a high Q parallel resonant circuit setup driven by a standard RF signal generator. The Colpitts oscillator is also tested successfully for supplying RF power to the high Q resonant circuit, which is required for the detection of trapped electrons/ions.

User interface prototype for geospatial early warning systems - a tsunami showcase

NASA Astrophysics Data System (ADS)

Hammitzsch, M.; Lendholt, M.; Esbrí, M. Á.

2012-03-01

The command and control unit's graphical user interface (GUI) is a central part of early warning systems (EWS) for man-made and natural hazards. The GUI combines and concentrates the relevant information of the system and offers it to human operators. It has to support operators successfully performing their tasks in complex workflows. Most notably in critical situations when operators make important decisions in a limited amount of time, the command and control unit's GUI has to work reliably and stably, providing the relevant information and functionality with the required quality and in time. The design of the GUI application is essential in the development of any EWS to manage hazards effectively. The design and development of such GUI is performed repeatedly for each EWS by various software architects and developers. Implementations differ based on their application in different domains. But similarities designing and equal approaches implementing GUIs of EWS are not quite harmonized enough with related activities and do not exploit possible synergy effects. Thus, the GUI's implementation of an EWS for tsunamis is successively introduced, providing a generic approach to be applied in each EWS for man-made and natural hazards.

Collaborative practice model between cardiologists and clinical pharmacists for management of patients with cardiovascular disease in an outpatient clinic.

PubMed

Ripley, Toni L; Adamson, Philip B; Hennebry, Thomas A; Van Tuyl, Joseph S; Harrison, Donald L; Rathbun, R Chris

2014-03-01

The increasing prevalence of cardiovascular disease (CVD) has prompted leading cardiovascular organizations to advocate utilization of a team approach to patient care that includes nonphysician providers. In spite of that, the American College of Cardiology reported that nonphysician providers are underutilized in the management of patients with CVD. A survey of cardiologists revealed that the underutilization is a result of lack of understanding of how best to involve nonphysician providers in the health care team. Clinical pharmacists are one category of nonphysician providers that have recognized effectiveness in managing patients with CVD. No example of a comprehensive model of collaboration between cardiologists and clinical pharmacists is described in the literature that could serve to close this gap in understanding. The objective of this report is to describe a model of cardiologist-clinical pharmacist collaboration in the longitudinal management of patients with CVD that has been successfully implemented in 2 diverse settings. The implementation, evolution, scope of practice, required pharmacist training, logistical elements needed for success, and implementation barriers are reviewed. A summary of the patients referred to the clinic are examined as well.

Models of care for musculoskeletal health: a cross-sectional qualitative study of Australian stakeholders' perspectives on relevance and standardised evaluation.

PubMed

Briggs, Andrew M; Jordan, Joanne E; Speerin, Robyn; Jennings, Matthew; Bragge, Peter; Chua, Jason; Slater, Helen

2015-11-16

The prevalence and impact of musculoskeletal conditions are predicted to rapidly escalate in the coming decades. Effective strategies are required to minimise 'evidence-practice', 'burden-policy' and 'burden-service' gaps and optimise health system responsiveness for sustainable, best-practice healthcare. One mechanism by which evidence can be translated into practice and policy is through Models of Care (MoCs), which provide a blueprint for health services planning and delivery. While evidence supports the effectiveness of musculoskeletal MoCs for improving health outcomes and system efficiencies, no standardised national approach to evaluation in terms of their 'readiness' for implementation and 'success' after implementation, is yet available. Further, the value assigned to MoCs by end users is uncertain. This qualitative study aimed to explore end users' views on the relevance of musculoskeletal MoCs to their work and value of a standardised evaluation approach. A cross-sectional qualitative study was undertaken. Subject matter experts (SMEs) with health, policy and administration and consumer backgrounds were drawn from three Australian states. A semi-structured interview schedule was developed and piloted to explore perceptions about musculoskeletal MoCs including: i) aspects important to their work (or life, for consumers) ii) usefulness of standardised evaluation frameworks to judge 'readiness' and 'success' and iii) challenges associated with standardised evaluation. Verbatim transcripts were analysed by two researchers using a grounded theory approach to derive key themes. Twenty-seven SMEs (n = 19; 70.4 % female) including five (18.5 %) consumers participated in the study. MoCs were perceived as critical for influencing and initiating changes to best-practice healthcare planning and delivery and providing practical guidance on how to implement and evaluate services. A 'readiness' evaluation framework assessing whether critical components across the health system had been considered prior to implementation was strongly supported, while 'success' was perceived as an already familiar evaluation concept. Perceived challenges associated with standardised evaluation included identifying, defining and measuring key 'readiness' and 'success' indicators; impacts of systems and context changes; cost; meaningful stakeholder consultation and developing a widely applicable framework. A standardised evaluation framework that includes a strong focus on 'readiness' is important to ensure successful and sustainable implementation of musculoskeletal MoCs.

System-wide lean implementation in health care: A multiple case study.

PubMed

Centauri, Federica; Mazzocato, Pamela; Villa, Stefano; Marsilio, Marta

2018-05-01

Background Lean practices have been widely used by health care organizations to meet efficiency, performance and quality improvement needs. The lean health care literature shows that the effective implementation of lean requires a holistic system-wide approach. However, there is still limited evidence on what drives effective system-wide lean implementation in health care. The existing literature suggests that a deeper understanding of how lean interventions interact with the organizational context is necessary to identify the critical variables to successfully sustain system-wide lean strategies. Purpose and methodology: A multiple case study of three Italian hospitals is conducted with the aim to explore the organizational conditions that are relevant for an effective system-wide lean implementation. A conceptual framework, built on socio-technical system schemas, is used to guide data collection and analysis. The analysis points out the importance to support lean implementation with an integrated and coordinated strategy involving the social, technical, and external components of the overall hospital system.

A multisite study of implementing supported employment in the Netherlands.

PubMed

van Erp, Nicole H J; Giesen, Femke B M; van Weeghel, Jaap; Kroon, Hans; Michon, Harry W C; Becker, Deborah; McHugo, Gregory J; Drake, Robert E

2007-11-01

This article reports on the implementation of the individual placement and support model of supported employment in four Dutch regions. The authors used structured site visits, employment data, and semistructured interviews to assess fidelity, employment outcomes, and facilitators of and barriers to successful implementation. At 24 months, the four sites reached a mean+/-SD fidelity score of 4.1+/-.3 (possible scores range from 1 to 5, with higher scores indicating closer adherence to the model). Of the 316 persons with mental illnesses, 57 (18%) obtained competitive jobs. Barriers to implementation included lack of organizational standards, loss of vocational staff, funding problems, insufficient time for program leaders, and inadequate cooperation between the involved organizations. Important facilitators were the skills and commitment of the vocational team members and the integration of vocational and mental health staff. To implement evidence-based supported employment in the Netherlands will require changes in financing, organizational structures, attitudes, cultural beliefs, and labor and disability regulations.

JPRS Report, Science & Technology, USSR: Science & Technology Policy.

DTIC Science & Technology

1987-07-10

gas exploration are being increased by 1.7-fold, while the amount of deep drilling is being increased by 1.5-fold. Such imposing tasks require new...territory based on geotraverses, ultradeep drilling , and space geological research has been introduced, a number of geodynamic models, including...cooperation of the ministry with the academy. The gauge of success of our cooperation is the implementation of these programs with the attainment of specific

In What Ways is the New Jersey County Vocational School Admissions Criteria a Predictor of Student Success on State Mandated Tests?

ERIC Educational Resources Information Center

Rubin, Scott; Ramaswami, Soundaram

2013-01-01

Vocational and Technical Education (VTE) at the secondary-school level has undergone transformation, especially in the last 25 to 30 years brought about by the implementation of the Carl D. Perkins Vocational and Technical Education Act of 1984. Earlier, the VTE education focus was to prepare students for entry-level jobs that did not require a…

A Comparison of the Effects of Video Modeling Other and Peer-Implemented Pivotal Response Training to Video Modeling Other on Positive Social Interactions of Young Children with Developmental Disabilities

ERIC Educational Resources Information Center

Kucskar, Maryssa

2017-01-01

Young children with developmental disabilities (DD) frequently have delays in social play skills. Students with DD may require social skills instruction in order to be successful in playing cooperatively with others. These opportunities to practice social play skills learned from specialized interventions must be available throughout the school…

Raising the Reading Skills of Secondary-Age Students with Severe and Persistent Reading Difficulties: Evaluation of the Efficacy and Implementation of a Phonics-Based Intervention Programme

ERIC Educational Resources Information Center

Jeffes, Ben

2016-01-01

The importance of reading skills to academic achievement, job acquisition and future success is well documented. Most of the research on reading interventions focuses on children in primary schools but many children start secondary school with very poor reading skills and schools require evidence-based interventions to support these children. The…

Touch-free, gesture-based control of medical devices and software based on the leap motion controller.

PubMed

Mauser, Stanislas; Burgert, Oliver

2014-01-01

There are several intra-operative use cases which require the surgeon to interact with medical devices. We used the Leap Motion Controller as input device and implemented two use-cases: 2D-Interaction (e.g. advancing EPR data) and selection of a value (e.g. room illumination brightness). The gesture detection was successful and we mapped its output to several devices and systems.

A course-based research experience: how benefits change with increased investment in instructional time.

PubMed

Shaffer, Christopher D; Alvarez, Consuelo J; Bednarski, April E; Dunbar, David; Goodman, Anya L; Reinke, Catherine; Rosenwald, Anne G; Wolyniak, Michael J; Bailey, Cheryl; Barnard, Daron; Bazinet, Christopher; Beach, Dale L; Bedard, James E J; Bhalla, Satish; Braverman, John; Burg, Martin; Chandrasekaran, Vidya; Chung, Hui-Min; Clase, Kari; Dejong, Randall J; Diangelo, Justin R; Du, Chunguang; Eckdahl, Todd T; Eisler, Heather; Emerson, Julia A; Frary, Amy; Frohlich, Donald; Gosser, Yuying; Govind, Shubha; Haberman, Adam; Hark, Amy T; Hauser, Charles; Hoogewerf, Arlene; Hoopes, Laura L M; Howell, Carina E; Johnson, Diana; Jones, Christopher J; Kadlec, Lisa; Kaehler, Marian; Silver Key, S Catherine; Kleinschmit, Adam; Kokan, Nighat P; Kopp, Olga; Kuleck, Gary; Leatherman, Judith; Lopilato, Jane; Mackinnon, Christy; Martinez-Cruzado, Juan Carlos; McNeil, Gerard; Mel, Stephanie; Mistry, Hemlata; Nagengast, Alexis; Overvoorde, Paul; Paetkau, Don W; Parrish, Susan; Peterson, Celeste N; Preuss, Mary; Reed, Laura K; Revie, Dennis; Robic, Srebrenka; Roecklein-Canfield, Jennifer; Rubin, Michael R; Saville, Kenneth; Schroeder, Stephanie; Sharif, Karim; Shaw, Mary; Skuse, Gary; Smith, Christopher D; Smith, Mary A; Smith, Sheryl T; Spana, Eric; Spratt, Mary; Sreenivasan, Aparna; Stamm, Joyce; Szauter, Paul; Thompson, Jeffrey S; Wawersik, Matthew; Youngblom, James; Zhou, Leming; Mardis, Elaine R; Buhler, Jeremy; Leung, Wilson; Lopatto, David; Elgin, Sarah C R

2014-01-01

There is widespread agreement that science, technology, engineering, and mathematics programs should provide undergraduates with research experience. Practical issues and limited resources, however, make this a challenge. We have developed a bioinformatics project that provides a course-based research experience for students at a diverse group of schools and offers the opportunity to tailor this experience to local curriculum and institution-specific student needs. We assessed both attitude and knowledge gains, looking for insights into how students respond given this wide range of curricular and institutional variables. While different approaches all appear to result in learning gains, we find that a significant investment of course time is required to enable students to show gains commensurate to a summer research experience. An alumni survey revealed that time spent on a research project is also a significant factor in the value former students assign to the experience one or more years later. We conclude: 1) implementation of a bioinformatics project within the biology curriculum provides a mechanism for successfully engaging large numbers of students in undergraduate research; 2) benefits to students are achievable at a wide variety of academic institutions; and 3) successful implementation of course-based research experiences requires significant investment of instructional time for students to gain full benefit.

A Course-Based Research Experience: How Benefits Change with Increased Investment in Instructional Time

PubMed Central

Shaffer, Christopher D.; Alvarez, Consuelo J.; Bednarski, April E.; Dunbar, David; Goodman, Anya L.; Reinke, Catherine; Rosenwald, Anne G.; Wolyniak, Michael J.; Bailey, Cheryl; Barnard, Daron; Bazinet, Christopher; Beach, Dale L.; Bedard, James E. J.; Bhalla, Satish; Braverman, John; Burg, Martin; Chandrasekaran, Vidya; Chung, Hui-Min; Clase, Kari; DeJong, Randall J.; DiAngelo, Justin R.; Du, Chunguang; Eckdahl, Todd T.; Eisler, Heather; Emerson, Julia A.; Frary, Amy; Frohlich, Donald; Gosser, Yuying; Govind, Shubha; Haberman, Adam; Hark, Amy T.; Hauser, Charles; Hoogewerf, Arlene; Hoopes, Laura L. M.; Howell, Carina E.; Johnson, Diana; Jones, Christopher J.; Kadlec, Lisa; Kaehler, Marian; Silver Key, S. Catherine; Kleinschmit, Adam; Kokan, Nighat P.; Kopp, Olga; Kuleck, Gary; Leatherman, Judith; Lopilato, Jane; MacKinnon, Christy; Martinez-Cruzado, Juan Carlos; McNeil, Gerard; Mel, Stephanie; Mistry, Hemlata; Nagengast, Alexis; Overvoorde, Paul; Paetkau, Don W.; Parrish, Susan; Peterson, Celeste N.; Preuss, Mary; Reed, Laura K.; Revie, Dennis; Robic, Srebrenka; Roecklein-Canfield, Jennifer; Rubin, Michael R.; Saville, Kenneth; Schroeder, Stephanie; Sharif, Karim; Shaw, Mary; Skuse, Gary; Smith, Christopher D.; Smith, Mary A.; Smith, Sheryl T.; Spana, Eric; Spratt, Mary; Sreenivasan, Aparna; Stamm, Joyce; Szauter, Paul; Thompson, Jeffrey S.; Wawersik, Matthew; Youngblom, James; Zhou, Leming; Mardis, Elaine R.; Buhler, Jeremy; Leung, Wilson; Lopatto, David; Elgin, Sarah C. R.

2014-01-01

There is widespread agreement that science, technology, engineering, and mathematics programs should provide undergraduates with research experience. Practical issues and limited resources, however, make this a challenge. We have developed a bioinformatics project that provides a course-based research experience for students at a diverse group of schools and offers the opportunity to tailor this experience to local curriculum and institution-specific student needs. We assessed both attitude and knowledge gains, looking for insights into how students respond given this wide range of curricular and institutional variables. While different approaches all appear to result in learning gains, we find that a significant investment of course time is required to enable students to show gains commensurate to a summer research experience. An alumni survey revealed that time spent on a research project is also a significant factor in the value former students assign to the experience one or more years later. We conclude: 1) implementation of a bioinformatics project within the biology curriculum provides a mechanism for successfully engaging large numbers of students in undergraduate research; 2) benefits to students are achievable at a wide variety of academic institutions; and 3) successful implementation of course-based research experiences requires significant investment of instructional time for students to gain full benefit. PMID:24591510

Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature.

PubMed

Simons, Sereh M J; Cillessen, Felix H J M; Hazelzet, Jan A

2016-08-02

A problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem- was introduced at the end of the sixties by Dr. Lawrence Weed to aid dealing with the multiplicity of patient problems. The problem list as a precondition is the centerpiece of the problem-oriented medical record (POMR) also called problem-oriented record (POR). Prior to the digital era, paper records presented a flat list of medical problems to the healthcare professional without the features that are possible with current technology. In modern EHRs a POMR based on a structured problem list can be used for clinical decision support, registries, order management, population health, and potentially other innovative functionality in the future, thereby providing a new incentive to the implementation and use of the POMR. On both 12 May 2014 and 1 June 2015 a systematic literature search was conducted. From the retrieved articles statements regarding the POMR and related to successful or non-successful implementation, were categorized. Generic determinants were extracted from these statements. In this research 38 articles were included. The literature analysis led to 12 generic determinants: clinical practice/reasoning, complete and accurate problem list, data structure/content, efficiency, functionality, interoperability, multi-disciplinary, overview of patient information, quality of care, system support, training of staff, and usability. Two main subjects can be distinguished in the determinants: the system that the problem list and POMR is integrated in and the organization using that system. The combination of the two requires a sociotechnical approach and both are equally important for successful implementation of a POMR. All the determinants have to be taken into account, but the weight given to each of the determinants depends on the organizationusing the problem list or POMR.

[Implementing evidence and implementation research: two different and prime realities].

PubMed

Rumbo Prieto, José María; Martínez Ques, Ángel Alfredo; Sobrido Prieto, María; Raña Lama, Camilo Daniel; Vázquez Campo, Miriam; Braña Marcos, Beatriz

Scientific research can contribute to more efficient health care, enhance care quality and safety of persons. In order for this to happen, the knowledge gained must be put into practice. Implementation is known as the introduction of a change or innovation to daily practice, which requires effective communication and the elimination of barriers that hinder this process. Best practice implementation experiences are being used increasingly in the field of nursing. The difficulty in identifying the factors that indicate the success or failure of implementation has led to increased studies to build a body of differentiated knowledge, recognized as implementation science or implementation research. Implementation research is the scientific study whose objective is the adoption and systematic incorporation of research findings into clinical practice to improve the quality and efficiency of health services. The purpose of implementation research is to improve the health of the population through equitable and effective implementation of rigorously evaluated scientific knowledge, which involves gathering the evidence that has a positive impact on the health of the community. In this text, we set out the characteristics of nursing implementation research, providing a synthesis of different methods, theories, key frameworks and implementation strategies, along with the terminology proposed for greater conceptual clarity. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Implementing a regional oncology information system: approach and lessons learned.

PubMed

Evans, W K; Ashbury, F D; Hogue, G L; Smith, A; Pun, J

2014-10-01

Paper-based medical record systems are known to have major problems of inaccuracy, incomplete data, poor accessibility, and challenges to patient confidentiality. They are also an inefficient mechanism of record-sharing for interdisciplinary patient assessment and management, and represent a major problem for keeping current and monitoring quality control to facilitate improvement. To address those concerns, national, regional, and local health care authorities have increased the pressure on oncology practices to upgrade from paper-based systems to electronic health records. Here, we describe and discuss the challenges to implementing a region-wide oncology information system across four independent health care organizations, and we describe the lessons learned from the initial phases that are now being applied in subsequent activities of this complex project. The need for change must be shared across centres to increase buy-in, adoption, and implementation. It is essential to establish physician leadership, commitment, and engagement in the process. Work processes had to be revised to optimize use of the new system. Culture change must be included in the change management strategy. Furthermore, training and resource requirements must be thoroughly planned, implemented, monitored, and modified as required for effective adoption of new work processes and technology. Interfaces must be established with multiple existing electronic systems across the region to ensure appropriate patient flow. Periodic assessment of the existing project structure is necessary, and adjustments are often required to ensure that the project meets its objectives. The implementation of region-wide oncology information systems across different health practice locations has many challenges. Leadership is essential. A strong, collaborative information-sharing strategy across the region and with the supplier is essential to identify, discuss, and resolve implementation problems. A structure that supports project management and accountability contributes to success.

ACE: A distributed system to manage large data archives

NASA Technical Reports Server (NTRS)

Daily, Mike I.; Allen, Frank W.

1993-01-01

Competitive pressures in the oil and gas industry are requiring a much tighter integration of technical data into E and P business processes. The development of new systems to accommodate this business need must comprehend the significant numbers of large, complex data objects which the industry generates. The life cycle of the data objects is a four phase progression from data acquisition, to data processing, through data interpretation, and ending finally with data archival. In order to implement a cost effect system which provides an efficient conversion from data to information and allows effective use of this information, an organization must consider the technical data management requirements in all four phases. A set of technical issues which may differ in each phase must be addressed to insure an overall successful development strategy. The technical issues include standardized data formats and media for data acquisition, data management during processing, plus networks, applications software, and GUI's for interpretation of the processed data. Mass storage hardware and software is required to provide cost effective storage and retrieval during the latter three stages as well as long term archival. Mobil Oil Corporation's Exploration and Producing Technical Center (MEPTEC) has addressed the technical and cost issues of designing, building, and implementing an Advanced Computing Environment (ACE) to support the petroleum E and P function, which is critical to the corporation's continued success. Mobile views ACE as a cost effective solution which can give Mobile a competitive edge as well as a viable technical solution.

Passive RFID Localisation Framework in Smart Homes Healthcare Settings.

PubMed

Alsinglawi, Belal; Liu, Tony; Nguyen, Quang Vinh; Gunawardana, Upul; Maeder, Anthony; Simoff, Simeon

2016-01-01

In recent years, Smart Homes have become a solution to benefit impaired individuals and elderly in their daily life settings. In healthcare applications, pervasive technologies have enabled the practicality of personal monitoring using Indoor positioning technologies. Radio-Frequency Identification (RFID) is a promising technology, which is useful for non-invasive tracking of activities of daily living. Many implementations have focused on using battery-enabled tags like in RFID active tags, which require frequent maintenance and they are costly. Other systems can use wearable sensors requiring individuals to wear tags which may be inappropriate for elders. Successful implementations of a tracking system are dependent on multiple considerations beyond the physical performance of the solution, such as affordability and human acceptance. This paper presents a localisation framework using passive RFID sensors. It aims to provide a low cost solution for subject location in Smart Homes healthcare.

Gene Therapy with the Sleeping Beauty Transposon System.

PubMed

Kebriaei, Partow; Izsvák, Zsuzsanna; Narayanavari, Suneel A; Singh, Harjeet; Ivics, Zoltán

2017-11-01

The widespread clinical implementation of gene therapy requires the ability to stably integrate genetic information through gene transfer vectors in a safe, effective, and economical manner. The latest generation of Sleeping Beauty (SB) transposon vectors fulfills these requirements, and may overcome limitations associated with viral gene transfer vectors and transient nonviral gene delivery approaches that are prevalent in ongoing clinical trials. The SB system enables high-level stable gene transfer and sustained transgene expression in multiple primary human somatic cell types, thereby representing a highly attractive gene transfer strategy for clinical use. Here, we review the most important aspects of using SB for gene therapy, including vectorization as well as genomic integration features. We also illustrate the path to successful clinical implementation by highlighting the application of chimeric antigen receptor (CAR)-modified T cells in cancer immunotherapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Implementing AORN recommended practices for hand hygiene.

PubMed

Patrick, Marcia; Van Wicklin, Sharon A

2012-04-01

This article focuses on implementing the revised AORN "Recommended practices for hand hygiene in the perioperative setting." The content of the document has been expanded and reorganized from the previous iteration and now includes specific activity statements about water temperature, water and soap dispensing controls, the type of dispensers to use, paper towel dispenser requirements, placement of soap and rub dispensers, and regulatory requirements for products and recommendations for hand hygiene practices. A successful hand hygiene program allows end users to have input into the selection and evaluation of products and should include educating personnel about proper hand hygiene, product composition and safety, and how and when to use specific products. Measures for competency evaluation and compliance monitoring include observations, quizzes, skills labs, electronic monitoring systems, handheld device applications, and data collection forms. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Of duty hour violations and shift work: changing the educational paradigm.

PubMed

Kohlbrenner, Amanda; Dirks, Rachel; Davis, James; Wolfe, Mary; Maser, Christina

2016-06-01

Successful surgical education balances learning opportunities with Accreditation Council on Graduate Medical Education (ACGME) duty hour requirements. We instituted a night shift system and hypothesized that implementation would decrease duty hour violations while maintaining quality education. A system of alternating teams working 12-hour shifts was instituted and was assessed via an electronic survey distributed at 2, 6, and 12 months after implementation. Resident duty hour violations and resident case volume were evaluated for 1 year before and 2 years after implementation of the night shift system. Survey data revealed a decrease in the perception that residents had problems meeting duty hour restrictions from 44% to 14% at 12 months (P = .012). Total violations increased 26% in the 1st year, subsequently decreasing by 62%, with shift length violations decreasing by 90%. Resident availability for didactics was improved, and average operative cases per academic year increased by 65%. Night shift systems are feasible and help meet duty hour requirements. Our program decreased violations while increasing operative volume and didactic time. Copyright © 2015 Elsevier Inc. All rights reserved.

A Roadmap for Using Agile Development in a Traditional Environment

NASA Technical Reports Server (NTRS)

Streiffert, Barbara; Starbird, Thomas; Grenander, Sven

2006-01-01

One of the newer classes of software engineering techniques is called 'Agile Development'. In Agile Development software engineers take small implementation steps and, in some cases, they program in pairs. In addition, they develop automatic tests prior to implementing their small functional piece. Agile Development focuses on rapid turnaround, incremental planning, customer involvement and continuous integration. Agile Development is not the traditional waterfall method or even a rapid prototyping method (although this methodology is closer to Agile Development). At the Jet Propulsion Laboratory (JPL) a few groups have begun Agile Development software implementations. The difficulty with this approach becomes apparent when Agile Development is used in an organization that has specific criteria and requirements handed down for how software development is to be performed. The work at the JPL is performed for the National Aeronautics and Space Agency (NASA). Both organizations have specific requirements, rules and processes for developing software. This paper will discuss some of the initial uses of the Agile Development methodology, the spread of this method and the current status of the successful incorporation into the current JPL development policies and processes.

A Roadmap for Using Agile Development in a Traditional Environment

NASA Technical Reports Server (NTRS)

Streiffert, Barbara A.; Starbird, Thomas; Grenander, Sven

2006-01-01

One of the newer classes of software engineering techniques is called 'Agile Development'. In Agile Development software engineers take small implementation steps and, in some cases they program in pairs. In addition, they develop automatic tests prior to implementing their small functional piece. Agile Development focuses on rapid turnaround, incremental planning, customer involvement and continuous integration. Agile Development is not the traditional waterfall method or even a rapid prototyping method (although this methodology is closer to Agile Development). At Jet Propulsion Laboratory (JPL) a few groups have begun Agile Development software implementations. The difficulty with this approach becomes apparent when Agile Development is used in an organization that has specific criteria and requirements handed down for how software development is to be performed. The work at the JPL is performed for the National Aeronautics and Space Agency (NASA). Both organizations have specific requirements, rules and procedure for developing software. This paper will discuss the some of the initial uses of the Agile Development methodology, the spread of this method and the current status of the successful incorporation into the current JPL development policies.

Implementation of a software for REmote COMparison of PARticlE and photon treatment plans: ReCompare.

PubMed

Löck, Steffen; Roth, Klaus; Skripcak, Tomas; Worbs, Mario; Helmbrecht, Stephan; Jakobi, Annika; Just, Uwe; Krause, Mechthild; Baumann, Michael; Enghardt, Wolfgang; Lühr, Armin

2015-09-01

To guarantee equal access to optimal radiotherapy, a concept of patient assignment to photon or particle radiotherapy using remote treatment plan exchange and comparison - ReCompare - was proposed. We demonstrate the implementation of this concept and present its clinical applicability. The ReCompare concept was implemented using a client-server based software solution. A clinical workflow for the remote treatment plan exchange and comparison was defined. The steps required by the user and performed by the software for a complete plan transfer were described and an additional module for dose-response modeling was added. The ReCompare software was successfully tested in cooperation with three external partner clinics and worked meeting all required specifications. It was compatible with several standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow. The ReCompare software can be applied to support non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by remote treatment plan exchange and comparison. Copyright © 2015. Published by Elsevier GmbH.

SAVY-4000 Surveillance and Life Extension Program Fiscal Year 2013 Annual Report

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

Stone, Timothy A.; Blair, Michael W.; Weis, Eric

2014-03-03

The Packaging Surveillance Program section of the DOE M441.1-1 /sup>1, Nuclear Material Packaging Manual (DOE, 2008) requires DOE contractors to “ensure that a surveillance program is established and implemented to ensure the nuclear material storage package continues to meet its design criteria.” In order to ensure continuing safe storage of nuclear material and the maximization of risk reduction, TA-55 has established a Surveillance Program to ensure storage container integrity for operations within its specified design life. The LANL SAVY-4000 Field Surveillance Plan2 defines the near-term field surveillance plan for SAVY-4000 containers as required by the Manual. A long-term surveillance planmore » will be established based on the results of the first several years of surveillance and the results of the lifetime extension studies as defined in the Accelerated Aging Plan3. This report details progress in positioning the Surveillance Program for successful implementation in FY14 and status of the Design Life Extension Program in terms of its implementation and data collection for FY13.« less

Intelligent control of mixed-culture bioprocesses

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

Stoner, D.L.; Larsen, E.D.; Miller, K.S.

A hierarchical control system is being developed and applied to a mixed culture bioprocess in a continuous stirred tank reactor. A bioreactor, with its inherent complexity and non-linear behavior was an interesting, yet, difficult application for control theory. The bottom level of the hierarchy was implemented as a number of integrated set point controls and data acquisition modules. Within the second level was a diagnostic system that used expert knowledge to determine the operational status of the sensors, actuators, and control modules. A diagnostic program was successfully implemented for the detection of stirrer malfunctions, and to monitor liquid delivery ratesmore » and recalibrate the pumps when deviations from desired flow rates occurred. The highest control level was a supervisory shell that was developed using expert knowledge and the history of the reactor operation to determine the set points required to meet a set of production criteria. At this stage the supervisory shell analyzed the data to determine the state of the system. In future implementations, this shell will determine the set points required to optimize a cost function using expert knowledge and adaptive learning techniques.« less

Nanotechnology in dentistry: prevention, diagnosis, and therapy.

PubMed

Abou Neel, Ensanya Ali; Bozec, Laurent; Perez, Roman A; Kim, Hae-Won; Knowles, Jonathan C

2015-01-01

Nanotechnology has rapidly expanded into all areas of science; it offers significant alternative ways to solve scientific and medical questions and problems. In dentistry, nanotechnology has been exploited in the development of restorative materials with some significant success. This review discusses nanointerfaces that could compromise the longevity of dental restorations, and how nanotechnolgy has been employed to modify them for providing long-term successful restorations. It also focuses on some challenging areas in dentistry, eg, oral biofilm and cancers, and how nanotechnology overcomes these challenges. The recent advances in nanodentistry and innovations in oral health-related diagnostic, preventive, and therapeutic methods required to maintain and obtain perfect oral health, have been discussed. The recent advances in nanotechnology could hold promise in bringing a paradigm shift in dental field. Although there are numerous complex therapies being developed to treat many diseases, their clinical use requires careful consideration of the expense of synthesis and implementation.

Nanotechnology in dentistry: prevention, diagnosis, and therapy

PubMed Central

Abou Neel, Ensanya Ali; Bozec, Laurent; Perez, Roman A; Kim, Hae-Won; Knowles, Jonathan C

2015-01-01

Nanotechnology has rapidly expanded into all areas of science; it offers significant alternative ways to solve scientific and medical questions and problems. In dentistry, nanotechnology has been exploited in the development of restorative materials with some significant success. This review discusses nanointerfaces that could compromise the longevity of dental restorations, and how nanotechnolgy has been employed to modify them for providing long-term successful restorations. It also focuses on some challenging areas in dentistry, eg, oral biofilm and cancers, and how nanotechnology overcomes these challenges. The recent advances in nanodentistry and innovations in oral health-related diagnostic, preventive, and therapeutic methods required to maintain and obtain perfect oral health, have been discussed. The recent advances in nanotechnology could hold promise in bringing a paradigm shift in dental field. Although there are numerous complex therapies being developed to treat many diseases, their clinical use requires careful consideration of the expense of synthesis and implementation. PMID:26504385

[Requirements for the successful installation of an data management system].

PubMed

Benson, M; Junger, A; Quinzio, L; Hempelmann, G

2002-08-01

Due to increasing requirements on medical documentation, especially with reference to the German Social Law binding towards quality management and introducing a new billing system (DRGs), an increasing number of departments consider to implement a patient data management system (PDMS). The installation should be professionally planned as a project in order to insure and complete a successful installation. The following aspects are essential: composition of the project group, definition of goals, finance, networking, space considerations, hardware, software, configuration, education and support. Project and finance planning must be prepared before beginning the project and the project process must be constantly evaluated. In selecting the software, certain characteristics should be considered: use of standards, configurability, intercommunicability and modularity. Our experience has taught us that vaguely defined goals, insufficient project planning and the existing management culture are responsible for the failure of PDMS installations. The software used tends to play a less important role.

Comprehensive Performance Nutrition for Special Operations Forces.

PubMed

Daigle, Karen A; Logan, Christi M; Kotwal, Russ S

2015-01-01

Special Operations Forces (SOF) training, combat, and contingency operations are unique and demanding. Performance nutrition within the Department of Defense has emphasized that nutrition is relative to factors related to the desired outcome, which includes successful performance of mentally and physically demanding operations and missions of tactical and strategic importance, as well as nonoperational assignments. Discussed are operational, nonoperational, and patient categories that require different nutrition strategies to facilitate category-specific performance outcomes. Also presented are 10 major guidelines for a SOF comprehensive performance nutrition program, practical nutrition recommendations for Special Operators and medical providers, as well as resources for dietary supplement evaluation. Foundational health concepts, medical treatment, and task-specific performance factors should be considered when developing and systematically implementing a comprehensive SOF performance nutrition program. When tailored to organizational requirements, SOF unit- and culture-specific nutrition education and services can optimize individual Special Operator performance, overall unit readiness, and ultimately, mission success. 2015.

What is the extent of research on the characteristics, behaviors, and impacts of health information technology champions? A scoping review.

PubMed

Shea, Christopher Michael; Belden, Charles M

2016-01-12

Although champions are commonly employed in health information technology (HIT) implementations, the state of empirical literature on HIT champions' is unclear. The purpose of our review was to synthesize quantitative and qualitative studies to identify the extent of research on the characteristics, behaviors, and impacts of HIT champions. Ultimately, our goal was to identify gaps in the literature and inform implementation science. Our review employed a broad search strategy using multiple databases-Embase, Pubmed, Cinahl, PsychInfo, Web of Science, and the Cochrane library. We identified 1728 candidate articles, of which 42 were retained for full-text review. Of the 42 studies included, fourteen studies employed a multiple-case study design (33 %), 12 additional articles employed a single-case study design (29 %), five used quantitative methods (12 %), two used mixed-methods (5 %), and one used a Delphi methodology (2 %). Our review revealed multiple categories and characteristics of champions as well as influence tactics they used to promote an HIT project. Furthermore, studies have assessed three general types of HIT champion impacts: (1) impacts on the implementation process of a specific HIT; (2) impacts on usage behavior or overall success of a specific HIT; and (3) impacts on general organizational-level innovativeness. However the extent to which HIT projects fail even with a champion and why such failures occur is not clear. Also unclear is whether all organizations require a champion for successful HIT project implementation. In other words, we currently do not know enough about the conditions under which (1) a health IT champion is needed, (2) multiple champions are needed, and (3) an appointed champion-as opposed to an emergent champion-can be successful. Although champions appear to have contributed to successful implementation of HIT projects, simply measuring the presence or absence of a champion is not sufficient for assessing impacts. Future research should aim for answers to questions about who champions should be, when they should be engaged, what they should do, how management can support their efforts, and what their impact is given the organizational context.

Real-time operating system for selected Intel processors

NASA Technical Reports Server (NTRS)

Pool, W. R.

1980-01-01

The rationale for system development is given along with reasons for not using vendor supplied operating systems. Although many system design and performance goals were dictated by problems with vendor supplied systems, other goals surfaced as a result of a design for a custom system able to span multiple projects. System development and management problems and areas that required redesign or major code changes for system implementation are examined as well as the relative successes of the initial projects. A generic description of the actual project is provided and the ongoing support requirements and future plans are discussed.

Workplace Wellness Programs: How Regulatory Flexibility Might Undermine Success

PubMed Central

2014-01-01

The Patient Protection and Affordable Care Act revised the law related to workplace wellness programs, which have become part of the nation’s broader health strategy. Health-contingent programs are required to be reasonably designed. However, the regulatory requirements are lax and might undermine program efficacy in terms of both health gains and financial return. I propose a method for the government to support a best-practices approach by considering an accreditation or certification process. Additionally I discuss the need for program evaluation and the potential for employers to be subject to litigation if programs are not carefully implemented. PMID:25211713

Performance measures in the earth observations commercialization applications program

NASA Astrophysics Data System (ADS)

Macauley, Molly K.

1996-03-01

Performance measures in the Earth Observations Commercialization Application Program (EOCAP) are key to its success and include net profitability; enhancements to industry productivity through generic innovations in industry practices, standards, and protocols; and documented contributions to public policy governing the newly developing remote sensing industry. Because EOCAP requires company co-funding, both parties to the agreement (the government and the corporate partner) have incentives to pursue these goals. Further strengthening progress towards these goals are requirements for business plans in the company's EOCAP proposal, detailed scrutiny given these plans during proposal selection, and regularly documented progress reports during project implementation.

Use of Fuzzycones for Sun-Only Attitude Determination: THEMIS Becomes ARTEMIS

NASA Technical Reports Server (NTRS)

Hashmall, Joseph A.; Felikson, Denis; Sedlak, Joseph E.

2009-01-01

In order for two THEMIS probes to successfully transition to ARTEMIS it will be necessary to determine attitudes with moderate accuracy using Sun sensor data only. To accomplish this requirement, an implementation of the Fuzzycones maximum likelihood algorithm was developed. The effect of different measurement uncertainty models on Fuzzycones attitude accuracy was investigated and a bin-transition technique was introduced to improve attitude accuracy using data with uniform error distributions. The algorithm was tested with THEMIS data and in simulations. The analysis results show that the attitude requirements can be met using Fuzzycones and data containing two bin-transitions.

Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations.

PubMed

Tuot, Delphine S; Leeds, Kiren; Murphy, Elizabeth J; Sarkar, Urmimala; Lyles, Courtney R; Mekonnen, Tekeshe; Chen, Alice H M

2015-12-19

Access to specialty care remains a challenge for primary care providers and patients. Implementation of electronic referral and/or consultation (eCR) systems provides an opportunity for innovations in the delivery of specialty care. We conducted key informant interviews to identify drivers, facilitators, barriers and evaluation metrics of diverse eCR systems to inform widespread implementation of this model of specialty care delivery. Interviews were conducted with leaders of 16 diverse health care delivery organizations between January 2013 and April 2014. A limited snowball sampling approach was used for recruitment. Content analysis was used to examine key informant interview transcripts. Electronic referral systems, which provide referral management and triage by specialists, were developed to enhance tracking and operational efficiency. Electronic consultation systems, which encourage bi-directional communication between primary care and specialist providers facilitating longitudinal virtual co-management, were developed to improve access to specialty expertise. Integrated eCR systems leverage both functionalities to enhance the delivery of coordinated, specialty care at the population level. Elements of successful eCR system implementation included executive and clinician leadership, established funding models for specialist clinician reimbursement, and a commitment to optimizing clinician workflows. eCR systems have great potential to streamline access to and enhance the coordination of specialty care delivery. While different eCR models help solve different organizational challenges, all require institutional investments for successful implementation, such as funding for program management, leadership and clinician incentives.

Development and validation of an automated ventilator-associated event electronic surveillance system: A report of a successful implementation.

PubMed

Hebert, Courtney; Flaherty, Jennifer; Smyer, Justin; Ding, Jing; Mangino, Julie E

2018-03-01

Surveillance is an important tool for infection control; however, this task can often be time-consuming and take away from infection prevention activities. With the increasing availability of comprehensive electronic health records, there is an opportunity to automate these surveillance activities. The objective of this article is to describe the implementation of an electronic algorithm for ventilator-associated events (VAEs) at a large academic medical center METHODS: This article reports on a 6-month manual validation of a dashboard for VAEs. We developed a computerized algorithm for automatically detecting VAEs and compared the output of this algorithm to the traditional, manual method of VAE surveillance. Manual surveillance by the infection preventionists identified 13 possible and 11 probable ventilator-associated pneumonias (VAPs), and the VAE dashboard identified 16 possible and 13 probable VAPs. The dashboard had 100% sensitivity and 100% accuracy when compared with manual surveillance for possible and probable VAP. We report on the successfully implemented VAE dashboard. Workflow of the infection preventionists was simplified after implementation of the dashboard with subjective time-savings reported. Implementing a computerized dashboard for VAE surveillance at a medical center with a comprehensive electronic health record is feasible; however, this required significant initial and ongoing work on the part of data analysts and infection preventionists. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

"Provoking conversations": case studies of organizations where Option Grid™ decision aids have become 'normalized'.

PubMed

Scalia, Peter; Elwyn, Glyn; Durand, Marie-Anne

2017-08-18

Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholders were conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota. 'Coherent' motivations were guided by financial incentives at CapitalCare, and by a 'champion' physician at HealthPartners. Nurses worked 'collectively' at both settings and played an important role at sites where successful implementation occurred. Some physicians did not understand the perceived utility of Option Grid™, which led to varying degrees of implementation success across sites. The appraisal work (reflexive monitoring) identified benefits, particularly in terms of information provision. Physicians at both settings, however, were concerned with time pressures and the suitability of the tool for patients with low levels of health literacy. Although both practice settings illustrated the mechanisms of normalization postulated by the theory, the extent to which Option Grid™ was routinely embedded in clinic workflow varied between sites, and between clinicians. Implementation of new interventions will require attention to an identified rationale (coherence), and to the collective action, cognitive participation, and assessment of value by organizational members of the organization.

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance.

PubMed

Campbell, S M; Sheaff, R; Sibbald, B; Marshall, M N; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M O

2002-03-01

To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Qualitative case studies using semi-structured interviews and documentation review. Twelve purposively sampled PCG/Ts in England. Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Participants' perceptions of the role of clinical governance in PCG/Ts. PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

Resources for development of training in public health and health managment in Eastern Europe: the Kaunas experience.

PubMed

Kalediene, Ramune

2002-01-01

The aim of this paper is to review the resources and steps required for development and evaluation of training in public health and management of public health as experienced in Kaunas University of Medicine, Lithuania. The transition from Departments of Social Medicine and Hygiene to a Faculty of Public Health of international standards requires a process of adaptation and development of human resources more than physical facilities. After restoration of independence in 1990, rapid development of training in public health was started in Lithuania. Great support was provided by the international projects Baltic Rim Partnership for Public Health (BRIMHEALTH) and European Union Trans-European Mobility Scheme for University Students (TEMPUS). Undergraduate and postgraduate training programs were successfully implemented in the Faculty of Public Health, Kaunas University of Medicine. Lithuanian experience could serve as an example of success and pitfalls in training a critical mass of professionals who should act as powerful advocates for health, promoting analysis, continuity and success of public health interventions, and health care reforms in countries in transition.

Views of implementation approaches by top managers in health service organizations.

PubMed

Nutt, P C

1996-01-01

This study examined how top managers view the prospects of success and resistance when using four implementation approaches in participative and control cultures that foster climates more or less conducive to change. An accommodation approach was viewed as having the best prospect of success and of lowering resistance in a participative culture. Bargaining and incentive approaches were thought to have successful and low resistance outcomes, which were just below those of accommodation, in a control type of culture. A persuasion approach was thought to be the least effective implementation approach in a control-oriented culture. These preferences differ from prescriptions found in the implementation literature. Assuming that preferences influence behavior, implementation success could be improved if managers selected an implementation approach according to the demands of the situation. More research is needed to appreciate fully the rationale that lies behind the preferences uncovered in this research.

Controlling tissue microenvironments: biomimetics, transport phenomena, and reacting systems.

PubMed

Fisher, Robert J; Peattie, Robert A

2007-01-01

The reconstruction of tissues ex vivo and production of cells capable of maintaining a stable performance for extended time periods in sufficient quantity for synthetic or therapeutic purposes are primary objectives of tissue engineering. The ability to characterize and manipulate the cellular microenvironment is critical for successful implementation of such cell-based bioengineered systems. As a result, knowledge of fundamental biomimetics, transport phenomena, and reaction engineering concepts is essential to system design and development. Once the requirements of a specific tissue microenvironment are understood, the biomimetic system specifications can be identified and a design implemented. Utilization of novel membrane systems that are engineered to possess unique transport and reactive features is one successful approach presented here. The limited availability of tissue or cells for these systems dictates the need for microscale reactors. A capstone illustration based on cellular therapy for type 1 diabetes mellitus via encapsulation techniques is presented as a representative example of this approach, to stress the importance of integrated systems.

Creating infrastructure supportive of evidence-based nursing practice: leadership strategies.

PubMed

Newhouse, Robin P

2007-01-01

Nursing leadership is the cornerstone of successful evidence-based practice (EBP) programs within health care organizations. The key to success is a strategic approach to building an EBP infrastructure, with allocation of appropriate human and material resources. This article indicates the organizational infrastructure that enables evidence-based nursing practice and strategies for leaders to enhance evidence-based practice using "the conceptual model for considering the determinants of diffusion, dissemination, and implementation of innovations in health service delivery and organization." Enabling EBP within organizations is important for promoting positive outcomes for nurses and patients. Fostering EBP is not a static or immediate outcome, but a long-term developmental process within organizations. Implementation requires multiple strategies to cultivate a culture of inquiry where nurses generate and answer important questions to guide practice. Organizations that can enable the culture and build infrastructure to help nurses develop EBP competencies will produce a professional environment that will result in both personal growth for their staff and improvements in quality that would not otherwise be possible.

Full-custom design of split-set data weighted averaging with output register for jitter suppression

NASA Astrophysics Data System (ADS)

Jubay, M. C.; Gerasta, O. J.

2015-06-01

A full-custom design of an element selection algorithm, named as Split-set Data Weighted Averaging (SDWA) is implemented in 90nm CMOS Technology Synopsys Library. SDWA is applied in seven unit elements (3-bit) using a thermometer-coded input. Split-set DWA is an improved DWA algorithm which caters the requirement for randomization along with long-term equal element usage. Randomization and equal element-usage improve the spectral response of the unit elements due to higher Spurious-free dynamic range (SFDR) and without significantly degrading signal-to-noise ratio (SNR). Since a full-custom, the design is brought to transistor-level and the chip custom layout is also provided, having a total area of 0.3mm2, a power consumption of 0.566 mW, and simulated at 50MHz clock frequency. On this implementation, SDWA is successfully derived and improved by introducing a register at the output that suppresses the jitter introduced at the final stage due to switching loops and successive delays.

Toward the Application of the Implicit Particle Filter to Real Data in a Shallow Water Model of the Nearshore Ocean

NASA Astrophysics Data System (ADS)

Miller, R.

2015-12-01

Following the success of the implicit particle filter in twin experiments with a shallow water model of the nearshore environment, the planned next step is application to the intensive Sandy Duck data set, gathered at Duck, NC. Adaptation of the present system to the Sandy Duck data set will require construction and evaluation of error models for both the model and the data, as well as significant modification of the system to allow for the properties of the data set. Successful implementation of the particle filter promises to shed light on the details of the capabilities and limitations of shallow water models of the nearshore ocean relative to more detailed models. Since the shallow water model admits distinct dynamical regimes, reliable parameter estimation will be important. Previous work by other groups give cause for optimism. In this talk I will describe my progress toward implementation of the new system, including problems solved, pitfalls remaining and preliminary results

Lean leadership attributes: a systematic review of the literature.

PubMed

Aij, Kjeld Harald; Teunissen, Maurits

2017-10-09

Purpose Emphasis on quality and reducing costs has led many health-care organizations to reconfigure their management, process, and quality control infrastructures. Many are lean, a management philosophy with roots in manufacturing industries that emphasizes elimination of waste. Successful lean implementation requires systemic change and strong leadership. Despite the importance of leadership to successful lean implementation, few researchers have probed the question of ideal leadership attributes to achieve lean thinking in health care. The purpose of this paper is to provide insight into applicable attributes for lean leaders in health care. Design/methodology/approach The authors systematically reviewed the literature on principles of leadership and, using Dombrowski and Mielke's (2013) conceptual model of lean leadership, developed a parallel theoretical model for lean leadership in health care. Findings This work contributes to the development of a new framework for describing leadership attributes within lean management of health care. Originality/value The summary of attributes can provide a model for health-care leaders to apply lean in their organizations.

A shared electronic health record: lessons from the coalface.

PubMed

Silvester, Brett V; Carr, Simon J

2009-06-01

A shared electronic health record system has been successfully implemented in Australia by a Division of General Practice in northern Brisbane. The system grew out of coordinated care trials that showed the critical need to share summary patient information, particularly for patients with complex conditions who require the services of a wide range of multisector, multidisciplinary health care professionals. As at 30 April 2008, connected users of the system included 239 GPs from 66 general practices, two major public hospitals, three large private hospitals, 11 allied health and community-based provider organisations and 1108 registered patients. Access data showed a patient's shared record was accessed an average of 15 times over a 12-month period. The success of the Brisbane implementation relied on seven key factors: connectivity, interoperability, change management, clinical leadership, targeted patient involvement, information at the point of care, and governance. The Australian Commission on Safety and Quality in Health Care is currently evaluating the system for its potential to reduce errors relating to inadequate information transfer during clinical handover.

Implementation of Joint Multi-Segment Training

NASA Technical Reports Server (NTRS)

Reagan, Marc; Smith, Wyatt; Bugrova, Skella; Silkov, Sergei

2000-01-01

The highest level of training for ISS flight is Joint Multi-Segment Training (JMST) simulations. These simulations allow two or more partners to conduct multi-segment training for their respective Mission Control Centers (MCC), include actual crew members, and usually include training facilities in each of the participating International Partner (IP) locations. It is the dress rehearsal for those events that exercise the interface between different IP modules and/or the decision making process between the different MCCs involved. This presentation will describe the challenge of successfully implementing JMST. It will start with a brief overview of who is involved, where they are located, and when JMSTs are required. Finally, it will illustrate many of the complications involved in just running a JMST between MCC-M and MCC-H. The viewer will leave with a much better appreciation for the complexities involved in successfully conducting a JMST of this nature, as well as an idea of how the picture will change as the other partners and payloads become involved.

Short-term outcomes following implementation of a dedicated young adult congenital heart disease transition program.

PubMed

Vaikunth, Sumeet S; Williams, Roberta G; Uzunyan, Merujan Y; Tun, Han; Barton, Cheryl; Chang, Philip M

2018-01-01

Transition from pediatric to adult care is a critical time for patients with congenital heart disease. Lapses in care can lead to poor outcomes, including increased mortality. Formal transition clinics have been implemented to improve success of transferring care from pediatric to adult providers; however, data regarding outcomes remain limited. We sought to evaluate outcomes of transfer within a dedicated transition clinic for young adult patients with congenital heart disease. We performed a retrospective analysis of all 73 patients seen in a dedicated young adult congenital heart disease transition clinic from January 2012 to December 2015 within a single academic institution that delivered pediatric and adult care at separate children's and adult hospitals, respectively. Demographic characteristics including congenital heart disease severity, gender, age, presence of comorbidities, presence of cardiac implantable electronic devices, and type of insurance were correlated to success of transfer. Rate of successful transfer was evaluated, and multivariate analysis was performed to determine which demographic variables were favorably associated with transfer. Thirty-nine percent of patients successfully transferred from pediatric to adult services during the study period. Severe congenital heart disease (OR 4.44, 95% CI 1.25-15.79, P = .02) and presence of a cardiac implantable electronic device (OR 4.93, 95% CI 1.18-20.58, P = .03) correlated with transfer. Trends favoring successful transfer with presence of comorbidities and private insurance were also noted. Despite a dedicated transition clinic, successful transfer rates remained relatively low though comparable to previously published rates. Severity of disease and presence of implantable devices correlated with successful transfer. Other obstacles to transfer remain and require combined efforts from pediatric and adult care systems, insurance carriers, and policy makers to improve transfer outcomes. © 2017 Wiley Periodicals, Inc.

Electrical, Electronic, and Electromechanical (EEE) parts management and control requirements for NASA space flight programs

NASA Technical Reports Server (NTRS)

1989-01-01

This document establishes electrical, electronic, and electromechanical (EEE) parts management and control requirements for contractors providing and maintaining space flight and mission-essential or critical ground support equipment for NASA space flight programs. Although the text is worded 'the contractor shall,' the requirements are also to be used by NASA Headquarters and field installations for developing program/project parts management and control requirements for in-house and contracted efforts. This document places increased emphasis on parts programs to ensure that reliability and quality are considered through adequate consideration of the selection, control, and application of parts. It is the intent of this document to identify disciplines that can be implemented to obtain reliable parts which meet mission needs. The parts management and control requirements described in this document are to be selectively applied, based on equipment class and mission needs. Individual equipment needs should be evaluated to determine the extent to which each requirement should be implemented on a procurement. Utilization of this document does not preclude the usage of other documents. The entire process of developing and implementing requirements is referred to as 'tailoring' the program for a specific project. Some factors that should be considered in this tailoring process include program phase, equipment category and criticality, equipment complexity, and mission requirements. Parts management and control requirements advocated by this document directly support the concept of 'reliability by design' and are an integral part of system reliability and maintainability. Achieving the required availability and mission success objectives during operation depends on the attention given reliability and maintainability in the design phase. Consequently, it is intended that the requirements described in this document are consistent with those of NASA publications, 'Reliability Program Requirements for Aeronautical and Space System Contractors,' NHB 5300.4(1A-l); 'Maintainability Program Requirements for Space Systems,' NHB 5300.4(1E); and 'Quality Program Provisions for Aeronautical and Space System Contractors,' NHB 5300.4(1B).

Implementing team huddles in small rural hospitals: How does the Kotter model of change apply?

PubMed

Baloh, Jure; Zhu, Xi; Ward, Marcia M

2017-12-17

To examine how the process of change prescribed in Kotter's change model applies in implementing team huddles, and to assess the impact of the execution of early change phases on change success in later phases. Kotter's model can help to guide hospital leaders to implement change and potentially to improve success rates. However, the model is under studied, particularly in health care. We followed eight hospitals implementing team huddles for 2 years, interviewing the change teams quarterly to inquire about implementation progress. We assessed how the hospitals performed in the three overarching phases of the Kotter model, and examined whether performance in the initial phase influenced subsequent performance. In half of the hospitals, change processes were congruent with Kotter's model, where performance in the initial phase influenced their success in subsequent phases. In other hospitals, change processes were incongruent with the model, and their success depended on implementation scope and the strategies employed. We found mixed support for the Kotter model. It better fits implementation that aims to spread to multiple hospital units. When the scope is limited, changes can be successful even when steps are skipped. Kotter's model can be a useful guide for nurse managers implementing changes. © 2017 John Wiley & Sons Ltd.

Advanced Free Flight Planner and Dispatcher's Workstation: Preliminary Design Specification

NASA Technical Reports Server (NTRS)

Wilson, J.; Wright, C.; Couluris, G. J.

1997-01-01

The National Aeronautics and Space Administration (NASA) has implemented the Advanced Air Transportation Technology (AATT) program to investigate future improvements to the national and international air traffic management systems. This research, as part of the AATT program, developed preliminary design requirements for an advanced Airline Operations Control (AOC) dispatcher's workstation, with emphasis on flight planning. This design will support the implementation of an experimental workstation in NASA laboratories that would emulate AOC dispatch operations. The work developed an airline flight plan data base and specified requirements for: a computer tool for generation and evaluation of free flight, user preferred trajectories (UPT); the kernel of an advanced flight planning system to be incorporated into the UPT-generation tool; and an AOC workstation to house the UPT-generation tool and to provide a real-time testing environment. A prototype for the advanced flight plan optimization kernel was developed and demonstrated. The flight planner uses dynamic programming to search a four-dimensional wind and temperature grid to identify the optimal route, altitude and speed for successive segments of a flight. An iterative process is employed in which a series of trajectories are successively refined until the LTPT is identified. The flight planner is designed to function in the current operational environment as well as in free flight. The free flight environment would enable greater flexibility in UPT selection based on alleviation of current procedural constraints. The prototype also takes advantage of advanced computer processing capabilities to implement more powerful optimization routines than would be possible with older computer systems.

Critical factors in case management: practical lessons from a cardiac case management program.

PubMed

Stafford, Randall S; Berra, Kathy

2007-08-01

Case management (CM) is an important strategy for chronic disease care. By utilizing non-physician providers for conditions requiring ongoing care and follow-up, CM can facilitate guideline-concordant care, patient empowerment, and improvement in quality of life. We identify a series of critical factors required for successful CM implementation. Heart to Heart is a clinical trial evaluating CM for coronary heart disease (CHD) risk reduction in a multiethnic, low-income population. Patients at elevated cardiac risk were randomized to CM plus primary care (212 patients) or to primary care alone (207). Over a mean follow-up of 17 months, patients received face-to-face nurse and dietitian visits. Mean contact time was 14 hours provided at an estimated cost of $1250 per patient for the 341 (81%) patients completing follow-up. Visits emphasized behavior change, risk-factor monitoring, self-management skills, and guideline-based pharmacotherapy. A statistically significant reduction in mean Framingham risk probability occurred in CM plus primary care relative to primary care alone (1.6% decrease in 10-year CHD risk, p = 0.007). Favorable changes were noted across individual risk factors. Our findings suggest that successful CM implementation relies on choosing appropriate case managers and investing in training, integrating CM into existing care systems, delineating the scope and appropriate levels of clinical decision making, using information systems, and monitoring outcomes and costs. While our population, setting, and intervention model are unique, these insights are broadly relevant. If implemented with attention to critical factors, CM has great potential to improve the process and outcomes of chronic disease care.

An object-oriented, technology-adaptive information model

NASA Technical Reports Server (NTRS)

Anyiwo, Joshua C.

1995-01-01

The primary objective was to develop a computer information system for effectively presenting NASA's technologies to American industries, for appropriate commercialization. To this end a comprehensive information management model, applicable to a wide variety of situations, and immune to computer software/hardware technological gyrations, was developed. The model consists of four main elements: a DATA_STORE, a data PRODUCER/UPDATER_CLIENT and a data PRESENTATION_CLIENT, anchored to a central object-oriented SERVER engine. This server engine facilitates exchanges among the other model elements and safeguards the integrity of the DATA_STORE element. It is designed to support new technologies, as they become available, such as Object Linking and Embedding (OLE), on-demand audio-video data streaming with compression (such as is required for video conferencing), Worldwide Web (WWW) and other information services and browsing, fax-back data requests, presentation of information on CD-ROM, and regular in-house database management, regardless of the data model in place. The four components of this information model interact through a system of intelligent message agents which are customized to specific information exchange needs. This model is at the leading edge of modern information management models. It is independent of technological changes and can be implemented in a variety of ways to meet the specific needs of any communications situation. This summer a partial implementation of the model has been achieved. The structure of the DATA_STORE has been fully specified and successfully tested using Microsoft's FoxPro 2.6 database management system. Data PRODUCER/UPDATER and PRESENTATION architectures have been developed and also successfully implemented in FoxPro; and work has started on a full implementation of the SERVER engine. The model has also been successfully applied to a CD-ROM presentation of NASA's technologies in support of Langley Research Center's TAG efforts.

Implementing care programmes for frail older people: a project management perspective.

PubMed

Bindels, Jill; Cox, Karen; Abma, Tineke A; van Schayck, Onno C P; Widdershoven, Guy

2015-01-01

To examine the issues that influenced the implementation of programmes designed to identify and support frail older people in the community in the Netherlands. Qualitative research methods were used to investigate the perspectives of project leaders, project members and members of the steering committee responsible for the implementation of the programmes. Interviews were conducted in 2009 (n = 10) and in 2012 (n = 13) and a focus group was organised in 2012 (n = 5). The interviews revealed that the implementation was influenced by the extent and quality of collaboration between organisations, adaptation to existing structures, future funding for the programmes and project leadership. A good relationship between participating organisations and professionals is required for successful implementation. A lack of clear project leadership and structural funding hampers the implementation of complex programmes in primary care settings. The findings of this study are useful for organisations and professionals who are planning to implement complex programmes. Identifying barriers concerning institutional collaboration, adaptation to existing structures, leadership and continuation of financial support at an early stage of the implementation process can support practitioners in overcoming them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Evaluating the Implementation of Performance Improvement Training: The E[superscript 3] Process for Success

ERIC Educational Resources Information Center

Larbi-Apau, Josephine A.; Moseley, James L.

2008-01-01

This article provides a comprehensive approach to careful review and evaluation of the implementation of performance training intervention. It discusses the E[superscript 3] process for success, a basic framework for evaluating the implementation phase of a training program implemented as a broad-based performance improvement strategy. The intent…

How did we make the Interdisciplinary Generalist Curriculum Project work? School-level efforts to facilitate success.

PubMed

Matson, C; Davis, A; Steinkohl, D C; Blavo, C

2001-04-01

This article examines how the schools funded by the Interdisciplinary Generalist Curriculum (IGC) Project handled the process of planning and implementing their proposals; incorporated the IGC requirements as templates for changes in educational programs and organizational infrastructures; and identified key educational and management issues that emerged over time. How collaboration flourished at each IGC school was the central functional ingredient for successful implementation. Shared power and support from the dean were essential for success. The need for excellent channels of communication among all constituencies in the process of curricular change cannot be overemphasized. The most common approach was the addition of the new interdisciplinary clinical curriculum to the existing, usually discipline-based, curriculum, with attempts to establish integrative horizontal connections among concurrent courses in years one and two. The integration, sequencing, and correlating of basic science and clinical material occupied much of the IGC course directors' time in the early stages. Several approaches were used to help ensure a beneficial initial clinical experience for medical students, while accepting that a uniform experience for all students was not attainable or necessary. Encouraging active learning on the part of students was a goal of IGC schools' planning in and of itself. The splash of establishing interdisciplinary communication structures and greater melding of disciplinary cultures that occurred at and among the IGC schools appeared to lead to ripple effects that were recognized within the first year of planning and early implementation.

Touchscreen questionnaire patient data collection in rheumatology practice: development of a highly successful system using process redesign.

PubMed

Newman, Eric D; Lerch, Virginia; Jones, J B; Stewart, Walter

2012-04-01

While questionnaires have been developed to capture patient-reported outcomes (PROs) in rheumatology practice, these instruments are not widely used. We developed a touchscreen interface designed to provide reliable and efficient data collection. Using the touchscreen to obtain PROs, we compared 2 different workflow models implemented separately in 2 rheumatology clinics. The Plan-Do-Study-Act methodology was used in 2 cycles of workflow redesign. Cycle 1 relied on off-the-shelf questionnaire builder software, and cycle 2 relied on a custom programmed software solution. During cycle 1, clinic 1 (private practice model, resource replete, simple flow) demonstrated a high completion rate at the start, averaging between 74% and 92% for the first 12 weeks. Clinic 2 (academic model, resource deficient, complex flow) did not achieve a consistent completion rate above 60%. The revised cycle 2 implementation protocol incorporated a 15-minute "nurse visit," an instant messaging system, and a streamlined authentication process, all of which contributed to substantial improvement in touchscreen questionnaire completion rates of ∼80% that were sustained without the need for any additional clinic staff support. Process redesign techniques and touchscreen technology were used to develop a highly successful, efficient, and effective process for the routine collection of PROs in a busy, complex, and resource-depleted academic practice and in typical private practice. The successful implementation required both a touchscreen questionnaire, human behavioral redesign, and other technical solutions. Copyright © 2012 by the American College of Rheumatology.

Prevention of childhood obesity and food policies in Latin America: from research to practice.

PubMed

Pérez-Escamilla, R; Lutter, C K; Rabadan-Diehl, C; Rubinstein, A; Calvillo, A; Corvalán, C; Batis, C; Jacoby, E; Vorkoper, S; Kline, L; Ewart-Pierce, E; Rivera, J A

2017-07-01

Addressing childhood obesity in Latin America requires a package of multisectoral, evidence-based policies that enable environments conducive to healthy lifestyles. Identify and examine key elements to translating research into effective obesity policies in Latin America. We examined obesity prevention policies through case studies developed with an expert in the specific policy. Policies were selected based on their level of implementation, visibility and potential impact to reduce childhood obesity. They include: (i) excise taxes on sugar sweetened beverages and energy-dense foods; (ii) front-of-package food label legislation; (iii) trans fatty acids removal from processed foods; and (iv) Ciclovías recreativas or 'open streets'. Case studies were coded to identify components that explained successful implementation and sustainability using the Complex Adaptive Health Systems framework. The analysis identified key elements for effective and sustainable policy, including evidence justifying policy; evidence-based advocacy by civil society; political will; and legislation and skillful negotiations across government, academia, the private sector and civil society. Scientific evidence and evaluation played an important role in achieving tipping points for policies' launch and sustain effective implementation. Well-coordinated, intersectoral partnerships are needed to successfully implement evidence-based anti-obesity policies. Prospective policy research may be useful for advancing knowledge translation. © 2017 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity.

Successful implementation of a P&T-approved therapeutic interchange program of angiotensin II receptor blockers in a medical center in Taiwan.

PubMed

Lee, Yen-Ying; Hsiao, Paul; Lin, You-Meei; Yen, Yu-Hsuan; Chen, Hsiang-Yin

2012-01-01

Therapeutic interchange is not a common practice in the medical society in Asia. We used clinic blood pressure readings, patients' tolerance, and cost saving as measures to evaluate the impact of a therapeutic interchange program implemented at a medical center in Taiwan. Taipei Medical University-Wan Fang Hospital initiated a therapeutic interchange program involving angiotensin II receptor blockers (ARBs). Data were retrospectively collected for 444 outpatients who were converted from other ARBs to candesartan. Evaluation of therapeutic efficacy, adverse effects associated with therapy, and drug costs was conducted before and after the program implementation. Patients whose treatment was converted to candesartan experienced no statistically significant differences in blood pressure, and the average number of antihypertensive agents used per patient remained unchanged. A direct cost savings of US$62,237 was estimated for the 444 patients studied. Only 3.15% of the patients developed adverse drug reactions potentially related to candesartan, and none required hospitalization. Based on the results of this retrospective chart review, the present ARB therapeutic interchange program was successfully developed and implemented. This is the first study to establish the positive impact of a well-run ARB therapeutic interchange program in Taiwan. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A Systems Engineering Approach to Quality Assurance for Aerospace Testing

NASA Technical Reports Server (NTRS)

Shepherd, Christena C.

2014-01-01

On the surface, it appears that AS9100 has little to say about how to apply a Quality Management System (QMS) to major aerospace test programs (or even smaller ones). It also appears that there is little in the quality engineering Body of Knowledge (BOK) that applies to testing, unless it is nondestructive examination (NDE), or some type of lab or bench testing associated with the manufacturing process. However, if one examines: a) how the systems engineering (SE) processes are implemented throughout a test program; and b) how these SE processes can be mapped to the requirements of AS9100, a number of areas for involvement of the quality professional are revealed. What often happens is that quality assurance during a test program is limited to inspections of the test article; what could be considered a manufacturing al fresco approach. This limits the quality professional and is a disservice to the programs and projects, since there are a number of ways that quality can enhance critical processes, and support efforts to improve risk reduction, efficiency and effectiveness. The Systems Engineering (SE) discipline is widely used in aerospace to ensure the progress from Stakeholder Expectations (the President, Congress, the taxpayers) to a successful, delivered product or service. Although this is well known, what is not well known is that these same SE processes are implemented in varying complexity, to prepare for and implement test projects that support research, development, verification and validation, qualification, and acceptance test projects. Although the test organization's terminology may vary from the SE terminology, and from one test service provider to another, the basic process is followed by successful, reliable testing organizations. For this analysis, NASA Procedural Requirements (NPR) 7123.1, NASA Systems Engineering Processes and Requirements is used to illustrate the SE processes that are used for major aerospace testing. Many of these processes are also implemented for smaller test projects, and this set of processes will also look familiar to those who have participated in launch site activation and flight demonstrations.

Evidence-based practice implementation in community mental health settings: the relative importance of key domains of implementation activity.

PubMed

Torrey, William C; Bond, Gary R; McHugo, Gregory J; Swain, Karin

2012-09-01

Implementation research has examined practice prioritization, implementation leadership, workforce development, workflow re-engineering, and practice reinforcement, but not addressed their relative importance as implementation drivers. This study investigated domains of implementation activities and correlated them to implementation success during a large national evidence-based practice implementation project. Implementation success was correlated with active leadership strategically devoted to redesigning the flow of work and reinforcing implementation through measurement and feedback. Relative attention to workforce development was negatively correlated with implementation. Active leaders should focus on redesigning the flow of work to support the implementation and on reinforcing program improvements.

Fidelity versus flexibility: translating evidence-based research into practice.

PubMed

Cohen, Deborah J; Crabtree, Benjamin F; Etz, Rebecca S; Balasubramanian, Bijal A; Donahue, Katrina E; Leviton, Laura C; Clark, Elizabeth C; Isaacson, Nicole F; Stange, Kurt C; Green, Lawrence W

2008-11-01

Understanding the process by which research is translated into practice is limited. This study sought to examine how interventions change during implementation. Data were collected from July 2005 to September 2007. A real-time and cross-case comparison was conducted, examining ten interventions designed to improve health promotion in primary care practices in practice-based research networks. An iterative group process was used to analyze qualitative data (survey data, interviews, site visits, and project diary entries made by grantees approximately every 2 weeks) and to identify intervention adaptations reported during implementation. All interventions required changes as they were integrated into practice. Modifications differed by project and by practice, and were often unanticipated. Three broad categories of changes were identified and include modifications undertaken to accommodate practices' and patients' circumstances as well as personnel costs. In addition, research teams played a crucial role in fostering intervention uptake through their use of personal influence and by providing motivation, retraining, and instrumental assistance to practices. These efforts by the research teams, although rarely considered an essential component of the intervention, were an active ingredient in successful implementation and translation. Changes are common when interventions are implemented into practice settings. The translation of evidence into practice will be improved when research design and reporting standards are modified to help quality-improvement teams understand both these adaptations and the effort required to implement interventions in practice.

The meaning and measurement of implementation climate

PubMed Central

2011-01-01

Background Climate has a long history in organizational studies, but few theoretical models integrate the complex effects of climate during innovation implementation. In 1996, a theoretical model was proposed that organizations could develop a positive climate for implementation by making use of various policies and practices that promote organizational members' means, motives, and opportunities for innovation use. The model proposes that implementation climate--or the extent to which organizational members perceive that innovation use is expected, supported, and rewarded--is positively associated with implementation effectiveness. The implementation climate construct holds significant promise for advancing scientific knowledge about the organizational determinants of innovation implementation. However, the construct has not received sufficient scholarly attention, despite numerous citations in the scientific literature. In this article, we clarify the meaning of implementation climate, discuss several measurement issues, and propose guidelines for empirical study. Discussion Implementation climate differs from constructs such as organizational climate, culture, or context in two important respects: first, it has a strategic focus (implementation), and second, it is innovation-specific. Measuring implementation climate is challenging because the construct operates at the organizational level, but requires the collection of multi-dimensional perceptual data from many expected innovation users within an organization. In order to avoid problems with construct validity, assessments of within-group agreement of implementation climate measures must be carefully considered. Implementation climate implies a high degree of within-group agreement in climate perceptions. However, researchers might find it useful to distinguish implementation climate level (the average of implementation climate perceptions) from implementation climate strength (the variability of implementation climate perceptions). It is important to recognize that the implementation climate construct applies most readily to innovations that require collective, coordinated behavior change by many organizational members both for successful implementation and for realization of anticipated benefits. For innovations that do not possess these attributes, individual-level theories of behavior change could be more useful in explaining implementation effectiveness. Summary This construct has considerable value in implementation science, however, further debate and development is necessary to refine and distinguish the construct for empirical use. PMID:21781328

Options for sampling and stratification for national forest inventories to implement REDD+ under the UNFCCC

PubMed Central

2010-01-01

Background Developing countries that are willing to participate in the recently adopted (16th Session of the Conference of Parties (COP) in Cancun) mitigation mechanism of Reducing emissions from Deforestation and Forest Degradation - and the role of conservation, sustainable management of forests and enhancement of forest carbon stocks (REDD+) - will have to establish a national forest monitoring system in order to assess anthropogenic forest-related greenhouse gas emissions by sources and removals by sinks. Such a system should support the Measurement, Reporting and Verification (MRV) requirement of the United Nations Framework Convention on Climate Change (UNFCCC) as the REDD+ mechanism is results-based. A national forest inventory (NFI) is one potential key component of such an MRV system. Following the Decision adopted during the 15th Session of the COP in Copenhagen, the most recent Intergovernmental Panel on Climate Change (IPCC) Guidance and Guidelines should be used as a basis for estimating anthropogenic forest-related greenhouse gas emissions by sources and removals by sinks and changes in forest carbon stocks and area. Results First, we present the key indispensable elements of the IPCC Guidance and Guidelines that have been developed to fulfil the UNFCCC reporting requirements. This is done in order to set the framework to develop the MRV requirement in which a NFI for REDD+ implementation could be developed. Second, within this framework, we develop and propose a novel scheme for the stratification of forest land for REDD+. Finally, we present some non-exhaustive optional elements within this framework that a country could consider to successfully operationalise and implement its REDD+ NFI. Conclusion Evidently, both the methodological guidance and political decisions on REDD+ under the UNFCCC will continue to evolve. Even so, and considering that there exists decades of experience in setting up traditional NFIs, developing a NFI that a country may use to directly support REDD+ activities under the UNFCCC represents the development of a new challenge in this field. It is therefore important that both the scientific community and national implementing agencies acquaint themselves with both the context and content of this challenge so that REDD+ mitigation actions may be implemented successfully and with environmental integrity. This paper provides important contributions to the subject through our proposal of the stratification of forest land for REDD+. PMID:21187009

An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator

PubMed Central

2012-01-01

Background To investigate organisational factors influencing the implementation challenges of redesigning services for people with long term conditions in three locations in England, using remote care (telehealth and telecare). Methods Case-studies of three sites forming the UK Department of Health’s Whole Systems Demonstrator (WSD) Programme. Qualitative research techniques were used to obtain data from various sources, including semi-structured interviews, observation of meetings over the course programme and prior to its launch, and document review. Participants were managers and practitioners involved in the implementation of remote care services. Results The implementation of remote care was nested within a large pragmatic cluster randomised controlled trial (RCT), which formed a core element of the WSD programme. To produce robust benefits evidence, many aspect of the trial design could not be easily adapted to local circumstances. While remote care was successfully rolled-out, wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT. Conclusions The implementation of a complex innovation such as remote care requires it to organically evolve, be responsive and adaptable to the local health and social care system, driven by support from front-line staff and management. This need for evolution was not always aligned with the imperative to gather robust benefits evidence. This tension needs to be resolved if government ambitions for the evidence-based scaling-up of remote care are to be realised. PMID:23153014

Experiencing Health Advocacy During Cervical Cancer Awareness Week: A National Initiative for Obstetrics and Gynaecology Residents.

PubMed

Posner, Glenn; Finlayson, Sarah; Luna, Vilma; Miller, Dianne; Fung-Kee-Fung, Michael

2015-07-01

The Royal College of Physicians and Surgeons of Canada requires that residents demonstrate competence in health advocacy (HA). We sought to develop and implement a national educational module for obstetrics and gynaecology residents to address the role of HA. This pilot program was centred on cervical cancer prevention, which lends itself to applying the principles of advocacy. An educational module was developed and disseminated to all obstetrics and gynaecology residency programs in Canada. The module describes options for HA involving cervical dysplasia screening, such as an outreach clinic or a forum for public/student education, which were to be implemented during Cervical Cancer Awareness Week. The measures of success were the number of programs implementing the curriculum, number of residents who participated, diversity of projects implemented, individuals (patients or learners) reached by the program, and the overall experience of the trainees. Three programs implemented the curriculum in 2011, one in 2012, and seven in 2013. After three years, the module has involved seven of 16 medical schools, over 100 residents, and thousands of women either directly or indirectly. Additionally, attributes of HA experienced by the residents were identified: teamwork, leadership, increased systems knowledge, increased social capital within the community, creativity, innovation, and adaptability. We have demonstrated that an educational module can be implemented nationally, helping our residents fulfill their HA requirements. Other specialties could use this module in building HA into their own programs.

The Productive Ward: releasing Time to Care(™)--what we can learn from the literature for implementation.

PubMed

White, Mark; Wells, John Sg; Butterworth, Tony

2014-10-01

This paper reviews the Productive Ward: Releasing Time to Care™ literature, identifying and discussing the key characteristics that may contribute to successful implementation. It is 5 years since the official UK launch of the Productive Ward, and the Republic of Ireland commenced a phased, national implementation programme in 2011. Thus it is timely to reflect on the implementation lessons learned to date and described in the literature. Using taxonomic mapping, this paper evaluates the current state of the literature that pertains to Productive Ward implementation experience; success factors; reports, and assessments. Seven common contextual characteristics were identified: robust and engaging communication; enabling and empowering roles; appropriate training; project planning and management; leadership; corporate/management engagement and support; and financial and human resource commitment. The key characteristics identified have a direct impact on the implementation of the Productive Ward. The interplay between these key characteristics and how this interplay influences successful implementation of the Productive Ward warrants further research. Acknowledging and embracing the seven characteristics during implementation will positively improve the progress and success of the initiatives implementation. © 2013 John Wiley & Sons Ltd.

What determines successful implementation of inpatient information technology systems?

PubMed

Spetz, Joanne; Burgess, James F; Phibbs, Ciaran S

2012-03-01

To identify the factors and strategies that were associated with successful implementation of hospital-based information technology (IT) systems in US Department of Veterans Affairs (VA) hospitals, and how these might apply to other hospitals. Qualitative analysis of 118 interviews conducted at 7 VA hospitals. The study focused on the inpatient setting, where nurses are the main patient-care providers; thus, the research emphasized the impact of Computerized Patient Record System and Bar Code Medication Administration on nurses. Hospitals were selected to represent a range of IT implementation dates, facility sizes, and geography. The subjects included nurses, pharmacists, physicians, IT staff, and managers. Interviews were guided by a semi-structured interview protocol, and a thematic analysis was conducted, with initial codes drawn from the content of the interview guides. Additional themes were proposed as the coding was conducted. Five broad themes arose as factors which affected the process and success of implementation: (1) organizational stability and implementation team leadership, (2) implementation timelines, (3) equipment availability and reliability, (4) staff training, and (5) changes in work flow Overall IT implementation success in the VA depended on: (1) whether there was support for change from both leaders and staff, (2) development of a gradual and flexible implementation approach, (3) allocation of adequate resources for equipment and infrastructure, hands-on support, and deployment of additional staff, and (4) how the implementation team planned for setbacks, and continued the process to achieve success. Problems that developed in the early stages of implementation tended to become persistent, and poor implementation can lead to patient harm.

Atmospheric, Magnetospheric and Plasmas in Space (AMPS) spacelab payload definition study; volume 4: Part 2, Labcraft payload general specification

NASA Technical Reports Server (NTRS)

Keeley, J. T.

1976-01-01

The Labcraft Payload General Specification (LPGS) amplifies those general requirements in the Labcraft Program Specification (LPS) to ensure that all hardware, software, and STS elements will successfully function as an integrated system to accomplish the objectives of the first Labcraft mission. Contract End Item Specifications (CEIS) and Procurement Drawings (PDs) prepared and implemented for all deliverable hardware and software elements are discussed.

Specialty service contracting.

PubMed

Malcolm, C L; Fukui, M

1993-01-01

Package pricing of specific services and procedures can be an effective cost-containment and marketing tool for payers and providers. Payers can secure fixed prices at discounted rates, and hospitals and physicians can retain and gain market share in an increasingly competitive health care market. Successful implementation of a package pricing strategy, however, requires a careful assessment of both market and operational factors. This chapter outlines how to identify opportunities for package pricing and how to establish rates and procedures.

A Non-Conventional Interdiction Strategy for the Global War on Terror

DTIC Science & Technology

2007-06-01

thesis is to explore an alternative strategic focus for the Department of Defense to implement in the conduct of the Global War on Terrorism. Our...thesis is as follows: A non-conventional approach to strategic policy, led by an enhanced Foreign Internal Defense concept, and judicious execution of...been and continues to be limited by its conventional tactical successes, when what is required is strategic application of FID, UW, and limited

Modular Algorithm Testbed Suite (MATS): A Software Framework for Automatic Target Recognition

DTIC Science & Technology

2017-01-01

004 OFFICE OF NAVAL RESEARCH ATTN JASON STACK MINE WARFARE & OCEAN ENGINEERING PROGRAMS CODE 32, SUITE 1092 875 N RANDOLPH ST ARLINGTON VA 22203 ONR...naval mine countermeasures (MCM) operations by automating a large portion of the data analysis. Successful long-term implementation of ATR requires a...Modular Algorithm Testbed Suite; MATS; Mine Countermeasures Operations U U U SAR 24 Derek R. Kolacinski (850) 230-7218 THIS PAGE INTENTIONALLY LEFT

Securing your financial future.

PubMed

Kachalia, Parag R

2009-04-01

Securing one's financial future requires dedication and planning. A clear plan must be implemented and continually re-examined to assure an individual remains on track to achieve this security. True success of the plan will be dependent upon taking the appropriate steps to protecting one's assets against unfortunate events along with building assets with a clear end goal in mind. This article will cover the fundamental steps an individual can take to secure their financial future.

Automated Monitoring of Pipeline Rights-of-Way

NASA Technical Reports Server (NTRS)

Frost, Chard Ritchie

2010-01-01

NASA Ames Research Center and the Pipeline Research Council International, Inc. have partnered in the formation of a research program to identify and develop the key technologies required to enable automated detection of threats to gas and oil transmission and distribution pipelines. This presentation describes the Right-of-way Automated Monitoring (RAM) program and highlights research successes to date, continuing challenges to implementing the RAM objectives, and the program's ongoing work and plans.

Increasing reliability of Gauss-Kronrod quadrature by Eratosthenes' sieve method

NASA Astrophysics Data System (ADS)

Adam, Gh.; Adam, S.

2001-04-01

The reliability of the local error estimates returned by the Gauss-Kronrod quadrature rules can be raised up to the theoretical 100% rate of success, under error estimate sharpening, provided a number of natural validating conditions are required. The self-validating scheme of the local error estimates, which is easy to implement and adds little supplementary computing effort, strengthens considerably the correctness of the decisions within the automatic adaptive quadrature.