Supporting Learning from Illustrated Texts: Conceptualizing and Evaluating a Learning Strategy

ERIC Educational Resources Information Center

Schlag, Sabine; Ploetzner, Rolf

2011-01-01

Texts and pictures are often combined in order to improve learning. Many students, however, have difficulty to appropriately process text-picture combinations. We have thus conceptualized a learning strategy which supports learning from illustrated texts. By inducing the processes of information selection, organization, integration, and…

A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions

ERIC Educational Resources Information Center

Powell, Byron J.; Proctor, Enola K.; Glass, Joseph E.

2014-01-01

Objective: This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. Method: A literature…

Instructional Effects of a Performance Support System Designed to Guide Preservice Teachers in Developing Technology Integration Strategies

ERIC Educational Resources Information Center

Kalota, Faisal; Hung, Wei-Chen

2013-01-01

The purpose of this formative evaluation was to investigate the experiences of preservice teachers utilizing performance support system (PSS) technology to develop knowledge related to classroom technology integration. A PSS provides end users just-in-time support to perform various tasks. Because teachers have time constraints, a PSS can be used…

Decision support for the integrated restoration and protection strategy of the Forest Service, Northern Region

Treesearch

Keith Reynolds; Barry Bollenbacher; Chip Fisher; Melissa Hart; Mary Manning; Eric Henderson; Bruce Sims

2016-01-01

This report documents a decision-support process developed in the U.S. Department of Agriculture, Forest Service, Northern Region to assess management opportunities as part of an ecosystem-based approach to management that emphasizes ecological resilience. The decision-support system described in this work implements what is known as the Integrated Restoration and...

Integrating Collaborative and Decentralized Models to Support Ubiquitous Learning

ERIC Educational Resources Information Center

Barbosa, Jorge Luis Victória; Barbosa, Débora Nice Ferrari; Rigo, Sandro José; de Oliveira, Jezer Machado; Rabello, Solon Andrade, Jr.

2014-01-01

The application of ubiquitous technologies in the improvement of education strategies is called Ubiquitous Learning. This article proposes the integration between two models dedicated to support ubiquitous learning environments, called Global and CoolEdu. CoolEdu is a generic collaboration model for decentralized environments. Global is an…

The 1986/1987 Army Communications Objectives Measurement System. Supplementary Tabulations of Officer Markets

DTIC Science & Technology

1988-08-01

assessments of advertising strategy efficiencies; (3) management of the advertising program; and (4) planning and development of new marketing strategies and...fashion; (2) To support Army assessments of advertising strategy in an integrated framework; and (3) To support Army advertising management and planning for...Army attain its annual recruiting goals. A second set of goals for ACOMS involved the use of ACOMS data to assess the Army’s advertising strategy . ACOMS

Concerns of Teacher Education Methods Instructors and Strategies for Integrating Technology into Methods Courses

ERIC Educational Resources Information Center

Kim, Miri

2005-01-01

The goal of this dissertation is to clarify the perceptions and concerns that methods faculty at a university located in the Midwest have about integrating instructional technology into their courses along with their current use of technology. Ultimately, this study aims to generate strategies to support methods instructors in their efforts to…

Community College Academic Integrity Lessons That Put Research into Practice

ERIC Educational Resources Information Center

Bealle, Penny

2017-01-01

Academic integrity is an educational issue requiring an educational response from all stakeholders, including faculty, students, librarians, learning support staff, and administrators. This article posits that an educational response at Suffolk County Community College (SCCC) advances progress toward an integrated academic integrity strategy at…

Solving the Puzzle of Recruitment and Retention-Strategies for Building a Robust Clinical and Translational Research Workforce.

PubMed

Nearing, Kathryn A; Hunt, Cerise; Presley, Jessica H; Nuechterlein, Bridget M; Moss, Marc; Manson, Spero M

2015-10-01

This paper is the first in a five-part series on the clinical and translational science educational pipeline and presents strategies to support recruitment and retention to create diverse pathways into clinical and translational research (CTR). The strategies address multiple levels or contexts of persistence decisions and include: (1) creating a seamless pipeline by forming strategic partnerships to achieve continuity of support for scholars and collective impact; (2) providing meaningful research opportunities to support identity formation as a scientist and sustain motivation to pursue and persist in CTR careers; (3) fostering an environment for effective mentorship and peer support to promote academic and social integration; (4) advocating for institutional policies to alleviate environmental pull factors; and, (5) supporting program evaluation-particularly, the examination of longitudinal outcomes. By combining institutional policies that promote a culture and climate for diversity with quality, evidence-based programs and integrated networks of support, we can create the environment necessary for diverse scholars to progress successfully and efficiently through the pipeline to achieve National Institutes of Health's vision of a robust CTR workforce. © 2015 Wiley Periodicals, Inc.

How 3 rural safety net clinics integrate care for patients: a qualitative case study.

PubMed

Derrett, Sarah; Gunter, Kathryn E; Nocon, Robert S; Quinn, Michael T; Coleman, Katie; Daniel, Donna M; Wagner, Edward H; Chin, Marshall H

2014-11-01

Integrated care focuses on care coordination and patient centeredness. Integrated care supports continuity of care over time, with care that is coordinated within and between settings and is responsive to patients' needs. Currently, little is known about care integration for rural patients. To examine challenges to care integration in rural safety net clinics and strategies to address these challenges. Qualitative case study. Thirty-six providers and staff from 3 rural clinics in the Safety Net Medical Home Initiative. Interviews were analyzed using the framework method with themes organized within 3 constructs: Team Coordination and Empanelment, External Coordination and Partnerships, and Patient-centered and Community-centered Care. Participants described challenges common to safety net clinics, including limited access to specialists for Medicaid and uninsured patients, difficulty communicating with external providers, and payment models with limited support for care integration activities. Rurality compounded these challenges. Respondents reported benefits of empanelment and team-based care, and leveraged local resources to support care for patients. Rural clinics diversified roles within teams, shared responsibility for patient care, and colocated providers, as strategies to support care integration. Care integration was supported by 2 fundamental changes to organize and deliver care to patients-(1) empanelment with a designated group of patients being cared for by a provider; and (2) a multidisciplinary team able to address rural issues. New funding and organizational initiatives of the Affordable Care Act may help to further improve care integration, although additional solutions may be necessary to address particular needs of rural communities.

Promoting Social Relationships and Integration for Supported Employees in Work Settings.

ERIC Educational Resources Information Center

Chadsey, Janis G.; Shelden, Debra L.

This monograph discusses findings from a 3-year project that investigated strategies that could be used to promote the social integration and relationships between young adults with and without disabilities in supported employment settings. Four studies were conducted. The first study was a descriptive study that described the nature, development,…

Using the LOINC Semantic Structure to Integrate Community-based Survey Items into a Concept-based Enterprise Data Dictionary to Support Comparative Effectiveness Research.

PubMed

Co, Manuel C; Boden-Albala, Bernadette; Quarles, Leigh; Wilcox, Adam; Bakken, Suzanne

2012-01-01

In designing informatics infrastructure to support comparative effectiveness research (CER), it is necessary to implement approaches for integrating heterogeneous data sources such as clinical data typically stored in clinical data warehouses and those that are normally stored in separate research databases. One strategy to support this integration is the use of a concept-oriented data dictionary with a set of semantic terminology models. The aim of this paper is to illustrate the use of the semantic structure of Clinical LOINC (Logical Observation Identifiers, Names, and Codes) in integrating community-based survey items into the Medical Entities Dictionary (MED) to support the integration of survey data with clinical data for CER studies.

Software development environments: Status and trends

NASA Technical Reports Server (NTRS)

Duffel, Larry E.

1988-01-01

Currently software engineers are the essential integrating factors tying several components together. The components consist of process, methods, computers, tools, support environments, and software engineers. The engineers today empower the tools versus the tools empowering the engineers. Some of the issues in software engineering are quality, managing the software engineering process, and productivity. A strategy to accomplish this is to promote the evolution of software engineering from an ad hoc, labor intensive activity to a managed, technology supported discipline. This strategy may be implemented by putting the process under management control, adopting appropriate methods, inserting the technology that provides automated support for the process and methods, collecting automated tools into an integrated environment and educating the personnel.

Integrating mobile devices into nursing curricula: opportunities for implementation using Rogers' Diffusion of Innovation model.

PubMed

Doyle, Glynda J; Garrett, Bernie; Currie, Leanne M

2014-05-01

To identify studies reporting mobile device integration into undergraduate and graduate nursing curricula. To explore the potential use of Rogers' Diffusion of Innovation model as a framework to guide implementation of mobile devices into nursing curricula. Literature review and thematic categorization. Literature published up until June 2013 was searched using EBSCO, PubMed, and Google Scholar. The literature was reviewed for research articles pertaining to mobile device use in nursing education. Research articles were grouped by study design, and articles were classified by: 1) strategies for individual adopters and 2) strategies for organizations. Rogers' Diffusion of Innovation theory was used to categorize reported implementation strategies. Fifty-two research studies were identified. Strategies for implementation were varied, and challenges to integrating mobile devices include lack of administrative support and time/funding to educate faculty as well as students. Overall, the use of mobile devices appears to provide benefits to nursing students; however the research evidence is limited. Anticipating challenges and ensuring a well laid out strategic plan can assist in supporting successful integration of mobile devices. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Patient Segmentation Analysis Offers Significant Benefits For Integrated Care And Support.

PubMed

Vuik, Sabine I; Mayer, Erik K; Darzi, Ara

2016-05-01

Integrated care aims to organize care around the patient instead of the provider. It is therefore crucial to understand differences across patients and their needs. Segmentation analysis that uses big data can help divide a patient population into distinct groups, which can then be targeted with care models and intervention programs tailored to their needs. In this article we explore the potential applications of patient segmentation in integrated care. We propose a framework for population strategies in integrated care-whole populations, subpopulations, and high-risk populations-and show how patient segmentation can support these strategies. Through international case examples, we illustrate practical considerations such as choosing a segmentation logic, accessing data, and tailoring care models. Important issues for policy makers to consider are trade-offs between simplicity and precision, trade-offs between customized and off-the-shelf solutions, and the availability of linked data sets. We conclude that segmentation can provide many benefits to integrated care, and we encourage policy makers to support its use. Project HOPE—The People-to-People Health Foundation, Inc.

A Case Study of a Program for University STEM Faculty to Redesign Courses Using Technology

ERIC Educational Resources Information Center

Bernal, Elaine V.

2016-01-01

The purpose of this case study was to evaluate a multi-campus university program designed to support STEM faculty in redesigning bottleneck courses, with integration of technology as one strategy. Despite the positive student learning outcomes in course redesign programs with an aim to support faculty in technology integration, there remains a…

Technology Integration through Professional Learning Community

ERIC Educational Resources Information Center

Cifuentes, Lauren; Maxwell, Gerri; Bulu, Sanser

2011-01-01

We describe efforts to build a learning community to support technology integration in three rural school districts and the contributions of various program strategies toward teacher growth. The Stages of Adoption Inventory, classroom observations, the Questionnaire for Technology Integration, interviews, STAR evaluation surveys, a survey of…

A clinical information systems strategy for a large integrated delivery network.

PubMed Central

Kuperman, G. J.; Spurr, C.; Flammini, S.; Bates, D.; Glaser, J.

2000-01-01

Integrated delivery networks (IDNs) are an emerging class of health care institutions. IDNs are formed from the affiliation of individual health care institutions and are intended to be more efficient in the current fiscal health care environment. To realize efficiencies and support their strategic visions, IDNs rely critically on excellent information technology (IT). Because of its importance to the mission of the IDN, strategic decisions about IT are made by the top leadership of the IDN. At Partners HealthCare System, a large IDN in Boston, MA, a clinical information systems strategy has been created to support the Partners clinical vision. In this paper, we discuss the Partners' structure, clinical vision, and current IT initiatives in place to address the clinical vision. The initiatives are: a clinical data repository, inpatient process support, electronic medical records, a portal strategy, referral applications, knowledge resources, support for product lines, patient computing, confidentiality, and clinical decision support. We address several of the issues encountered in trying to bring excellent information technology to a large IDN. PMID:11079921

The implications of e-health system delivery strategies for integrated healthcare: lessons from England.

PubMed

Eason, Ken; Waterson, Patrick

2013-05-01

This paper explores the implications that different technical strategies for sharing patient information have for healthcare workers and, as a consequence, for the extent to which these systems provide support for integrated care. Four technical strategies were identified and the forms of coupling they made with healthcare agencies were classified. A study was conducted in England to examine the human and organizational implications of systems implemented by these four strategies. Results were used from evaluation reports of two systems delivered as part of the NPfIT (National Programme for Information Technology) and from user responses to systems delivered in two local health communities in England. In the latter study 40 clinical respondents reported the use of systems to support integrated care in six healthcare pathways. The implementation of a detailed care record system (DCRS) in the NPfIT was problematic because it could not meet the diverse needs of all healthcare agencies and it required considerable local customization. The programme evolved to allow different systems to be delivered for each local health community. A national Summary Care Record (SCR) was implemented but many concerns were raised about wide access to confidential patient information. The two technical strategies that required looser forms of coupling and were under local control led to wide user adoption. The systems that enabled data to be transferred between local systems were successfully used to support integrated care in specific healthcare pathways. The portal approach gave many users an opportunity to view patient data held on a number of databases and this system evolved over a number of years as a result of requests from the user community. The UK national strategy to deliver single shared database systems requires tight coupling between many users and has led to poor adoption because of the diverse needs of healthcare agencies. Sharing patient information has been more successful when local systems have been developed to serve particular healthcare pathways or when separate databases are viewable through a portal. On the basis of this evidence technical strategies that permit the local design of tight coupling are necessary if information systems are to support integrated care in healthcare pathways. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A transdisciplinary approach for supporting the integration of ecosystem services into land and water management

NASA Astrophysics Data System (ADS)

Fatt Siew, Tuck; Döll, Petra

2015-04-01

Transdisciplinary approaches are useful for supporting integrated land and water management. However, the implementation of the approach in practice to facilitate the co-production of useable socio-hydrological (and -ecological) knowledge among scientists and stakeholders is challenging. It requires appropriate methods to bring individuals with diverse interests and needs together and to integrate their knowledge for generating shared perspectives/understanding, identifying common goals, and developing actionable management strategies. The approach and the methods need, particularly, to be adapted to the local political and socio-cultural conditions. To demonstrate how knowledge co-production and integration can be done in practice, we present a transdisciplinary approach which has been implemented and adapted for supporting land and water management that takes ecosystem services into account in an arid region in northwestern China. Our approach comprises three steps: (1) stakeholder analysis and interdisciplinary knowledge integration, (2) elicitation of perspectives of scientists and stakeholders, scenario development, and identification of management strategies, and (3) evaluation of knowledge integration and social learning. Our adapted approach has enabled interdisciplinary and cross-sectoral communication among scientists and stakeholders. Furthermore, the application of a combination of participatory methods, including actor modeling, Bayesian Network modeling, and participatory scenario development, has contributed to the integration of system, target, and transformation knowledge of involved stakeholders. The realization of identified management strategies is unknown because other important and representative decision makers have not been involved in the transdisciplinary research process. The contribution of our transdisciplinary approach to social learning still needs to be assessed.

Using the LOINC Semantic Structure to Integrate Community-based Survey Items into a Concept-based Enterprise Data Dictionary to Support Comparative Effectiveness Research

PubMed Central

Co, Manuel C.; Boden-Albala, Bernadette; Quarles, Leigh; Wilcox, Adam; Bakken, Suzanne

2012-01-01

In designing informatics infrastructure to support comparative effectiveness research (CER), it is necessary to implement approaches for integrating heterogeneous data sources such as clinical data typically stored in clinical data warehouses and those that are normally stored in separate research databases. One strategy to support this integration is the use of a concept-oriented data dictionary with a set of semantic terminology models. The aim of this paper is to illustrate the use of the semantic structure of Clinical LOINC (Logical Observation Identifiers, Names, and Codes) in integrating community-based survey items into the Medical Entities Dictionary (MED) to support the integration of survey data with clinical data for CER studies. PMID:24199059

Promotion of family integrity in the acute care setting: a review of the literature.

PubMed

Van Horn, Elizabeth R; Kautz, Donald

2007-01-01

The acute illness of 1 family member can then negatively affect all family members and lead to the disruption of family functioning and integrity. During the patient's hospitalization, nurses are in a key position to support family members, maintain family integrity, and ready them for assuming the role of caretaker during the patient's recovery and management of health at home. This article reviews current research findings that provide empirical support for activities that promote family integrity. Strategies for nurses to support family members during the hospitalization of an adult family member and suggestions for future research are provided.

Strategies for Validation Testing of Ground Systems

NASA Technical Reports Server (NTRS)

Annis, Tammy; Sowards, Stephanie

2009-01-01

In order to accomplish the full Vision for Space Exploration announced by former President George W. Bush in 2004, NASA will have to develop a new space transportation system and supporting infrastructure. The main portion of this supporting infrastructure will reside at the Kennedy Space Center (KSC) in Florida and will either be newly developed or a modification of existing vehicle processing and launch facilities, including Ground Support Equipment (GSE). This type of large-scale launch site development is unprecedented since the time of the Apollo Program. In order to accomplish this successfully within the limited budget and schedule constraints a combination of traditional and innovative strategies for Verification and Validation (V&V) have been developed. The core of these strategies consists of a building-block approach to V&V, starting with component V&V and ending with a comprehensive end-to-end validation test of the complete launch site, called a Ground Element Integration Test (GEIT). This paper will outline these strategies and provide the high level planning for meeting the challenges of implementing V&V on a large-scale development program. KEY WORDS: Systems, Elements, Subsystem, Integration Test, Ground Systems, Ground Support Equipment, Component, End Item, Test and Verification Requirements (TVR), Verification Requirements (VR)

De-escalating Antibiotic Use in the Inpatient Setting: Strategies, Controversies, and Challenges.

PubMed

Daniel Markley, J; Bernard, Shaina; Bearman, Gonzalo; Stevens, Michael P

2017-04-01

Antibiotic de-escalation (ADE) is widely accepted as an integral strategy to curtail the global antibiotic resistance crisis. However, there is significant uncertainty regarding the ideal ADE strategy and its true impact on antibiotic resistance. Rapid diagnostic testing has the potential to enhance ADE strategies. Herein, we aim to discuss the current strategies, controversies, and challenges of ADE in the inpatient setting. A consensus definition of ADE remains elusive at this time. Preliminary studies utilizing rapid diagnostic tests including matrix-assisted laser desorption/ionization time of flight (MALDI-TOF), procalcitonin, and other molecular techniques have demonstrated the potential to support ADE strategies. In the absence of evidence-based, highly specific ADE protocols, the likelihood that individual providers will make consistent, often challenging, decisions to de-escalate antibiotic therapy is low. Antimicrobial stewardship programs should support local physicians with ADE and develop innovative ways to integrate ADE into the broader construct of antimicrobial stewardship programs. The evolving field of rapid diagnostics has significant potential to improve ADE strategies, but more research is needed to fully realize this goal.

Stakeholder engagement: a key component of integrating genomic information into electronic health records

PubMed Central

Hartzler, Andrea; McCarty, Catherine A.; Rasmussen, Luke V.; Williams, Marc S.; Brilliant, Murray; Bowton, Erica A.; Clayton, Ellen Wright; Faucett, William A.; Ferryman, Kadija; Field, Julie R.; Fullerton, Stephanie M.; Horowitz, Carol R.; Koenig, Barbara A.; McCormick, Jennifer B.; Ralston, James D.; Sanderson, Saskia C.; Smith, Maureen E.; Trinidad, Susan Brown

2014-01-01

Integrating genomic information into clinical care and the electronic health record can facilitate personalized medicine through genetically guided clinical decision support. Stakeholder involvement is critical to the success of these implementation efforts. Prior work on implementation of clinical information systems provides broad guidance to inform effective engagement strategies. We add to this evidence-based recommendations that are specific to issues at the intersection of genomics and the electronic health record. We describe stakeholder engagement strategies employed by the Electronic Medical Records and Genomics Network, a national consortium of US research institutions funded by the National Human Genome Research Institute to develop, disseminate, and apply approaches that combine genomic and electronic health record data. Through select examples drawn from sites of the Electronic Medical Records and Genomics Network, we illustrate a continuum of engagement strategies to inform genomic integration into commercial and homegrown electronic health records across a range of health-care settings. We frame engagement as activities to consult, involve, and partner with key stakeholder groups throughout specific phases of health information technology implementation. Our aim is to provide insights into engagement strategies to guide genomic integration based on our unique network experiences and lessons learned within the broader context of implementation research in biomedical informatics. On the basis of our collective experience, we describe key stakeholder practices, challenges, and considerations for successful genomic integration to support personalized medicine. PMID:24030437

The effective integration of analysis, modeling, and simulation tools.

DOT National Transportation Integrated Search

2013-08-01

The need for model integration arises from the recognition that both transportation decisionmaking and the tools supporting it continue to increase in complexity. Many strategies that agencies evaluate require using tools that are sensitive to supply...

Effectiveness of Integration and Re-Integration into Work Strategies for Persons with Chronic Conditions: A Systematic Review of European Strategies

PubMed Central

Ito, Elizabeth; Scaratti, Chiara; Vlachou, Anastasia; Stavroussi, Panayiota; Brecelj, Valentina; Kovačič, Dare S.

2018-01-01

Due to low employment rates associated to chronic conditions in Europe, it is essential to foster effective integration and re-integration into work strategies. The objective of this systematic review is to summarize the evidence on the effectiveness of strategies for integration and re-integration to work for persons with chronic diseases or with musculoskeletal disorders, implemented in Europe in the past five years. A systematic search was conducted in MedLine, PsycINFO, CDR-HTA, CDR-DARE and Cochrane Systematic Reviews. Overall, 32 relevant publications were identified. Of these, 21 were considered eligible after a methodological assessment and included. Positive changes in employment status, return to work and sick leave outcomes were achieved with graded sickness-absence certificates, part-time sick leave, early ergonomic interventions for back pain, disability evaluation followed by information and advice, and with multidisciplinary, coordinated and tailored return to work interventions. Additionally, a positive association between the co-existence of active labour market policies to promote employment and passive support measures (e.g., pensions or benefits) and the probability of finding a job was observed. Research on the evaluation of the effectiveness of strategies targeting integration and re-integration into work for persons with chronic health conditions needs, however, to be improved and strengthened. PMID:29562715

A qualitative evaluation of a physician-delivered pedometer-based step count prescription strategy with insight from participants and treating physicians.

PubMed

Cooke, Alexandra B; Pace, Romina; Chan, Deborah; Rosenberg, Ellen; Dasgupta, Kaberi; Daskalopoulou, Stella S

2018-05-01

The integration of pedometers into clinical practice has the potential to enhance physical activity levels in patients with chronic disease. Our SMARTER randomized controlled trial demonstrated that a physician-delivered step count prescription strategy has measurable effects on daily steps, glycemic control, and insulin resistance in patients with type 2 diabetes and/or hypertension. In this study, we aimed to understand perceived barriers and facilitators influencing successful uptake and sustainability of the strategy, from patient and physician perspectives. Qualitative in-depth interviews were conducted in a purposive sample of physicians (n = 10) and participants (n = 20), including successful and less successful cases in terms of pedometer-assessed step count improvements. Themes that achieved saturation in either group through thematic analysis are presented. All participants appreciated the pedometer-based monitoring combined with step count prescriptions. Accountability to physicians and support offered by the trial coordinator influenced participant motivation. Those who increased step counts adopted strategies to integrate more steps into their routines and were able to overcome weather-related barriers by finding indoor alternative options to outdoor steps. Those who decreased step counts reported difficulty in overcoming weather-related challenges, health limitations and work constraints. Physicians indicated the strategy provided a framework for discussing physical activity and motivating patients, but emphasized the need for support from allied professionals to help deliver the strategy in busy clinical settings. A physician-delivered step count prescription strategy was feasibly integrated into clinical practice and successful in engaging most patients; however, continual support is needed for maximal engagement and sustained use. Copyright © 2018 Elsevier B.V. All rights reserved.

Collaboration process for integrated social and health care strategy implementation.

PubMed

Korpela, Jukka; Elfvengren, Kalle; Kaarna, Tanja; Tepponen, Merja; Tuominen, Markku

2012-01-01

To present a collaboration process for creating a roadmap for the implementation of a strategy for integrated health and social care. The developed collaboration process includes multiple phases and uses electronic group decision support system technology (GDSS). A case study done in the South Karelia District of Social and Health Services in Finland during 2010-2011. An expert panel of 13 participants was used in the planning process of the strategy implementation. The participants were interviewed and observed during the case study. As a practical result, a roadmap for integrated health and social care strategy implementation has been developed. The strategic roadmap includes detailed plans of several projects which are needed for successful integration strategy implementation. As an academic result, a collaboration process to create such a roadmap has been developed. The collaboration process and technology seem to suit the planning process well. The participants of the meetings were satisfied with the collaboration process and the GDSS technology. The strategic roadmap was accepted by the participants, which indicates satisfaction with the developed process.

Planner-Based Control of Advanced Life Support Systems

NASA Technical Reports Server (NTRS)

Muscettola, Nicola; Kortenkamp, David; Fry, Chuck; Bell, Scott

2005-01-01

The paper describes an approach to the integration of qualitative and quantitative modeling techniques for advanced life support (ALS) systems. Developing reliable control strategies that scale up to fully integrated life support systems requires augmenting quantitative models and control algorithms with the abstractions provided by qualitative, symbolic models and their associated high-level control strategies. This will allow for effective management of the combinatorics due to the integration of a large number of ALS subsystems. By focusing control actions at different levels of detail and reactivity we can use faster: simpler responses at the lowest level and predictive but complex responses at the higher levels of abstraction. In particular, methods from model-based planning and scheduling can provide effective resource management over long time periods. We describe reference implementation of an advanced control system using the IDEA control architecture developed at NASA Ames Research Center. IDEA uses planning/scheduling as the sole reasoning method for predictive and reactive closed loop control. We describe preliminary experiments in planner-based control of ALS carried out on an integrated ALS simulation developed at NASA Johnson Space Center.

Prospects for Developing L2 Students' Effective Use of Vocabulary Learning-Strategies via Web-Based Training

ERIC Educational Resources Information Center

Ranalli, Jim

2009-01-01

A large body of research supports the efficacy of learning strategies employed in the acquisition of second language vocabulary. However, research also indicates that many such strategies are underused or misused by learners and, further, that any effort to integrate learner training in the use of such strategies into classroom instruction faces a…

Supporting Positive Behaviour in Alberta Schools: A School-Wide Approach

ERIC Educational Resources Information Center

Mackenzie, Nancy

2008-01-01

Drawing on current research and best practices, this three-part resource, "Supporting Positive Behaviour in Alberta Schools," provides information, strategies, stories from schools and sample tools for systematically teaching, supporting and reinforcing positive behaviour. This integrated system of school-wide, classroom management, and…

Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice

PubMed Central

2015-01-01

A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health. PMID:26474761

Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles.

PubMed

Fleury, Marie-Josée; Grenier, Guy; Vallée, Catherine; Aubé, Denise; Farand, Lambert

2017-03-10

This study evaluates implementation of the Quebec Mental Health Reform (2005-2015), which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered. Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1) reform characteristics; 2) implementation context; 3) organizational characteristics; and 4) integration strategies. While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions. Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.

Integrative Medicine and Mood, Emotions and Mental Health.

PubMed

Shah, Anuj K; Becicka, Roman; Talen, Mary R; Edberg, Deborah; Namboodiri, Sreela

2017-06-01

An integrative approach to individuals with mood, emotional or mental health concerns involves a comprehensive model of care that is person-centered. Integrative medicine builds on a patient's personal meaning and goals (spiritual aspects) and includes herbal therapies, nutritional support, movement and physical manipulative therapies, mindfulness, relaxation strategies, and psychotherapies. Published by Elsevier Inc.

Building an Evaluation Strategy for an Integrated Curriculum in Chemical Engineering

ERIC Educational Resources Information Center

McCarthy, Joseph J.; Parker, Robert S.; Abatan, Adetola; Besterfield-Sacre, Mary

2011-01-01

Increasing knowledge integration has gained wide-spread support as an important goal in engineering education. The Chemical Engineering Pillars curriculum at the University of Pittsburgh, unique for its use of block scheduling, is one of the first four-year, integrated curricula in engineering, and is specifically designed to facilitate knowledge…

Office of Space Science: Integrated technology strategy

NASA Technical Reports Server (NTRS)

Huntress, Wesley T., Jr.; Reck, Gregory M.

1994-01-01

This document outlines the strategy by which the Office of Space Science, in collaboration with the Office of Advanced Concepts and Technology and the Office of Space Communications, will meet the challenge of the national technology thrust. The document: highlights the legislative framework within which OSS must operate; evaluates the relationship between OSS and its principal stakeholders; outlines a vision of a successful OSS integrated technology strategy; establishes four goals in support of this vision; provides an assessment of how OSS is currently positioned to respond to the goals; formulates strategic objectives to meet the goals; introduces policies for implementing the strategy; and identifies metrics for measuring success. The OSS Integrated Technology Strategy establishes the framework through which OSS will satisfy stakeholder expectations by teaming with partners in NASA and industry to develop the critical technologies required to: enhance space exploration, expand our knowledge of the universe, and ensure continued national scientific, technical and economic leadership.

Mental Health Collaborative Care and Its Role in Primary Care Settings

PubMed Central

Goodrich, David E.; Kilbourne, Amy M.; Nord, Kristina M.; Bauer, Mark S.

2013-01-01

Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims under healthcare reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components. PMID:23881714

Mental health collaborative care and its role in primary care settings.

PubMed

Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S

2013-08-01

Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.

Credit with Education: A Promising Title II Microfinance Strategy--Supporting Integrated Food Security and Nutrition Programs To Improve Health and Well-Being of Women and Children). Food and Nutrition Technical Assistance.

ERIC Educational Resources Information Center

Dunford, Christopher; Denman, Vicki

This paper introduces the reader to microfinance integrated with health and nutrition education as a promising strategy for Title II practitioners. The paper provides an overview of how microfinance, particularly village banking, can contribute to the food-security objectives of Title II. It describes a variant of village banking, called…

Integrated corridor management analysis, modeling, and simulation results for the test corridor.

DOT National Transportation Integrated Search

2008-06-01

This report documents the Integrated Corridor Management (ICM) Analysis Modeling and Simulation (AMS) tools and strategies used on a Test Corridor, presents results and lessons-learned, and documents the relative capability of AMS to support benefit-...

Providing Feasible Implementation Support: Direct Training and Implementation Planning in Consultation

ERIC Educational Resources Information Center

Collier-Meek, Melissa A.; Sanetti, Lisa M. H.; Boyle, Ashley M.

2016-01-01

To deliver interventions completely and consistently (i.e., with adequate treatment integrity) and, thus, have a positive impact on student outcomes, implementers, such as teachers and paraprofessionals, often require support. To efficiently deliver implementation support, school psychologists could embed research-based strategies into their…

Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme

PubMed Central

Perreault, Michel; Grenier, Guy; Imboua, Armelle; Brochu, Serge

2016-01-01

Background: Fragmentation and lack of coordination often occur among organisations offering treatment for individuals with substance-use disorders. Better integration from a system perspective within a network of organisations offering substance-use disorder services can be developed using various integration strategies at the administrative and clinical levels. This study aims to identify integration strategies implemented in Quebec substance-use disorder networks and to assess their strengths and limitations. Methods: A total of 105 stakeholders representing two regions and four local substance-use disorder networks participated in focus groups or individual interviews. Thematic qualitative and descriptive quantitative analyses were conducted. Results: Six types of service integration strategies have been implemented to varying degrees in substance-use disorder networks. They are: 1) coordination activities-governance, 2) primary-care consolidation models, 3) information and monitoring management tools, 4) service coordination strategies, 5) clinical evaluation tools and 6) training activities. Conclusion: Important investments have been made in Quebec for the training and assessment of individuals with substance-use disorders, particularly in terms of support for emergency room liaison teams and the introduction of standardised clinical evaluation tools. However, the development of integration strategies was insufficient to ensure the implementation of successful networks. Planning, consolidation of primary care for substance-use disorders and systematic implementation of various clinical and administrative integration strategies are needed in order to ensure a better continuum of care for individuals with substance-use disorders. PMID:27616951

A framework for developing and integrating effective routing strategies within the emergency management decision-support system.

DOT National Transportation Integrated Search

2012-05-01

This report describes the modeling, calibration, and validation of a VISSIM traffic-flow simulation of the San Jos, California, downtown network and examines various evacuation scenarios and first-responder routings to assess strategies that would ...

Anti-Drug Abuse Strategy Report. State of New York. 1990 Update.

ERIC Educational Resources Information Center

New York Governor's Office, Albany. Statewide Anti-Drug Abuse Council.

This annual report from the Statewide Anti-Drug Abuse Council of New York proposes strategies for the coming year. Ongoing support for the state and local law enforcement efforts is reaffirmed as a vital component of the strategy. The council promotes a strengthening of their commitment and focus on severely impacted populations, integration of…

Development the conceptual design of Knowledge Based System for Integrated Maintenance Strategy and Operation

NASA Astrophysics Data System (ADS)

Milana; Khan, M. K.; Munive, J. E.

2014-07-01

The importance of maintenance has escalated significantly by the increasing of automation in manufacturing process. This condition switches traditional maintenance perspective of inevitable cost into the business competitive driver. Consequently, maintenance strategy and operation decision needs to be synchronized to business and manufacturing concerns. This paper shows the development of conceptual design of Knowledge Based System for Integrated Maintenance Strategy and Operation (KBIMSO). The framework of KBIMSO is elaborated to show the process of how the KBIMSO works to reach the maintenance decision. By considering the multi-criteria of maintenance decision making, the KB system embedded with GAP and AHP to support integrated maintenance strategy and operation which is novel in this area. The KBIMSO is useful to review the existing maintenance system and give reasonable recommendation of maintenance decisions in respect to business and manufacturing perspective.

The eXtensible ontology development (XOD) principles and tool implementation to support ontology interoperability.

PubMed

He, Yongqun; Xiang, Zuoshuang; Zheng, Jie; Lin, Yu; Overton, James A; Ong, Edison

2018-01-12

Ontologies are critical to data/metadata and knowledge standardization, sharing, and analysis. With hundreds of biological and biomedical ontologies developed, it has become critical to ensure ontology interoperability and the usage of interoperable ontologies for standardized data representation and integration. The suite of web-based Ontoanimal tools (e.g., Ontofox, Ontorat, and Ontobee) support different aspects of extensible ontology development. By summarizing the common features of Ontoanimal and other similar tools, we identified and proposed an "eXtensible Ontology Development" (XOD) strategy and its associated four principles. These XOD principles reuse existing terms and semantic relations from reliable ontologies, develop and apply well-established ontology design patterns (ODPs), and involve community efforts to support new ontology development, promoting standardized and interoperable data and knowledge representation and integration. The adoption of the XOD strategy, together with robust XOD tool development, will greatly support ontology interoperability and robust ontology applications to support data to be Findable, Accessible, Interoperable and Reusable (i.e., FAIR).

Conceptualising Institutional Support for Early, Mid, and Later Career Teachers

ERIC Educational Resources Information Center

Fraser, Kym; Greenfield, Rosie; Pancini, Geri

2017-01-01

In this paper we argue that institutions need to support early career teachers to learn to teach in much the same way that students who are new to higher education are supported: through integrated and intentionally designed transition strategies. We take a published student transition typology and adapt it to identify ways of supporting early…

User's Guide for SeedCalc: A Decision-Support System for Integrated Pest Management in Slash Pine Seed Orchards

Treesearch

Carl W. Fatzinger; Wayne N. Dixon

1996-01-01

SeedCalc, a decision-support system designed for use on personal computers, evaluates the consequences of different pest management strategies in slash pine (Pinus ellliottii Engelm. var. elliottii) seed orchards.

Integrated Watershed Management using the Watershed Management Optimization Support Tool (WMOST)

EPA Science Inventory

Integrated watershed management is an effective planning strategy to balance tradeoffs between competing water uses within a watershed. WMOST is an Excel-based decision tool to aid planners in making cost effective decisions that meet water quantity and quality regulations. WMOST...

What is the role of health education in the integrated strategy to control transmission of Schistosoma japonicum in China?

PubMed

Liu, Rong; Dong, Hui-Fen; Jiang, Ming-Sen

2012-05-01

In 2009, Wang et al.'s field trial published in the New England Journal of Medicine, reported that a comprehensive strategy aiming to reduce the roles of humans and cattle as sources of Schistosoma japonicum infection in snails was implemented and proved effective and promising in dramatically reducing the percentage of infected humans and snails, which had been extended to other endemic provinces in China afterwards. This implies that the integrated schistosomiasis-control strategies of interventions including political will, financial support and residents' participation to control human and bovine sources of S. japonicum infection in snails may direct to successfully interrupt the parasitic transmission and to ultimately eliminate schistosomiasis. Confusingly, however, the role of health education, which is a critical part of the integrated strategy and should play an active role in schistosomiasis control, was not reflected. We wish the authors to provide the readers a better and clearer statement of the role of health education as part of the integrated control strategy and so we write this comment.

Risk Management for the International Space Station

NASA Technical Reports Server (NTRS)

Sebastian, J.; Brezovic, Philip

2002-01-01

The International Space Station (ISS) is an extremely complex system, both technically and programmatically. The Space Station must support a wide range of payloads and missions. It must be launched in numerous launch packages and be safely assembled and operated in the harsh environment of space. It is being designed and manufactured by many organizations, including the prime contractor, Boeing, the NASA institutions, and international partners and their contractors. Finally, the ISS has multiple customers, (e.g., the Administration, Congress, users, public, international partners, etc.) with contrasting needs and constraints. It is the ISS Risk Management Office strategy to proactively and systematically manages risks to help ensure ISS Program success. ISS program follows integrated risk management process (both quantitative and qualitative) and is integrated into ISS project management. The process and tools are simple and seamless and permeate to the lowest levels (at a level where effective management can be realized) and follows the continuous risk management methodology. The risk process assesses continually what could go wrong (risks), determine which risks need to be managed, implement strategies to deal with those risks, and measure effectiveness of the implemented strategies. The process integrates all facets of risk including cost, schedule and technical aspects. Support analysis risk tools like PRA are used to support programatic decisions and assist in analyzing risks.

Emergency Support Function 15: Communication Synchronization during Defense Support of Civil Authorities Operations

DTIC Science & Technology

2015-06-12

Security Strategy to integrate government security agency participation for increased national security.33 Morris , Morris , and Jones posit ICA occurs...New National Strategy Takes Whole-of-Government Approach,” American Forces Press Services (Washington, DC: DoD News, 2010), 1. 34 John C. Morris ...Elizabeth D. Morris , and Dale M. Jones, “Reaching for the Philosopher’s Stone: Contingent Coordination and the Military’s Response to Hurricane Katrina

Strategies to promote a climate of academic integrity and minimize student cheating and plagiarism.

PubMed

Scanlan, Craig L

2006-01-01

Student academic misconduct is a growing problem for colleges and universities, including those responsible for preparing health professionals. Although the implementation of honor codes has had a positive impact on this problem, further reduction in student cheating and plagiarism can be achieved only via a comprehensive strategy that promotes an institutional culture of academic integrity. Such a strategy must combine efforts both to deter and detect academic misconduct, along with fair but rigorous application of sanctions against such behaviors. Methods useful in preventing or deterring dishonest behaviors among students include early integrity training complemented with course-level reinforcement, faculty role-modeling, and the application of selected testing/assignment preventive strategies, including honor pledges and honesty declarations. Giving students more responsibility for oversight of academic integrity also may help address this problem and better promote the culture needed to uphold its principles. Successful enforcement requires that academic administration provide strong and visible support for upholding academic integrity standards, including the provision of a clear and fair process and the consistent application of appropriate sanctions against those whose conduct is found to violate these standards.

Overcoming roadblocks: current and emerging reimbursement strategies for integrated mental health services in primary care.

PubMed

O'Donnell, Allison N; Williams, Mark; Kilbourne, Amy M

2013-12-01

The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.

Catalog and Assessment of the Manpower and Personnel Research Division Data Bases

DTIC Science & Technology

1992-11-01

objectives are: to assess the effectiveness of Army advertising, to assess the advertising strategy in an integrated framework, and to support management...and planning of future advertising strategy . 8POMSOR$ DCSPER, USAREC INSTRUMENT CLEARANCE APPROVAL NUMBERS: N/A TECH ARZ/TBAM RESPONSIBLE: MPPRG

An Integrated Approach Is Needed for Ecosystem Based Fisheries Management: Insights from Ecosystem-Level Management Strategy Evaluation

PubMed Central

Fulton, Elizabeth A.; Smith, Anthony D. M.; Smith, David C.; Johnson, Penelope

2014-01-01

An ecosystem approach is widely seen as a desirable goal for fisheries management but there is little consensus on what strategies or measures are needed to achieve it. Management strategy evaluation (MSE) is a tool that has been widely used to develop and test single species fisheries management strategies and is now being extended to support ecosystem based fisheries management (EBFM). We describe the application of MSE to investigate alternative strategies for achieving EBFM goals for a complex multispecies fishery in southeastern Australia. The study was undertaken as part of a stakeholder driven process to review and improve the ecological, economic and social performance of the fishery. An integrated management strategy, involving combinations of measures including quotas, gear controls and spatial management, performed best against a wide range of objectives and this strategy was subsequently adopted in the fishery, leading to marked improvements in performance. Although particular to one fishery, the conclusion that an integrated package of measures outperforms single focus measures we argue is likely to apply widely in fisheries that aim to achieve EBFM goals. PMID:24454722

The Need for E-Learning Strategies: Higher Education Institutions and Their Responses to a Changing Environment

ERIC Educational Resources Information Center

Boezerooij, Petra; van der Wende, Marijk; Huisman, Jeroen

2007-01-01

Integrating e-Learning in their educational delivery and support processes is one way of strategy formation higher education institutions can deploy to respond to their changing environment. In this article, the focus of such a strategy formation is on three strategic choices: traditional, face-to-face, campus-based education (back-to-basics),…

The ODDI Odyssey: Developing and Integrating Operations for the International Space Station

NASA Astrophysics Data System (ADS)

Deal, Ryan W.

2002-01-01

International Space Station (ISS) comprise the deliverable products (OP-01 Reports) of the Boeing Operations Data Development and Integration (ODDI) Integrated Product Team (IPT) to the NASA customer. The ODDI IPT's mission is to exceed the customer's expectations by providing high-quality data and sound techniques for assembling and operating the ISS. strategies in order to streamline the generation of operations products that the Mission Operations Directorate (MOD) utilizes for its crew and ground operations procedures development. Just as for other business practices, operations is a transformation process, converting inputs (resources) into outputs (products) based on a strategy that works best for the established competitive priorities of the operations organization. product reviews, and supporting other ISS operations duties (such as Mission Evaluation Room support) must be balanced with meeting schedules for delivery of the ODDI IPT's OP-01 Reports in accordance with the ISS assembly sequence timeline.

Family Support and Community Economic Development.

ERIC Educational Resources Information Center

Lalley, Jacqueline, Ed.

1997-01-01

This report of the Family Resource Coalition of America examines the interrelationship of sustainable community economic strategies and sustainable family units. The introductory section of the report consists of one article, "Integrating Community Development and Family Support." The second section, "Community Building: A Movement…

Parents' Executive Functioning and Involvement in Their Child's Education: An Integrated Literature Review.

PubMed

Wilson, Damali M; Gross, Deborah

2018-04-01

Parents' involvement in their children's education is integral to academic success. Several education-based organizations have identified recommendations for how parents can best support their children's learning. However, executive functioning (EF), a high-ordered cognitive skill set, contributes to the extent to which parents can follow through with these recommendations. This integrative review of the literature describes how executive function can affect parents' ability to facilitate and actively participate in their child's education and provides strategies for all school staff to strengthen parent-school partnerships when parents have limitations in EF. EF skills are fluid and influenced by several factors, including parental age, sleep, stress, and mood/affect. Despite possible limitations in parental EF, there are strategies school personnel can employ to strengthen partnership with parents to support their children's academic success. As reforms in education call for increased customization and collaboration with families, parental EF is an important consideration for school personnel. Awareness and understanding of how parents' EF affects children's learning will help schools better support parents in supporting their children's academic success. © 2018 The Authors. Journal of School Health published by Wiley Periodicals, Inc. on behalf of American School Health Association.

Integrating Financial Aid and Financial Policies: Case Studies from Five States. Changing Direction: Integrating Higher Education Financial Aid and Financing Policies.

ERIC Educational Resources Information Center

Western Interstate Commission for Higher Education, Boulder, CO.

This report is a collection of five state case studies comprising a major component of the first phase of the project, "Changing Direction: Integrating Higher Education Financial Aid and Financing Policies." The project explored state-level strategies to better align financing and financial aid policies and support more informed decision…

Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes.

PubMed

Moran, Anna M; Coyle, Julia; Pope, Rod; Boxall, Dianne; Nancarrow, Susan A; Young, Jennifer

2014-02-13

To identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts. This is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts. This review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme. Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts.

Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes

PubMed Central

2014-01-01

Objective To identify mechanisms for the successful implementation of support strategies for health-care practitioners in rural and remote contexts. Design This is an integrative review and thematic synthesis of the empirical literature that examines support interventions for health-care practitioners in rural and remote contexts. Results This review includes 43 papers that evaluated support strategies for the rural and remote health workforce. Interventions were predominantly training and education programmes with limited evaluations of supervision and mentoring interventions. The mechanisms associated with successful outcomes included: access to appropriate and adequate training, skills and knowledge for the support intervention; accessible and adequate resources; active involvement of stakeholders in programme design, implementation and evaluation; a needs analysis prior to the intervention; external support, organisation, facilitation and/or coordination of the programme; marketing of the programme; organisational commitment; appropriate mode of delivery; leadership; and regular feedback and evaluation of the programme. Conclusion Through a synthesis of the literature, this research has identified a number of mechanisms that are associated with successful support interventions for health-care practitioners in rural and remote contexts. This research utilised a methodology developed for studying complex interventions in response to the perceived limitations of traditional systematic reviews. This synthesis of the evidence will provide decision-makers at all levels with a collection of mechanisms that can assist the development and implementation of support strategies for staff in rural and remote contexts. PMID:24521004

Evaluation of a pilot police-led suicide early alert surveillance strategy in the UK.

PubMed

McGeechan, Grant James; Richardson, Catherine; Weir, Kevin; Wilson, Lynn; O'Neill, Gillian; Newbury-Birch, Dorothy

2017-07-19

Those bereaved by suicide are at increased risk of psychological harm, which can be reduced with the provision of timely support. This paper outlines an evaluation of a pilot police-led suicide strategy, in comparison to a coroner-led suicide strategy looking at the number, and length of time it takes for deaths to be recorded for each strategy. Additionally, the police-led strategy offers timely contact from support services for bereaved individuals. We examined what impact this offer of support had on the capacity of support services. A mixed methods evaluation compared how long it took for suspected suicides to be recorded using both strategies. The number of referrals received by support services during the pilot strategy were compared with those from previous years. A feedback focus group, and interviews, were held with key stakeholders. The coroner strategy was more consistent at identifying suspected suicides; however, reports were filed quicker by the police. Bereaved individuals were willing to share contact details with police officers and consent for referral to support services which lead to increased referrals. The focus group and interviews revealed that the pilot police strategy needs better integration into routine police practice. This strategy has the potential to deliver a real benefit to those bereaved by suicide; however, there are still aspects which could be improved. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Employing Knowledge Transfer to Support IS Implementation in SMEs

ERIC Educational Resources Information Center

Wynn, Martin; Turner, Phillip; Abas, Hanida; Shen, Rui

2009-01-01

Information systems strategy is an increasingly important component of overall business strategy in small and medium-sized enterprises (SMEs). The need for readily available and consistent management information, drawn from integrated systems based on sound and upgradeable technologies, has led many senior company managers to review the business…

Examining the Integration of Technology in the Early Childhood Classroom

ERIC Educational Resources Information Center

Willmann, Kerri Lynn

2017-01-01

Reading achievement scores in the United States are low and educators need more strategies to support young students in literacy. It is important to identify the technologies and implementation strategies that educators find beneficial for literacy instruction. The purpose of this qualitative study was to investigate perspectives on instructional…

Gender sensitive education in watershed management to support environmental friendly city

NASA Astrophysics Data System (ADS)

Asteria, D.; Budidarmono; Herdiansyah, H.; Ni’mah, N. L.

2018-03-01

This study is about gender-sensitive perspective in watershed management education program as one of capacity building for citizens in watershed management with community-based strategy to support environmental friendly cities and security for women from flood disasters. Involving women and increasing women’s active participation in sustainable watershed management is essential in urban area. In global warming and climate change situations, city management should be integrated between social aspect and environmental planning. This study used mix method (concurrent embedded type, with quantitative as primary method) with research type is descriptive-explanatory. The result of this study is education strategies with gender approaches and affirmative action through emancipation approach and local knowledge from women’s experiences can increase women’s participation. Women’s empowerment efforts need integrated intervention and collaboration from government, NGO, and other stakeholders to optimize women’s role in watershed management for support environmental friendly city. The implication of this study is an educational strategy on watershed conservation with gender perspective to offer social engineering alternatives for decision makers to policy of sustainable watershed management in urban area related to flood mitigation efforts.

Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System.

PubMed

Psek, Wayne; Davis, F Daniel; Gerrity, Gloria; Stametz, Rebecca; Bailey-Davis, Lisa; Henninger, Debra; Sellers, Dorothy; Darer, Jonathan

2016-01-01

Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders' perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders' perspectives on the LHS and learning activities in an integrated delivery system. A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders' responses were categorized into themes. Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals. Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed. Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery.

Perspective: deconstructing integration: a framework for the rational application of integration as a guiding curricular strategy.

PubMed

Goldman, Ellen; Schroth, W Scott

2012-06-01

In response to historical criticism, evolving accreditation standards, and recent reports on curricula, medical educators and medical schools have been eagerly pursuing integration as a goal of curricular reform. The general education literature broadly considers integration to be the deliberate unification of separate areas of knowledge, and it provides support for the concept that integration better meets the needs of adult learners in professional education. The use of integration as a curricular goal is not without its critics, however, nor is it free of difficulties in implementation. In this perspective, the authors propose that most of these difficulties arise from a failure to recognize that integration is a strategy for curricular development rather than a goal in itself, and they argue that adopting a systematic approach to integration offers many potential benefits. They articulate the conceptual and practical issues that they believe are critical to consider in order to achieve successful curricular integration, and they suggest that integration should be approached as a subset of broader curriculum development decisions. They propose a three-level framework for applying integration as a guiding curricular strategy, in which decisions about integration must follow curricular decisions made at the program level, the course level, and then the individual session level.

Assessing NETS.T Performance in Teacher Candidates: Exploring the Wayfind Teacher Assessment

ERIC Educational Resources Information Center

Banister, Savilla; Vannatta Reinhart, Rachel

2013-01-01

To effectively integrate digital technologies in K-12 schools, teachers must be provided with undergraduate experiences that strongly support these integration resources and strategies. The National Educational Technology Standards for Teachers (NETS.T) provide a framework for teacher candidates and inservice teachers to identify their…

An Integrated Strategy for an Apparel Design Curriculum

ERIC Educational Resources Information Center

Bye, Elizabeth; Labat, Karen L.

2005-01-01

The core of apparel design education is the studio experience. This article discusses an Integrated Apparel Design Curriculum model built on a foundation of creative and technical experimentation and learning which contributes to developing abstract thinking skills. Various learning styles are supported as students work through the design process…

Analysis of integrated healthcare networks' performance: a contingency-strategic management perspective.

PubMed

Lin, B Y; Wan, T T

1999-12-01

Few empirical analyses have been done in the organizational researches of integrated healthcare networks (IHNs) or integrated healthcare delivery systems. Using a contingency derived contact-process-performance model, this study attempts to explore the relationships among an IHN's strategic direction, structural design, and performance. A cross-sectional analysis of 100 IHNs suggests that certain contextual factors such as market competition and network age and tax status have statistically significant effects on the implementation of an IHN's service differentiation strategy, which addresses coordination and control in the market. An IHN's service differentiation strategy is positively related to its integrated structural design, which is characterized as integration of administration, patient care, and information system across different settings. However, no evidence supports that the development of integrated structural design may benefit an IHN's performance in terms of clinical efficiency and financial viability.

Managing physical and mental health conditions: Consumer perspectives on integrated care.

PubMed

Rollins, Angela L; Wright-Berryman, Jennifer; Henry, Nancy H; Quash, Alicia M; Benbow, Kyle; Bonfils, Kelsey A; Hedrick, Heidi; Miller, Alex P; Firmin, Ruthie; Salyers, Michelle P

2017-01-01

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.

Incentives for vertical integration in healthcare: the effect of reimbursement systems.

PubMed

Byrne, M M; Ashton, C M

1999-01-01

In the United States, many healthcare organizations are being transformed into large integrated delivery systems, even though currently available empirical evidence does not provide strong or unequivocal support for or against vertical integration. Unfortunately, the manager cannot delay organizational changes until further research has been completed, especially when further research is not likely to reveal a single, correct solution for the diverse healthcare systems in existence. Managers must therefore carefully evaluate the expected effects of integration on their individual organizations. Vertical integration may be appropriate if conditions facing the healthcare organization provide opportunities for efficiency gains through reorganization strategies. Managers must consider (1) how changes in the healthcare market have affected the dynamics of production efficiency and transaction costs; (2) the likelihood that integration strategies will achieve increases in efficiency or reductions in transaction costs; and (3) how vertical integration will affect other costs, and whether the benefits gained will outweigh additional costs and efficiency losses. This article presents reimbursement systems as an example of how recent changes in the industry may have changed the dynamics and efficiency of production. Evaluation of the effects of vertical integration should allow for reasonable adjustment time, but obviously unsuccessful strategies should not be followed or maintained.

Identifying Cost-Effective Water Resources Management Strategies: Watershed Management Optimization Support Tool (WMOST)

EPA Science Inventory

The Watershed Management Optimization Support Tool (WMOST) is a public-domain software application designed to aid decision makers with integrated water resources management. The tool allows water resource managers and planners to screen a wide-range of management practices for c...

Supporting Community Pharmacies with Implementation of a Web-Based Medication Management Application.

PubMed

Turner, Kea; Renfro, Chelsea; Ferreri, Stefanie; Roberts, Kim; Pfeiffenberger, Trista; Shea, Christopher M

2018-04-01

 Community pharmacists' role in clinical care is expanding in the United States and information systems are needed that extend beyond a dispensing workflow. As pharmacies adopt new systems, implementation support will be needed. This study identifies the barriers and facilitators experienced by community pharmacies in implementing a Web-based medication management application and describes the implementation strategies used to support these pharmacies.  Semistructured interviews were conducted with 28 program and research staff that provides support to community pharmacies participating in a statewide pharmacy network. Interviews were recorded, transcribed verbatim, and analyzed for themes using the Expert Recommendations for Implementing Change (ERIC).  Findings suggest that leadership support, clinical training, and computer literacy facilitated implementation, while lack of system integration, staff resistance to change, and provider reluctance to share data served as barriers. To overcome the barriers, implementation support was provided, such as assessing readiness for implementation, developing a standardized and interoperable care plan, and audit and feedback of documentation quality.  Participants used a wide array of strategies to support community pharmacies with implementation and tailored approaches to accommodate pharmacy-specific preferences. Most of the support was delivered preimplementation or in the early phase of implementation and by program or research staff rather than peer-to-peer. Implementing new pharmacy information system requires a significant amount of implementation support to help end-users learn about program features, how to integrate the software into workflow, and how to optimize the software to improve patient care. Future research should identify which implementation strategies are associated with program performance. Schattauer.

[Women-and Child-Friendly Institutional Strategies with an integral approach in Colombia].

PubMed

Farías-Jiménez, Patricia; Arocha-Zuluaga, Gina Paola; Trujillo-Ramírez, Kenny Margarita; Botero-Uribe, Inés

2014-01-01

It is uncommon to implement and document a maternal and child healthcare strategy on a territorial and institutional level is infrequent. Therefore, we aimed to describe the experience of a consulting team composed of two physicians, two nurses and two nutritionists, whose purpose was to support the introduction of the Women- and Child-Friendly Institutional Strategy with an integral approach in 25 healthcare institutions in three Colombian departments (Cauca, Huila and Nariño), according to unmet basic needs. The Women- and Child-Friendly Institutional Strategy, considered a senior management strategy, promotes a specific method that allows monitoring of institutions during the implementation of a health and nutritional care strategy for women and children, and offers them the possibility of voluntarily becoming accredited as a Women- and Child-Friendly Institutions. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

A Knowledge Management Approach to Support Software Process Improvement Implementation Initiatives

NASA Astrophysics Data System (ADS)

Montoni, Mariano Angel; Cerdeiral, Cristina; Zanetti, David; Cavalcanti da Rocha, Ana Regina

The success of software process improvement (SPI) implementation initiatives depends fundamentally of the strategies adopted to support the execution of such initiatives. Therefore, it is essential to define adequate SPI implementation strategies aiming to facilitate the achievement of organizational business goals and to increase the benefits of process improvements. The objective of this work is to present an approach to support the execution of SPI implementation initiatives. We also describe a methodology applied to capture knowledge related to critical success factors that influence SPI initiatives. This knowledge was used to define effective SPI strategies aiming to increase the success of SPI initiatives coordinated by a specific SPI consultancy organization. This work also presents the functionalities of a set of tools integrated in a process-centered knowledge management environment, named CORE-KM, customized to support the presented approach.

Translating person-centered care into practice: A comparative analysis of motivational interviewing, illness-integration support, and guided self-determination.

PubMed

Zoffmann, Vibeke; Hörnsten, Åsa; Storbækken, Solveig; Graue, Marit; Rasmussen, Bodil; Wahl, Astrid; Kirkevold, Marit

2016-03-01

Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD]. Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools. Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. Professionals must critically consider the context in their choice of approach. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Examining Curricular Integration Strategies To Optimize Learning Of The Anatomical Sciences

NASA Astrophysics Data System (ADS)

Lisk, Kristina Adriana Ayako

Background: Integration of basic and clinical science knowledge is essential to clinical practice. Although the importance of these two knowledge domains is well-recognized, successfully supporting the development of learners' integrated basic and clinical science knowledge, remains an educational challenge. In this dissertation, I examine curricular integration strategies to optimize learning of the anatomical sciences. Objectives: The studies were designed to achieve the following research aims: 1) to objectively identify clinically relevant content for an integrated musculoskeletal anatomy curriculum; 2) to examine the value of integrated anatomy and clinical science instruction compared to clinical science instruction alone on novices' diagnostic accuracy and diagnostic reasoning process; 3) to compare the effect of integrating and segregating anatomy and clinical science instruction along with a learning strategy (self-explanation) on novices' diagnostic accuracy. Methods: A modified Delphi was used to objectively select clinically relevant content for an integrated musculoskeletal anatomy curriculum. Two experimental studies were created to compare different instructional strategies to optimize learning of the curricular content. In both of these studies, novice learners were taught the clinical features of musculoskeletal pathologies using different learning approaches. Diagnostic performance was measured immediately after instruction and one-week later. Results: The results show that the Delphi method is an effective strategy to select clinically relevant content for integrated anatomy curricula. The findings also demonstrate that novices who were explicitly taught the clinical features of musculoskeletal diseases using causal basic science descriptions had superior diagnostic accuracy and a better understanding of the relative importance of key clinical features for disease categories. Conclusions: This research demonstrates how integration strategies can be applied at multiple levels of the curriculum. Further, this work shows the value of cognitive integration of anatomy and clinical science and it emphasizes the importance of purposefully linking the anatomical and clinical sciences in day-to-day teaching.

EvalCOMIX®: A Web-Based Programme to Support Collaboration in Assessment

ERIC Educational Resources Information Center

Ibarra-Sáiz, María Soledad; Rodríguez-Gómez, Gregorio

2016-01-01

For many years assessment strategies and practices have emphasized on the one hand the importance of integrating assessment and learning and, secondly, the need to develop technological tools that facilitate this relationship and integration. In this paper, firstly we describe the EvalCOMIX® web service and then we present the opinions of…

Academic Integrity and Student Plagiarism: Guided Instructional Strategies for Business Communication Assignments

ERIC Educational Resources Information Center

Okoro, Ephraim A.

2011-01-01

Maintaining academic integrity is critical to the sustainability of a civil society and to the democratic process. Educators across the disciplines are growing increasingly disturbed by the level of plagiarism on university campuses. The author contends that developing supportive ways of empowering students to become more independent writers in…

Toward Integration: An Instructional Model of Science and Academic Language

ERIC Educational Resources Information Center

Silva, Cecilia; Weinburgh, Molly; Malloy, Robert; Smith, Kathy Horak; Marshall, Jenesta Nettles

2012-01-01

In this article, the authors outline an instructional model that can be used to optimize science and language learning in the classroom. The authors have developed the 5R instructional model (Weinburgh & Silva, 2010) to support teachers as they integrate academic language into content instruction. The model combines five strategies already…

End of Asset Life Reinvestment Decision Support Tool (INFR2R11AT)

EPA Science Inventory

This “End of Asset Life” Reinvestment Decision-Support Tool is intended as a step by step guide for the asset management practitioner who faces the challenge of developing an investment strategy that represents the best integration of maintenance, operations, and capital investme...

Behavioral Health and Performance, Risk to Mitigation Strategy

NASA Technical Reports Server (NTRS)

Leveton, Lauren; Whitemire, Alexandra

2009-01-01

This poster reviews the working of the Behavioral Health and Performance (BHP) group, which supports the research element which manages an integrated program for future space flight. The BHP operations group supports astronauts and their families in all phases of the International Space Station Mission, and post mission effects.

Mapping European Welfare Models: State of the Art of Strategies for Professional Integration and Reintegration of Persons with Chronic Diseases

PubMed Central

Scaratti, Chiara; Silvaggi, Fabiola; Ávila, Carolina C.; Muñoz-Murillo, Amalia; Stavroussi, Panayiota; Roka, Olga; Burger, Helena; Fheodoroff, Klemens; Tobiasz-Adamczyk, Beata; Gruber, Sonja; Svestkova, Olga; Halvorsen, Rune; Kadyrbaeva, Asel; Ferraina, Sabrina

2018-01-01

Background: Persons with chronic diseases (PwCDs) often experience work-related problems, and innovative actions to improve their participation in the labor market are needed. In the frame of the European (EU) Pathways Project, the aim of the study is to compare existing strategies (policies, systems, and services) for professional (re-)integration of PwCDs and mental health conditions available at both European and national level between different European welfare models: Scandinavian, Continental, Anglo-Saxon, Mediterranean, and “Post-Communist”. Method: The European strategies were identified by an overview of relevant academic and grey literature searched through Medline and internet searches, while national strategies were explored through questionnaires and in-depth interviews with national relevant stakeholders. Results: The mapping of existing strategies revealed that, both at European and national level, PwCDs are often considered as part of the group of “persons with disabilities” and only in this case they can receive employment support. European countries put in place actions to support greater labor market participation, but these differ from country to country. Conclusion: Strategies targeting “persons with disabilities” do not necessarily address all the needs of persons with chronic diseases. Countries should consider the importance of employment for all to achieve smart, sustainable, and inclusive growth. PMID:29673231

Integrating Infrastructures in the United States: Experience and Prospects

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

Wilbanks, Thomas

Infrastructure integration has been limited in the United States because infrastructure management responsibilities are fragmented by divisions between sectors and between the public and the private sector, but some changes are under way. Stimulated by a number of extreme events in recent decades, data and modeling capabilities for simulating infrastructure interdependencies have been developed and applied, and infrastructure integration in some cities has been encouraged by such foci as emergency preparedness and “green infrastructure” strategies. Integrative strategies have been explored for energy and water resource systems, in some cases related to other sectors as well. In summary, infrastructure integration inmore » the United States is occurring from the ground up, due in many cases to climate change impacts and risks. A number of examples of successes, supported by broad coalitions of interested parties (with evident sociopolitical payoffs), suggest that integration will increase through time.« less

Environmental Control and Life Support Integration Strategy for 6-Crew Operations Stephanie Duchesne

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie M.

2009-01-01

The International Space Station (ISS) crew compliment has increased in size from 3 to 6 crew members . In order to support this increase in crew on ISS, the United States on-orbit Segment (USOS) has been outfitted with a suite of regenerative Environmental Control and Life Support (ECLS) hardware including an Oxygen Generation System(OGS), Waste and Hygiene Compartment (WHC), and a Water Recovery System (WRS). The WRS includes the Urine Processor Assembly (UPA) and the Water Processor Assembly (WPA). With this additional life support hardware, the ISS has achieved full redundancy in its on-orbit life support system between the USOS and Russian Segment (RS). The additional redundancy created by the Regenerative ECLS hardware creates the opportunity for independent support capabilities between segments, and for the first time since the start of ISS, the necessity to revise Life Support strategy agreements. Independent operating strategies coupled with the loss of the Space Shuttle supply and return capabilities in 2010 offer new and unique challenges. This paper will discuss the evolution of the ISS Life Support hardware strategy in support of 6-Crew on ISS, as well as the continued work that is necessary to ensure the support of crew and ISS Program objectives through the life of station.

Environmental Control and Life Support Integration Strategy for 6-Crew Operations

NASA Technical Reports Server (NTRS)

Duchesne, Stephanie M.; Tressler, Chad H.

2010-01-01

The International Space Station (ISS) crew complement has increased in size from 3 to 6 crew members. In order to support this increase in crew on ISS, the United States on-orbit Segment (USOS) has been outfitted with a suite of regenerative Environmental Control and Life Support (ECLS) hardware including an Oxygen Generation System (OGS), Waste and Hygiene Compartment (WHC), and a Water Recovery System (WRS). The WRS includes the Urine Processor Assembly (UPA) and the Water Processor Assembly (WPA). With this additional life support hardware, the ISS has achieved full redundancy in its on-orbit life support system between the t OS and Russian Segment (RS). The additional redundancy created by the Regenerative ECLS hardware creates the opportunity for independent support capabilities between segments, and for the first time since the start of ISS, the necessity to revise Life Support strategy agreements. Independent operating strategies coupled with the loss of the Space Shuttle supply and return capabilities in 2010 offer new and unique challenges. This paper will discuss the evolution of the ISS Life Support hardware strategy in support of 6-Crew on ISS, as well as the continued work that is necessary to ensure the support of crew and ISS Program objectives through the life of station

How To Build an Integrated Neighborhood Approach to Support Community-Dwelling Older People?

PubMed Central

Cramm, Jane Murray; Nieboer, Anna Petra

2016-01-01

Background: Although the need for integrated neighborhood approaches (INAs) is widely recognized, we lack insight into strategies like INA. We describe diverse Dutch INA partners’ experiences to provide integrated person- and population-centered support to community-dwelling older people using an adapted version of Valentijn and colleagues’ integrated care model. Our main objective was to explore the experiences with INA participation. We sought to increase our understanding of the challenges facing these partners and identify factors facilitating and inhibiting integration within and among multiple levels. Methods: Twenty-one interviews with INA partners (including local health and social care organizations, older people, municipal officers, and a health insurer) were conducted and subjected to latent content analysis. Results: This study showed that integrated care and support provision through an INA is a complex, dynamic process requiring multilevel alignment of activities. The INA achieved integration at the personal, service, and professional levels only occasionally. Micro-level bottom-up initiatives were not aligned with top-down incentives, forcing community workers to establish integration despite rather than because of meso- and macro-level contexts. Conclusions: Top-down incentives should be better aligned with bottom-up initiatives. This study further demonstrated the importance of community-level engagement in integrated care and support provision. PMID:27616960

Management of a CFD organization in support of space hardware development

NASA Technical Reports Server (NTRS)

Schutzenhofer, L. A.; Mcconnaughey, P. K.; Mcconnaughey, H. V.; Wang, T. S.

1991-01-01

The management strategy of NASA-Marshall's CFD branch in support of space hardware development and code validation implements various elements of total quality management. The strategy encompasses (1) a teaming strategy which focuses on the most pertinent problem, (2) quick-turnaround analysis, (3) the evaluation of retrofittable design options through sensitivity analysis, and (4) coordination between the chief engineer and the hardware contractors. Advanced-technology concepts are being addressed via the definition of technology-development projects whose products are transferable to hardware programs and the integration of research activities with industry, government agencies, and universities, on the basis of the 'consortium' concept.

Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model.

PubMed

van Rensburg, André Janse; Fourie, Pieter

2016-01-01

Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies. Health policies from five SADC countries were analysed using the Rainbow Model as framework. Electronic copies of policy documents were transferred into NVivo 10, which aided in the framework analysis on the different types of integrated mental health care promoted in the countries assessed. Several Rainbow Model components were emphasised. Clinical integration strategies (coordination of person-focused care) such as centrality of client needs, case management and continuity were central considerations, while others such as patient education and client satisfaction were largely lacking. Professional integration (inter-professional partnerships) was mentioned in terms of agreements on interdisciplinary collaboration and performance management, while organisational integration (inter-organisational relationships) emerged under the guise of inter-organisational governance, population needs and interest management. Among others, available resources, population management and stakeholder management fed into system integration strategies (horizontally and vertically integrated systems), while functional integration strategies (financial, management and information system functions) included human resource, information and resource management. Normative integration (a common frame of reference) included collective attitude, sense of urgency, and linking cultures, though aspects such as conflict management, quality features of the informal collaboration, and trust were largely lacking. Most countries stressed the importance of integrating mental health on primary healthcare level, though an absence of supporting strategies could prove to bar implementation. Inter-service collaboration emerged as a significant goal, though a lack of (especially) normative integration dimensions could prove to be a key omission. Despite the usefulness of the Rainbow Model, it failed to adequately frame regional governance aspects of integration, as the SADC Secretariat could play an important role in coordinating and supporting the development and strengthening of better mental health systems.

Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury.

PubMed

Cotner, Bridget A; Ottomanelli, Lisa; O'Connor, Danielle R; Trainor, John K

2018-06-01

In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified. Over 24 months of implementation, 82 key medical and vocational staff underwent semi-structured interviews (n = 130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes. Some barriers to implementation occurred throughout the study, such as Veterans' lack of motivation and providers' difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team. Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities. Implications for Rehabilitation Key facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support. Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns. Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.

Leadership Perspectives on Operationalizing the Learning Health Care System in an Integrated Delivery System

PubMed Central

Psek, Wayne; Davis, F. Daniel; Gerrity, Gloria; Stametz, Rebecca; Bailey-Davis, Lisa; Henninger, Debra; Sellers, Dorothy; Darer, Jonathan

2016-01-01

Introduction: Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders’ perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders’ perspectives on the LHS and learning activities in an integrated delivery system. Methods: A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders’ responses were categorized into themes. Findings: Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals. Discussion: Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed. Conclusion: Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery. PMID:27683668

Methods of Genomic Competency Integration in Practice

PubMed Central

Jenkins, Jean; Calzone, Kathleen A.; Caskey, Sarah; Culp, Stacey; Weiner, Marsha; Badzek, Laurie

2015-01-01

Purpose Genomics is increasingly relevant to health care, necessitating support for nurses to incorporate genomic competencies into practice. The primary aim of this project was to develop, implement, and evaluate a year-long genomic education intervention that trained, supported, and supervised institutional administrator and educator champion dyads to increase nursing capacity to integrate genomics through assessments of program satisfaction and institutional achieved outcomes. Design Longitudinal study of 23 Magnet Recognition Program® Hospitals (21 intervention, 2 controls) participating in a 1-year new competency integration effort aimed at increasing genomic nursing competency and overcoming barriers to genomics integration in practice. Methods Champion dyads underwent genomic training consisting of one in-person kick-off training meeting followed by monthly education webinars. Champion dyads designed institution-specific action plans detailing objectives, methods or strategies used to engage and educate nursing staff, timeline for implementation, and outcomes achieved. Action plans focused on a minimum of seven genomic priority areas: champion dyad personal development; practice assessment; policy content assessment; staff knowledge needs assessment; staff development; plans for integration; and anticipated obstacles and challenges. Action plans were updated quarterly, outlining progress made as well as inclusion of new methods or strategies. Progress was validated through virtual site visits with the champion dyads and chief nursing officers. Descriptive data were collected on all strategies or methods utilized, and timeline for achievement. Descriptive data were analyzed using content analysis. Findings The complexity of the competency content and the uniqueness of social systems and infrastructure resulted in a significant variation of champion dyad interventions. Conclusions Nursing champions can facilitate change in genomic nursing capacity through varied strategies but require substantial training in order to design and implement interventions. Clinical Relevance Genomics is critical to the practice of all nurses. There is a great opportunity and interest to address genomic knowledge deficits in the practicing nurse workforce as a strategy to improve patient outcomes. Exemplars of champion dyad interventions designed to increase nursing capacity focus on improving education, policy, and healthcare services. PMID:25808828

Supported employment outcomes across a decade: is there evidence of improvement in the quality of implementation?

PubMed

Mank, David; Cioffi, Andrea; Yovanoff, Paul

2003-06-01

There is little question that the strategies used to improve supported employment outcomes, namely higher wages and higher levels of integration, have changed since the mid-1980s. Innovations of natural supports and employer leadership have helped increase the capacity of provider agencies and the business community to include people with disabilities in the workforce. This report is the sixth in a series that focuses on features of natural supports and its relationship to outcomes. Our purpose in this paper is to describe an analysis designed to investigate the features of employment, wage, and integration outcomes of jobs acquired by people with disabilities early in the development of supported employment compared to more recent years.

Indicators and Measurement Tools for Health Systems Integration: A Knowledge Synthesis.

PubMed

Suter, Esther; Oelke, Nelly D; da Silva Lima, Maria Alice Dias; Stiphout, Michelle; Janke, Robert; Witt, Regina Rigatto; Van Vliet-Brown, Cheryl; Schill, Kaela; Rostami, Mahnoush; Hepp, Shelanne; Birney, Arden; Al-Roubaiai, Fatima; Marques, Giselda Quintana

2017-11-13

Despite far reaching support for integrated care, conceptualizing and measuring integrated care remains challenging. This knowledge synthesis aimed to identify indicator domains and tools to measure progress towards integrated care. We used an established framework and a Delphi survey with integration experts to identify relevant measurement domains. For each domain, we searched and reviewed the literature for relevant tools. From 7,133 abstracts, we retrieved 114 unique tools. We found many quality tools to measure care coordination, patient engagement and team effectiveness/performance. In contrast, there were few tools in the domains of performance measurement and information systems, alignment of organizational goals and resource allocation. The search yielded 12 tools that measure overall integration or three or more indicator domains. Our findings highlight a continued gap in tools to measure foundational components that support integrated care. In the absence of such targeted tools, "overall integration" tools may be useful for a broad assessment of the overall state of a system. Continued progress towards integrated care depends on our ability to evaluate the success of strategies across different levels and context. This study has identified 114 tools that measure integrated care across 16 domains, supporting efforts towards a unified measurement framework.

Water governance: learning by developing adaptive capacity to incorporate climate variability and change.

PubMed

Kashyap, A

2004-01-01

There is increasing evidence that global climate variability and change is affecting the quality and availability of water supplies. Integrated water resources development, use, and management strategies, represent an effective approach to achieve sustainable development of water resources in a changing environment with competing demands. It is also a key to achieving the Millennium Development Goals. It is critical that integrated water management strategies must incorporate the impacts of climate variability and change to reduce vulnerability of the poor, strengthen sustainable livelihoods and support national sustainable development. UNDP's strategy focuses on developing adaptation in the water governance sector as an entry point within the framework of poverty reduction and national sustainable development. This strategy aims to strengthen the capacity of governments and civil society organizations to have access to early warning systems, ability to assess the impact of climate variability and change on integrated water resources management, and developing adaptation intervention through hands-on learning by undertaking pilot activities.

Strategies for Student Attendance and School Climate in Baltimore's Community Schools

ERIC Educational Resources Information Center

Durham, Rachel E.; Connolly, Faith

2017-01-01

In 2012, the Community School Engagement Strategy was adopted by the Family League of Baltimore as a way to address historical racial and structural inequalities that have produced unequal educational outcomes among the city's children and youth. The goals of community schools include integrating health and social supports for children and their…

Exploring Challenges and Opportunities of Coproduction: USDA Climate Hub Efforts to Integrate Coproduction with Applied Research and Decision Support Tool Development in the Northwest

NASA Astrophysics Data System (ADS)

Roesch-McNally, G.; Prendeville, H. R.

2017-12-01

A lack of coproduction, the joint production of new technologies or knowledge among technical experts and other groups, is arguably one of the reasons why much scientific information and resulting decision support systems are not very usable. Increasingly, public agencies and academic institutions are emphasizing the importance of coproduction of scientific knowledge and decision support systems in order to facilitate greater engagement between the scientific community and key stakeholder groups. Coproduction has been embraced as a way for the scientific community to develop actionable scientific information that will assist end users in solving real-world problems. Increasing the level of engagement and stakeholder buy-in to the scientific process is increasingly necessary, particularly in the context of growing politicization of science and the scientific process. Coproduction can be an effective way to build trust and can build-on and integrate local and traditional knowledge. Employing coproduction strategies may enable the development of more relevant and useful information and decision support tools that address stakeholder challenges at relevant scales. The USDA Northwest Climate Hub has increasingly sought ways to integrate coproduction in the development of both applied research projects and the development of decision support systems. Integrating coproduction, however, within existing institutions is not always simple, given that coproduction is often more focused on process than products and products are, for better or worse, often the primary focus of applied research and tool development projects. The USDA Northwest Climate Hub sought to integrate coproduction into our FY2017 call for proposal process. As a result we have a set of proposals and fledgling projects that fall along the engagement continuum (see Figure 1- attached). We will share the challenges and opportunities that emerged from this purposeful integration of coproduction into the work that we prioritized for funding. This effort highlights strategies for how federal agencies might consider how and whether to codify coproduction tenets into their collaborations and agenda setting.

An integrative review on coping skills in nursing students: implications for policymaking.

PubMed

Labrague, L J; McEnroe-Petitte, D M; Al Amri, M; Fronda, D C; Obeidat, A A

2018-06-01

This study critically appraised both quantitative and qualitative studies describing coping strategies utilized by nursing students when faced with stress. Stress in nursing students during clinical training is well documented in the nursing literature. The need to utilize positive-coping strategies is necessary to effectively deal with stress and its accompanying stressors. An integrative review method was used in this review. PsycINFO, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and Scopus were the databases used in searching for relevant literature using the following search terms; 'coping', 'nursing students', clinical training', 'ways of coping' and 'clinical practice'. A total of 27 studies published from 2001 to 2016 were included in this review. Findings demonstrated that nursing students utilized problem-focused coping strategies rather than emotion-focused coping strategies. Specific coping behaviours utilized included problem-solving behaviours, self-confident approaches and seeking of support from family and friends. The review contributes to the growing literature on coping strategies in nursing students and may have implications on nursing education and nursing policy. This review also demonstrated a scarcity of studies that links specific coping strategies to nursing school stressors and examines predictors of coping skills in nursing students. Institutionalization of structured student orientation programme, implementation of well-planned mentoring programmes and establishment of support unit/centres may be helpful in supporting nursing students during their clinical placement. By developing empirically based interventions, nursing faculty can assist nursing students in strengthening their positive-coping skills to effectively deal with various stressors encountered. © 2017 International Council of Nurses.

A Landscape Model (LEEMATH) to Evaluate Effects of Management Impacts on Timber and Wildlife Habitat

Treesearch

Harbin Li; David L. Gartner; Pu Mou; Carl C. Trettin

2000-01-01

Managing forest resources for sustainability requires the successful integration of economic and ecological goals. To attain such integration, land managers need decision support tools that incorporate science, land-use strategies, and policy options to assess resources sustainability at large scales. Landscape Evaluation of Effects of Management Activities on Timber...

Teaching Kindergarten Students about the Water Cycle through Arts and Invention

ERIC Educational Resources Information Center

Smith, Latisha L.; Samarakoon, Deepanee

2016-01-01

Research evidence for the benefits of arts integration is mounting. The purpose of this study was to determine if integration of the arts was an effective strategy for teaching the water cycle to kindergarten students. The study included lessons that supported both a science and an engineering standard of the Next Generation Science Standards and…

Examining the Effect of Self-Explanation on Cognitive Integration of Basic and Clinical Sciences in Novices

ERIC Educational Resources Information Center

Lisk, Kristina; Agur, Anne M. R.; Woods, Nicole N.

2017-01-01

Several studies have shown that cognitive integration of basic and clinical sciences supports diagnostic reasoning in novices; however, there has been limited exploration of the ways in which educators can translate this model of mental activity into sound instructional strategies. The use of "self-explanation" during learning has the…

PEO Integration Acronym Book

DTIC Science & Technology

2011-02-01

Command CASE Computer Aided Software Engineering CASEVAC Casualty Evacuation CASTFOREM Combined Arms And Support Task Force Evaluation Model CAT Center For...Advanced Technologies CAT Civil Affairs Team CAT Combined Arms Training CAT Crew Integration CAT Crisis Action Team CATIA Computer-Aided Three...Dimensional Interactive Application CATOX Catalytic Oxidation CATS Combined Arms Training Strategy CATT Combined Arms Tactical Trainer CATT Computer

The Effects of Self-Monitoring and Performance Feedback on the Treatment Integrity of Behavior Intervention Plan Implementation and Generalization

ERIC Educational Resources Information Center

Mouzakitis, Angela; Codding, Robin S.; Tryon, Georgiana

2015-01-01

Accurate implementation of individualized behavior intervention plans (BIPs) is a critical aspect of evidence-based practice. Research demonstrates that neither training nor consultation is sufficient to improve and maintain high rates of treatment integrity (TI). Therefore, evaluation of ongoing support strategies is needed. The purpose of this…

Expanding Opportunities to Learn to Support Inclusive Education through Drama-Enhanced Literacy Practices

ERIC Educational Resources Information Center

Kilinc, Sultan; Farrand, Kathleen; Chapman, Kathryn; Kelley, Michael; Millinger, Jenny; Adams, Korbi

2017-01-01

This study examines how the Early Years Educators at Play (EYEPlay) professional development (PD) programme supported inclusive learning settings for all children, including English language learners and students with disabilities. The EYEPlay PD model is a year-long programme that integrates drama strategies into literacy practices within…

Professional Development for E-Learning: Researching a Strategy for New Zealand's Tertiary Education Sector

ERIC Educational Resources Information Center

Shephard, Kerry; Mansvelt, Juliana; Stein, Sarah; Suddaby, Gordon; Harris, Irene; O'Hara, Duncan

2011-01-01

This collaborative research project devised a framework to support professional development for e-learning within New Zealand's diverse and integrated tertiary education sector. The research was supported by New Zealand's Ministry of Education. The research included reviews of developments in the United Kingdom, Australia and New Zealand and a…

Using Augmented Reality to Support a Software Editing Course for College Students

ERIC Educational Resources Information Center

Wang, Y.-H.

2017-01-01

This study aimed to explore whether integrating augmented reality (AR) techniques could support a software editing course and to examine the different learning effects for students using online-based and AR-based blended learning strategies. The researcher adopted a comparative research approach with a total of 103 college students participating…

Quality of life, coping strategies, social support and self-efficacy in women after acute myocardial infarction: a mixed methods approach.

PubMed

Fuochi, G; Foà, C

2018-03-01

Quality of life, coping strategies, social support and self-efficacy are important psychosocial variables strongly affecting the experience of acute myocardial infarction (AMI) in women. To gain a more in-depth understanding of how coping strategies, self-efficacy, quality of life and social support shape women's adjustment to AMI. Mixed methods study. Quantitative data were collected through a standardised questionnaire on coping strategies, self-efficacy, quality of life and social support. Qualitative data stemmed from 57 semistructured interviews conducted with post-AMI female patients on related topics. Quantitative data were analysed with unpaired two-sample t-tests on the means, comparing women who experienced AMI (N = 77) with a control group of women who did not have AMI (N = 173), and pairwise correlations on the AMI sample. Qualitative data were grouped into coding families and analysed through thematic content analysis. Qualitative and quantitative results were then integrated, for different age groups. Quantitative results indicated statistically significant differences between women who experienced AMI and the control group: the former showed lower self-perceived health, perceived social support and social support coping, but greater self-efficacy, use of acceptance, avoidance and religious coping. Pairwise correlations showed that avoidance coping strategy was negatively correlated with quality of life, while the opposite was true for problem-oriented coping, perceived social support and self-efficacy. Qualitative results extended and confirmed quantitative results, except for coping strategies: avoidance coping seemed more present than reported in the standardised measures. Mixed methods provide understanding of the importance of social support, self-efficacy and less avoidant coping strategies to women's adjustment to AMI. Women need support from health professionals with knowledge of these topics, to facilitate their adaptation to AMI. © 2017 Nordic College of Caring Science.

Photothermal Effect Enhanced Cascade-Targeting Strategy for Improved Pancreatic Cancer Therapy by Gold Nanoshell@Mesoporous Silica Nanorod.

PubMed

Zhao, Ruifang; Han, Xuexiang; Li, Yiye; Wang, Hai; Ji, Tianjiao; Zhao, Yuliang; Nie, Guangjun

2017-08-22

Pancreatic cancer, one of the leading causes of cancer-related mortality, is characterized by desmoplasia and hypovascular cancerous tissue, with a 5 year survival rate of <8%. To overcome the severe resistance of pancreatic cancer to conventional therapies, we synthesized gold nanoshell-coated rod-like mesoporous silica (GNRS) nanoparticles which integrated cascade tumor targeting (mediated by photothermal effect and molecular receptor binding) and photothermal treatment-enhanced gemcitabine chemotherapy, under mild near-infrared laser irradiation condition. GNRS significantly improved gemcitabine penetration and accumulation in tumor tissues, thus destroying the dense stroma barrier of pancreatic cancer and reinforcing chemosensitivity in mice. Our current findings strongly support the notion that further development of this integrated plasmonic photothermal strategy may represent a promising translational nanoformulation for effective treatment of pancreatic cancer with integral cascade tumor targeting strategy and enhanced drug delivery efficacy.

Launching forward: The integration of behavioral health in primary care as a key strategy for promoting young child wellness.

PubMed

Oppenheim, Jennifer; Stewart, Whitney; Zoubak, Ekaterina; Donato, Ingrid; Huang, Larke; Hudock, William

2016-03-01

In 2008, the Substance Abuse and Mental Health Services Administration (SAMHSA) created a national grant program, Project LAUNCH (Linking Actions for Unmet Needs in Children's Health), to improve behavioral health and developmental outcomes for young children through the incorporation of prevention and wellness promotion practices in key early childhood settings. Project LAUNCH supports states, tribal nations, and territories to improve coordination across early childhood systems and implement 5 core strategies of prevention and promotion. This article focuses on the lessons learned from 1 of the 5 core strategies: integration of behavioral health into primary care for young children. This paper analyzes the experiences of a sample of Project LAUNCH grantees, describing 10 common elements of integration approaches and exploring some of the challenges of promoting health and preventing social, emotional, and behavioral problems at a population level. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Integrality: life principle and right to health.

PubMed

Viegas, Selma Maria Fonseca; Penna, Cláudia Maria de Mattos

2015-01-01

To understand the health integrality in the daily work of Family Health Strategy (FHS) and its concept according to the managers in Jequitinhonha Valley, Minas Gerais, Brazil. This is a multiple case study of holistic and qualitative approach based on the Quotidian Comprehensive Sociology. The subjects were workers of the Family Health Strategy teams, the support team and managers in a total of 48. The results show the integrality as a principle of life and right to health and to contemplate it in the quotidian of doings in health, others principles of the Unified Health System may be addressed consecutively. The universal right to health care needs is declared in contemplation of integrity of being, the idealization of a subject-centered care, one that is our aim in health care, which signals a step towards a change of attitude in seeking comprehensive care. It is considered that the principle of integrality is a difficult accomplishment in its dimensions.

Delaware statewide ITMS integration : ITS evaluation strategy

DOT National Transportation Integrated Search

2002-01-01

In 2000 the U.S. Congress earmarked funds for selected projects that were assessed as supporting the improvements of transportation efficiency, promoting safety, increasing traffic flow, reducing emissions, improving traveler information, enhancing a...

EJ 2020 Action Agenda: EPA’s Environmental Justice Strategy

EPA Pesticide Factsheets

The EJ 2020 Action Agenda is EPA's strategic plan for integrating environmental justice into its programs, policies, and activities and will support making a difference in overburdened, underserved, and economically distressed communities.

Collecting, Integrating, and Disseminating Patient-Reported Outcomes for Research in a Learning Healthcare System

PubMed Central

Harle, Christopher A.; Lipori, Gloria; Hurley, Robert W.

2016-01-01

Introduction: Advances in health policy, research, and information technology have converged to increase the electronic collection and use of patient-reported outcomes (PROs). Therefore, it is important to share lessons learned in implementing PROs in research information systems. Case Description: The purpose of this case study is to describe a novel information system for electronic PROs and lessons learned in implementing that system to support research in an academic health center. The system incorporates freely available and commercial software and involves clinical and research workflows that support the collection, transformation, and research use of PRO data. The software and processes that comprise the system serve three main functions, (i) collecting electronic PROs in clinical care, (ii) integrating PRO data with non-patient generated clinical data, and (iii) disseminating data to researchers through the institution’s research informatics infrastructure, including the i2b2 (Informatics for Integrating Biology and the Bedside) system. Strategies: Our successful design and implementation was driven by three overarching strategies. First, we selected and implemented multiple interfaced technologies to support PRO collection, management, and research use. Second, we aimed to use standardized approaches to measuring PROs, sending PROs between systems, and disseminating PROs. Finally, we focused on using technologies and processes that aligned with existing clinical research information management strategies within our organization. Conclusion: These experiences and lessons may help future implementers and researchers enhance the scale and sustainable use of systems for research use of PROs. PMID:27563683

National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care.

PubMed

Gvozdanović, Darko; Koncar, Miroslav; Kojundzić, Vinko; Jezidzić, Hrvoje

2007-01-01

In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

Promoting discovery and access to real time observations produced by regional coastal ocean observing systems

NASA Astrophysics Data System (ADS)

Anderson, D. M.; Snowden, D. P.; Bochenek, R.; Bickel, A.

2015-12-01

In the U.S. coastal waters, a network of eleven regional coastal ocean observing systems support real-time coastal and ocean observing. The platforms supported and variables acquired are diverse, ranging from current sensing high frequency (HF) radar to autonomous gliders. The system incorporates data produced by other networks and experimental systems, further increasing the breadth of the collection. Strategies promoted by the U.S. Integrated Ocean Observing System (IOOS) ensure these data are not lost at sea. Every data set deserves a description. ISO and FGDC compliant metadata enables catalog interoperability and record-sharing. Extensive use of netCDF with the Climate and Forecast convention (identifying both metadata and a structured format) is shown to be a powerful strategy to promote discovery, interoperability, and re-use of the data. To integrate specialized data which are often obscure, quality control protocols are being developed to homogenize the QC and make these data more integrate-able. Data Assembly Centers have been established to integrate some specialized streams including gliders, animal telemetry, and HF radar. Subsets of data that are ingested into the National Data Buoy Center are also routed to the Global Telecommunications System (GTS) of the World Meteorological Organization to assure wide international distribution. From the GTS, data are assimilated into now-cast and forecast models, fed to other observing systems, and used to support observation-based decision making such as forecasts, warnings, and alerts. For a few years apps were a popular way to deliver these real-time data streams to phones and tablets. Responsive and adaptive web sites are an emerging flexible strategy to provide access to the regional coastal ocean observations.

The integration of occupational therapy into primary care: a multiple case study design

PubMed Central

2013-01-01

Background For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration. Methods A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires. Results Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers. Conclusion With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group. An understanding of professional roles, trust and communication are foundations for interprofessional collaborative practice. PMID:23679667

The Need for Flexibility in Conservation Practices: Exotic Species as an Example

NASA Astrophysics Data System (ADS)

Prévot-Julliard, Anne-Caroline; Clavel, Joanne; Teillac-Deschamps, Pauline; Julliard, Romain

2011-03-01

To garner support for biodiversity from the World's human population, conservation biologists need an open-minded, integrated conservation strategy. We suggest that this strategy should include efforts to (1) preserve existing high quality, diverse ecosystems, (2) remediate impaired systems, (3) balance the needs of people and ecological resources, and (4) engender appreciation of nature and its services. We refer to these four key tenets as reservation, restoration, reconciliation, and reconnection. We illustrate these concepts by presenting the debate surrounding the management of exotic species from an unusual perspective, the benefits of exotic species. By this example we hope to encourage an integrated approach to conservation in which management strategies can be flexible, adjusting to society's needs and the overall goals of conservation.

Towards an Operations Strategy for the Infusion of Product-Centric Services into Manufacturing

NASA Astrophysics Data System (ADS)

Baines, Tim S.; Lightfoot, Howard W.

The work in this chapter is concerned with product-centric servitization. This is where a portfolio of services are formed and integrated to support product availability and use. Such servitization can be a valuable source of revenue for a manufacturer, yet little attention has been given to the configuration of the wider operations strategy that needs to be in place to deliver integrated products and services successfully. Therefore, the purpose of this chapter is to put forward a generic set of characteristics for such operations. Our intention is that these characteristics will be valuable to practitioners contemplating sophisticated forms of servitization, as they suggest the likely and significant changes that will be needed to the operations strategy of a conventional manufacturing organisation.

Collaborative modeling of an implementation strategy: a case study to integrate health promotion in primary and community care.

PubMed

Grandes, Gonzalo; Sanchez, Alvaro; Cortada, Josep M; Pombo, Haizea; Martinez, Catalina; Balagué, Laura; Corrales, Mary Helen; de la Peña, Enrique; Mugica, Justo; Gorostiza, Esther

2017-12-06

Evidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care. Between 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations. All four centers chose to address physical activity, diet, and smoking. They selected the 5 A's evidence-based clinical intervention to be adapted to the context of the health centers. The planned implementation strategy worked at multiple levels: bottom-up primary care organizational change, top-down support from managers, community involvement, and the development of innovative e-health information and communication tools. Shared decision making and practice facilitation were perceived as the most positive aspects of the collaborative modeling process, which took more time than expected, especially the development of the new e-health tools integrated into electronic health records. Collaborative modeling of an implementation strategy for the integration of health promotion in primary and community care was feasible in motivated centers. However, it was difficult, being hindered by the heavy workload in primary care and generating uncertainty inherent to a bottom-up decision making processes. Lessons from this experience could be useful in diverse settings and for other clinical interventions. Two companion papers report the evaluation of its feasibility and assess quantitatively and qualitatively the implementation process.

Mapping European Welfare Models: State of the Art of Strategies for Professional Integration and Reintegration of Persons with Chronic Diseases.

PubMed

Scaratti, Chiara; Leonardi, Matilde; Silvaggi, Fabiola; Ávila, Carolina C; Muñoz-Murillo, Amalia; Stavroussi, Panayiota; Roka, Olga; Burger, Helena; Fheodoroff, Klemens; Tobiasz-Adamczyk, Beata; Sabariego, Carla; Esteban, Eva; Gruber, Sonja; Svestkova, Olga; Halvorsen, Rune; Kadyrbaeva, Asel; Ferraina, Sabrina

2018-04-17

Background: Persons with chronic diseases (PwCDs) often experience work-related problems, and innovative actions to improve their participation in the labor market are needed. In the frame of the European (EU) Pathways Project, the aim of the study is to compare existing strategies (policies, systems, and services) for professional (re-)integration of PwCDs and mental health conditions available at both European and national level between different European welfare models: Scandinavian, Continental, Anglo-Saxon, Mediterranean, and “Post-Communist”. Method : The European strategies were identified by an overview of relevant academic and grey literature searched through Medline and internet searches, while national strategies were explored through questionnaires and in-depth interviews with national relevant stakeholders. Results : The mapping of existing strategies revealed that, both at European and national level, PwCDs are often considered as part of the group of “persons with disabilities” and only in this case they can receive employment support. European countries put in place actions to support greater labor market participation, but these differ from country to country. Conclusion : Strategies targeting “persons with disabilities” do not necessarily address all the needs of persons with chronic diseases. Countries should consider the importance of employment for all to achieve smart, sustainable, and inclusive growth.

Organizational Strategies to Implement Hospital Pressure Ulcer Prevention Programs: Findings from a National Survey

PubMed Central

SOBAN, LYNN M.; KIM, LINDA; YUAN, ANITA H.; MILTNER, REBECCA S.

2017-01-01

Aim To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system. Background Comprehensive pressure ulcer programs include nursing interventions such as use of a risk assessment tool and organizational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programs. Methods Data were collected by an email survey to all Chief Nursing Officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarize survey responses and evaluate relationships between some variables. Results Organizational strategies that support pressure ulcer prevention program implementation (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalized within individual hospitals. Conclusion Organizational strategies to support implementation of pressure ulcer preventive programs are often not optimally operationalized to achieve consistent, sustainable performance. Implications for Nursing Management The results of this study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. PMID:27487972

Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

PubMed

Delon, Sandra; Mackinnon, Blair

2009-01-01

Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

Influencing the Instructional Design Strategies of New Teachers: Foreign Language and Technology Teacher Education.

ERIC Educational Resources Information Center

Cunningham, Ann C.; Redmond, Mary Lynn

2002-01-01

Presents the foreign language education program at Wake Forest University as an example of how a content-focused curriculum can be enhanced by a supportive technology program. An emphasis on content, research, and practice supported by integrated, state-of-the-art technology prepares graduates of the foreign language education program to lead…

Understanding Students' Adaptation to Graduate School: An Integration of Social Support Theory and Social Learning Theory

ERIC Educational Resources Information Center

Tsay, Crystal Han-Huei

2012-01-01

The contemporary business world demands adaptive individuals (Friedman & Wyman, 2005). Adaptation is essential for any life transition. It often involves developing coping mechanisms, strategies, and seeking of social support. Adaptation occurs in many settings from moving to a new culture, taking a new job, starting or finishing an…

Social factors predictive of social integration for adults with brain injury.

PubMed

Batchos, Elisabeth; Easton, Amanda; Haak, Christopher; Ditchman, Nicole

2018-08-01

Individuals with acquired brain injury (ABI) may not only struggle with physical and cognitive impairments, but may also face challenges reintegrating into the community socially. Research has demonstrated that following ABI, individuals' social networks tend to dwindle, support may decline, and isolation increases. This study examined factors impacting social integration in a community-based sample of 102 individuals with ABI. Potential predictors included emotional support, instrumental support, problem solving confidence, and approach-avoidance style (AAS) of problem solving, while controlling for age, gender, education, and time since injury. Hierarchical regression was used to analyze whether these factors were predictive of social integration. The final model accounted for 33% of the variance in social integration outcomes. Results demonstrated that emotional support was initially a significant predictor; however, when controlling for emotional support the variance in social integration was better accounted for by social problem solving - specifically, AAS. A follow-up mediation analysis indicated that the relationship between social problem solving (specifically, AAS) and social integration was partially mediated by emotional support. This suggests that for individuals with ABI, a tendency to approach rather than avoid social problem solving issues is a significant predictor for social integration both directly and indirectly through its association with emotional social support. Implications for Rehabilitation Both instrumental and emotional social support should be assessed in patients with acquired brain injury (ABI), ensuring that emotional needs are met in addition to the more obvious instrumental needs. Barriers to problem solving for people with ABI may limit optimal social integration; thus, assessment and intervention aimed at increasing AAS are recommended. To enhance the social integration outcomes of people with brain injury, strength-based psychosocial rehabilitation should optimally balance an individual's abilities with areas requiring compensation, focusing on how to approach rather than avoid problems as well as strategies to cultivate emotional social support.

A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions

PubMed Central

Powell, Byron J.; Proctor, Enola K.; Glass, Joseph E.

2013-01-01

Objective This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. Methods A literature search was conducted using electronic databases and a manual search. Results Eleven studies were identified that tested implementation strategies with a randomized (n = 10) or controlled clinical trial design (n = 1). The wide range of clinical interventions, implementation strategies, and outcomes evaluated precluded meta-analysis. However, the majority of studies (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome. Conclusions There is a clear need for more rigorous research on the effectiveness of implementation strategies, and we provide several suggestions that could improve this research area. PMID:24791131

Sustained transfer of knowledge to practice in long-term care: facilitators and barriers of a mental health learning initiative.

PubMed

Stolee, Paul; McAiney, Carrie A; Hillier, Loretta M; Harris, Diane; Hamilton, Pam; Kessler, Linda; Madsen, Victoria; Le Clair, J Kenneth

2009-01-01

This article explores facilitators and barriers to the impact and sustainability of a learning initiative to increase capacity of long-term care (LTC) homes to manage the mental health needs of older persons, through development of in-house Psychogeriatric Resource Persons (PRPs). Twenty interviews were conducted with LTC staff. Management support, particularly designation of time for PRP activities, development of PRP teams, and supportive learning strategies were significant factors affecting sustained knowledge transfer. Continuing education that is provided and evaluated on an ongoing basis, secures management commitment, is integrated within a broader system strategy, and provides on-the-job support has the greatest potential to affect care.

Healthcare provider education to support integration of pharmacogenomics in practice: the eMERGE Network experience

PubMed Central

Rohrer Vitek, Carolyn R; Abul-Husn, Noura S; Connolly, John J; Hartzler, Andrea L; Kitchner, Terrie; Peterson, Josh F; Rasmussen, Luke V; Smith, Maureen E; Stallings, Sarah; Williams, Marc S; Wolf, Wendy A; Prows, Cynthia A

2017-01-01

Ten organizations within the Electronic Medical Records and Genomics Network developed programs to implement pharmacogenomic sequencing and clinical decision support into clinical settings. Recognizing the importance of informed prescribers, a variety of strategies were used to incorporate provider education to support implementation. Education experiences with pharmacogenomics are described within the context of each organization's prior involvement, including the scope and scale of implementation specific to their Electronic Medical Records and Genomics projects. We describe common and distinct education strategies, provide exemplars and share challenges. Lessons learned inform future perspectives. Future pharmacogenomics clinical implementation initiatives need to include funding toward implementing provider education and evaluating outcomes. PMID:28639489

Digital case-based learning system in school.

PubMed

Gu, Peipei; Guo, Jiayang

2017-01-01

With the continuing growth of multi-media learning resources, it is important to offer methods helping learners to explore and acquire relevant learning information effectively. As services that organize multi-media learning materials together to support programming learning, the digital case-based learning system is needed. In order to create a case-oriented e-learning system, this paper concentrates on the digital case study of multi-media resources and learning processes with an integrated framework. An integration of multi-media resources, testing and learning strategies recommendation as the learning unit is proposed in the digital case-based learning framework. The learning mechanism of learning guidance, multi-media materials learning and testing feedback is supported in our project. An improved personalized genetic algorithm which incorporates preference information and usage degree into the crossover and mutation process is proposed to assemble the personalized test sheet for each learner. A learning strategies recommendation solution is proposed to recommend learning strategies for learners to help them to learn. The experiments are conducted to prove that the proposed approaches are capable of constructing personalized sheets and the effectiveness of the framework.

Digital case-based learning system in school

PubMed Central

Gu, Peipei

2017-01-01

With the continuing growth of multi-media learning resources, it is important to offer methods helping learners to explore and acquire relevant learning information effectively. As services that organize multi-media learning materials together to support programming learning, the digital case-based learning system is needed. In order to create a case-oriented e-learning system, this paper concentrates on the digital case study of multi-media resources and learning processes with an integrated framework. An integration of multi-media resources, testing and learning strategies recommendation as the learning unit is proposed in the digital case-based learning framework. The learning mechanism of learning guidance, multi-media materials learning and testing feedback is supported in our project. An improved personalized genetic algorithm which incorporates preference information and usage degree into the crossover and mutation process is proposed to assemble the personalized test sheet for each learner. A learning strategies recommendation solution is proposed to recommend learning strategies for learners to help them to learn. The experiments are conducted to prove that the proposed approaches are capable of constructing personalized sheets and the effectiveness of the framework. PMID:29107965

The Italian Dementia National Plan. Commentary.

PubMed

Di Fiandra, Teresa; Canevelli, Marco; Di Pucchio, Alessandra; Vanacore, Nicola

2015-01-01

The Italian Dementia National Plan was formulated in October 2014 by the Italian Ministry of Health in close cooperation with the regions, the National Institute of Health and the three major national associations of patients and carers. The main purpose of this strategy was to provide directive indications for promoting and improving interventions in the dementia field, not limiting to specialist and therapeutic actions, but particularly focusing on the support of patients and families throughout the pathways of care. Four main objectives are indicated: 1) promote health- and social-care interventions and policies; 2) create/strengthen the integrated network of services for dementia based on an integrated approach; 3) implement strategies for promoting appropriateness and quality of care; and 4) improve the quality of life of persons with dementia and their families by supporting empowerment and stigma reduction. These objectives and the pertaining actions are described in the present paper.

Recommendations for palliative and bereavement care in the NICU: a family-centered integrative approach.

PubMed

Kenner, C; Press, J; Ryan, D

2015-12-01

Technological advances have increased our ability to detect a life-threatening, life-limiting or lethal problem early in pregnancy, leaving parents months to anticipate a death or a prematurely born infant. Babies can also be born with unanticipated problems that could lead to death. In either scenario, perinatal palliative care should be offered as a strategy for family support. Since the preponderance of professional training focuses on saving lives, many health professionals are uncomfortable with palliative care. This article's purpose is to define best practices for the provision of family-centered perinatal and neonatal palliative care and provision of support to bereaved families experiencing anticipated and unanticipated life-limiting conditions or death of their infant. An overview of core concepts and values is presented, followed by intervention strategies to promote an integrated family-centered approach to palliative and bereavement care. The concluding section presents evidence-based recommendations.

Characterization of Model-Based Reasoning Strategies for Use in IVHM Architectures

NASA Technical Reports Server (NTRS)

Poll, Scott; Iverson, David; Patterson-Hine, Ann

2003-01-01

Open architectures are gaining popularity for Integrated Vehicle Health Management (IVHM) applications due to the diversity of subsystem health monitoring strategies in use and the need to integrate a variety of techniques at the system health management level. The basic concept of an open architecture suggests that whatever monitoring or reasoning strategy a subsystem wishes to deploy, the system architecture will support the needs of that subsystem and will be capable of transmitting subsystem health status across subsystem boundaries and up to the system level for system-wide fault identification and diagnosis. There is a need to understand the capabilities of various reasoning engines and how they, coupled with intelligent monitoring techniques, can support fault detection and system level fault management. Researchers in IVHM at NASA Ames Research Center are supporting the development of an IVHM system for liquefying-fuel hybrid rockets. In the initial stage of this project, a few readily available reasoning engines were studied to assess candidate technologies for application in next generation launch systems. Three tools representing the spectrum of model-based reasoning approaches, from a quantitative simulation based approach to a graph-based fault propagation technique, were applied to model the behavior of the Hybrid Combustion Facility testbed at Ames. This paper summarizes the characterization of the modeling process for each of the techniques.

An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy.

PubMed

Karwalajtys, Tina; Kaczorowski, Janusz

2010-01-01

Cardiovascular disease (CVD) is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.

The Relationship of Acculturation Strategies to Resilience: The Moderating Impact of Social Support among Qiang Ethnicity following the 2008 Chinese Earthquake.

PubMed

Han, Li; Berry, John W; Zheng, Yong

2016-01-01

International research has mostly confirmed the positive association between acculturation strategies and resilience in ethnic groups, but the mediating and moderating mechanisms underlying the relationships are still under-investigated. The present study aimed to investigate the associations between acculturation strategies (based on two cultural identities) and resilience of 898 Qiang ethnicity volunteers (mean age = 29.5), especially exploring the mediating and moderating effects of personality, spiritual belief and social support on the relationship between acculturation strategy (using two cultural identities as latent variables in model analysis) and resilience following the occurrence of 2008 Wenchuan earthquake in Sichuan, taking such mechanisms into account. Results were as follows: (1) All variable presented significant positive correlations; (2) Consistent with the mediating hypotheses, personality and spiritual beliefs played a partial mediating role in the relationship between two cultural identities and resilience; (3) High or low level of perceived social support had a moderating effect on cultural identities and resilience; (4) The integration strategy was the most optimal style to promote the development of resilience, but marginalization was the least effective style.

InTeGrate: Interdisciplinary Teaching about the Earth for a Sustainable Future

NASA Astrophysics Data System (ADS)

Manduca, C. A.

2017-12-01

InTeGrate supports integrated interdisciplinary learning about resource and environmental issues across the undergraduate curriculum to create a sustainable and just civilization. The project has developed teaching materials and examples of their use in programs and is currently engaged in a suite of activities that support use of these resources in improving undergraduate Earth education. Thirty-three sets of teaching materials supporting instruction over time periods of 2 weeks to a full semester have been developed by teams of faculty and peer-reviewed to ensure strong research-based pedagogic design and attention to five design principles: 1) address one or more grand challenges involving the Earth and society, 2) develop student ability to address interdisciplinary problems, 3) improve student understanding of the nature and methods of science and developing geoscientific habits of mind, 4) make use of authentic and credible science data to learn central concepts in the context of scientific methods of inquiry, and, 5) incorporate systems thinking. They have been tested in a wide variety of institutional and disciplinary settings and are documented with instructor notes describing adaptation for specific settings. All published materials passed a review for scientific accuracy. Sixteen program models demonstrate strategies for strengthening learning about Earth and sustainability at scales ranging from a department to an interinstitutional collaboration. These examples document the use of InTeGrate resources in the development and evaluation of these programs. A synthesis of lessons learned by these projects addresses strategies for teaching about the Earth across the curriculum. InTeGrate is currently supporting use of ideas and resources developed over the past six years of project work through a webinar series, workshops at professional society meetings, a traveling workshop program for departments and regions, a set of online learning communities and ongoing development of its website and publications. More than 50,000 students have received instruction influenced by InTeGrate.

Integrated Global Observation Strategy - Ozone and Atmospheric Chemistry Project

NASA Technical Reports Server (NTRS)

Hilsenrath, Ernest; Readings, C. J.; Kaye, J.; Mohnen, V.; Einaudi, Franco (Technical Monitor)

2000-01-01

The "Long Term Continuity of Stratospheric Ozone Measurements and Atmospheric Chemistry" project was one of six established by the Committee on Earth Observing Satellites (CEOS) in response to the Integrated Global Observing Strategy (IGOS) initiative. IGOS links satellite and ground based systems for global environmental observations. The strategy of this project is to develop a consensus of user requirements including the scientific (SPARC, IGAC, WCRP) and the applications community (WMO, UNEP) and to develop a long-term international plan for ozone and atmospheric chemistry measurements. The major components of the observing system include operational and research (meeting certain criteria) satellite platforms planned by the space faring nations which are integrated with a well supported and sustained ground, aircraft, and balloon measurements program for directed observations as well satellite validation. Highly integrated and continuous measurements of ozone, validation, and reanalysis efforts are essential to meet the international scientific and applications goals. In order to understand ozone trends, climate change, and air quality, it is essential to conduct long term measurements of certain other atmospheric species. These species include key source, radical, and reservoir constituents.

Heterogeneous Biomedical Database Integration Using a Hybrid Strategy: A p53 Cantcer Research Database

PubMed Central

Bichutskiy, Vadim Y.; Colman, Richard; Brachmann, Rainer K.; Lathrop, Richard H.

2006-01-01

Complex problems in life science research give rise to multidisciplinary collaboration, and hence, to the need for heterogeneous database integration. The tumor suppressor p53 is mutated in close to 50% of human cancers, and a small drug-like molecule with the ability to restore native function to cancerous p53 mutants is a long-held medical goal of cancer treatment. The Cancer Research DataBase (CRDB) was designed in support of a project to find such small molecules. As a cancer informatics project, the CRDB involved small molecule data, computational docking results, functional assays, and protein structure data. As an example of the hybrid strategy for data integration, it combined the mediation and data warehousing approaches. This paper uses the CRDB to illustrate the hybrid strategy as a viable approach to heterogeneous data integration in biomedicine, and provides a design method for those considering similar systems. More efficient data sharing implies increased productivity, and, hopefully, improved chances of success in cancer research. (Code and database schemas are freely downloadable, http://www.igb.uci.edu/research/research.html.) PMID:19458771

Health Systems Integration of Sexual and Reproductive Health and HIV Services in Sub-Saharan Africa: A Scoping Study

PubMed Central

Kendall, Tamil; Langer, Ana; Bärnighausen, Till

2014-01-01

Objective: Both sexual and reproductive health (SRH) services and HIV programs in sub-Saharan Africa are typically delivered vertically, operating parallel to national health systems. The objective of this study was to map the evidence on national and international strategies for integration of SRH and HIV services in sub-Saharan Africa and to develop a research agenda for future health systems integration. Methods: We examined the literature on national and international strategies to integrate SRH and HIV services using a scoping study methodology. Current policy frameworks, national HIV strategies and research, and gray literature on integration were mapped. Five countries in sub-Saharan Africa with experience of integrating SRH and HIV services were purposively sampled for detailed thematic analysis, according to the health systems functions of governance, policy and planning, financing, health workforce organization, service organization, and monitoring and evaluation. Results: The major international health policies and donor guidance now support integration. Most integration research has focused on linkages of SRH and HIV front-line services. Yet, the common problems with implementation are related to delayed or incomplete integration of higher level health systems functions: lack of coordinated leadership and unified national integration policies; separate financing streams for SRH and HIV services and inadequate health worker training, supervision and retention. Conclusions: Rigorous health systems research on the integration of SRH and HIV services is urgently needed. Priority research areas include integration impact, performance, and economic evaluation to inform the planning, financing, and coordination of integrated service delivery. PMID:25436826

Indicators and Measurement Tools for Health Systems Integration: A Knowledge Synthesis

PubMed Central

Oelke, Nelly D.; da Silva Lima, Maria Alice Dias; Stiphout, Michelle; Janke, Robert; Witt, Regina Rigatto; Van Vliet-Brown, Cheryl; Schill, Kaela; Rostami, Mahnoush; Hepp, Shelanne; Birney, Arden; Al-Roubaiai, Fatima; Marques, Giselda Quintana

2017-01-01

Background: Despite far reaching support for integrated care, conceptualizing and measuring integrated care remains challenging. This knowledge synthesis aimed to identify indicator domains and tools to measure progress towards integrated care. Methods: We used an established framework and a Delphi survey with integration experts to identify relevant measurement domains. For each domain, we searched and reviewed the literature for relevant tools. Findings: From 7,133 abstracts, we retrieved 114 unique tools. We found many quality tools to measure care coordination, patient engagement and team effectiveness/performance. In contrast, there were few tools in the domains of performance measurement and information systems, alignment of organizational goals and resource allocation. The search yielded 12 tools that measure overall integration or three or more indicator domains. Discussion: Our findings highlight a continued gap in tools to measure foundational components that support integrated care. In the absence of such targeted tools, “overall integration” tools may be useful for a broad assessment of the overall state of a system. Conclusions: Continued progress towards integrated care depends on our ability to evaluate the success of strategies across different levels and context. This study has identified 114 tools that measure integrated care across 16 domains, supporting efforts towards a unified measurement framework. PMID:29588637

Integrated care

PubMed Central

Gröne, Oliver; Garcia-Barbero, Mila

2001-01-01

Abstract The WHO European Office for Integrated Health Care Services in Barcelona is an integral part of the World Health Organizations' Regional Office for Europe. The main purpose of the Barcelona office is within the integration of services to encourage and facilitate changes in health care services in order to promote health and improve management and patient satisfaction by working for quality, accessibility, cost-effectiveness and participation. This position paper outlines the need for Integrated Care from a European perspective, provides a theoretical framework for the meaning of Integrated Care and its strategies and summarizes the programmes of the office that will support countries in the WHO European Region to improve health services. PMID:16896400

Joint Peru/United States report on Peru/United States cooperative energy assessment. Volume 1. Executive summary, main report and appendices

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

Not Available

1979-08-01

In 1978, the US and Peru conducted a comprehensive assessment of Peru's energy resources, needs, and uses and developed several alternative energy strategies that utilize the available resources to meet their energy requirements. This Volume I reports the findings of the assessment and contains the executive summary, the main report, and five appendices of information that support the integrated energy supply and demand analysis. The following chapters are included: The Energy Situation in Peru (economic context and background, energy resources and production, energy consumption patterns); Reference Supply and Demand Projection (approach, procedures, and assumptions; economic projections; energy demand and supplymore » projections; supply/demand integration; uncertainties); and The Development of Strategies and Options (the analysis of options; strategies; increased use of renewables, hydropower, coal; increased energy efficiency; and financial analysis of strategies).« less

Relational systems change: implementing a model of change in integrating services for women with substance abuse and mental health disorders and histories of trauma.

PubMed

Markoff, Laurie S; Finkelstein, Norma; Kammerer, Nina; Kreiner, Peter; Prost, Carol A

2005-01-01

This article describes the "relational systems change" model developed by the Institute for Health and Recovery, and the implementation of the model in Massachusetts from 1998-2002 to facilitate systems change to support the delivery of integrated and trauma-informed services for women with co-occurring substance abuse and mental health disorders and histories of violence and empirical evidence of resulting systems changes. The federally funded Women Embracing Life and Living (WELL) Project utilized relational strategies to facilitate systems change within and across 3 systems levels: local treatment providers, community (or region), and state. The WELL Project demonstrates that a highly collaborative, inclusive, and facilitated change process can effect services integration within agencies (intra-agency), strengthen integration within a regional network of agencies (interagency), and foster state support for services integration.

A Case Study of Students' Perceptions of Social Integration Strategies to Retain First-Generation Underprepared Students at a Private Community College

ERIC Educational Resources Information Center

Holmes, Charlene L.

2012-01-01

For many first-generation students, college is one of the biggest transitions they will make. Community colleges' open door policy has allowed entry to a significant number of these students despite the inability to meet their immeasurable needs. Vast attention has been placed on research supporting the integration of academic and social…

Integrative Literature Review: Concept Mapping--A Strategy to Support the Development of Practice, Research, and Theory within Human Resource Development

ERIC Educational Resources Information Center

Daley, Barbara J.; Conceicao, Simone C. O.; Mina, Liliana; Altman, Brian A.; Baldor, Maria; Brown, James

2010-01-01

The purpose of this integrative literature review is to summarize research on concept mapping and to offer ideas on how concept mapping can facilitate practice, research, and theory development within human resource development. In this review, more than 300 articles, written in both English and Spanish, presented at two different concept mapping…

Schools as Community Hubs: Integrating Support Services to Drive Educational Outcomes. A Series of Discussion Papers on Building Healthy Neighborhoods. No. 3

ERIC Educational Resources Information Center

Horn, Michael B.; Freeland, Julia; Butler, Stuart M.

2015-01-01

Effective approaches to the problems of struggling neighborhoods--from health to school success and poverty--require the focused use of integrated strategies. Consistent with this, community schools and many charter schools now function as hubs, helping to deliver a range of services beyond education in order to prepare their students to learn and…

Cultural influences on the use of social support by Chinese immigrants in Japan: "face" as a keyword.

PubMed

Matsudaira, Tomomi

2003-03-01

In this study, the author demonstrates that cultural differences between China and Japan contribute to the social support relationships in the early migration stages. Twenty-two Chinese immigrants in Japan underwent semistructured interviews, the data from which were analyzed qualitatively. The author identified three impression management strategies that related to concepts of shared "face," social debt and benevolence, and independence. All three reflect the Chinese concept of face. This social context enhanced immigrants' commitment to support relationships and to the use of available support from Japanese providers. The author discusses differences between face and self-esteem in terms of impression management strategies. The findings suggest that cultural conflict must be recognized if integration of cultural differences between the two countries is to be achieved.

Process control integration requirements for advanced life support systems applicable to manned space missions

NASA Technical Reports Server (NTRS)

Spurlock, Paul; Spurlock, Jack M.; Evanich, Peggy L.

1991-01-01

An overview of recent developments in process-control technology which might have applications in future advanced life support systems for long-duration space operations is presented. Consideration is given to design criteria related to control system selection and optimization, and process-control interfacing methodology. Attention is also given to current life support system process control strategies, innovative sensors, instrumentation and control, and innovations in process supervision.

Construction of the food and nutrition security policy in Brazil: strategies and challenges in the promotion of intersectorality at the federal government level.

PubMed

Burlandy, Luciene

2009-01-01

This article analyzes institutional strategies of the Brazilian federal government that aim at promoting intersectorality in the field of Food and Nutrition Security (FNS), based on bibliographic review and document analysis. It is assumed that, although formal institutionality in this government level is not enough to promote intersectorality, it is important in process induction. It follows that the combination of different institutional mechanisms favors intersectorality, such as: the existence and location of councils integrated by government sectors and civil society in the presidency; political support by the presidency and inclusion of the issue as being strategic in the governmental agenda; assembly of institutional spaces that articulate the highest government spheres and that integrate technical levels; programs that integrate food production, commercialization, and consumption. Challenges concern interrelation with economic policy and the construction of budget agreed among sectors, integrated to policy management and monitoring.

Missouri botanical garden’s support of ex-situ conservation with living collections

Treesearch

David Gunn; Meg Engelhardt; Derek Lyle

2017-01-01

The Missouri Botanical Garden’s living collections are critical for supporting its multi-disciplinary strategy of integrated plant conservation. The Garden is increasing ex-situ collections of plants in need of conservation to build species diversity into its displays for visitor education. Current areas of focus include native Missouri species and International Union...

Employer-driven consumerism: integrating health into the business model.

PubMed

Thompson, Michael; Checkley, Joseph

2006-01-01

Consumer-driven health care is a misnomer. Notwithstanding the enormous role the individual consumer has to play in reshaping the U.S. health care delivery system, this article will focus on the employer as the key driver of change and innovation in the consumerism revolution. American Standard provides a case study of how one major employer has evaluated health care in the context of its business and aggressively integrated consumerism and health into the core of its business. Other companies will appropriately execute consumerism strategies in a fashion consistent with their own needs, culture, resources and populations. However, the principles supporting those strategies will be very much consistent.

Crossing the quality chasm: the role of information technology departments.

PubMed

Weir, Charlene R; Hicken, Bret L; Rappaport, Hank Steven; Nebeker, Jonathan R

2006-01-01

Integrating information technology (IT) into medical settings is considered essential to transforming hospitals into 21st-century health care institutions. Yet the role of IT departments in maximizing the effectiveness of information systems is not well understood. This article reports a 3-round Delphi panel of Veterans Administration personnel experienced with provider order entry electronic systems. In round 1, 35 administrative, clinical, and IT personnel answered 10 open-ended questions about IT strategies and structures that best support successful transformation. In round 2, panelists rated item importance and ranked proposed strategies. In round 3, panelists received aggregate feedback and rerated the items. Four domains emerged from round 1: IT organization, IT performance monitoring, user-support activities, and core IT responsibilities (eg, computer security, training). In rounds 2 and 3, IT performance monitoring was rated the most important, closely followed by clinical support. Strategies associated with each domain are identified and discussed.

Evaluation of noise impact mitigation protocols to support CSS : final report.

DOT National Transportation Integrated Search

2008-03-01

This research project developed and evaluated practical ways of involving the public in context sensitive sound mitigation strategies. The integrated use of photo montage, PowerPoint presentation, linked traffic sound files, and audience response sys...

Bridging the gap: strategies to integrate classroom and clinical learning.

PubMed

Flood, Lisa Sue; Robinia, Kristi

2014-08-01

Nursing students often feel their classroom (didactic) learning and clinical (practice) experiences are disconnected which can lead to a rejection of academe and dissatisfaction with the profession. This classroom/clinical divide may be exacerbated because of the increased use of part-time clinical faculty, who are often isolated from their didactic peers. If clinical faculty, either novice or experienced, are disconnected from didactic faculty, is it any wonder students feel their learning is fragmented? The purpose of this paper is to discuss strategies to help bridge the gap between didactic and clinical learning. Specific integration strategies for faculty are presented using examples from a baccalaureate adult nursing didactic course and its related clinical course. The role of a clinical coordinator in facilitating course integration and support for part-time clinical faculty is described. Ideas for using technology to enhance learning and suggestions to promote socialization to decrease faculty isolation are also discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

A future task for health-promotion research: Integration of health promotion and sustainable development.

PubMed

Jelsøe, Erling; Thualagant, Nicole; Holm, Jesper; Kjærgård, Bente; Andersen, Heidi Myglegård; From, Ditte-Marie; Land, Birgit; Pedersen, Kirsten Bransholm

2018-02-01

Based on previous studies and reflections collected from participants in a workshop at the 8th Nordic Health Promotion Research Network conference, we reveal current tendencies and discuss future challenges for health-promotion research regarding integration of sustainable development principles. Despite obvious interfaces and interactions between the two, our contention is that strategies for health promotion are not sufficiently integrated with strategies for sustainable development and that policies aimed at solving health or sustainability problems may therefore cause new, undesired and unforeseen environmental and health problems. As illustrated in previous research and as deliberated in the above-mentioned workshop, a number of barriers are identified. These are believed to be related to historical segregation, the conceptual understandings of health promotion and sustainable development, as well as the politics and implementation of policy goals in both areas. Three focal points are proposed as important challenges to address in future research: (a) the duality of health promotion and sustainability and how it can be handled in order to enhance mutually supportive processes between them; (b) the social dimension of sustainability and how it can be strengthened in the development of strategies for health promotion and sustainable development; and (c) exploring and identifying policy approaches and strategies for integrating health promotion and sustainable development.

Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

PubMed

Aradeon, Susan B; Doctor, Henry V

2016-01-01

The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support structures. Innovative communication body tools and the rote learning Rapid Imitation Practice training methodology enabled low-literate volunteers to saturate their communities with informed group discussions transferring communication capacity and ownership to the discussion participants. CCER is especially efficient because virtually every timely, community referral for emergency maternal care results in a saved life, whereas on average, only one in every eight births delivered by an SBA (12%) is expected to be a delivery-associated complication requiring lifesaving care.

Academic performance and perception of learning following a peer coaching teaching and assessment strategy.

PubMed

Moore, Catherine; Westwater-Wood, Sarah; Kerry, Roger

2016-03-01

Peer coaching has been associated with positive effects on learning. Specifically, these associations have been explored in complex healthcare professions. A social theory of learning has been proposed as a key component of the utility of peer coaching. Further, within the peer coaching model, assessment has been considered as an important driver. Empirical support for these dimensions of the model is lacking. To quantify assessment achievements and explore emergent attitudes and beliefs about learning related to a specific peer coaching model with integrated assessment. A longitudinal study based in a UK Higher Education Institute recorded assessment achievements and surveyed attitudes and beliefs in consecutive Year 1 undergraduate (physiotherapy) students (n = 560) between 2002 and 2012. A 6% improvement in academic achievement was demonstrated following the introduction of a peer coaching learning model. This was increased by a further 5% following the implementation of an integrated assessment. The improvement related to an overall averaged increase of one marking band. Students valued the strategy, and themes relating to the importance of social learning emerged from survey data. Peer coaching is an evidence-based teaching and learning strategy which can facilitate learning in complex subject areas. The strategy is underpinned by social learning theory which is supported by emergent student-reported attitudes.

Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.

PubMed

Soban, Lynn M; Kim, Linda; Yuan, Anita H; Miltner, Rebecca S

2017-09-01

To describe the presence and operationalisation of organisational strategies to support implementation of pressure ulcer prevention programmes across acute care hospitals in a large, integrated health-care system. Comprehensive pressure ulcer programmes include nursing interventions such as use of a risk assessment tool and organisational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programmes. Data were collected by an e-mail survey to all chief nursing officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarise survey responses and evaluate relationships between some variables. Organisational strategies that support implementation of a pressure ulcer prevention programme (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalised within individual hospitals. Organisational strategies to support implementation of pressure ulcer preventive programmes are often not optimally operationalised to achieve consistent, sustainable performance. The results of the present study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Monitoring System for Storm Readiness and Recovery of Test Facilities: Integrated System Health Management (ISHM) Approach

NASA Technical Reports Server (NTRS)

Figueroa, Fernando; Morris, Jon; Turowski, Mark; Franzl, Richard; Walker, Mark; Kapadia, Ravi; Venkatesh, Meera; Schmalzel, John

2010-01-01

Severe weather events are likely occurrences on the Mississippi Gulf Coast. It is important to rapidly diagnose and mitigate the effects of storms on Stennis Space Center's rocket engine test complex to avoid delays to critical test article programs, reduce costs, and maintain safety. An Integrated Systems Health Management (ISHM) approach and technologies are employed to integrate environmental (weather) monitoring, structural modeling, and the suite of available facility instrumentation to provide information for readiness before storms, rapid initial damage assessment to guide mitigation planning, and then support on-going assurance as repairs are effected and finally support recertification. The system is denominated Katrina Storm Monitoring System (KStorMS). Integrated Systems Health Management (ISHM) describes a comprehensive set of capabilities that provide insight into the behavior the health of a system. Knowing the status of a system allows decision makers to effectively plan and execute their mission. For example, early insight into component degradation and impending failures provides more time to develop work around strategies and more effectively plan for maintenance. Failures of system elements generally occur over time. Information extracted from sensor data, combined with system-wide knowledge bases and methods for information extraction and fusion, inference, and decision making, can be used to detect incipient failures. If failures do occur, it is critical to detect and isolate them, and suggest an appropriate course of action. ISHM enables determining the condition (health) of every element in a complex system-of-systems or SoS (detect anomalies, diagnose causes, predict future anomalies), and provide data, information, and knowledge (DIaK) to control systems for safe and effective operation. ISHM capability is achieved by using a wide range of technologies that enable anomaly detection, diagnostics, prognostics, and advise for control: (1) anomaly detection algorithms and strategies, (2) fusion of DIaK for anomaly detection (model-based, numerical, statistical, empirical, expert-based, qualitative, etc.), (3) diagnostics/prognostics strategies and methods, (4) user interface, (5) advanced control strategies, (6) integration architectures/frameworks, (7) embedding of intelligence. Many of these technologies are mature, and they are being used in the KStorMS. The paper will describe the design, implementation, and operation of the KStorMS; and discuss further evolution to support other needs such as condition-based maintenance (CBM).

Troubleshooting Portfolios

ERIC Educational Resources Information Center

Crismond, David; Peterie, Matthew

2017-01-01

The Troubleshooting Portfolios approach was developed at the Olathe Northwest High School in Olathe, Kansas. This approach supports integrated STEM and "informed design" thinking and learning, in which students: (1) use design strategies effectively; (2) work creatively and collaboratively in teams; (3) make knowledge-driven decisions;…

Integrated Schistosomiasis and Soil-Transmitted Helminthiasis Control over Five Years on Kome Island, Tanzania

PubMed Central

Kaatano, Godfrey M.; Siza, Julius E.; Mwanga, Joseph R.; Min, Duk-Yong; Yong, Tai-Soon; Chai, Jong-Yil; Ko, Yunsuk; Chang, Su Young; Kullaya, Cyril M.; Rim, Han-Jong; Changalucha, John M.; Eom, Keeseon S.

2015-01-01

Integrated control strategies are important for sustainable control of schistosomiasis and soil-transmitted helminthiasis, despite their challenges for their effective implementation. With the support of Good Neighbors International in collaboration with National Institute of Medical Research, Mwanza, Tanzania, integrated control applying mass drug administration (MDA), health education using PHAST, and improved safe water supply has been implemented on Kome Island over 5 years for controlling schistosomiasis and soil-transmitted helminths (STHs). Baseline surveys for schistosomiasis and STHs was conducted before implementation of any integrated control strategies, followed by 4 cross-sectional follow-up surveys on randomly selected samples of schoolchildren and adults in 10 primary schools and 8 villages, respectively, on Kome islands. Those follow-up surveys were conducted for impact evaluation after introduction of control strategies interventions in the study area. Five rounds of MDA have been implemented from 2009 along with PHAST and improved water supply with pumped wells as other control strategies for complementing MDA. A remarkable steady decline of schistosomiasis and STHs was observed from 2009 to 2012 with significant trends in their prevalence decline, and thereafter infection rate has remained at a low sustainable control. By the third follow-up survey in 2012, Schistosoma mansoni infection prevalence was reduced by 90.5% and hookworm by 93.3% among schoolchildren while in adults the corresponding reduction was 83.2% and 56.9%, respectively. Integrated control strategies have successfully reduced S. mansoni and STH infection status to a lower level. This study further suggests that monitoring and evaluation is a crucial component of any large-scale STH and schistosomiasis intervention. PMID:26537032

Integrated Schistosomiasis and Soil-Transmitted Helminthiasis Control over Five Years on Kome Island, Tanzania.

PubMed

Kaatano, Godfrey M; Siza, Julius E; Mwanga, Joseph R; Min, Duk-Yong; Yong, Tai-Soon; Chai, Jong-Yil; Ko, Yunsuk; Chang, Su Young; Kullaya, Cyril M; Rim, Han-Jong; Changalucha, John M; Eom, Keeseon S

2015-10-01

Integrated control strategies are important for sustainable control of schistosomiasis and soil-transmitted helminthiasis, despite their challenges for their effective implementation. With the support of Good Neighbors International in collaboration with National Institute of Medical Research, Mwanza, Tanzania, integrated control applying mass drug administration (MDA), health education using PHAST, and improved safe water supply has been implemented on Kome Island over 5 years for controlling schistosomiasis and soil-transmitted helminths (STHs). Baseline surveys for schistosomiasis and STHs was conducted before implementation of any integrated control strategies, followed by 4 cross-sectional follow-up surveys on randomly selected samples of schoolchildren and adults in 10 primary schools and 8 villages, respectively, on Kome islands. Those follow-up surveys were conducted for impact evaluation after introduction of control strategies interventions in the study area. Five rounds of MDA have been implemented from 2009 along with PHAST and improved water supply with pumped wells as other control strategies for complementing MDA. A remarkable steady decline of schistosomiasis and STHs was observed from 2009 to 2012 with significant trends in their prevalence decline, and thereafter infection rate has remained at a low sustainable control. By the third follow-up survey in 2012, Schistosoma mansoni infection prevalence was reduced by 90.5% and hookworm by 93.3% among schoolchildren while in adults the corresponding reduction was 83.2% and 56.9%, respectively. Integrated control strategies have successfully reduced S. mansoni and STH infection status to a lower level. This study further suggests that monitoring and evaluation is a crucial component of any large-scale STH and schistosomiasis intervention.

New Strategy and Innovative Projects at the National Biosurveillance Integration Center

PubMed Central

Bennett, Steven; Quitugua, Teresa

2013-01-01

Objective Enhance knowledge of the vision, mission, strategic goals, and objectives of the National Biosurveillance Integration Center (NBIC). Learn about innovative biosurveillance projects ongoing in NBIC. Introduction For a number of years, the federal government has provided biosurveillance in various domains within different departments and agencies. Congress recognized the need for a means of integrating these separate information sources into a more useable resource by chartering NBIC within the Department of Homeland Security. Methods NBIC engaged the biosurveillance community within and beyond the federal government through a series of extensive discussions, workshops, and symposia to define a strategy for future development of integrated biosurveillance activities grounded in legislative and presidential direction. The NBIC Strategic Plan was extensively reviewed by the twelve federal Departments that comprise the National Biosurveillance Integration System (NBIS) as well as the White House Office of Management and Budget. The NBIC Strategic Plan is currently being revised for release of a public version. The NBIC also engaged partners in the development of projects designed to develop and test new approaches to biosurveillance. Results The NBIC Strategic Plan was delivered to Congress in August, 2012. The plan explains the Center’s approach, why it is needed, and how it seeks to execute the mission of integrating national biosurveillance information to provide relevant and timely information that effectively supports decision making. Projects are underway involving text analyses of emergency medical system data, changes to poison control center data collection and analysis, and the application of machine learning to social media analyses. A sub-working group of the NBIS has been established to guide selection of future pilot project areas to address prioritized requirements for integrated biosurveillance. Conclusions NBIC has increased flexibility in its commitment to collaboration and coordination, engaged in bold new approaches, and is defining requirements that will encourage buy-in and support of the users across the levels of government and the private sector. With success in its mission, NBIC will support its partners’ missions and provide relevant and timely information that effectively supports decision making.

Environmental Control and Life Support Integration Strategy for 6-Crew Operations

NASA Technical Reports Server (NTRS)

2009-01-01

The International Space Station (ISS) crew compliment will be increasing in size from 3 to 6 crew members in the summer of 2009. In order to support this increase in crew on ISS, the United States on-orbit Segment (USOS) has been outfitted with a suite of regenerative Environmental Control and Life Support (ECLS) hardware including an Oxygen Generation System(OGS), Waste and Hygiene Compartment (WHC), and a Water Recovery System (WRS). The WRS includes the Urine Processor Assembly (UPA) and the Water Processor Assembly (WPA). A critical step in advancing to a 6Crew support capability on ISS is a full checkedout and verification of the Regenerative ECLS hardware. With a successful checkout, the ISS will achieve full redundancy in its onorbit life support system between the USOS and Russian Segment (RS). The additional redundancy created by the Regenerative ECLS hardware creates the opportunity for independent support capabilities between segments, and for the first time since the start of ISS, the necessity to revise Life Support strategy agreements. Independent operating strategies coupled with the loss of the Space Shuttle supply and return capabilities in 2010 offers additional challenges. These challenges create the need for a higher level of onorbit consumables reserve to ensure crewmember life support during a system failure. This paper will discuss the evolution of the ISS Life Support hardware strategy in support of 6Crew on ISS, as well as the continued work which will be necessary to ensure the support of crew and ISS Program objectives through the life of station.

Chronic Care Management evolves towards Integrated Care in Counties Manukau, New Zealand.

PubMed

Rea, Harry; Kenealy, Tim; Wellingham, John; Moffitt, Allan; Sinclair, Gary; McAuley, Sue; Goodman, Meg; Arcus, Kim

2007-04-13

Despite anecdotes of many chronic care management and integrated care projects around New Zealand, there is no formal process to collect and share relevant learning within (but especially between) District Health Boards (DHBs). We wish to share our experiences and hope to stimulate a productive exchange of ongoing learning. We define chronic care management and integrated care, then summarise current theory and evidence. We describe national policy development (relevant to integrated care, since 2000) including the New Zealand Health Strategy, the NZ Primary Care Strategy, the development of Primary Health Organisations (PHOs), capitation payments, Care Plus, and Services to Improve Access funding. We then describe chronic care management in Counties Manukau, which evolved both prior to and during the international refinement of theory and evidence and the national policy development and implementation. We reflect on local progress to date and opportunities for (and barriers to) future improvements, aided by comparative reflections on the United Kingdom (UK). Our most important messages are addressed as follows: To policymakers and funders--a fragile culture change towards teamwork in the health system is taking place in New Zealand; this change needs to be specifically and actively supported. To PHOs--general practices need help to align their internal (within-practice) financial signals with the new world of capitation and integrated care. To primary and secondary care doctors, nurses, and other carers - systematic chronic care management and integrated care can improve patient quality of life; and if healthcare structures and systems are properly managed to support integration, then healthcare provider professional and personal satisfaction will improve.

Clinical practice guidelines on the evidence-based use of integrative therapies during and following breast cancer treatment

PubMed Central

Greenlee, Heather; DuPont-Reyes, Melissa J.; Balneaves, Lynda G.; Carlson, Linda E.; Cohen, Misha R.; Deng, Gary; Johnson, Jillian A.; Mumber, Matthew; Seely, Dugald; Zick, Suzanna; Boyce, Lindsay; Tripathy, Debu

2018-01-01

Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. PMID:28436999

System Engineering and Integration of Controls for Advanced Life Support

NASA Technical Reports Server (NTRS)

Overland, David; Hoo, Karlene; Ciskowski, Marvin

2006-01-01

The Advanced Integration Matrix (AIM) project at the Johnson Space Center (JSC) was chartered to study and solve systems-level integration issues for exploration missions. One of the first issues identified was an inability to conduct trade studies on control system architectures due to the absence of mature evaluation criteria. Such architectures are necessary to enable integration of regenerative life support systems. A team was formed to address issues concerning software and hardware architectures and system controls.. The team has investigated what is required to integrate controls for the types of non-linear dynamic systems encountered in advanced life support. To this end, a water processing bioreactor testbed is being developed which will enable prototyping and testing of integration strategies and technologies. Although systems such as the water bioreactors exhibit the complexities of interactions between control schemes most vividly, it is apparent that this behavior and its attendant risks will manifest itself among any set of interdependent autonomous control systems. A methodology for developing integration requirements for interdependent and autonomous systems is a goal of this team and this testbed. This paper is a high-level summary of the current status of the investigation, the issues encountered, some tentative conclusions, and the direction expected for further research.

Construction of reduced graphene oxide supported molybdenum carbides composite electrode as high-performance anode materials for lithium ion batteries

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

Chen, Minghua; Zhang, Jiawei; Chen, Qingguo, E-mail: qgchen@263.net

Highlights: • Reduced graphene oxide supported molybdenum carbides are prepared by two-step strategy. • A unique sheet-on-sheet integrated nanostructure is favorable for fast ion/electron transfer. • The integrated electrode shows excellent Li ion storage performance. - Abstract: Metal carbides are emerging as promising anodes for advanced lithium ion batteries (LIBs). Herein we report reduced graphene oxide (RGO) supported molybdenum carbides (Mo{sub 2}C) integrated electrode by the combination of solution and carbothermal methods. In the designed integrated electrode, Mo{sub 2}C nanoparticles are uniformly dispersed among graphene nanosheets, forming a unique sheet-on-sheet integrated nanostructure. As anode of LIBs, the as-prepared Mo{sub 2}C-RGOmore » integrated electrode exhibits noticeable electrochemical performances with a high reversible capacity of 850 mAh g{sup −1} at 100 mA g{sup −1}, and 456 mAh g{sup −1} at 1000 mA g{sup −1}, respectively. Moreover, the Mo{sub 2}C-RGO integrated electrode shows excellent cycling life with a capacity of ∼98.6 % at 1000 mA g{sup −1} after 400 cycles. Our research may pave the way for construction of high-performance metal carbides anodes of LIBs.« less

U.S. Dental Schools' Preparation for the Integrated National Board Dental Examination.

PubMed

Duong, Mai-Ly T; Cothron, Annaliese E; Lawson, Nathaniel C; Doherty, Eileen H

2018-03-01

An Integrated National Board Dental Examination (INBDE) combining basic, behavioral, and clinical sciences will be implemented in 2020 to replace the current two-part National Board Dental Examination required for all candidates who seek to practice dentistry in the U.S. The aims of this study were to determine how U.S. dental schools are preparing for implementation of the INBDE and to assess their top administrators' attitudes about the new exam. A total of 150 deans, academic deans, and other administrators at all 64 U.S. dental schools with graduating classes in 2016 were emailed a 19-question electronic survey. The survey questions addressed the respondents' level of support, perceived benefits and challenges, and planned preparation strategies for the INBDE. The individual response rate was 59%, representing 57 of the 64 schools. Approximately 60% of the respondents either agreed or strongly agreed that they support the integrated exam, while roughly 25% either somewhat or strongly disagreed. While most respondents (72%) reported that their institutions would be prepared for the INBDE, 74% reported that the merged exam created additional strain for their institutions. Respondents reported viewing content integration and clinical applicability as benefits of the INBDE, while required curriculum changes and student preparedness and stress were seen as challenges. Most of the respondents reported their schools were currently employing strategies to prepare for the INBDE including meetings with faculty and students and changes to curricula and course content. The beginning of the fourth year and the end of the third year were the most frequently reported times when schools planned to require students to take the INBDE, although almost half of the respondents did not yet know what it would be required at their school. Several schools were reconsidering using the boards as a passing requirement. This study found that support for the INBDE was not universal, but strategies are under way to prepare students, faculty, and curricula for this new means of assessment.

Services and supports for individuals with co-occurring disorders and long-term homelessness.

PubMed

Foster, Susan; LeFauve, Charlene; Kresky-Wolff, Marilyn; Rickards, Lawrence D

2010-04-01

Co-occurring mental health and substance use disorders are highly prevalent among individuals experiencing long-term homelessness. This paper describes strategies used by 11 projects funded by the Federal Collaborative Initiative to Help End Chronic Homelessness (CICH) to serve individuals with co-occurring disorders (COD) as they transition from homelessness to permanent-supported housing. Findings are based on the observations of clients, program team members, and administrators. This paper presents findings organized around three themes: characteristics and needs of CICH clients with COD, strategies employed to respond to those needs, and challenges associated with implementing an integrated approach to COD. Client characteristics include histories of untreated or intermittently treated mental health and substance use disorders, often further complicated by trauma and chronic illness. Project teams endorsed a variety of services and supports such as engagement, stabilization, motivational techniques, groups, and trauma-informed interventions as useful for their clients with COD. Challenges identified include difficult client behavior, the extended time required for change to occur within this population, inadequate staffing and community resources, and system barriers. The paper concludes with recommendations for further research into the effectiveness of various combinations of service strategies for this population in non-traditional settings during the earliest stage of recovery, along with a call for overcoming workforce and system-level barriers to providing integrated care.

Fiscal year 1980-81 implementation plan in support of technical development and integration of sampling and aggregation procedures. [crop acreage estimation

NASA Technical Reports Server (NTRS)

1981-01-01

The specific objectives of the FY 1980-81 tasks are: (1) further refinements to the weighted aggregation procedure; (2) improved approaches for estimating within-stratum variance; (3) more intensive investigation of alternative sampling strategies such as full-frame sampling strategy, and (4) further developments in regard to a simulated approach for assessing the performance of the overall designed sampling and aggregation system.

Challenges of Implementing ESD in the Education Sector; Experiences in Norway

NASA Astrophysics Data System (ADS)

Sandås, Astrid; Benedict, Faye

This article presents and reflects on Norwegian experiences over a period of about 15 years with implementing the Norwegian national strategy for education for sustainable development (ESD) in the education system. We extract lessons about integration of ESD into education systems. After an introduction to central ideas of sustainable development and ESD, the article discusses the need for appropriate strategies and instruments. Key factors are collaboration to allow pupils and schools to actively contribute to a positive development locally and globally, interdisciplinary approaches to complex sustainability issues, and appropriate use of the ICT and other media. ESD programmes and activities should support school development and build the capacity of schools and teachers for integration of ESD.

The Relationship of Acculturation Strategies to Resilience: The Moderating Impact of Social Support among Qiang Ethnicity following the 2008 Chinese Earthquake

PubMed Central

Han, Li; Berry, John W.; Zheng, Yong

2016-01-01

International research has mostly confirmed the positive association between acculturation strategies and resilience in ethnic groups, but the mediating and moderating mechanisms underlying the relationships are still under-investigated. The present study aimed to investigate the associations between acculturation strategies (based on two cultural identities) and resilience of 898 Qiang ethnicity volunteers (mean age = 29.5), especially exploring the mediating and moderating effects of personality, spiritual belief and social support on the relationship between acculturation strategy (using two cultural identities as latent variables in model analysis) and resilience following the occurrence of 2008 Wenchuan earthquake in Sichuan, taking such mechanisms into account. Results were as follows: (1) All variable presented significant positive correlations; (2) Consistent with the mediating hypotheses, personality and spiritual beliefs played a partial mediating role in the relationship between two cultural identities and resilience; (3) High or low level of perceived social support had a moderating effect on cultural identities and resilience; (4) The integration strategy was the most optimal style to promote the development of resilience, but marginalization was the least effective style. PMID:27741274

Integration of internationally educated nurses into the U.S. Workforce.

PubMed

Wolcott, Krista; Llamado, Suzanne; Mace, Denise

2013-01-01

This study describes the integration experiences of internationally educated nurses, managers, and educators working in Northern California. The purpose of this qualitative pilot study was to explore the experiences of internationally educated nurses and the nurse managers and educators working with them, to understand the issues, and to highlight potential solutions for addressing integration challenges. Through interviews and qualitative analysis, successful strategies and persistent challenges were identified. Major themes identified included communication difficulties; financial challenges; the need for outside social support; and educational orientations focused on culture, nurse role, and communication techniques.

Precepting 101: Teaching Strategies and Tips for Success for Preceptors.

PubMed

Lazarus, Judy

2016-11-01

The current shortage of certified nurse-midwives and certified midwives willing to serve as preceptors for midwifery education programs limits the number of students accepted into education programs. Preceptors are an essential link between academic programs and clinical practice and are indispensable to the growth of the midwifery profession. Preceptors create a safe environment for learning and teach adult learners through a variety of clinical teaching strategies. Novice preceptors need training and support to learn a new role, and experienced preceptors desire continued support and training. Before starting, preceptors need to identify sources of support and mentoring as well as understand the academic program's expectations for the student. This article draws on the clinical education literature to describe approaches to teaching all types of students. Practical strategies for integrating all levels of students into busy clinical settings are identified. Two approaches for clinical teaching, the Five Minute Preceptor and SNAPPS, are discussed in detail. Strategies for providing effective feedback and approaches to student evaluation are provided. © 2016 by the American College of Nurse-Midwives.

Modeling for Integrated Science Management and Resilient Systems Development

NASA Technical Reports Server (NTRS)

Shelhamer, M.; Mindock, J.; Lumpkins, S.

2014-01-01

Many physiological, environmental, and operational risks exist for crewmembers during spaceflight. An understanding of these risks from an integrated perspective is required to provide effective and efficient mitigations during future exploration missions that typically have stringent limitations on resources available, such as mass, power, and crew time. The Human Research Program (HRP) is in the early stages of developing collaborative modeling approaches for the purposes of managing its science portfolio in an integrated manner to support cross-disciplinary risk mitigation strategies and to enable resilient human and engineered systems in the spaceflight environment. In this talk, we will share ideas being explored from fields such as network science, complexity theory, and system-of-systems modeling. Initial work on tools to support these explorations will be discussed briefly, along with ideas for future efforts.

New tools for optimizing fluid resuscitation in acute pancreatitis

PubMed Central

Bortolotti, Perrine; Saulnier, Fabienne; Colling, Delphine; Redheuil, Alban; Preau, Sebastien

2014-01-01

Acute pancreatitis (AP) is a frequent disease with degrees of increasing severity responsible for high morbidity. Despite continuous improvement in care, mortality remains significant. Because hypovolemia, together with microcirculatory dysfunction lead to poor outcome, fluid therapy remains a cornerstone of the supportive treatment. However, poor clinical evidence actually support the aggressive fluid therapy recommended in recent guidelines since available data are controversial. Fluid management remains unclear and leads to current heterogeneous practice. Different strategies may help to improve fluid resuscitation in AP. On one hand, integration of fluid therapy in a global hemodynamic resuscitation has been demonstrated to improve outcome in surgical or septic patients. Tailored fluid administration after early identification of patients with high-risk of poor outcome presenting inadequate tissue oxygenation is a major part of this strategy. On the other hand, new decision parameters have been developed recently to improve safety and efficiency of fluid therapy in critically ill patients. In this review, we propose a personalized strategy integrating these new concepts in the early fluid management of AP. This new approach paves the way to a wide range of clinical studies in the field of AP. PMID:25473163

Integrated Logistics Support approach: concept for the new big projects: E-ELT, SKA, CTA

NASA Astrophysics Data System (ADS)

Marchiori, G.; Rampini, F.; Formentin, F.

2014-08-01

The Integrated Logistic Support is a process supporting strategies and optimizing activities for a correct project management and system engineering development. From the design & engineering of complex technical systems, to the erection on site, acceptance and after-sales service, EIE GROUP covers all aspects of the Integrated Logistics Support (ILS) process that includes: costing process centered around the life cycle cost and Level of Repair Analyses; engineering process which influences the design via means of reliability, modularization, etc.; technical publishing process based on international specifications; ordering administration process for supply support. Through the ILS, EIE GROUP plans and directs the identification and development of logistics support and system requirements for its products, with the goal of creating systems that last longer and require less support, thereby reducing costs and increasing return on investments. ILS therefore, addresses these aspects of supportability not only during acquisition, but also throughout the operational life cycle of the system. The impact of the ILS is often measured in terms of metrics such as reliability, availability, maintainability and testability (RAMT), and System Safety (RAMS). Example of the criteria and approach adopted by EIE GROUP during the design, manufacturing and test of the ALMA European Antennas and during the design phase of the E-ELT telescope and Dome are presented.

Integrating the Unmanned Aircraft System into the National Airspace System

DTIC Science & Technology

2011-06-18

Comprehensive Planning and a Results-Oriented Training Strategy are needed to Support Growing Inventories , GAO-10-331. (Washington, DC: Government...integration of manned and unmanned flight is a challenge facing bureaucratic inertia and in need of our government’s emphasis on resolution. This paper...26 Due to lack of funding in 1979, the remaining 60 UAVs in the U.S Air Force inventory were deactivated and put into storage. The following 10

Quality user support: Supporting quality users

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

Woolley, T.C.

1994-12-31

During the past decade, fundamental changes have occurred in technical computing in the oil industry. Technical computing systems have moved from local, fragmented quantity, to global, integrated, quality. The compute power available to the average geoscientist at his desktop has grown exponentially. Technical computing applications have increased in integration and complexity. At the same time, there has been a significant change in the work force due to the pressures of restructuring, and the increased focus on international opportunities. The profile of the user of technical computing resources has changed. Users are generally more mature, knowledgeable, and team oriented than theirmore » predecessors. In the 1990s, computer literacy is a requirement. This paper describes the steps taken by Oryx Energy Company to address the problems and opportunities created by the explosive growth in computing power and needs, coupled with the contraction of the business. A successful user support strategy will be described. Characteristics of the program include: (1) Client driven support; (2) Empowerment of highly skilled professionals to fill the support role; (3) Routine and ongoing modification to the support plan; (4) Utilization of the support assignment to create highly trained advocates on the line; (5) Integration of the support role to the reservoir management team. Results of the plan include a highly trained work force, stakeholder teams that include support personnel, and global support from a centralized support organization.« less

Actor modelling and its contribution to the development of integrative strategies for management of pharmaceuticals in drinking water.

PubMed

Titz, Alexandra; Döll, Petra

2009-02-01

Widespread presence of human pharmaceuticals in water resources across the globe is documented. While some, but certainly not enough, research on the occurrence, fate and effect of pharmaceuticals in water resources has been carried out, a holistic risk management strategy is missing. The transdisciplinary research project "start" aimed to develop an integrative strategy by the participation of experts representing key actors in the problem field "pharmaceuticals in drinking water". In this paper, we describe a novel modelling method, actor modelling with the semi-quantitative software DANA (Dynamic Actor Network Analysis), and its application in support of identifying an integrative risk management strategy. Based on the individual perceptions of different actors, the approach allows the identification of optimal strategies. Actors' perceptions were elicited by participatory model building and interviews, and were then modelled in perception graphs. Actor modelling indicated that an integrative strategy that targets environmentally-responsible prescription, therapy, and disposal of pharmaceuticals on one hand, and the development of environmentally-friendly pharmaceuticals on the other hand, will likely be most effective for reducing the occurrence of pharmaceuticals in drinking water (at least in Germany where the study was performed). However, unlike most other actors, the pharmaceutical industry itself does not perceive that the production of environmentally-friendly pharmaceuticals is an action that helps to achieve its goals, but contends that continued development of highly active pharmaceutical ingredients will help to reduce the occurrence of pharmaceuticals in the water cycle. Investment in advanced waste or drinking water treatment is opposed by both the wastewater treatment company and the drinking water supplier, and is not mentioned as appropriate by the other actors. According to our experience, actor modelling is a useful method to suggest effective and realisable integrative risk management strategies in complex problem fields that involve many societal actors.

Hospital recruitment for a pragmatic cluster-randomized clinical trial: Lessons learned from the COMPASS study.

PubMed

Johnson, Anna M; Jones, Sara B; Duncan, Pamela W; Bushnell, Cheryl D; Coleman, Sylvia W; Mettam, Laurie H; Kucharska-Newton, Anna M; Sissine, Mysha E; Rosamond, Wayne D

2018-01-26

Pragmatic randomized clinical trials are essential to determine the effectiveness of interventions in "real-world" clinical practice. These trials frequently use a cluster-randomized methodology, with randomization at the site level. Despite policymakers' increased interest in supporting pragmatic randomized clinical trials, no studies to date have reported on the unique recruitment challenges faced by cluster-randomized pragmatic trials. We investigated key challenges and successful strategies for hospital recruitment in the Comprehensive Post-Acute Stroke Services (COMPASS) study. The COMPASS study is designed to compare the effectiveness of the COMPASS model versus usual care in improving functional outcomes, reducing the numbers of hospital readmissions, and reducing caregiver strain for patients discharged home after stroke or transient ischemic attack. This model integrates early supported discharge planning with transitional care management, including nurse-led follow-up phone calls after 2, 30, and 60 days and an in-person clinic visit at 7-14 days involving a functional assessment and neurological examination. We present descriptive statistics of the characteristics of successfully recruited hospitals compared with all eligible hospitals, reasons for non-participation, and effective recruitment strategies. We successfully recruited 41 (43%) of 95 eligible North Carolina hospitals. Leading, non-exclusive reasons for non-participation included: insufficient staff or financial resources (n = 33, 61%), lack of health system support (n = 16, 30%), and lack of support of individual decision-makers (n = 11, 20%). Successful recruitment strategies included: building and nurturing relationships, engaging team members and community partners with a diverse skill mix, identifying gatekeepers, finding mutually beneficial solutions, having a central institutional review board, sharing published pilot data, and integrating contracts and review board administrators. Although we incorporated strategies based on the best available evidence at the outset of the study, hospital recruitment required three times as much time and considerably more staff than anticipated. To reach our goal, we tailored strategies to individuals, hospitals, and health systems. Successful recruitment of a sufficient number and representative mix of hospitals requires considerable preparation, planning, and flexibility. Strategies presented here may assist future trial organizers in implementing cluster-randomized pragmatic trials. Clinicaltrials.gov, NCT02588664 . Registered on 23 October 2015.

From perceived autonomy support to intentional behaviour: Testing an integrated model in three healthy-eating behaviours.

PubMed

Girelli, Laura; Hagger, Martin; Mallia, Luca; Lucidi, Fabio

2016-01-01

A motivational model integrating self-determination theory, the theory of planned behaviour, and the health action process approach was tested in three samples in three behavioural contexts: fruit and vegetable, breakfast, and snack consumption. Perceived support for autonomous (self-determined) forms of motivation from parents and autonomous motivation from self-determination theory were hypothesised to predict intention and behaviour indirectly via the mediation of attitude and perceived behavioural control from the theory of planned behaviour. It was also expected that planning strategies would mediate the effect of intention on behaviour. Relations in the proposed models were expected to be similar across the behaviours. A two-wave prospective design was adopted. Three samples of high-school students (total N = 1041; 59.60% female; M age = 17.13 years ± 1.57) completed measures of perceived autonomy support, autonomous motivation, theory of planned behaviour constructs, planning strategies and behaviour for each of the three behavioural contexts. Three months later, 816 participants (62,24% female; M age: 17.13 years, SD = 1.58) of the initial sample self-reported their behaviour referred to the previous three months. Structural equation models provided support for the key hypothesised effects of the proposed model for the three health-related behaviours. Two direct effects were significantly different across the three behaviours: the effect of perceived autonomy support on perceived behavioural control and the effect of attitude on intention. In addition, planning strategies mediated the effect of intention on behaviour in fruit and vegetable sample only. Findings extend knowledge of the processes by which psychological antecedents from the theories affect energy-balance related behaviours. Copyright © 2015 Elsevier Ltd. All rights reserved.

A framework for developing and integrating effective routing strategies within the emergency management decision-support system : [research brief].

DOT National Transportation Integrated Search

2012-05-01

The terrorist attacks on September 11th, as well as other coordinated attacks on transit centers in Madrid and London, have underscored the importance of evacuation planning to : transportation professionals. With computer technology advancement, urb...

Integrated corridor management I-15 San Diego, California : analysis plan.

DOT National Transportation Integrated Search

2010-02-01

This AMS Analysis Plan for the I-15 Corridor outlines the various tasks associated with the application of the ICM AMS tools and strategies to this corridor in order to support benefit-cost assessment for the successful implementation of ICM. The rep...

Information Literacy and the Introductory Management Classroom

ERIC Educational Resources Information Center

Leigh, Jennifer S. A.; Gibbon, Cynthia A.

2008-01-01

This article proposes that the integration of information literacy standards into the management classroom can address underdeveloped student research strategies and promote effective use of print, digital, and free Web resources. Incorporating information literacy can support management educators in their need to balance disciplinary content,…

Calculation of the Actual Cost of Engine Maintenance

DTIC Science & Technology

2003-03-01

Cost Estimating Integrated Tools ( ACEIT ) helps analysts store, retrieve, and analyze data; build cost models; analyze risk; time phase budgets; and...Tools ( ACEIT ).” n. pag. http://www.aceit.com/ 21 February 2003. • USAMC Logistics Support Activity (LOGSA). “Cost Analysis Strategy Assessment

Integrated NTP Vehicle Radiation Design

NASA Technical Reports Server (NTRS)

Caffrey, Jarvis A.; Rodriquez, Mitchell A.

2018-01-01

The development of a nuclear thermal propulsion stage requires consideration for radiation emitted from the nuclear reactor core. Applying shielding mass is an effective mitigating solution, but a better alternative is to incorporate some mitigation strategies into the propulsion stage and crew habitat. In this way, the required additional mass is minimized and the mass that must be applied may in some cases be able to serve multiple purposes. Strategies for crew compartment shielding are discussed that reduce dose from both engine and cosmic sources, and in some cases may also serve to reduce life support risks by permitting abundant water reserves. Early consideration for integrated mitigation solutions in a crewed nuclear thermal propulsion (NTP) vehicle will enable reduced radiation burden from both cosmic and nuclear sources, improved thrust-to-weight ratio or payload capacity by reducing 'dead mass' of shielding, and generally support a more robust risk posture for a NTP-powered Mars mission by permitting shorter trip times and increased water reserves.

Integrated NTP Vehicle Radiation Design

NASA Technical Reports Server (NTRS)

Caffrey, Jarvis; Rodriquez, Mitchell

2018-01-01

The development of a nuclear thermal propulsion stage requires consideration for radiation emitted from the nuclear reactor core. Applying shielding mass is an effective mitigating solution, but a better alternative is to incorporate some mitigation strategies into the propulsion stage and crew habitat. In this way, the required additional mass is minimized and the mass that must be applied may in some cases be able to serve multiple purposes. Strategies for crew compartment shielding are discussed that reduce dose from both engine and cosmic sources, and in some cases may also serve to reduce life support risks by permitting abundant water reserves. Early consideration for integrated mitigation solutions in a crewed nuclear thermal propulsion (NTP) vehicle will enable reduced radiation burden from both cosmic and nuclear sources, improved thrust-to-weight ratio or payload capacity by reducing 'dead mass' of shielding, and generally support a more robust risk posture for a NTP-powered Mars mission by permitting shorter trip times and increased water reserves

Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches

PubMed Central

2013-01-01

Background Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice. Methods We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice. Results Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture. Conclusions Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes. PMID:23530744

Leveraging Event Reporting Through Knowledge Support: A Knowledge-Based Approach to Promoting Patient Fall Prevention.

PubMed

Yao, Bin; Kang, Hong; Miao, Qi; Zhou, Sicheng; Liang, Chen; Gong, Yang

2017-01-01

Patient falls are a common safety event type that impairs the healthcare quality. Strategies including solution tools and reporting systems for preventing patient falls have been developed and implemented in the U.S. However, the current strategies do not include timely knowledge support, which is in great need in bridging the gap between reporting and learning. In this study, we constructed a knowledge base of fall events by combining expert-reviewed fall prevention solutions and then integrating them into a reporting system. The knowledge base enables timely and tailored knowledge support and thus will serve as a prevailing fall prevention tool. This effort holds promise in making knowledge acquisition and management a routine process for enhancing the reporting and understanding of patient safety events.

Case study: technology initiative led to advanced lead optimization screening processes at Bristol-Myers Squibb, 2004-2009.

PubMed

Zhang, Litao; Cvijic, Mary Ellen; Lippy, Jonathan; Myslik, James; Brenner, Stephen L; Binnie, Alastair; Houston, John G

2012-07-01

In this paper, we review the key solutions that enabled evolution of the lead optimization screening support process at Bristol-Myers Squibb (BMS) between 2004 and 2009. During this time, technology infrastructure investment and scientific expertise integration laid the foundations to build and tailor lead optimization screening support models across all therapeutic groups at BMS. Together, harnessing advanced screening technology platforms and expanding panel screening strategy led to a paradigm shift at BMS in supporting lead optimization screening capability. Parallel SAR and structure liability relationship (SLR) screening approaches were first and broadly introduced to empower more-rapid and -informed decisions about chemical synthesis strategy and to broaden options for identifying high-quality drug candidates during lead optimization. Copyright © 2012 Elsevier Ltd. All rights reserved.

Advancing Understanding of Acculturation for Adolescents of Asian Immigrants: Person-Oriented Analysis of Acculturation Strategy among Korean American Youth

PubMed Central

Choi, Yoonsun; Tan, Kevin Poh Hiong; Yasui, Miwa; Hahm, Hyeouk Chris

2016-01-01

Acculturation strategy, a significant predictor of immigrant adaptation, has been understudied with Asian Americans, in particular, Asian American youth. Using person-oriented latent profile analysis, this study identified acculturation strategies among Korean American early adolescents living in the Midwest. Two-hundred ninety one families were interviewed in 2007 that included 220 youth (mean age = 13, 47.7% female), along with 272 mothers and 164 fathers (N=656). They were re-interviewed in 2008 (N=588). The study found three distinct acculturation strategies: separation (11.8%, n=26), integrated bicultural (66.9%, n=150), and modest bicultural (21.3%, n=44). Integrated bicultural youth reported the strongest sense of ethnic identity and the most favorable characteristics, providing empirical support for the benefit of biculturalism. The findings further suggest that separation may not be as detrimental as previously thought, and modest bicultural—biculturalism that is not fully developed—may in fact be less desirable among Korean American youth. PMID:27146143

NASA Human Health and Performance Strategy

NASA Technical Reports Server (NTRS)

Davis, Jeffrey R.

2012-01-01

In May 2007, what was then the Space Life Sciences Directorate, issued the 2007 Space Life Sciences Strategy for Human Space Exploration. In January 2012, leadership and key directorate personnel were once again brought together to assess the current and expected future environment against its 2007 Strategy and the Agency and Johnson Space Center goals and strategies. The result was a refined vision and mission, and revised goals, objectives, and strategies. One of the first changes implemented was to rename the directorate from Space Life Sciences to Human Health and Performance to better reflect our vision and mission. The most significant change in the directorate from 2007 to the present is the integration of the Human Research Program and Crew Health and Safety activities. Subsequently, the Human Health and Performance Directorate underwent a reorganization to achieve enhanced integration of research and development with operations to better support human spaceflight and International Space Station utilization. These changes also enable a more effective and efficient approach to human system risk mitigation. Since 2007, we have also made significant advances in external collaboration and implementation of new business models within the directorate and the Agency, and through two newly established virtual centers, the NASA Human Health and Performance Center and the Center of Excellence for Collaborative Innovation. Our 2012 Strategy builds upon these successes to address the Agency s increased emphasis on societal relevance and being a leader in research and development and innovative business and communications practices. The 2012 Human Health and Performance Vision is to lead the world in human health and performance innovations for life in space and on Earth. Our mission is to enable optimization of human health and performance throughout all phases of spaceflight. All HHPD functions are ultimately aimed at achieving this mission. Our activities enable mission success, optimizing human health and productivity in space before, during, and after the actual spaceflight experience of our crews, and include support for ground-based functions. Many of our spaceflight innovations also provide solutions for terrestrial challenges, thereby enhancing life on Earth. Our strategic goals are aimed at leading human exploration and ISS utilization, leading human health and performance internationally, excelling in management and advancement of innovations in health and human system integration, and expanding relevance to life on Earth and creating enduring support and enthusiasm for space exploration.

NASA Human Health and Performance Strategy

NASA Technical Reports Server (NTRS)

Davis, Jeffrey R.

2012-01-01

In May 2007, what was then the Space Life Sciences Directorate, issued the 2007 Space Life Sciences Strategy for Human Space Exploration. In January 2012, leadership and key directorate personnel were once again brought together to assess the current and expected future environment against its 2007 Strategy and the Agency and Johnson Space Center goals and strategies. The result was a refined vision and mission, and revised goals, objectives, and strategies. One of the first changes implemented was to rename the directorate from Space Life Sciences to Human Health and Performance to better reflect our vision and mission. The most significant change in the directorate from 2007 to the present is the integration of the Human Research Program and Crew Health and Safety activities. Subsequently, the Human Health and Performance Directorate underwent a reorganization to achieve enhanced integration of research and development with operations to better support human spaceflight and International Space Station utilization. These changes also enable a more effective and efficient approach to human system risk mitigation. Since 2007, we have also made significant advances in external collaboration and implementation of new business models within the directorate and the Agency, and through two newly established virtual centers, the NASA Human Health and Performance Center and the Center of Excellence for Collaborative Innovation. Our 2012 Strategy builds upon these successes to address the Agency's increased emphasis on societal relevance and being a leader in research and development and innovative business and communications practices. The 2012 Human Health and Performance Vision is to lead the world in human health and performance innovations for life in space and on Earth. Our mission is to enable optimization of human health and performance throughout all phases of spaceflight. All HH&P functions are ultimately aimed at achieving this mission. Our activities enable mission success, optimizing human health and productivity in space before, during, and after the actual spaceflight experience of our crews, and include support for ground-­- based functions. Many of our spaceflight innovations also provide solutions for terrestrial challenges, thereby enhancing life on Earth. Our strategic goals are aimed at leading human exploration and ISS utilization, leading human health and performance internationally, excelling in management and advancement of innovations in health and human system integration, and expanding relevance to life on Earth and creating enduring support and enthusiasm for space exploration.

Managers' Support for Employee Wellness Programs: An Integrative Review.

PubMed

Passey, Deborah G; Brown, Meagan C; Hammerback, Kristen; Harris, Jeffrey R; Hannon, Peggy A

2018-01-01

The aim of this integrative literature review is to synthesize the existing evidence regarding managers' support for employee wellness programs. The search utilized multiple electronic databases and libraries. Inclusion criteria comprised peer-reviewed research published in English, between 1990 and 2016, and examining managers' support in the context of a worksite intervention. The final sample included 21 articles for analysis. Two researchers extracted and described results from each of the included articles using a content analysis. Two researchers independently rated the quality of the included articles. Researchers synthesized data into a summary table by study design, sample, data collected, key findings, and quality rating. Factors that may influence managers' support include their organization's management structure, senior leadership support, their expected roles, training on health topics, and their beliefs and attitudes toward wellness programs and employee health. Managers' support may influence the organizational culture, employees' perception of support, and employees' behaviors. When designing interventions, health promotion practitioners and researchers should consider strategies that target senior, middle, and line managers' support. Interventions need to include explicit measures of managers' support as part of the evaluation plan.

Perception, Attitude and Instructional Preferences on Physics in High School Students: An Exploration in an International Setting

NASA Astrophysics Data System (ADS)

Narayanan, Mini; Gafoor, Abdul

Questionnaire survey explored perception, attitude and instructional preferences with respect to gender and nationality in high school students of India and USA, a sample of 1101 Indian and 458 US students. Descriptive Statistics techniques were adopted for analysis. Male and female students in USA were at the high and low ends of the spectrum, respectively, in perception and attitude. Preference on instructional strategies was found to be independent of nationality, exposed strategies, opting science, class size and facilities. Responses from both countries indicate preference for an integrated instructional strategy that has strong teacher involvement in a student-centered framework. A thoughtful and properly designed instructional strategy could provide sufficient elements in modifying students' epistemological beliefs. Understanding the nature and process of physics along with a better learning outcome is usually not possible by administering student-centered or teacher-centered strategies alone in their purest form. This study provides adequate support in obtaining two equally significant but contrasting goals in Physics Education Research, to gain conceptual development with increased interest and attainment in learners, through integration.

Benefits to Speech Perception in Noise From the Binaural Integration of Electric and Acoustic Signals in Simulated Unilateral Deafness

PubMed Central

Ma, Ning; Morris, Saffron; Kitterick, Pádraig Thomas

2016-01-01

Objectives: This study used vocoder simulations with normal-hearing (NH) listeners to (1) measure their ability to integrate speech information from an NH ear and a simulated cochlear implant (CI), and (2) investigate whether binaural integration is disrupted by a mismatch in the delivery of spectral information between the ears arising from a misalignment in the mapping of frequency to place. Design: Eight NH volunteers participated in the study and listened to sentences embedded in background noise via headphones. Stimuli presented to the left ear were unprocessed. Stimuli presented to the right ear (referred to as the CI-simulation ear) were processed using an eight-channel noise vocoder with one of the three processing strategies. An Ideal strategy simulated a frequency-to-place map across all channels that matched the delivery of spectral information between the ears. A Realistic strategy created a misalignment in the mapping of frequency to place in the CI-simulation ear where the size of the mismatch between the ears varied across channels. Finally, a Shifted strategy imposed a similar degree of misalignment in all channels, resulting in consistent mismatch between the ears across frequency. The ability to report key words in sentences was assessed under monaural and binaural listening conditions and at signal to noise ratios (SNRs) established by estimating speech-reception thresholds in each ear alone. The SNRs ensured that the monaural performance of the left ear never exceeded that of the CI-simulation ear. The advantages of binaural integration were calculated by comparing binaural performance with monaural performance using the CI-simulation ear alone. Thus, these advantages reflected the additional use of the experimentally constrained left ear and were not attributable to better-ear listening. Results: Binaural performance was as accurate as, or more accurate than, monaural performance with the CI-simulation ear alone. When both ears supported a similar level of monaural performance (50%), binaural integration advantages were found regardless of whether a mismatch was simulated or not. When the CI-simulation ear supported a superior level of monaural performance (71%), evidence of binaural integration was absent when a mismatch was simulated using both the Realistic and the Ideal processing strategies. This absence of integration could not be accounted for by ceiling effects or by changes in SNR. Conclusions: If generalizable to unilaterally deaf CI users, the results of the current simulation study would suggest that benefits to speech perception in noise can be obtained by integrating information from an implanted ear and an NH ear. A mismatch in the delivery of spectral information between the ears due to a misalignment in the mapping of frequency to place may disrupt binaural integration in situations where both ears cannot support a similar level of monaural speech understanding. Previous studies that have measured the speech perception of unilaterally deaf individuals after CI but with nonindividualized frequency-to-electrode allocations may therefore have underestimated the potential benefits of providing binaural hearing. However, it remains unclear whether the size and nature of the potential incremental benefits from individualized allocations are sufficient to justify the time and resources required to derive them based on cochlear imaging or pitch-matching tasks. PMID:27116049

Benefits to Speech Perception in Noise From the Binaural Integration of Electric and Acoustic Signals in Simulated Unilateral Deafness.

PubMed

Ma, Ning; Morris, Saffron; Kitterick, Pádraig Thomas

2016-01-01

This study used vocoder simulations with normal-hearing (NH) listeners to (1) measure their ability to integrate speech information from an NH ear and a simulated cochlear implant (CI), and (2) investigate whether binaural integration is disrupted by a mismatch in the delivery of spectral information between the ears arising from a misalignment in the mapping of frequency to place. Eight NH volunteers participated in the study and listened to sentences embedded in background noise via headphones. Stimuli presented to the left ear were unprocessed. Stimuli presented to the right ear (referred to as the CI-simulation ear) were processed using an eight-channel noise vocoder with one of the three processing strategies. An Ideal strategy simulated a frequency-to-place map across all channels that matched the delivery of spectral information between the ears. A Realistic strategy created a misalignment in the mapping of frequency to place in the CI-simulation ear where the size of the mismatch between the ears varied across channels. Finally, a Shifted strategy imposed a similar degree of misalignment in all channels, resulting in consistent mismatch between the ears across frequency. The ability to report key words in sentences was assessed under monaural and binaural listening conditions and at signal to noise ratios (SNRs) established by estimating speech-reception thresholds in each ear alone. The SNRs ensured that the monaural performance of the left ear never exceeded that of the CI-simulation ear. The advantages of binaural integration were calculated by comparing binaural performance with monaural performance using the CI-simulation ear alone. Thus, these advantages reflected the additional use of the experimentally constrained left ear and were not attributable to better-ear listening. Binaural performance was as accurate as, or more accurate than, monaural performance with the CI-simulation ear alone. When both ears supported a similar level of monaural performance (50%), binaural integration advantages were found regardless of whether a mismatch was simulated or not. When the CI-simulation ear supported a superior level of monaural performance (71%), evidence of binaural integration was absent when a mismatch was simulated using both the Realistic and the Ideal processing strategies. This absence of integration could not be accounted for by ceiling effects or by changes in SNR. If generalizable to unilaterally deaf CI users, the results of the current simulation study would suggest that benefits to speech perception in noise can be obtained by integrating information from an implanted ear and an NH ear. A mismatch in the delivery of spectral information between the ears due to a misalignment in the mapping of frequency to place may disrupt binaural integration in situations where both ears cannot support a similar level of monaural speech understanding. Previous studies that have measured the speech perception of unilaterally deaf individuals after CI but with nonindividualized frequency-to-electrode allocations may therefore have underestimated the potential benefits of providing binaural hearing. However, it remains unclear whether the size and nature of the potential incremental benefits from individualized allocations are sufficient to justify the time and resources required to derive them based on cochlear imaging or pitch-matching tasks.

The potential of the inventory of learning styles to study students' learning patterns in three types of medical curricula.

PubMed

Van der Veken, J; Valcke, M; Muijtjens, A; De Maeseneer, J; Derese, A

2008-01-01

Introducing innovative curricular designs can be evaluating by scrutinizing the learning patterns students use. Studying the potential of Vermunt's Inventory of Learning Styles (ILS) in detecting differences in student learning patterns in different medical curricula. Cross-sectional between-subjects comparison of ILS-scores in third-year medical students in a conventional, an integrated contextual and a PBL-curriculum using one-way post hoc ANOVA. Response rate was 85%: 197 conventional, 130 integrated contextual and 301 PBL students. The results show a differential impact from the three curricula. In relation to processing strategies, the students in the problem-based curriculum showed less rote learning and rehearsing, greater variety in sources of knowledge used and less ability to express study content in a personal manner than did the students in the conventional curriculum. The students of the integrated contextual curriculum showed more structuring of subject matter by integrating different aspects into a whole. In relation to regulation strategies, the students in the problem-based curriculum showed significantly more self-regulation of learning content and the students in the integrated contextual curriculum showed lower levels of regulation. As to learning orientations, the students in the problem-based curriculum showed less ambivalence and the students of the conventional curriculum were less vocationally oriented. The study provides empirical support for expected effects of traditional and innovative curricula which thus far were not well supported by empirical studies.

An Assessment of Institutional Capacity for Integrated Landscape Management in Eastern Cameroon.

PubMed

Brown, H Carolyn Peach

2018-07-01

Landscape approaches have become prominent in efforts to address issues of conservation and development through bringing together different actors and sectors, to reconcile diverse land uses, and promote synergies. Some have suggested that integrated landscape management approaches are consistent with the goals of REDD+ and offer a strategy to address multiple goals of climate change mitigation, biodiversity conservation, maintenance of ecosystem services, and socio-economic development. Institutional or governance arrangements have been shown to be a critical component in influencing outcomes in landscapes. Using diverse methodologies, this study investigated the capacity of institutions to support the planning, implementation, and resource mobilization needed to integrate climate change mitigation, conservation, and livelihood goals in a forest mosaic landscape in East Cameroon. Results showed that diverse institutions are present in the landscape, including institutions of relevant government agencies, local government, local non-government, the private sector, and hybrid institutions of conservation, development and research institutions. However, the overall institutional capacity for integrated landscape planning and management in the study area is limited, although some institutions exhibit increased capacity in some areas over others. Multiple strategies can be employed to build the necessary human, financial, and leadership capacity, and facilitate the institutional planning and coordination that is foundational to multi-stakeholder landscape governance. Given the complexity of integrating climate change mitigation, conservation and livelihood goals in a landscape, building such institutional capacity is a long term endeavour that requires sustained effort and ongoing financial, technical and human resource support.

Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception.

PubMed

DeSisto, Carla L; Estrich, Cameron; Kroelinger, Charlan D; Goodman, David A; Pliska, Ellen; Mackie, Christine N; Waddell, Lisa F; Rankin, Kristin M

2017-11-21

Implementation strategies are imperative for the successful adoption and sustainability of complex evidence-based public health practices. Creating a learning collaborative is one strategy that was part of a recently published compilation of implementation strategy terms and definitions. In partnership with the Centers for Disease Control and Prevention and other partner agencies, the Association of State and Territorial Health Officials recently convened a multi-state Learning Community to support cross-state collaboration and provide technical assistance for improving state capacity to increase access to long-acting reversible contraception (LARC) in the immediate postpartum period, an evidence-based practice with the potential for reducing unintended pregnancy and improving maternal and child health outcomes. During 2015-2016, the Learning Community included multi-disciplinary, multi-agency teams of state health officials, payers, clinicians, and health department staff from 13 states. This qualitative study was conducted to better understand the successes, challenges, and strategies that the 13 US states in the Learning Community used for increasing access to immediate postpartum LARC. We conducted telephone interviews with each team in the Learning Community. Interviews were semi-structured and organized by the eight domains of the Learning Community. We coded transcribed interviews for facilitators, barriers, and implementation strategies, using a recent compilation of expert-defined implementation strategies as a foundation for coding the latter. Data analysis showed three ways that the activities of the Learning Community helped in policy implementation work: structure and accountability, validity, and preparing for potential challenges and opportunities. Further, the qualitative data demonstrated that the Learning Community integrated six other implementation strategies from the literature: organize clinician implementation team meetings, conduct educational meetings, facilitation, promote network weaving, provide ongoing consultation, and distribute educational materials. Convening a multi-state learning collaborative is a promising approach for facilitating the implementation of new reimbursement policies for evidence-based practices complicated by systems challenges. By integrating several implementation strategies, the Learning Community serves as a meta-strategy for supporting implementation.

High-Payoff Space Transportation Design Approach with a Technology Integration Strategy

NASA Technical Reports Server (NTRS)

McCleskey, C. M.; Rhodes, R. E.; Chen, T.; Robinson, J.

2011-01-01

A general architectural design sequence is described to create a highly efficient, operable, and supportable design that achieves an affordable, repeatable, and sustainable transportation function. The paper covers the following aspects of this approach in more detail: (1) vehicle architectural concept considerations (including important strategies for greater reusability); (2) vehicle element propulsion system packaging considerations; (3) vehicle element functional definition; (4) external ground servicing and access considerations; and, (5) simplified guidance, navigation, flight control and avionics communications considerations. Additionally, a technology integration strategy is forwarded that includes: (a) ground and flight test prior to production commitments; (b) parallel stage propellant storage, such as concentric-nested tanks; (c) high thrust, LOX-rich, LOX-cooled first stage earth-to-orbit main engine; (d) non-toxic, day-of-launch-loaded propellants for upper stages and in-space propulsion; (e) electric propulsion and aero stage control.

A comprehensive strategy for designing a Web-based medical curriculum.

PubMed Central

Zucker, J.; Chase, H.; Molholt, P.; Bean, C.; Kahn, R. M.

1996-01-01

In preparing for a full featured online curriculum, it is necessary to develop scaleable strategies for software design that will support the pedagogical goals of the curriculum and which will address the issues of acquisition and updating of materials, of robust content-based linking, and of integration of the online materials into other methods of learning. A complete online curriculum, as distinct from an individual computerized module, must provide dynamic updating of both content and structure and an easy pathway from the professor's notes to the finished online product. At the College of Physicians and Surgeons, we are developing such strategies including a scripted text conversion process that uses the Hypertext Markup Language (HTML) as structural markup rather than as display markup, automated linking by the use of relational databases and the Unified Medical Language System (UMLS), integration of text, images, and multimedia along with interface designs which promote multiple contexts and collaborative study. PMID:8947624

Supporting minority nursing students: 'Opportunity for Success' for Ethiopian immigrants in Israel.

PubMed

Arieli, D; Hirschfeld, M J

2013-06-01

To report on an Israeli academic nursing project, aimed at supporting the integration of Ethiopian immigrants into nursing studies. The representation of ethnic minorities within nursing is crucial for the provision of efficient care in diverse societies. Nevertheless, successful integration of minority students in nursing programs is not a simple task and needs developing support systems that will attract and retain students from minorities. Ethiopian Jewish immigrants and their descendants in Israel form a community of 120,000 people. Their participation in the national workforce is low, as well as their average income. The paper is based on formative evaluation, using action research, of an academic nursing program in Israel. Four main strategies identify this project: (1) a policy of institutional commitment, (2) personal relations with staff, (3) personal tutoring, and (4) cultural safety education. The project has reached success in terms of attraction, retention and students' satisfactions. The project's two main challenges, which need further concern, are: (1) giving support without labelling and (2) supporting without creating dependency. CONCLUSIONS AND INTERNATIONAL POLICY IMPLICATIONS: Appropriate strategies can enable success of minority students. Nevertheless, the amount of support needed for such programs raises two major questions: (1) To what extent should individual nursing departments be expected to bear solutions to this widely experienced problem? (2) How does focusing on one minority affect cultural safety of the overall group? © 2013 The Authors. International Nursing Review © 2013 International Council of Nurses.

Sleep-mediated memory consolidation depends on the level of integration at encoding.

PubMed

Himmer, Lea; Müller, Elias; Gais, Steffen; Schönauer, Monika

2017-01-01

There is robust evidence that sleep facilitates declarative memory consolidation. Integration of newly acquired memories into existing neocortical knowledge networks has been proposed to underlie this effect. Here, we test whether sleep affects memory retention for word-picture associations differently when it was learned explicitly or using a fast mapping strategy. Fast mapping is an incidental form of learning that references new information to existing knowledge and possibly allows neocortical integration already during encoding. If the integration of information into neocortical networks is a main function of sleep-dependent memory consolidation, material learned via fast mapping should therefore benefit less from sleep. Supporting this idea, we find that sleep has a protective effect on explicitly learned associations. In contrast, memory for associations learned by fast mapping does not benefit from sleep and remains stable regardless of whether sleep or wakefulness follows learning. Our results thus indicate that the need for sleep-mediated consolidation depends on the strategy used for learning and might thus be related to the level of integration of newly acquired memory achieved during encoding. Copyright © 2016 Elsevier Inc. All rights reserved.

Investigation of Low Cost Sensor-Based Leak Detection System for Fence Line Applications

EPA Science Inventory

With recent technological advances, low-cost time-resolved sensors may become effective tools to support time-integrated passive sampling strategies by helping to decipher origin of emissions in real-time. As part of the Petroleum Refinery Risk and Technology Review, New Source ...

Attracting Non-Traditional Students to Campus Activities and Leadership Programs: Providing Links to Academics, Persistence Are Key.

ERIC Educational Resources Information Center

Tucker, Marcie S.

2003-01-01

Explores some strategies to attract non-traditional students to campus activities, highlights a model program that integrates scholarship support and leadership programs, explores new ways of marketing to these students, and offers some suggestions for continued development. (EV)

Technology-Rich Schools Up Close

ERIC Educational Resources Information Center

Levin, Barbara B.; Schrum, Lynne

2013-01-01

This article observes that schools that use technology well have key commonalities, including a project-based curriculum and supportive, distributed leadership. The authors' research into tech-rich schools revealed that schools used three strategies to integrate technology successfully. They did so by establishing the vision and culture,…

Both Theory and Practice: Science Literacy Instruction and Theories of Reading

ERIC Educational Resources Information Center

Wright, Katherine Landau; Franks, Amanda D.; Kuo, Li-Jen; McTigue, Erin M.; Serrano, Jiniva

2016-01-01

Many journal articles detail recommendations to naturally integrate literacy instruction into content-area classes, particularly science, claiming that such instructional practices will support both literacy and content-knowledge acquisition. This begs the question, are the literacy strategies recommended for content-area instruction founded in…

Educating for Sustainability in Developing Countries: The Need for Environmental Education Support.

ERIC Educational Resources Information Center

Hale, Monica

1993-01-01

The Earth Summit in Rio de Janeiro emphasized the need for both the developing and developed world to work toward sustainable development. This paper reviews environmental education, sustainable development, and environmental strategies for aid donors to integrate into their programs. (Author/MDH)

Model-based reconfiguration: Diagnosis and recovery

NASA Technical Reports Server (NTRS)

Crow, Judy; Rushby, John

1994-01-01

We extend Reiter's general theory of model-based diagnosis to a theory of fault detection, identification, and reconfiguration (FDIR). The generality of Reiter's theory readily supports an extension in which the problem of reconfiguration is viewed as a close analog of the problem of diagnosis. Using a reconfiguration predicate 'rcfg' analogous to the abnormality predicate 'ab,' we derive a strategy for reconfiguration by transforming the corresponding strategy for diagnosis. There are two obvious benefits of this approach: algorithms for diagnosis can be exploited as algorithms for reconfiguration and we have a theoretical framework for an integrated approach to FDIR. As a first step toward realizing these benefits we show that a class of diagnosis engines can be used for reconfiguration and we discuss algorithms for integrated FDIR. We argue that integrating recovery and diagnosis is an essential next step if this technology is to be useful for practical applications.

Integration, warehousing, and analysis strategies of Omics data.

PubMed

Gedela, Srinubabu

2011-01-01

"-Omics" is a current suffix for numerous types of large-scale biological data generation procedures, which naturally demand the development of novel algorithms for data storage and analysis. With next generation genome sequencing burgeoning, it is pivotal to decipher a coding site on the genome, a gene's function, and information on transcripts next to the pure availability of sequence information. To explore a genome and downstream molecular processes, we need umpteen results at the various levels of cellular organization by utilizing different experimental designs, data analysis strategies and methodologies. Here comes the need for controlled vocabularies and data integration to annotate, store, and update the flow of experimental data. This chapter explores key methodologies to merge Omics data by semantic data carriers, discusses controlled vocabularies as eXtensible Markup Languages (XML), and provides practical guidance, databases, and software links supporting the integration of Omics data.

Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes.

PubMed

Bernhard, Gerda; Ose, Dominik; Baudendistel, Ines; Seidling, Hanna M; Stützle, Marion; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

2017-04-01

Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients' self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients' needs and priorities and guide patient-centered interventions to support patients' self-management activities. Community and social support networks operating in patients' lives need to be engaged in the self-management support.

Simulation as a learning strategy: supporting undergraduate nursing students with disabilities.

PubMed

Azzopardi, Toni; Johnson, Amanda; Phillips, Kirrilee; Dickson, Cathy; Hengstberger-Sims, Cecily; Goldsmith, Mary; Allan, Trevor

2014-02-01

To promote simulation as a learning strategy to support undergraduate nursing students with disabilities. Supporting undergraduate nursing students with disabilities has gained further momentum because of amendments to the Disability Discrimination Act in 2009. Providers of higher education must now ensure proactive steps to prevent discrimination against students with a disability are implemented to assist in course progression. Simulation allows for the impact of a student's disability to be assessed and informs the determination of reasonable adjustments to be implemented. Further suitable adjustments can then be determined in a safe environment and evaluated prior to scheduled placement. Auditing in this manner, offers a risk management strategy for all while maintaining the academic integrity of the program. Discursive. Low, medium and high fidelity simulation activities critically analysed and their application to support undergraduate nursing students with disabilities assessed. With advancing technology and new pedagogical approaches simulation as a learning strategy can play a significant role. In this role, simulation supports undergraduate nursing students with disabilities to meet course requirements, while offering higher education providers an important risk management strategy. The discussion recommends simulation is used to inform the determination of reasonable adjustments for undergraduate nursing students with disabilities as an effective, contemporary curriculum practice. Adoption of simulation, in this way, will meet three imperatives: comply with current legislative requirements, embrace advances in learning technologies and embed one of the six principles of inclusive curriculum. Achieving these imperatives is likely to increase accessibility for all students and offer students with a disability a supportive learning experience. Provides capacity to systematically assess, monitor, evaluate and support students with a disability. The students' reasonable adjustments can be determined prior to attending clinical practice to minimise risks and ensure the safety of all. © 2013 Blackwell Publishing Ltd.

Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment.

PubMed

Greenlee, Heather; DuPont-Reyes, Melissa J; Balneaves, Lynda G; Carlson, Linda E; Cohen, Misha R; Deng, Gary; Johnson, Jillian A; Mumber, Matthew; Seely, Dugald; Zick, Suzanna M; Boyce, Lindsay M; Tripathy, Debu

2017-05-06

Answer questions and earn CME/CNE Patients with breast cancer commonly use complementary and integrative therapies as supportive care during cancer treatment and to manage treatment-related side effects. However, evidence supporting the use of such therapies in the oncology setting is limited. This report provides updated clinical practice guidelines from the Society for Integrative Oncology on the use of integrative therapies for specific clinical indications during and after breast cancer treatment, including anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance. Clinical practice guidelines are based on a systematic literature review from 1990 through 2015. Music therapy, meditation, stress management, and yoga are recommended for anxiety/stress reduction. Meditation, relaxation, yoga, massage, and music therapy are recommended for depression/mood disorders. Meditation and yoga are recommended to improve quality of life. Acupressure and acupuncture are recommended for reducing chemotherapy-induced nausea and vomiting. Acetyl-L-carnitine is not recommended to prevent chemotherapy-induced peripheral neuropathy due to a possibility of harm. No strong evidence supports the use of ingested dietary supplements to manage breast cancer treatment-related side effects. In summary, there is a growing body of evidence supporting the use of integrative therapies, especially mind-body therapies, as effective supportive care strategies during breast cancer treatment. Many integrative practices, however, remain understudied, with insufficient evidence to be definitively recommended or avoided. CA Cancer J Clin 2017;67:194-232. © 2017 American Cancer Society. © 2017 American Cancer Society.

Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

PubMed Central

Aradeon, Susan B; Doctor, Henry V

2016-01-01

The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support structures. Innovative communication body tools and the rote learning Rapid Imitation Practice training methodology enabled low-literate volunteers to saturate their communities with informed group discussions transferring communication capacity and ownership to the discussion participants. CCER is especially efficient because virtually every timely, community referral for emergency maternal care results in a saved life, whereas on average, only one in every eight births delivered by an SBA (12%) is expected to be a delivery-associated complication requiring lifesaving care. PMID:27088844

New Pathways into Robotics: Strategies for Broadening Participation

NASA Astrophysics Data System (ADS)

Rusk, Natalie; Resnick, Mitchel; Berg, Robbie; Pezalla-Granlund, Margaret

2008-02-01

This paper suggests new strategies for introducing students to robotics technologies and concepts, and argues for the importance of providing multiple entry points into robotics. In particular, the paper describes four strategies that have been successful in engaging a broad range of learners: (1) focusing on themes, not just challenges; (2) combining art and engineering; (3) encouraging storytelling; (4) organizing exhibitions, rather than competitions. The paper describes a new technology, called the PicoCricket, that supports these strategies by enabling young people to design and program artistic creations that integrate light, sound, music, and motion. The paper concludes with an analysis of robotics activities in three educational environments, examining how these new strategies and technologies can engage young people with diverse interests and learning styles.

Cultural sensitivity and supportive expressive psychotherapy: an integrative approach to treatment.

PubMed

White, Tracela M; Gibbons, Mary Beth Connolly; Schamberger, Megan

2006-01-01

Cultural sensitivity is a concept that has become increasingly important in psychotherapy research and practice. In response to the growing ethnic minority population and the increased demand for psychological services among minority clients, many therapists and researchers have attempted to identify competencies and guidelines for providing culturally sensitive approaches to treatment. However, many cultural sensitivity concepts are theoretical and have rarely been integrated into an established psychotherapeutic framework. The purpose of this manuscript is to operationalize the concepts of cultural sensitivity into specific therapeutic techniques using a manual-guided Supportive Expressive Psychotherapy approach. Developing these strategies may serve to further assist therapists with the delivery of mental health services to ethnic minority clients.

Clinical teaching and support for learners in the practice environment.

PubMed

McBrien, Barry

The purpose of planned clinical experience for students of nursing is primarily to provide students with the opportunity to develop their clinical skills, integrate theory and practice, and assist with their socialization into nursing. Nursing, in the main, is a practice-based profession. To this extent, it is essential that nurse education continues to have a strong practical element despite its full integration into higher education institutions (Department of Health, 1999). However, providing adequate support and supervision for learners is challenging. Undoubtedly, exacerbated by increasing numbers of learners, staff shortages and mentors training deficits. This article aims to critically analyse several strategies, which can be used to promote clinical learning.

IDESSA: An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas

NASA Astrophysics Data System (ADS)

Meyer, Hanna; Authmann, Christian; Dreber, Niels; Hess, Bastian; Kellner, Klaus; Morgenthal, Theunis; Nauss, Thomas; Seeger, Bernhard; Tsvuura, Zivanai; Wiegand, Kerstin

2017-04-01

Bush encroachment is a syndrome of land degradation that occurs in many savannas including those of southern Africa. The increase in density, cover or biomass of woody vegetation often has negative effects on a range of ecosystem functions and services, which are hardly reversible. However, despite its importance, neither the causes of bush encroachment, nor the consequences of different resource management strategies to combat or mitigate related shifts in savanna states are fully understood. The project "IDESSA" (An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas) aims to improve the understanding of the complex interplays between land use, climate patterns and vegetation dynamics and to implement an integrative monitoring and decision-support system for the sustainable management of different savanna types. For this purpose, IDESSA follows an innovative approach that integrates local knowledge, botanical surveys, remote-sensing and machine-learning based time-series of atmospheric and land-cover dynamics, spatially explicit simulation modeling and analytical database management. The integration of the heterogeneous data will be implemented in a user oriented database infrastructure and scientific workflow system. Accessible via web-based interfaces, this database and analysis system will allow scientists to manage and analyze monitoring data and scenario computations, as well as allow stakeholders (e. g. land users, policy makers) to retrieve current ecosystem information and seasonal outlooks. We present the concept of the project and show preliminary results of the realization steps towards the integrative savanna management and decision-support system.

An introduction to the multisystem model of knowledge integration and translation.

PubMed

Palmer, Debra; Kramlich, Debra

2011-01-01

Many nurse researchers have designed strategies to assist health care practitioners to move evidence into practice. While many have been identified as "models," most do not have a conceptual framework. They are unidirectional, complex, and difficult for novice research users to understand. These models have focused on empirical knowledge and ignored the importance of practitioners' tacit knowledge. The Communities of Practice conceptual framework allows for the integration of tacit and explicit knowledge into practice. This article describes the development of a new translation model, the Multisystem Model of Knowledge Integration and Translation, supported by the Communities of Practice conceptual framework.

International Space Station Configuration Analysis and Integration

NASA Technical Reports Server (NTRS)

Anchondo, Rebekah

2016-01-01

Ambitious engineering projects, such as NASA's International Space Station (ISS), require dependable modeling, analysis, visualization, and robotics to ensure that complex mission strategies are carried out cost effectively, sustainably, and safely. Learn how Booz Allen Hamilton's Modeling, Analysis, Visualization, and Robotics Integration Center (MAVRIC) team performs engineering analysis of the ISS Configuration based primarily on the use of 3D CAD models. To support mission planning and execution, the team tracks the configuration of ISS and maintains configuration requirements to ensure operational goals are met. The MAVRIC team performs multi-disciplinary integration and trade studies to ensure future configurations meet stakeholder needs.

Strengthening Financial Management. New Directions for Community Colleges, Number 50.

ERIC Educational Resources Information Center

Campbell, Dale F., Ed.

1985-01-01

This collection of essays examines strategies to strengthen financial management in the community colleges from the perspective of college finance and administrative support officers. Part I focuses on selected role functions that college business officers perform, containing "Integrating Academic Planning and Budgeting," by Byron N. McClenney and…

76 FR 53933 - Delegation Authority for the Office of Sustainable Housing and Communities

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

..., reinforce local and regional development strategies to support economic growth, and reduce bureaucratic... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5519-D-01] Delegation Authority for the... regional planning efforts that integrate housing and transportation decisions, and increase the capacity to...

Investigation of a Low Cost Sensor-Based Leak Detection System for Fence Line Applications

EPA Science Inventory

With recent technological advances, low-cost time-resolved sensors may become effective tools to support time-integrated passive sampling strategies by helping to decipher origin of emissions in real-time. As part of the Petroleum Refinery Risk and Technology Review, New Source P...

Time Out from Tension: Teaching Young Children How To Relax. Teaching Strategies.

ERIC Educational Resources Information Center

Scully, Patricia

2003-01-01

Discusses how using relaxation and stress reduction activities with individual preschool and elementary school-age children during difficult periods can help them regain control, and how integrating relaxation techniques into everyday activities helps to establish positive behavior patterns to support healthy living. Presents breathing activities…

Supporting Source Integration in Student Writing

ERIC Educational Resources Information Center

Refaei, Brenda; Kumar, Rita; Wahman, M. Lauren; Peplow, Amber Burkett

2017-01-01

A cross-disciplinary team of composition, communication, and library faculty used lesson study to investigate interdisciplinary instructional strategies to improve students' use of quoting in their writing. The team developed a three-class lesson plan to introduce the concept of quoting, practice the concept, and allow students to reflect on their…

Knowledge Building by Full Integration with Virtual Reality Environments and Its Effects on Personal and Social Life.

ERIC Educational Resources Information Center

Fialho, Francisco Antonio Pereira; Catapan, Araci Hack

1999-01-01

Argues that the creation of distributed environments for constructivist learning is a challenge which requires a multidisciplinary development and support team. Outlines recommended strategies for the collective creation of virtual worlds which can improve learning. Contains 11 references. (Author/WRM)

Preparing International Students for the Re-Entry Transition.

ERIC Educational Resources Information Center

Arthur, Nancy

2003-01-01

Counselors play an integral role in assisting international students to manage cross-cultural transitions. Re-entry counseling can support international students to examine their transition experiences, provide education about re-entry, and help to develop anticipatory coping strategies. An example of a workshop is described as a method of…

Predictable Charts: An Effective Strategy to Engage and Impact Learners

ERIC Educational Resources Information Center

McClure, Erin

2016-01-01

This article explores how to integrate reading, writing, speaking, and listening instruction by engaging students in Predictable Charts. Discover how Predictable Charts can support students with reading, writing, speaking, and listening in Kindergarten, First Grade, or Special Education classrooms. Through this article, learn the steps to…

Integrating Literacy and the Content Curriculum to Support Diverse Learners

ERIC Educational Resources Information Center

Fenty, Nicole S.; Brydon, Melissa

2017-01-01

This study explored the impact of training special education teacher candidates to implement content literacy strategy instruction on the teacher candidates' feelings of self-efficacy, beliefs, and practice. The study also explored the impact of implementing content literacy interventions on the content knowledge of elementary age students with or…

Cincinnati's Bold New Venture: A Unified K-12 Reading/Communication Arts Program.

ERIC Educational Resources Information Center

Green, Reginald Leon

1989-01-01

Describes a unified reading/communication arts program in the Cincinnati Public School System which uses new basal texts, support materials, and a customized instructional system for each grade level, integrating listening, speaking, reading, writing, and thinking skills into a unified language approach. Discusses intervention strategies,…

An Implemented Strategy for Campus Connectivity and Cooperative Computing.

ERIC Educational Resources Information Center

Halaris, Antony S.; Sloan, Lynda W.

1989-01-01

ConnectPac, a software package developed at Iona College to allow a computer user to access all services from a single personal computer, is described. ConnectPac uses mainframe computing to support a campus computing network, integrating personal and centralized computing into a menu-driven user environment. (Author/MLW)

Global Leadership in Higher Education Administration: Perspectives on Internationalization by University Presidents, Vice-Presidents and Deans

ERIC Educational Resources Information Center

Sullivan, Janice

2011-01-01

The purpose of the study was to identify international university administrators' perspectives on organizational strategies to support higher education internationalization. Internationalization is the conscious effort to integrate international, intercultural, and global dimensions into the ethos and outcomes of higher education (NAFSA, 2008). A…

Effects of Environmental and Instructional Factors on Student Motivation and Self-Directed Learning

ERIC Educational Resources Information Center

Burkhalter, Anne D.

2014-01-01

This study analyzed the impact of parent involvement and integration of multiple intelligences strategies in classroom instruction on student motivation and academic achievement. The population for this study comprised of 13 elementary students receiving special education services. Parent involvement was developed and supported through weekly home…

Fostering Evidence-Informed Teaching in Crucial Classes: Faculty Development in Gateway Courses

ERIC Educational Resources Information Center

McGowan, Susannah; Felten, Peter; Caulkins, Joshua; Artze-Vega, Isis

2017-01-01

Faculty and faculty developers can improve student learning and outcomes in gateway courses by improving course design, integrating active learning, and aligning assessments with course goals. Drawing on the authors' varied experiences and a large national initiative, this chapter outlines challenges and strategies to support gateway-course…

Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa.

PubMed

Schneider, Helen; Nxumalo, Nonhlanhla

2017-09-15

National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa's community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles.

Atmospheric Monitoring Strategy for Ground Testing of Closed Ecological Life Support Systems

NASA Technical Reports Server (NTRS)

Feighery, John; Cavenall, Ivan; Knight, Amanda

2004-01-01

This paper reviews the evolution and current state of atmospheric monitoring on the International Space Station to provide context from which we can imagine a more advanced and integrated system. The unique environmental hazards of human space flight are identified and categorized into groups, taking into consideration the time required for the hazard to become a threat to human health or performance. The key functions of a comprehensive monitoring strategy for a closed ecological life support system are derived from past experience and a survey of currently available technologies for monitoring air quality. Finally, a system architecture is developed incorporating the lessons learned from ISS and other analogous closed life support systems. The paper concludes by presenting recommendations on how to proceed with requirements definition and conceptual design of an air monitoring system for exploration missions.

Towards vertical integration in general practice education: literature review and discussion paper.

PubMed

O'Regan, A; Culhane, A; Dunne, C; Griffin, M; Meagher, D; McGrath, D; O'Dwyer, P; Cullen, W

2013-09-01

Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development. To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges. We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches. The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures. Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

Integrating community health workers into a patient-centered medical home to support disease self-management among Vietnamese Americans: lessons learned.

PubMed

Wennerstrom, Ashley; Bui, Tap; Harden-Barrios, Jewel; Price-Haywood, Eboni G

2015-01-01

There is evidence that patient-centered medical homes (PCMHs) and community health workers (CHWs) improve chronic disease management. There are few models for integrating CHWs into PCMHs in order to enhance disease self-management support among diverse populations. In this article, we describe how a community-based nonprofit agency, a PCMH, and academic partners collaborated to develop and implement the Patient Resource and Education Program (PREP). We employed CHWs as PCMH care team members to provide health education and support to Vietnamese American patients with uncontrolled diabetes and/or hypertension. We began by conducting focus groups to assess patient knowledge, desire for support, and availability of community resources. Based on findings, we developed PREP with CHW guidance on cultural tailoring of educational materials and methods. CHWs received training in core competencies related to self-management support principles and conducted the 4-month intervention for PCMH patients. Throughout the program, we conducted process evaluation through structured team meetings and patient satisfaction surveys. We describe successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, and we make recommendations for other PCMHs seeking to integrate CHWs into care teams. © 2014 Society for Public Health Education.

Triple surveillance: a proposal for an integrated strategy to support and accelerate birth defect prevention

PubMed Central

Mastroiacovo, Pierpaolo

2018-01-01

Abstract Preventing neural tube defects (NTDs) easily qualifies as a high‐value opportunity to improve childhood survival and health: the unmet need is significant (major preventable burden), the intervention is transformative (providing sufficient folic acid), and delivery strategies (e.g., fortification) are effective in low‐resource countries. Yet, NTD prevention is lagging. Can public health surveillance help fix this problem? Critics contend that surveillance is largely unnecessary, that limited resources are best spent on interventions, and that surveillance is unrealistic in developing countries. The counterargument is twofold: (1) in the absence of surveillance, interventions will provide fewer benefits and cost more and (2) effective surveillance is likely possible nearly everywhere, with appropriate strategies. As a base strategy, we propose “triple surveillance:” integrating surveillance of cause (folate insufficiency), of disease occurrence (NTD prevalence), and of health outcomes (morbidity, mortality, and disability). For better sustainability and usefulness, it is crucial to refocus and streamline surveillance activities (no recreational data collection), weave surveillance into clinical care (integrate in clinical workflow), and, later, work on including additional risk factors and pediatric outcomes (increase benefits at low marginal cost). By doing so, surveillance becomes not a roadblock but a preferential path to prevention and better care. PMID:29532515

Collecting, Integrating, and Disseminating Patient-Reported Outcomes for Research in a Learning Healthcare System.

PubMed

Harle, Christopher A; Lipori, Gloria; Hurley, Robert W

2016-01-01

Advances in health policy, research, and information technology have converged to increase the electronic collection and use of patient-reported outcomes (PROs). Therefore, it is important to share lessons learned in implementing PROs in research information systems. The purpose of this case study is to describe a novel information system for electronic PROs and lessons learned in implementing that system to support research in an academic health center. The system incorporates freely available and commercial software and involves clinical and research workflows that support the collection, transformation, and research use of PRO data. The software and processes that comprise the system serve three main functions, (i) collecting electronic PROs in clinical care, (ii) integrating PRO data with non-patient generated clinical data, and (iii) disseminating data to researchers through the institution's research informatics infrastructure, including the i2b2 (Informatics for Integrating Biology and the Bedside) system. Our successful design and implementation was driven by three overarching strategies. First, we selected and implemented multiple interfaced technologies to support PRO collection, management, and research use. Second, we aimed to use standardized approaches to measuring PROs, sending PROs between systems, and disseminating PROs. Finally, we focused on using technologies and processes that aligned with existing clinical research information management strategies within our organization. These experiences and lessons may help future implementers and researchers enhance the scale and sustainable use of systems for research use of PROs.

Modularising ontology and designing inference patterns to personalise health condition assessment: the case of obesity.

PubMed

Sojic, Aleksandra; Terkaj, Walter; Contini, Giorgia; Sacco, Marco

2016-05-04

The public health initiatives for obesity prevention are increasingly exploiting the advantages of smart technologies that can register various kinds of data related to physical, physiological, and behavioural conditions. Since individual features and habits vary among people, the design of appropriate intervention strategies for motivating changes in behavioural patterns towards a healthy lifestyle requires the interpretation and integration of collected information, while considering individual profiles in a personalised manner. The ontology-based modelling is recognised as a promising approach in facing the interoperability and integration of heterogeneous information related to characterisation of personal profiles. The presented ontology captures individual profiles across several obesity-related knowledge-domains structured into dedicated modules in order to support inference about health condition, physical features, behavioural habits associated with a person, and relevant changes over time. The modularisation strategy is designed to facilitate ontology development, maintenance, and reuse. The domain-specific modules formalised in the Web Ontology Language (OWL) integrate the domain-specific sets of rules formalised in the Semantic Web Rule Language (SWRL). The inference rules follow a modelling pattern designed to support personalised assessment of health condition as age- and gender-specific. The test cases exemplify a personalised assessment of the obesity-related health conditions for the population of teenagers. The paper addresses several issues concerning the modelling of normative concepts related to obesity and depicts how the public health concern impacts classification of teenagers according to their phenotypes. The modelling choices regarding the ontology-structure are explained in the context of the modelling goal to integrate multiple knowledge-domains and support reasoning about the individual changes over time. The presented modularisation pattern enhances reusability of the domain-specific modules across various health care domains.

Aligning incentives in health care: physician practice and health system partnership.

PubMed

Levin, L Scott; Gustave, Lori

2013-06-01

The key to successfully aligning hospitals and physicians is financial integration and joint incentives for academic, quality, and clinical productivity. Many physician practices and health systems are moving toward closer integration, but mainly through consolidation and employment strategies. We describe a fully integrated physician and hospital relationship including an overview of an aligned funds flow process that affords the department support for clinical services and teaching, research, and administrative activity. We also describe a physician compensation model that provides incentive not only for increased clinical performance, but also quality and academic objectives. The content of this article was acquired through our own experience in managing the Department of Orthopaedic Surgery at the University of Pennsylvania Health System including the health system's funds flow process. Based on input from both health system leaders and the faculty, the department's compensation plan was totally redesigned to create a line-of-sight plan that credits clinical performance and academic productivity. Our model is multifactorial and provides sustainable support for the department and a compensation plan that is competitive within the local market and nationally. The health system's funds flow process has enhanced alignment of the faculty and hospitals by providing compensation for nonclinical time and assists the department's growth strategies by providing funding for new faculty and gain-sharing of improved hospital margin. The implementation of the compensation plan increased productivity by 8% in its first year with no additional resources. Academic productivity in that same year was arguably at or above any other year in the department's history in terms of accepted publications, national presentations, and research grants awarded. A model of complete integration between an academic department and a health system is achievable through a systematic process of mission-based support.

Curricular Integration in Pharmacy Education

PubMed Central

Pearson, Marion L.; Hubball, Harry T.

2012-01-01

This article reviews the concepts of curricular integration and integrative learning. These concepts have reemerged in contemporary higher education reforms and are crucial in pharmacy programs where students are expected to acquire the knowledge, skills, and abilities needed for competent practice in a complex environment. Enhancing integration requires negotiating obstacles, including institutional traditions of disciplinary structures and disciplinary differences in understandings of knowledge and approaches to teaching and learning; investing the time and effort to design and implement integrated curricula; and using learning-centered pedagogical strategies. Evidence supporting the value of such efforts is not compelling, as much because of insufficient research as lackluster findings. Future avenues of scholarly inquiry are suggested to evaluate curricular integration, distinguishing between the curriculum espoused by planners, the curriculum enacted by instructors, and the curriculum experienced by students. PMID:23275669

Using peer support groups to enhance community integration of veterans in transition.

PubMed

Drebing, Charles E; Reilly, Erin; Henze, Kevin T; Kelly, Megan; Russo, Anthony; Smolinsky, John; Gorman, Jay; Penk, Walter E

2018-05-01

Peer support groups, also known as "self-help groups," provide a unique tool for helping veterans working through the military-to-civilian transition to achieve higher levels of social support and community integration. The number and variety of community-based peer support groups has grown to the point that there are now more visits to these groups each year than to mental health professionals. The focus of these groups on the provision of social support, the number and variety of groups, the lack of cost, and their availability in the community make them a natural transition tool for building community-based social support. A growing literature suggests that these groups are associated with measurable improvements in social support, clinical symptoms, self-efficacy and coping. For clinical populations, the combination of peer support groups and clinical care results in better outcomes than either alone. Given this evidence, we suggest clinical services use active referral strategies to help veterans engage in peer support groups as a means of improving community reintegration and clinical outcomes. Finally, suggestions for identifying appropriate peer support groups and assisting with active referrals are provided. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

What makes online substance-use interventions engaging? A systematic review and narrative synthesis

PubMed Central

Milward, Joanna; Drummond, Colin; Fincham-Campbell, Stephanie; Deluca, Paolo

2018-01-01

Background Online substance-use interventions are effective in producing reductions in harmful-use. However, low user engagement rates with online interventions reduces overall effectiveness of interventions. Identifying optimal strategies with which to engage users with online substance-use interventions may improve usage rates and subsequent effectiveness. Objectives (1) To identify the most prevalent engagement promoting strategies utilised to increase use of online substance-use interventions. (2) To determine whether the identified engagement promoting strategies increased said use of online substance-use interventions. Review methods The reviewed followed Cochrane methodology. Databases were searched for online substance-use interventions and engagement promoting strategies limited by study type (randomised controlled trial). Due to heterogeneity between engagement promoting strategies and engagement outcomes, meta-analytic techniques were not possible. Narrative synthesis methods were used. Results Fifteen studies were included. Five different engagement promoting strategies were identified: (1) tailoring; (2) delivery strategies; (3) incentives; (4) reminders; (5) social support. The most frequently reported engagement promoting strategies was tailoring (47% of studies), followed by reminders and social support (40% of studies) and delivery strategies (33% of studies). The narrative synthesis demonstrated that tailoring, multimedia delivery of content and reminders are potential techniques for promoting engagement. The evidence for social support was inconclusive and negative for incentives. Conclusions This review was the first to examine engagement promoting strategies in solely online substance-use interventions. Three strategies were identified that may be integral in promoting engagement with online substance-use interventions. However, the small number of eligible extracted studies, inconsistent reporting of engagement outcomes and diversity of engagement features prevent firmer conclusions. More high-quality trials examining engagement are required.

Meeting the needs? Perceived support of a nurse-led lifestyle programme for young adults with mental illness in a primary health-care setting.

PubMed

Rönngren, Ylva; Björk, Annette; Kristiansen, Lisbeth; Haage, David; Enmarker, Ingela; Audulv, Åsa

2018-02-01

Being a young adult with mental illness challenges all aspects of health, including an increased risk for developing lifestyle-related diseases. There is a lack of lifestyle programmes in primary health care that target physical, mental, and social needs for young adults with mental illness. The aim of the present study was to describe the experiences of young adults with mental illness receiving support from a nurse-led lifestyle programme, and how this support was related to their life context, including challenges and coping strategies. Two focus groups and six individual interviews were performed with 13 young adults (16-25 years), and analysed using a qualitative content analysis. The findings showed that the young adults experienced challenges in their daily lives, including psychiatric symptoms, lack of social understanding, and loneliness. The study indicated that the programme could support lifestyle habits with its components of supportive interpersonal relationships, awareness of coping strategies, understanding of health and illness, and cognitive support (e.g. schedules and reminders). However, the programme could not meet everyone's needs for new social relationships or more comprehensive support. Even so, this nurse-led programme provides health information-management strategies that could easily be integrated in a primary health-care setting. © 2017 Australian College of Mental Health Nurses Inc.

Implementing Elementary School Next Generation Science Standards

NASA Astrophysics Data System (ADS)

Kennedy, Katheryn B.

Implementation of the Next Generation Science Standards requires developing elementary teacher content and pedagogical content knowledge of science and engineering concepts. Teacher preparation for this undertaking appears inadequate with little known about how in-service Mid-Atlantic urban elementary science teachers approach this task. The purpose of this basic qualitative interview study was to explore the research questions related to perceived learning needs of 8 elementary science teachers and 5 of their administrators serving as instructional leaders. Strategies needed for professional growth to support learning and barriers that hamper it at both building and district levels were included. These questions were considered through the lens of Schon's reflective learning and Weick's sensemaking theories. Analysis with provisional and open coding strategies identified informal and formal supports and barriers to teachers' learning. Results indicated that informal supports, primarily internet usage, emerged as most valuable to the teachers' learning. Formal structures, including professional learning communities and grade level meetings, arose as both supportive and restrictive at the building and district levels. Existing formal supports emerged as the least useful because of the dominance of other priorities competing for time and resources. Addressing weaknesses within formal supports through more effective planning in professional development can promote positive change. Improvement to professional development approaches using the internet and increased hands on activities can be integrated into formal supports. Explicit attention to these strategies can strengthen teacher effectiveness bringing positive social change.

Feasibility and Preliminary Outcomes From a Pilot Study of an Integrated Health-Mental Health Promotion Program in School Mental Health Services

PubMed Central

George, Melissa W.; Trumpeter, Nevelyn N.; Wilson, Dawn K.; McDaniel, Heather L.; Schiele, Bryn; Prinz, Ron; Weist, Mark D.

2014-01-01

The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program. PMID:24297005

Challenges with the implementation of an Integrated Disease Surveillance and Response (IDSR) system: systematic review of the lessons learned.

PubMed

Phalkey, Revati K; Yamamoto, Shelby; Awate, Pradip; Marx, Michael

2015-02-01

Despite a realistic strategy and availability of resources, multiple challenges still overwhelm countries grappling with the challenges of communicable disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy is by far the most pragmatic strategy in resource-poor settings. The objective of this study was to systematically review and document the lessons learned and the challenges identified with the implementation of the IDSR in low- and middle-income countries and to identify the main barriers that contribute to its sub-optimal functioning. A systematic review of literature published in English using Web of Knowledge, PubMed, and databases of the World Health Organization (WHO) and the Centers for Disease Control (CDC) between 1998 and 2012 was undertaken. Additionally, manual reference and grey literature searches were conducted. Citations describing core and support functions or the quality attributes of the IDSR as described by WHO and CDC were included in the review. Thirty-three assessment studies met the inclusion criteria. IDSR strategy has been best adopted and implemented in the WHO-AFRO region. Although significant progress is made in overcoming the challenges identified with vertical disease surveillance strategies, gaps still exist. Mixed challenges with core and support IDSR functions were observed across countries. Main issues identified include non-sustainable financial resources, lack of co-ordination, inadequate training and turnover of peripheral staff, erratic feedback, inadequate supervision from the next level, weak laboratory capacities coupled with unavailability of job aids (case definitions/reporting formats), and poor availability of communication and transport systems particularly at the periphery. Best outcomes in core functions and system attributes were reported when support surveillance functions performed optimally. Apart from technical and technological issues, human resources and the health care system structures that receive the IDSR determine its output. The challenges identified with IDSR implementation are largely 'systemic'. IDSR will best benefit from skill-based training of personnel and strengthening of the support surveillance functions alongside health care infrastructures at the district level. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

PubMed

Elmusharaf, Khalifa; Byrne, Elaine; O'Donovan, Diarmuid

2015-09-08

Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

Integrated hierarchical geo-environmental survey strategy applied to the detection and investigation of an illegal landfill: A case study in the Campania Region (Southern Italy).

PubMed

Di Fiore, Vincenzo; Cavuoto, Giuseppe; Punzo, Michele; Tarallo, Daniela; Casazza, Marco; Guarriello, Silvio Marco; Lega, Massimiliano

2017-10-01

This paper describes an approach to detect and investigate the main characteristics of a solid waste landfill through the integration of geological, geographical and geophysical methods. In particular, a multi-temporal analysis of the landfill morphological evolution was carried out using aerial and satellite photos, since there were no geological and geophysical data referring to the study area. Subsequently, a surface geophysical prospection was performed through geoelectric and geomagnetic methods. In particular, the combination of electrical resistivity, induced polarization and magnetic measurements removed some of the uncertainties, generally associated with a separate utilization of these techniques. This approach was successfully tested to support the Prosecutor Office of Salerno (S Italy) during a specific investigation about an illegal landfill. All the collected field data supported the reconstruction of the site-specific history, while the real quarry geometry and site geology were defined. Key elements of novelty of this method are the combination and the integration of different methodological approaches, as the parallel and combined use of satellite, aerial and in-situ collected data, that were validated in a real investigation and that revealed the effectiveness of this strategy. Copyright © 2017 Elsevier B.V. All rights reserved.

Ontology-supported research on vaccine efficacy, safety and integrative biological networks.

PubMed

He, Yongqun

2014-07-01

While vaccine efficacy and safety research has dramatically progressed with the methods of in silico prediction and data mining, many challenges still exist. A formal ontology is a human- and computer-interpretable set of terms and relations that represent entities in a specific domain and how these terms relate to each other. Several community-based ontologies (including Vaccine Ontology, Ontology of Adverse Events and Ontology of Vaccine Adverse Events) have been developed to support vaccine and adverse event representation, classification, data integration, literature mining of host-vaccine interaction networks, and analysis of vaccine adverse events. The author further proposes minimal vaccine information standards and their ontology representations, ontology-based linked open vaccine data and meta-analysis, an integrative One Network ('OneNet') Theory of Life, and ontology-based approaches to study and apply the OneNet theory. In the Big Data era, these proposed strategies provide a novel framework for advanced data integration and analysis of fundamental biological networks including vaccine immune mechanisms.

Ontology-supported Research on Vaccine Efficacy, Safety, and Integrative Biological Networks

PubMed Central

He, Yongqun

2016-01-01

Summary While vaccine efficacy and safety research has dramatically progressed with the methods of in silico prediction and data mining, many challenges still exist. A formal ontology is a human- and computer-interpretable set of terms and relations that represent entities in a specific domain and how these terms relate to each other. Several community-based ontologies (including the Vaccine Ontology, Ontology of Adverse Events, and Ontology of Vaccine Adverse Events) have been developed to support vaccine and adverse event representation, classification, data integration, literature mining of host-vaccine interaction networks, and analysis of vaccine adverse events. The author further proposes minimal vaccine information standards and their ontology representations, ontology-based linked open vaccine data and meta-analysis, an integrative One Network (“OneNet”) Theory of Life, and ontology-based approaches to study and apply the OneNet theory. In the Big Data era, these proposed strategies provide a novel framework for advanced data integration and analysis of fundamental biological networks including vaccine immune mechanisms. PMID:24909153

Evolving technologies drive the new roles of Biomedical Engineering.

PubMed

Frisch, P H; St Germain, J; Lui, W

2008-01-01

Rapidly changing technology coupled with the financial impact of organized health care, has required hospital Biomedical Engineering organizations to augment their traditional operational and business models to increase their role in developing enhanced clinical applications utilizing new and evolving technologies. The deployment of these technology based applications has required Biomedical Engineering organizations to re-organize to optimize the manner in which they provide and manage services. Memorial Sloan-Kettering Cancer Center has implemented a strategy to explore evolving technologies integrating them into enhanced clinical applications while optimally utilizing the expertise of the traditional Biomedical Engineering component (Clinical Engineering) to provide expanded support in technology / equipment management, device repair, preventive maintenance and integration with legacy clinical systems. Specifically, Biomedical Engineering is an integral component of the Medical Physics Department which provides comprehensive and integrated support to the Center in advanced physical, technical and engineering technology. This organizational structure emphasizes the integration and collaboration between a spectrum of technical expertise for clinical support and equipment management roles. The high cost of clinical equipment purchases coupled with the increasing cost of service has driven equipment management responsibilities to include significant business and financial aspects to provide a cost effective service model. This case study details the dynamics of these expanded roles, future initiatives and benefits for Biomedical Engineering and Memorial Sloan Kettering Cancer Center.

General practice integration in Australia. Primary health services provider and consumer perceptions of barriers and solutions.

PubMed

Appleby, N J; Dunt, D; Southern, D M; Young, D

1999-08-01

To identify practical examples of barriers and possible solutions to improve general practice integration with other health service providers. Twelve focus groups, including one conducted by teleconference, were held across Australia with GPs and non GP primary health service providers between May and September, 1996. Focus groups were embedded within concept mapping sessions, which were used to conceptually explore the meaning of integration in general practice. Data coding, organising and analysis were based on the techniques documented by Huberman and Miles. Barriers to integration were perceived to be principally due to the role and territory disputes between the different levels of government and their services, the manner in which the GP's role is currently defined, and the system of GP remuneration. Suggestions on ways to improve integration involved two types of strategies. The first involves initiatives implemented 'top down' through major government reform to service structures, including the expansion of the role of divisions of general practice, and structural changes to the GP remuneration systems. The second type of strategy suggested involves initiatives implemented from the 'bottom up' involving services such as hospitals (e.g. additional GP liaison positions) and the use of information technology to link services and share appropriate patient data. The findings support the need for further research and evaluation of initiatives aimed at achieving general practice integration at a systems level. There is little evidence to suggest which types of initiatives improve integration. However, general practice has been placed in the centre of the health care debate and is likely to remain central to the success of such initiatives. Clarification of the future role and authority of general practice will therefore be required if such integrative strategies are to be successful at a wider health system level.

Enhancing the Impact of Family Justice Centers via Motivational Interviewing: An Integrated Review.

PubMed

Simmons, Catherine A; Howell, Kathryn H; Duke, Michael R; Beck, J Gayle

2016-12-01

The Family Justice Center (FJC) model is an approach to assisting survivors of intimate partner violence (IPV) that focuses on integration of services under one roof and co-location of staff members from a range of multidisciplinary agencies. Even though the FJC model is touted as a best practice strategy to help IPV survivors, empirical support for the effectiveness of this approach is scarce. The current article consolidates this small yet promising body of empirically based literature in a clinically focused review. Findings point to the importance of integrating additional resources into the FJC model to engage IPV survivors who have ambivalent feelings about whether to accept help, leave the abusive relationship, and/or participate in criminal justice processes to hold the offender accountable. One such resource, motivational interviewing (MI), holds promise in aiding IPV survivors with these decisions, but empirical investigation into how MI can be incorporated into the FJC model has yet to be published. This article, therefore, also integrates the body of literature supporting the FJC model with the body of literature supporting MI with IPV survivors. Implications for practice, policy, and research are incorporated throughout this review. © The Author(s) 2015.

Self-regulated learning in a dynamic coaching model for supporting college students with traumatic brain injury: two case reports.

PubMed

Kennedy, Mary R T; Krause, Miriam O

2011-01-01

To describe a program that integrates self-regulated learning theory with supported education for college students with traumatic brain injury using a dynamic coaching model; to demonstrate the feasibility of developing and implementing such a program; and to identify individualized outcomes. Case study comparisons. University setting. Two severely injured students with cognitive impairments. A dynamic coaching model of supported education which incorporated self-regulated learning was provided for students with traumatic brain injury while attending college. Outcomes were both short and long term including decontextualized standardized test scores, self-reported academic challenges, number and specificity of reported strategies, grades on assignments, number of credits completed versus attempted, and changes in academic status and campus life. Students improved on graded assignments after strategy instruction and reported using more strategies by the end of the year. Students completed most of the credits they attempted, were in good academic standing, and made positive academic decisions. Performance on decontextualized tests pre- and postintervention was variable. It is feasible to deliver a hybrid supported education program that is dynamically responsive to individual students' needs and learning styles. Reasons for including both functional and standardized test outcomes are discussed.

Social integration, psychological distress, and smoking behaviors in a midwest LGBT community.

PubMed

Sivadon, Angela; Matthews, Alicia K; David, Kevin M

2014-01-01

Lesbian, gay, bisexual, and transgender (LGBT) populations have smoking rates twice that of their heterosexual counterparts. To design effective outreach, prevention, and treatments for these individuals, a comprehensive understanding of associated factors is needed. To increase understanding of how social integration and psychological distress are related to smoking behaviors among LGBT populations. A cross-sectional, descriptive study of 135 LGBT adults using an online data collection strategy. Multivariate analyses were performed to examine factors associated with current smoking status. Social integration was not significantly related to smoking behaviors in this LGBT population, although psychological distress was higher among smokers than nonsmokers. Although social support has been reported to have an impact on health behaviors in the general population, the present findings suggest that the benefits of social support may not apply to the smoking activities of LGBT individuals. © The Author(s) 2014.

Advancing Understanding of Acculturation for Adolescents of Asian Immigrants: Person-Oriented Analysis of Acculturation Strategy Among Korean American Youth.

PubMed

Choi, Yoonsun; Tan, Kevin Poh Hiong; Yasui, Miwa; Hahm, Hyeouk Chris

2016-07-01

Acculturation strategy, a significant predictor of immigrant adaptation, has been under-studied with Asian Americans, in particular, Asian American youth. Using person-oriented latent profile analysis, this study identified acculturation strategies among Korean American early adolescents living in the Midwest. Two-hundred ninety-one families were interviewed in 2007 that included 220 youth (mean age 13, 47.7 % female), along with 272 mothers and 164 fathers (N = 656). They were re-interviewed in 2008 (N = 588). The study found three distinct acculturation strategies: separation (11.8 %, n = 26), integrated bicultural (66.9 %, n = 150), and modest bicultural (21.3 %, n = 44). Integrated bicultural youth reported the strongest sense of ethnic identity and the most favorable characteristics, providing empirical support for the benefit of biculturalism. The findings further suggest that separation may not be as detrimental as previously thought, and modest bicultural-biculturalism that is not fully developed-may in fact be less desirable among Korean American youth.

An adaptable navigation strategy for Virtual Microscopy from mobile platforms.

PubMed

Corredor, Germán; Romero, Eduardo; Iregui, Marcela

2015-04-01

Real integration of Virtual Microscopy with the pathologist service workflow requires the design of adaptable strategies for any hospital service to interact with a set of Whole Slide Images. Nowadays, mobile devices have the actual potential of supporting an online pervasive network of specialists working together. However, such devices are still very limited. This article introduces a novel highly adaptable strategy for streaming and visualizing WSI from mobile devices. The presented approach effectively exploits and extends the granularity of the JPEG2000 standard and integrates it with different strategies to achieve a lossless, loosely-coupled, decoder and platform independent implementation, adaptable to any interaction model. The performance was evaluated by two expert pathologists interacting with a set of 20 virtual slides. The method efficiently uses the available device resources: the memory usage did not exceed a 7% of the device capacity while the decoding times were smaller than the 200 ms per Region of Interest, i.e., a window of 256×256 pixels. This model is easily adaptable to other medical imaging scenarios. Copyright © 2015 Elsevier Inc. All rights reserved.

Clustering, climate and dengue transmission.

PubMed

Junxiong, Pang; Yee-Sin, Leo

2015-06-01

Dengue is currently the most rapidly spreading vector-borne disease, with an increasing burden over recent decades. Currently, neither a licensed vaccine nor an effective anti-viral therapy is available, and treatment largely remains supportive. Current vector control strategies to prevent and reduce dengue transmission are neither efficient nor sustainable as long-term interventions. Increased globalization and climate change have been reported to influence dengue transmission. In this article, we reviewed the non-climatic and climatic risk factors which facilitate dengue transmission. Sustainable and effective interventions to reduce the increasing threat from dengue would require the integration of these risk factors into current and future prevention strategies, including dengue vaccination, as well as the continuous support and commitment from the political and environmental stakeholders.

Design and control strategies for CELSS - Integrating mechanistic paradigms and biological complexities

NASA Technical Reports Server (NTRS)

Moore, B., III; Kaufmann, R.; Reinhold, C.

1981-01-01

Systems analysis and control theory consideration are given to simulations of both individual components and total systems, in order to develop a reliable control strategy for a Controlled Ecological Life Support System (CELSS) which includes complex biological components. Because of the numerous nonlinearities and tight coupling within the biological component, classical control theory may be inadequate and the statistical analysis of factorial experiments more useful. The range in control characteristics of particular species may simplify the overall task by providing an appropriate balance of stability and controllability to match species function in the overall design. The ultimate goal of this research is the coordination of biological and mechanical subsystems in order to achieve a self-supporting environment.

Application of two passive strategies on the load mitigation of large offshore wind turbines

NASA Astrophysics Data System (ADS)

Shirzadeh, Rasoul; Kühn, Martin

2016-09-01

This study presents the numerical results of two passive strategies to reduce the support structure loads of a large offshore wind turbine. In the first approach, an omnidirectional tuned mass damper is designed and implemented in the tower top to alleviate the structural vibrations. In the second approach, a viscous fluid damper model which is diagonally attached to the tower at two points is developed. Aeroelastic simulations are performed for the offshore 10MW INNWIND.EU reference wind turbine mounted on a jacket structure. Lifetime damage equivalent loads are evaluated at the tower base and compared with those for the reference wind turbine. The results show that the integrated design can extend the lifetime of the support structure.

Beliefs and perception of ill-health causation: a socio-cultural qualitative study in rural North-Eastern Ethiopia.

PubMed

Kahissay, Mesfin H; Fenta, Teferi G; Boon, Heather

2017-01-26

Understanding perceptions of the causes of ill-health common in indigenous communities may help policy makers to design effective integrated primary health care strategies to serve these communities. This study explored the indigenous beliefs of ill-health causation among those living in the Tehuledere Woreda /district/ in North East Ethiopia from a socio-cultural perspective. The study employed a qualitative ethnographic method informed by Murdock's Theory of Illness. Participatory observation, over a total of 5 months during the span of one year, was supplemented by focus group discussions (n = 96 participants in 10 groups) and in-depth interviews (n = 20) conducted with key informants. Data were analyzed thematically using narrative strategies. In these communities, illness is perceived to have supernatural (e.g., almighty God/ Allah, nature spirits, and human agents of the supernatural), natural (e.g., environmental sanitation and personal hygiene, poverty, biological and psychological factors) and societal causes (e.g., social trust, experiences of family support and harmony; and violation of social taboos). Therefore, the explanatory model of illness causation in this community was very similar to that of the Murdock model with one key difference: social elements need to be added to the model. Members of the study community believes that supernatural, natural and social elements are linked to ill-health causation. A successful integrated primary health care strategy should include strategies for supporting patients' needs in all three of these domains.

Integration and baseline management training and transition plan

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

Jech, J.B.

The purpose of the Integration and Baseline Management Training and Transition Plan is to provide a training outline for the Integration and Baseline Management (I and BM) organization and a transition strategy for the Master Equipment List (MEL) Phase 1 application. The training outline includes the following courses: MEL Phase 1 Application Course 1 Master Equipment List General Overview. Course 2 Master Equipment List Editing. Tank Waste Remediation System (TWRS) Labeling Related Course 3 TWRS Equipment Labeling Program (Course Number 350545). As part of courses 1, 2, and 3, it is recommended that a lesson plan be developed and integratedmore » into each of the three courses on the subject of Configuration Management (CM) to include: CM concepts, terminology, definitions, fundamentals and its application with respect to the course. The strategy for the MEL Phase 1 application is to train internal organizations (I and BM) on the MEL-General Overview for read only users and train MEL-Editing for edit users (only on an as needed basis). For external organizations, the strategy is to train selected personnel on the MEL-General Overview and transition them from read only privileges to editing privileges when the appropriate administrative procedures that outline the external organization`s responsibilities (to support MEL) are established. The purpose of this training is to ensure support of the I and BM organization objectives within the TV,IRS Division. These training courses will be added to the existing required training for I and BM personnel only. Other organizations implementing the training will be directed by their management on which training is required.« less

The Development and Impact of POWERSOURCE[c]: Year 5. CRESST Report 792

ERIC Educational Resources Information Center

Phelan, Julia; Vendlinski, Terry; Choi, Kilchan; Dai, Yunyun; Herman, Joan; Baker, Eva L.

2011-01-01

The POWERSOURCE[c] intervention is intended as a generalizable and powerful formative assessment strategy that can be integrated with any mathematics curriculum. POWERSOURCE[c] includes both a system of learning-based assessments and an infrastructure to support teachers' use of those assessments to improve student learning. The core undertaking…

The Impact of the Supplemental Instruction Leader on Student Performance in Introductory Accounting

ERIC Educational Resources Information Center

Jones, Jefferson P.

2013-01-01

This study explores the association between a supplemental instruction (SI) program and student performance in an introductory accounting course. SI is a proactive academic support program that is aimed at improving student learning in traditionally "high-risk" college courses by integrating learning and critical thinking strategies with…

USING A LIFE-CYCLE APPROACH TO ACHIEVE SUSTAINABLE MUNICIPAL SOLID WASTE MANAGEMENT STRATEGIES IN THE UNITED STATES

EPA Science Inventory

The paper discusses a computer-based decision support tool that has been developed to assist local governments in evaluating the cost and environmental performance of integrated municipal solid waste (MSW) managment systems. ongoing case studies of the tool at the local level are...

Integrating Literacy and Math: Strategies for K-6 Teachers

ERIC Educational Resources Information Center

Fogelberg, Ellen; Skalinder, Carole; Satz, Patti; Hiller, Barbara; Bernstein, Lisa; Vitantonio, Sandra

2008-01-01

Many K-6 teachers and students still think of mathematics as a totally separate subject from literacy. Yet incorporating math content into the language arts block helps students gain skills for reading many kinds of texts. Bringing reading, writing, and talking into the math classroom supports the development of conceptual knowledge and problem…

Online Chats: A Strategy to Enhance Learning in Large Classes

ERIC Educational Resources Information Center

Mtshali, Muntuwenkosi Abraham; Maistry, Suriamurthee Moonsamy; Govender, Desmond Wesley

2015-01-01

Online-supported teaching and learning is a technological innovation in education that integrates face-to-face teaching in plenary lectures, with an online component using a learning management system. This extends opportunities to students to interact with one another via online chats in the process of transacting their learning. There is a need…

Making Good Choices: Districts Take the Lead. Comprehensive School Reform.

ERIC Educational Resources Information Center

North Central Regional Educational Lab., Oak Brook, IL.

Public schools across the country are aiming to improve student performance by engaging in comprehensive school reform (CSR). This guide was created to help school districts make CSR an integral part of their strategies for improving student achievement. Five components for CSR are described: (1) Strategizing, whereby the district supports CSR by…

Using Open Educational Practices to Support Institutional Strategic Excellence in Teaching, Learning & Scholarship

ERIC Educational Resources Information Center

Carey, Thomas; Davis, Alan; Ferreras, Salvador; Porter, David

2015-01-01

This paper explores the integration of Open Educational Practices (OEP) into an institutional strategy to develop distinctive excellence in teaching, learning and scholarship. The institution in the case study is a public polytechnic university serving a metropolitan area in Canada. If emerging Open Educational Practices are to flourish at our…

The Effects of Participation, Performance, and Interest in a Game-Based Writing Environment

ERIC Educational Resources Information Center

Liao, Calvin C. Y.; Chang, Wan-Chen; Chan, Tak-Wai

2018-01-01

We have observed that many computer-supported writing environments based on pedagogical strategies have only been designed to incorporate the cognitive aspects, but motivational aspects should also be included. Hence, we theorize that integrating game-based learning into the writing environment may be a practical approach that can facilitate…

Transpersonal Graduate Education in Psychology: Alumni Self-Identified Thematic Patterns of Development

ERIC Educational Resources Information Center

Campbell, Colleen J.

2010-01-01

In a world that changes every day, individuals who assist others with change, support change, and create strategies for change, herein referred to as "change agents", play an important role in society. The California Institute of Integral Studies (CIIS), The Institute of Transpersonal Psychology (ITP), and Saybrook Graduate School and…

Targeted Food Marketing to Youth: Engaging Professionals in an Online Environment

ERIC Educational Resources Information Center

Katras, Mary Jo; Kunkel, Kelly; Croymans, Sara R.; Routh, Brianna; Schroeder, Mary; Olson, Carrie Ann

2014-01-01

The use of technology provides unique ways to create an engaged online community of learning for professionals that can be integrated into existing and future Extension programming. The Targeted Food Marketing to Youth online professional development course uses strategies and tools to create and support an engaged online community.

The Impact of "Virtualization" on Independent Study Course Completion Rates: The British Columbia Open University Experiment

ERIC Educational Resources Information Center

Giguere, Louis

2009-01-01

In 1997 the British Columbia Open University (BCOU) adopted a virtualization strategy based primarily on twinning off-line independent study distance education courses (textbook-based with study guide and telephone and e-mail tutor support) with alternate online versions (textbook-based with integrated conferencing and communications provided…

Integration of Reading and Writing Strategies To Improve Reading.

ERIC Educational Resources Information Center

Murphy, Judy

A program was developed for improving the reading of first-grade students in a progressive suburban community in northern Illinois. The problem was originally noted by an increase in the need for support services and low standardized test scores. Analysis of probable cause data revealed that students lacked knowledge of the relationship between…

Integration of Reading and Writing Strategies To Improve Reading.

ERIC Educational Resources Information Center

Lewandowski, Susan

A program was developed for improving the reading of second-grade students in a progressive suburban community in northern Illinois. The problem was originally noted by an increase in the need for support services and low standardized test scores. Analysis of probable cause data revealed that students lacked knowledge of the relationship between…

Processing of intended and unintended strategic issues and integration into the strategic agenda.

PubMed

Ridder, Hans-Gerd; Schrader, Jan Simon

2017-11-01

Strategic change is needed in hospitals due to external and internal pressures. However, research on strategic change, as a combination of management and medical expertise in hospitals, remains scarce. We analyze how intended strategic issues are processed into deliberate strategies and how unintended strategic issues are processed into emergent strategies in the management of strategy formation in hospitals. This study empirically investigates the integration of medical and management expertise in strategy formation. The longitudinal character of the case study enabled us to track patterns of intended and unintended strategic issues over 2 years. We triangulated data from interviews, observations, and documents. In accordance with the quality standards of qualitative research procedures, we analyzed the data by pattern matching and provided analytical generalization regarding strategy formation in hospitals. Our findings suggest that strategic issues are particularly successful within the strategy formation process if interest groups are concerned with the strategic issue, prospective profits are estimated, and relevant decisions makers are involved early on. Structure and interaction processes require clear criteria and transparent procedures for effective strategy formation. There is systematic neglect of medical expertise in processes of generating strategies. Our study reveals that the decentralized structure of medical centers is an adequate template for both the operationalization of intended strategic issues and the development of unintended strategic issues. However, tasks, roles, responsibility, resources, and administrative support are necessary for effective management of strategy formation. Similarly, criteria, procedures, and decision-making are prerequisites for effective strategy formation.

A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond

PubMed Central

Devroey, Dirk

2017-01-01

Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012–2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care. PMID:29588631

A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond.

PubMed

Borgermans, Liesbeth; Devroey, Dirk

2017-09-25

Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012-2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

The challenge of promoting integration: conceptualization, implementation, and assessment of a pilot care delivery model for patients with type 2 diabetes.

PubMed

Nasmith, Louise; Coté, Brigitte; Cox, Joseph; Inkell, Diane; Rubenstein, Heather; Jimenez, Vania; Rodriguez, Rosario; Larouche, Danielle; Contandriopoulos, Andre-Pierre

2004-01-01

The Côte-des-Neiges diabetes pilot project strove to conceptualize, implement, and assess an integrated health care system for Type 2 diabetes. Using a disease management and population-based approach, a multidisciplinary team sought to (1). organize health care in an integrative framework, (2). promote behavior changes in patients to foster self-care, (3). introduce tools to allow family physicians to modify their practices, and (4). encourage local community action to support patients and providers. Information from a needs assessment helped guide the development of the care model, which was implemented over a 1-year period. A preliminary assessment was undertaken using qualitative methods. Data were collected through in-depth interviews, focus groups, participant observation, and document analysis. (1). Physicians and patients appreciated having access to a multidisciplinary team and related services, and personalized communication was preferred to computerized links. (2). Patients also perceived the benefit of individualized assessment and self-care educational sessions allowing them to participate in their illness management. (3). A diabetes care flow sheet altered the management strategies of physicians. (4). Limited time prevented full development of networking efforts to promote community mobilization. Approaches to chronic diseases such as diabetes require integrative health care strategies to support patients and providers in their community. In spite of time constraints, patients perceived the value of education with increasing involvement in their illness, physicians reported changes in their practice, and steps were initiated to mobilize community resources.

Integrating postgraduate and undergraduate general practice education: qualitative study.

PubMed

O'Regan, Andrew; Culhane, Aidan; Dunne, Colum; Griffin, Michael; McGrath, Deirdre; Meagher, David; O'Dwyer, Pat; Cullen, Walter

2013-05-01

Educational activity in general practice has increased considerably in the past 20 years. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' capacity to fulfil this role. To explore the potential for vertical integration in undergraduate and postgraduate education in general practice, by describing the experience of (and attitudes towards) 'vertical integration in general practice education' among key stakeholder groups. Qualitative study of GPs, practice staff, GPs-in-training and medical students involving focus groups which were thematically analysed. We identified four overarching themes: (1) Important practical features of vertical integration are interaction between learners at different stages, active involvement in clinical teams and interagency collaboration; (2) Vertical integration may benefit GPs/practices, students and patients through improved practice systems, exposure to team-working and multi-morbidity and opportunistic health promotion, respectively; (3) Capacity issues may challenge its implementation; (4) Strategies such as recognising and addressing diverse learner needs and inter-agency collaboration can promote vertical integration. Vertical integration, whereby practices support students and trainees at different stages, may enhance general practices' teaching capacity. Recognising the diverse educational needs of learners at different stages and collaboration between agencies responsible for the planning and delivery of specialist training and medical degree programmes would appear to be important.

Promoting Social Nurturance and Positive Social Environments to Reduce Obesity in High Risk Youth

PubMed Central

Wilson, Dawn K.; Sweeney, Allison M.; Kitzman-Ulrich, Heather; Gause, Haylee; St. George, Sara M.

2017-01-01

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth’s behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family and social-environmental level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and health care providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth. PMID:28229248

Promoting Social Nurturance and Positive Social Environments to Reduce Obesity in High-Risk Youth.

PubMed

Wilson, Dawn K; Sweeney, Allison M; Kitzman-Ulrich, Heather; Gause, Haylee; St George, Sara M

2017-03-01

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth's behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and healthcare providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth.

Population Health Management for Inflammatory Bowel Disease.

PubMed

Dulai, Parambir S; Singh, Siddharth; Ohno-Machado, Lucilla; Sandborn, William J

2018-01-01

Inflammatory bowel diseases (IBDs) are chronic and impose significant, multidimensional burdens on patients and health care systems. The increasing prevalence of IBD will only worsen this problem globally-population health management (PHM) strategies are needed to increase quality of care and population health outcomes while reducing health care costs. We discuss the key components of PHM in IBD. Effective implementation of PHM strategies requires accurate identification of at-risk patients and key areas of variability in care. Improving outcomes of the at-risk population requires implementation of a multicomponent chronic care model designed to shift delivery of ambulatory care from acute, episodic, and reactive encounters, to proactive, planned, long-term care. This is achieved through team care of an activated patient with the help of remote monitoring, clinical information systems, and integrated decision support, with accompanying changes in delivery systems. Performance measurement is integral to any PHM strategy. This involves developing and implementing meaningful metrics of different phases of quality of IBD care and measuring them efficiently using modern clinical information systems. Such an integrated framework of PHM in IBD will facilitate the delivery of high-value care to patients. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Leveraging geospatial data, technology, and methods for improving the health of communities: priorities and strategies from an expert panel convened by the CDC.

PubMed

Elmore, Kim; Flanagan, Barry; Jones, Nicholas F; Heitgerd, Janet L

2010-04-01

In 2008, CDC convened an expert panel to gather input on the use of geospatial science in surveillance, research and program activities focused on CDC's Healthy Communities Goal. The panel suggested six priorities: spatially enable and strengthen public health surveillance infrastructure; develop metrics for geospatial categorization of community health and health inequity; evaluate the feasibility and validity of standard metrics of community health and health inequities; support and develop GIScience and geospatial analysis; provide geospatial capacity building, training and education; and, engage non-traditional partners. Following the meeting, the strategies and action items suggested by the expert panel were reviewed by a CDC subcommittee to determine priorities relative to ongoing CDC geospatial activities, recognizing that many activities may need to occur either in parallel, or occur multiple times across phases. Phase A of the action items centers on developing leadership support. Phase B focuses on developing internal and external capacity in both physical (e.g., software and hardware) and intellectual infrastructure. Phase C of the action items plan concerns the development and integration of geospatial methods. In summary, the panel members provided critical input to the development of CDC's strategic thinking on integrating geospatial methods and research issues across program efforts in support of its Healthy Communities Goal.

Dawn of a New Space Age: Developing a Global Exploration Strategy.

NASA Technical Reports Server (NTRS)

Volosin, Jeff

2006-01-01

Jeff Volosin is an aerospace engineer with over 20 years of experience in the design, development, and operations of both robotic and crewed spacecraft. Mr. Volosin is currently leading the NASA effort to develop and integrate a global exploration strategy which reflects the lunar exploration interests of international space agencies, academia and commercial stakeholders. Prior to joining NASA as a member of the Exploration Systems Mission Directorate in 2004, Jeff was an aerospace contractor, serving in a number of leadership positions including: Operations Manager for the NASA Communications Network and Flight Operations Manager for the Advanced Composition Explorer, Tropical Rainfall Measuring Mission, and the NOAA Polar and Geostationary satellite constellations. Earlier in his career, Jeff spent 4 years as a system engineer supporting the Space Exploration Initiative studies on human voyages to the Moon and Mars and also supported the Space Station program as an advanced life support engineer.

Strategies to support spirituality in health care communication: a home hospice cancer caregiver case study.

PubMed

Reblin, Maija; Otis-Green, Shirley; Ellington, Lee; Clayton, Margaret F

2014-12-01

Although there is growing recognition of the importance of integrating spirituality within health care, there is little evidence to guide clinicians in how to best communicate with patients and family about their spiritual or existential concerns. Using an audio-recorded home hospice nurse visit immediately following the death of a patient as a case-study, we identify spiritually-sensitive communication strategies. The nurse incorporates spirituality in her support of the family by 1) creating space to allow for the expression of emotions and spiritual beliefs and 2) encouraging meaning-based coping, including emphasizing the caregivers' strengths and reframing negative experiences. Hospice provides an excellent venue for modeling successful examples of spiritual communication. Health care professionals can learn these techniques to support patients and families in their own holistic practice. All health care professionals benefit from proficiency in spiritual communication skills. Attention to spiritual concerns ultimately improves care. © The Author(s) 2014.

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

Tagestad, Jerry D.; Bolte, John; Guzy, Michael

During this final year of the Pacific Northwest Regional Collaboratory we focused significantly on continuing the relationship between technical teams and government end-users. The main theme of the year was integration. This took the form of data integration via our web portal and integration of our technologies with the end users. The PNWRC's technical portfolio is based on EOS strategies, and focuses on 'applications of national priority: water management, invasive species, coastal management and ecological forecasting.' The products of our technical approaches have been well received by the community of focused end-users. The objective this year was to broaden thatmore » community and develop external support to continue and operationalize product development.« less

Integrating disease management into the outpatient delivery system during and after managed care.

PubMed

Villagra, Victor G

2004-01-01

Managed care introduced disease management as a replacement strategy to utilization management. The focus changed from influencing treatment decisions to supporting self-care and compliance. Disease management rendered operational many elements of the chronic care model, but it did so outside the delivery system, thus escaping the financial limitations, cultural barriers, and inertia inherent in effecting radical change from within. Medical management "after managed care" should include the functional and structural integration of disease management with primary care clinics. Such integration would supply the infrastructure that primary care physicians need to coordinate the care of chronically ill patients more effectively.

Perioperative Palliative Care Considerations for Surgical Oncology Nurses.

PubMed

Sipples, Rebecca; Taylor, Richard; Kirk-Walker, Deborah; Bagcivan, Gulcan; Dionne-Odom, J Nicholas; Bakitas, Marie

2017-02-01

To explore the opportunities to incorporate palliative care into perioperative oncology patient management and education strategies for surgical oncology nurses. Articles related to palliative care and surgical oncology to determine the degree of integration, gaps, and implications for practice. Although evidence supports positive patient outcomes when palliative care is integrated in the perioperative period, uptake of palliative care into surgical settings is slow. Palliative care concepts are not adequately integrated into surgical and nursing education. With appropriate palliative care education and training, surgical oncology nurses will be empowered to foster surgical-palliative care collaborations to improve patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Integration of design and inspection

NASA Astrophysics Data System (ADS)

Simmonds, William H.

1990-08-01

Developments in advanced computer integrated manufacturing technology, coupled with the emphasis on Total Quality Management, are exposing needs for new techniques to integrate all functions from design through to support of the delivered product. One critical functional area that must be integrated into design is that embracing the measurement, inspection and test activities necessary for validation of the delivered product. This area is being tackled by a collaborative project supported by the UK Government Department of Trade and Industry. The project is aimed at developing techniques for analysing validation needs and for planning validation methods. Within the project an experimental Computer Aided Validation Expert system (CAVE) is being constructed. This operates with a generalised model of the validation process and helps with all design stages: specification of product requirements; analysis of the assurance provided by a proposed design and method of manufacture; development of the inspection and test strategy; and analysis of feedback data. The kernel of the system is a knowledge base containing knowledge of the manufacturing process capabilities and of the available inspection and test facilities. The CAVE system is being integrated into a real life advanced computer integrated manufacturing facility for demonstration and evaluation.

Integrating palliative care into the trajectory of cancer care

PubMed Central

Hui, David; Bruera, Eduardo

2016-01-01

Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We end by discussing how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available. PMID:26598947

Knowledge management in dementia care networks: a qualitative analysis of successful information and support strategies for people with dementia living at home and their family caregivers.

PubMed

Heinrich, S; Laporte Uribe, F; Roes, M; Hoffmann, W; Thyrian, J R; Wolf-Ostermann, K; Holle, B

2016-02-01

Stakeholders involved in community dementia support services often work on their own and without coordination with other services. These circumstances can result in a lack of information and support for people with dementia and their family caregivers at home. To increase the coordination between existing support services, so-called 'Dementia Care Networks' (DCNs) have been established. Most of the tasks that are performed in DCNs are based on communication strategies. Therefore, knowledge management (KM) is a key process in these networks. However, few studies have focused on this topic. This study attempted to evaluate KM strategies in DCNs across Germany as part of the DemNet-D study. A qualitative interview study design was used. Qualitative data were collected during single and group interviews with key persons associated with thirteen DCNs. Interviews were audiotaped and transcribed, and a structured content analysis was conducted. The framework for the analysis was derived from a KM model. Information dissemination strategies for people with dementia and their informal caregivers based on actively established contacts appear to be more successful than passive strategies. General practitioners often play a key role as external gatekeepers in initiating contact between a network and a person affected by dementia. In this context, case managers can help integrate external stakeholders, such as general practitioners or pharmacists, into DCNs using different KM strategies. The systematic development of common objectives under an agency-neutral leadership seems to be an important aspect of successful KM within DCNs. The findings reported here can help DCNs optimize their KM strategies for generating tailored information and support services for people with dementia living at home and their family caregivers. In particular, the identified potential knowledge distribution barriers and facilitators will be of practical use to DCN stakeholders. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Oncology nurses and indoor tanning: stylish or risky behavior?

PubMed

Leong, Christina Marie; Palos, Guadalupe R

2014-06-01

Being tan has become a social norm, and some nurses engage in that widely accepted lifestyle. Mounting evidence of the increased risk to melanoma and nonmelanoma skin cancers associated with indoor tanning supports the need for nurses to integrate skin cancer education, counseling, and referrals into routine practice. The current article presents an overview of the risks associated with indoor tanning, discusses its acceptance as a social norm, and offers strategies to support oncology nurses in changing the widespread trend.

Structured Analysis of the Logistic Support Analysis (LSA) Task, ’Integrated Logistic Support (ILS) Assessment Maintenance Planning E-1 Element’ (APJ 966-204)

DTIC Science & Technology

1988-10-01

Structured Analysis involves building a logical (non-physical) model of a system, using graphic techniques which enable users, analysts, and designers to... Design uses tools, especially graphic ones, to render systems readily understandable. 8 Ř. Structured Design offers a set of strategies for...in the overall systems design process, and an overview of the assessment procedures, as well as a guide to the overall assessment. 20. DISTRIBUTION

Automated Logistics Support Analysis Tool, Version 1.0 User’s Manual, LSA Task 101, Early LSA Strategy

DTIC Science & Technology

1991-05-01

US AMCCOM INTEGRATED LOGISTIC SUPPORT OFFICE AMSMC-LSP ROCK ISLAND, IL by AMERICAN POWER JET COMPANY RIDGEFIELD, NJ ARLINGTON, VA WILLIAMSBURG, VA ST...the American Power Jet (APJ) Company , under contract to HQs AMCCOM. A major goal of the project is to unify the military and contractor approach to...and should be addressed to: George Chernowitz AMERICAN POWER JET COMPANY 705 Grand Avenue Ridgefield, New Jersey 07657 Phone: (201) 945-8203 TABLE OF

Gellan Gum-Based Hydrogels for Osteochondral Repair.

PubMed

Costa, Lígia; Silva-Correia, Joana; Oliveira, J Miguel; Reis, Rui L

2018-01-01

Gellan gum (GG) is a widely explored natural polysaccharide that has been gaining attention in tissue engineering (TE) and regenerative medicine field, and more recently in osteochondral TE approaches. Taking advantage of its inherent features such as biocompatibility, biodegradability, similarity with the extracellular matrix and easy functionalization, GG-based hydrogels have been studied for their potential for cartilage and bone tissue regeneration. Several preclinical studies describe the successful outcome of GG in cartilage tissue engineering. By its turn, GG composites have also been proposed in several strategies to guide bone formation. The big challenge in osteochondral TE approaches is still to achieve cartilage and bone regeneration simultaneously through a unique integrated bifunctional construct. The potential of GG to be used as polymeric support to reach both bone and cartilage regeneration has been demonstrated. This chapter provides an overview of GG properties and the functionalization strategies employed to tailor its behaviour to a particular application. The use of GG in soft and hard tissues regeneration approaches, as well in osteochondral integrated TE strategies is also revised.

Construction of technological artifacts and teaching strategies to promote flexible scientific understanding

NASA Astrophysics Data System (ADS)

Spitulnik, Michele Wisnudel

Science education reforms advocate inquiry as a way to build explanations and make informed decisions. Based on this call this dissertation (1) defines flexible scientific understanding by elaborating on content, inquiry and epistemic understandings; (2) describes an inquiry based unit that integrates dynamic modeling software; (3) examines students' understandings as they construct models; and (4) identifies instructional strategies that support inquiry and model building. A curriculum unit was designed to engage students in inquiry by identifying problems and constructing models to represent, explain and predict phenomena. Ninth grade students in a public mid-western high school worked in teams of 2-3 to ask questions, find information and reflect on the purposes of models. Data sources including classroom video, observations, interviews, student models and handouts were used to formulate cases that examine how two groups construct understanding. A teacher case study identifies the teaching strategies that support understanding. Categories within content, inquiry and epistemic understandings were used to analyze student understandings and teaching supports. The findings demonstrate that students can build flexible understanding by constructing models. Students built: (1) content understanding by identifying key ideas and building relationships and explanations of phenomena; (2) inquiry understanding by defining problems, constructing models and developing positions; and (3) epistemic understanding by describing the purposes of models as generalizing phenomena, testing hypotheses and making predictions. However, students demonstrated difficulty in using evidence to defend scientific arguments. Strategies that support flexible understanding were also identified. Content supports include: setting expectations for explanations; using examples to illustrate explanations; modeling questions; and providing feedback that prompts detailed explanations. Supports for inquiry are setting expectations for data gathering; using examples that illustrate model building; modeling the development of an argument; and providing feedback to promote coherent models. Epistemic supports include: using examples to illustrate purposes and assumptions within models, and providing feedback as students evaluate their models. The dissertation demonstrates that teaching strategies impact student understanding but are challenging to implement. When strategies are not used, students do not necessarily construct desired outcomes such as, using evidence to support arguments.

iPAS: AES Flight System Technology Maturation for Human Spaceflight

NASA Technical Reports Server (NTRS)

Othon, William L.

2014-01-01

In order to realize the vision of expanding human presence in space, NASA will develop new technologies that can enable future crewed spacecraft to go far beyond Earth orbit. These technologies must be matured to the point that future project managers can accept the risk of incorporating them safely and effectively within integrated spacecraft systems, to satisfy very challenging mission requirements. The technologies must also be applied and managed within an operational context that includes both on-board crew and mission support on Earth. The Advanced Exploration Systems (AES) Program is one part of the NASA strategy to identify and develop key capabilities for human spaceflight, and mature them for future use. To support this initiative, the Integrated Power Avionics and Software (iPAS) environment has been developed that allows engineers, crew, and flight operators to mature promising technologies into applicable capabilities, and to assess the value of these capabilities within a space mission context. This paper describes the development of the integration environment to support technology maturation and risk reduction, and offers examples of technology and mission demonstrations executed to date.

Interprofessional Clinical Rounding: Effects on Processes and Outcomes of Care.

PubMed

Ashcraft, Susan; Bordelon, Curry; Fells, Sheila; George, Vera; Thombley, Karen; Shirey, Maria R

Communication breakdown is viewed as a significant contributor to preventable patient harm. Interprofessional rounding (IPR) is one method of communication supporting the evidenced-based care delivery. The purpose of this paper is to explore the benefits of IPR for patients, clinicians, and the healthcare system. Interprofessional rounding supports collaboration, discussion, and timely intervention to prevent miscommunication leading to adverse patient events. Adherence to evidence-based care suggests a positive impact on patient, process, and financial outcomes. Statistically significant IPR-related improvements are seen in reducing mortality, lengths of stay, medication errors, and hospitalization costs as well as improved staff and patient satisfaction. One IPR-related gap in the literature is integrative care delivery, a strategy that provides a unified plan to meet the complex needs of patients and produce optimal outcomes. Activation and standardization with active participation in IPR support a collaborative integration of care. Embracing IPR and advocating for collaboration across the care continuum is a crucial process in preventing adverse events. Integrated care delivery through IPR provides a unified plan to meet the complex needs of patients, prevent harm, and produce best possible outcomes.

Design of Clinical Support Systems Using Integrated Genetic Algorithm and Support Vector Machine

NASA Astrophysics Data System (ADS)

Chen, Yung-Fu; Huang, Yung-Fa; Jiang, Xiaoyi; Hsu, Yuan-Nian; Lin, Hsuan-Hung

Clinical decision support system (CDSS) provides knowledge and specific information for clinicians to enhance diagnostic efficiency and improving healthcare quality. An appropriate CDSS can highly elevate patient safety, improve healthcare quality, and increase cost-effectiveness. Support vector machine (SVM) is believed to be superior to traditional statistical and neural network classifiers. However, it is critical to determine suitable combination of SVM parameters regarding classification performance. Genetic algorithm (GA) can find optimal solution within an acceptable time, and is faster than greedy algorithm with exhaustive searching strategy. By taking the advantage of GA in quickly selecting the salient features and adjusting SVM parameters, a method using integrated GA and SVM (IGS), which is different from the traditional method with GA used for feature selection and SVM for classification, was used to design CDSSs for prediction of successful ventilation weaning, diagnosis of patients with severe obstructive sleep apnea, and discrimination of different cell types form Pap smear. The results show that IGS is better than methods using SVM alone or linear discriminator.

Supportive care for older people with frailty in hospital: An integrative review.

PubMed

Nicholson, Caroline; Morrow, Elizabeth M; Hicks, Allan; Fitzpatrick, Joanne

2017-01-01

Growing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care. To identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation. An integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term 'supportive care'. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken. Literature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n=52) were integrated using synthesis of themes. Relevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings. The findings and model developed here will inform future interventions and can help staff and hospital managers to develop appropriate strategies, staff training and resource allocation models to improve the quality of health care for older people. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Coping strategies used by traumatic spinal cord injury patients in Sri Lanka: a focus group study.

PubMed

Arya, Sumedha; Xue, Siqi; Embuldeniya, Amanda; Narammalage, Harsha; da Silva, Tricia; Williams, Shehan; Ravindran, Arun

2016-10-01

Psychosocial consequences of traumatic spinal cord injury (SCI) have been well documented in Western populations, but there is no published literature on such incidence in the Sri Lankan population. The purpose of this study was to explore the psychosocial impact of SCI in a Sri Lankan population and to examine this population's coping mechanisms. Participants were recruited purposively at the Ragama Rheumatology and Rehabilitation Hospital, the sole rehabilitation facility for SCI patients in Sri Lanka. Focus groups were conducted with 23 consenting individuals. Interview transcripts were analysed using descriptive thematic analysis. Four domains of life impact, three types of active coping strategies and four types of external supports were identified. Decreased ambulation and burden on family life were significant concerns for male and female participants alike. Religious practices were reported most frequently as active coping strategies, followed by positive reframing and goal-setting. Reported external supports included guided physiotherapy, informational workshops, social support and peer networks. Rehabilitation efforts for Sri Lankan SCI patients should be sensitive to psychosocial concerns in addition to physical concerns in order to help patients re-integrate into their family lives and community. Furthermore, religious practices should be respected as possible aids to rehabilitation. Implications for Rehabilitation Rehabilitative efforts should be conscientious of patients' psychosocial well-being in addition to their physical well-being. Hospital-based rehabilitative efforts for traumatic spinal cord injury patients should promote functional independence and community re-integration. Spiritual and/or religious practices should be respected as ways by which traumatic spinal cord injury patients may confront personal challenges that arise following injury.

Chinese students in Japan: the mediator and the moderator between their personality and mental health.

PubMed

Sun, Yi

2013-01-01

To clarify the influence of personality traits on the psychological acculturation of Chinese international students in Japan, the present study used three structuring questions: (a) What personality trait makes the students vulnerable to psychological distress? (b) What mediates between personality and psychological distress? (c) What buffers personality from psychological distress? The study examined personality traits (Harm-Avoidance, HA; and Self-Directedness, SD; two dimensions of the Temperament and Character Inventory), acculturation attitudes (integration, assimilation, separation, and marginalization), and the mental health (General Health Questionnaire (GHQ)-30) of 253 Chinese students in Japan (17-30 years of age) using self-report questionnaires. The hypotheses are: For the Chinese international students in Japan, (a) the individuals with high HA or low SD are more vulnerable to psychological distress; (b) the acculturation strategy mediates between personality (HA/SD) and mental health (GHQ); (c) social support can moderate the effect of personality on acculturation adaptation. The results show that the Chinese international students in Japan had higher GHQ scores compared to normative standards, and marginalization (a less adaptive strategy) was their second most preferred acculturation strategy, next to integration. Individuals with high HA or low SD were more likely to have a marginalization attitude and suffer from more psychological distress. The mediation effect of marginalization and the moderation effect of social support in life (SSL) between HA/SD and GHQ were confirmed. Most of the hypotheses were supported by the results. Explanations of these findings and their implication for acculturation adaptation are discussed.

Manifestations of integrated public health policy in Dutch municipalities.

PubMed

Peters, Dorothee; Harting, Janneke; van Oers, Hans; Schuit, Jantine; de Vries, Nanne; Stronks, Karien

2016-06-01

Integrated public health policy (IPHP) aims at integrating health considerations into policies of other sectors. Since the limited empirical evidence available may hamper its further development, we systematically analysed empirical manifestations of IPHP, by placing policy strategies along a continuum of less-to-more policy integration, going from intersectoral action (IA) to healthy public policy (HPP) to health in all policies (HiAP). Our case study included 34 municipal projects of the Dutch Gezonde Slagkracht Programme (2009-15), which supports the development and implementation of IPHP on overweight, alcohol and drug abuse, and smoking. Our content analysis of project application forms and interviews with all project leaders used a framework approach involving the policy strategies and the following policy variables: initiator, actors, policy goals, determinants and policy instruments. Most projects showed a combination of policy strategies. However, manifestations of IPHP in overweight projects predominantly involved IA. More policy integration was apparent in alcohol/drugs projects (HPP) and in all-theme projects (HiAP). More policy integration was related to broad goal definitions, which allowed for the involvement of actors representing several policy sectors. This enabled the implementation of a mix of policy instruments. Determinants of health were not explicitly used as a starting point of the policy process. If a policy problem justifies policy integration beyond IA, it might be helpful to start from the determinants of health (epidemiological reality), systematically transform them into policy (policy reality) and set broad policy goals, since this gives actors from other sectors the opportunity to participate. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Structure of the Social Support Network of Patients with Severe and Persistent Psychiatric Disorders in Follow-Ups to Primary Health Care.

PubMed

de Souza, Jacqueline; de Almeida, Letícia Yamawaka; Moll, Marciana Fernandes; Silva, Lucas Duarte; Ventura, Carla Aparecida Arena

2016-02-01

The objective of this study is to analyze the characteristics of social support networks of patients with psychiatric disorders at follow-up to primary care. This is a cross-sectional qualitative research study. Forty-five interviews were held with patients and their supporters. The results showed small and dense networks, with a strong emphasis on the bonds with formal supporters and a scant network of informal supporters. It is recommended to develop strategies to improve social support networks and use this as an outcome indicator related to social integration of these patients and to the quality of services involved with outpatient healthcare. Copyright © 2015 Elsevier Inc. All rights reserved.

Integration of the Uncertainties of Anion and TOC Measurements into the Flammability Control Strategy for Sludge Batch 8 at the DWPF

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

Edwards, T. B.

2013-03-14

The Savannah River National Laboratory (SRNL) has been working with the Savannah River Remediation (SRR) Defense Waste Processing Facility (DWPF) in the development and implementation of a flammability control strategy for DWPF’s melter operation during the processing of Sludge Batch 8 (SB8). SRNL’s support has been in response to technical task requests that have been made by SRR’s Waste Solidification Engineering (WSE) organization. The flammability control strategy relies on measurements that are performed on Slurry Mix Evaporator (SME) samples by the DWPF Laboratory. Measurements of nitrate, oxalate, formate, and total organic carbon (TOC) standards generated by the DWPF Laboratory aremore » presented in this report, and an evaluation of the uncertainties of these measurements is provided. The impact of the uncertainties of these measurements on DWPF’s strategy for controlling melter flammability also is evaluated. The strategy includes monitoring each SME batch for its nitrate content and its TOC content relative to the nitrate content and relative to the antifoam additions made during the preparation of the SME batch. A linearized approach for monitoring the relationship between TOC and nitrate is developed, equations are provided that integrate the measurement uncertainties into the flammability control strategy, and sample calculations for these equations are shown to illustrate the impact of the uncertainties on the flammability control strategy.« less

Integrating personal medicine into service delivery: empowering people in recovery.

PubMed

MacDonald-Wilson, Kim L; Deegan, Patricia E; Hutchison, Shari L; Parrotta, Nancy; Schuster, James M

2013-12-01

Illness management and recovery strategies are considered evidence-based practices. The article describes how a web-based application, CommonGround, has been used to support implementation of such strategies in outpatient mental health services and assess its impact. The specific focus of this article is Personal Medicine, self-management strategies that are a salient component of the CommonGround intervention. With support from counties and a not-for-profit managed care organization, CommonGround has been introduced in 10 medication clinics, one Assertive Community Treatment (ACT) team, and one peer support center across Pennsylvania. Methods include analysis of data from the application's database and evaluation of health functioning, symptoms, and progress toward recovery. Health functioning improved over time and use of self-management strategies was associated with fewer concerns about medication side effects, fewer concerns about the impact of mental health medicine on physical health, more reports that mental health medicines were helping, and greater progress in individuals' recovery. Using Personal Medicine empowers individuals to work with their prescribers to find a "right balance" between what they do to be well and what they take to be well. This program helps individuals and their service team focus on individual strengths and resilient self-care strategies. More research is needed to assess factors that may predict changes in outcomes and how a web-based tool focused on self-management strategies may moderate those factors. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Science for Managing Riverine Ecosystems: Actions for the USGS Identified in the Workshop "Analysis of Flow and Habitat for Instream Aquatic Communities"

USGS Publications Warehouse

Bencala, Kenneth E.; Hamilton, David B.; Petersen, James H.

2006-01-01

Federal and state agencies need improved scientific analysis to support riverine ecosystem management. The ability of the USGS to integrate geologic, hydrologic, chemical, geographic, and biological data into new tools and models provides unparalleled opportunities to translate the best riverine science into useful approaches and usable information to address issues faced by river managers. In addition to this capability to provide integrated science, the USGS has a long history of providing long-term and nationwide information about natural resources. The USGS is now in a position to advance its ability to provide the scientific support for the management of riverine ecosystems. To address this need, the USGS held a listening session in Fort Collins, Colorado in April 2006. Goals of the workshop were to: 1) learn about the key resource issues facing DOI, other Federal, and state resource management agencies; 2) discuss new approaches and information needs for addressing these issues; and 3) outline a strategy for the USGS role in supporting riverine ecosystem management. Workshop discussions focused on key components of a USGS strategy: Communications, Synthesis, and Research. The workshop identified 3 priority actions the USGS can initiate now to advance its capabilities to support integrated science for resource managers in partner government agencies and non-governmental organizations: 1) Synthesize the existing science of riverine ecosystem processes to produce broadly applicable conceptual models, 2) Enhance selected ongoing instream flow projects with complementary interdisciplinary studies, and 3) Design a long-term, watershed-scale research program that will substantively reinvent riverine ecosystem science. In addition, topical discussion groups on hydrology, geomorphology, aquatic habitat and populations, and socio-economic analysis and negotiation identified eleven important complementary actions required to advance the state of the science and to develop the tools for supporting decisions on riverine ecosystem management. These eleven actions lie within the continuum of Communications, Synthesis, and Research.

Triple surveillance: a proposal for an integrated strategy to support and accelerate birth defect prevention.

PubMed

Botto, Lorenzo D; Mastroiacovo, Pierpaolo

2018-02-01

Preventing neural tube defects (NTDs) easily qualifies as a high-value opportunity to improve childhood survival and health: the unmet need is significant (major preventable burden), the intervention is transformative (providing sufficient folic acid), and delivery strategies (e.g., fortification) are effective in low-resource countries. Yet, NTD prevention is lagging. Can public health surveillance help fix this problem? Critics contend that surveillance is largely unnecessary, that limited resources are best spent on interventions, and that surveillance is unrealistic in developing countries. The counterargument is twofold: (1) in the absence of surveillance, interventions will provide fewer benefits and cost more and (2) effective surveillance is likely possible nearly everywhere, with appropriate strategies. As a base strategy, we propose "triple surveillance:" integrating surveillance of cause (folate insufficiency), of disease occurrence (NTD prevalence), and of health outcomes (morbidity, mortality, and disability). For better sustainability and usefulness, it is crucial to refocus and streamline surveillance activities (no recreational data collection), weave surveillance into clinical care (integrate in clinical workflow), and, later, work on including additional risk factors and pediatric outcomes (increase benefits at low marginal cost). By doing so, surveillance becomes not a roadblock but a preferential path to prevention and better care. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

Implementing stakeholder-informed research in the substance abuse treatment sector: strategies used by Connections, a Canadian knowledge translation and exchange project.

PubMed

Henderson, Joanna; Sword, Wendy; Niccols, Alison; Dobbins, Maureen

2014-05-29

Researcher-stakeholder collaboration has been identified as critical to bridging research and health system change. While collaboration models vary, meaningful stakeholder involvement over time ("integrated knowledge translation") is advocated to improve the relevance of research to knowledge users. This short report describes the integrated knowledge translation efforts of Connections, a knowledge translation and exchange project to improve services for women with substance abuse problems and their children, and implementation barriers and facilitators. Strategies of varying intensities were used to engage diverse stakeholders, including policy makers and people with lived experience, and executive directors, program managers, and service providers from Canadian addiction agencies serving women. Barriers to participation included individual (e.g., interest), organizational (e.g., funding), and system level (e.g., lack of centralized stakeholder database) barriers. Similarly, facilitators included individual (e.g., perceived relevance) and organizational (e.g., support) facilitators, as well as initiative characteristics (e.g., multiple involvement opportunities). Despite barriers, Connections' stakeholder-informed research efforts proved essential for developing clinically relevant and feasible processes, measures, and implementation strategies. Stakeholder-researcher collaboration is possible and robust integrated knowledge translation efforts can be productive. Future work should emphasize developing and evaluating a range of strategies to address stakeholders' knowledge translation needs and to facilitate sustained and meaningful involvement in research.

Diagnostic, design and implementation of an integrated model of care in France: a bottom-up process with a continuous leadership

PubMed Central

de Stampa, Matthieu; Vedel, Isabelle; Mauriat, Claire; Bagaragaza, Emmanuel; Routelous, Christelle; Bergman, Howard; Lapointe, Liette; Cassou, Bernard; Ankri, Joel; Henrard, Jean-Claude

2010-01-01

Purpose To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs. Context Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs). Case description In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agées (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase. Conclusions The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements.

Energy Systems Integration: NREL + HECO

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

Hawaiian Electric Companies' (HECO) customers are among the nation's fastest-adopters of solar PV systems. For HECO, the increased daytime PV generation raises feeder voltage profiles. Emerging technologies such as advanced PV inverters, battery storage, electric vehicles, and controllable loads also have an impact on voltage profiles. From the utility's perspective, it is yet unclear how to effectively manage these customer-sited resources. NREL is helping HECO understand its options by validating several voltage regulation strategies, making specific use of advanced inverters with voltage support functions, and their integration with other controllable sources.

Protein-Level Integration Strategy of Multiengine MS Spectra Search Results for Higher Confidence and Sequence Coverage.

PubMed

Zhao, Panpan; Zhong, Jiayong; Liu, Wanting; Zhao, Jing; Zhang, Gong

2017-12-01

Multiple search engines based on various models have been developed to search MS/MS spectra against a reference database, providing different results for the same data set. How to integrate these results efficiently with minimal compromise on false discoveries is an open question due to the lack of an independent, reliable, and highly sensitive standard. We took the advantage of the translating mRNA sequencing (RNC-seq) result as a standard to evaluate the integration strategies of the protein identifications from various search engines. We used seven mainstream search engines (Andromeda, Mascot, OMSSA, X!Tandem, pFind, InsPecT, and ProVerB) to search the same label-free MS data sets of human cell lines Hep3B, MHCCLM3, and MHCC97H from the Chinese C-HPP Consortium for Chromosomes 1, 8, and 20. As expected, the union of seven engines resulted in a boosted false identification, whereas the intersection of seven engines remarkably decreased the identification power. We found that identifications of at least two out of seven engines resulted in maximizing the protein identification power while minimizing the ratio of suspicious/translation-supported identifications (STR), as monitored by our STR index, based on RNC-Seq. Furthermore, this strategy also significantly improves the peptides coverage of the protein amino acid sequence. In summary, we demonstrated a simple strategy to significantly improve the performance for shotgun mass spectrometry by protein-level integrating multiple search engines, maximizing the utilization of the current MS spectra without additional experimental work.

Working Sandwich Generation Women Utilize Strategies within and between Roles to Achieve Role Balance.

PubMed

Evans, Kiah L; Millsteed, Jeannine; Richmond, Janet E; Falkmer, Marita; Falkmer, Torbjorn; Girdler, Sonya J

2016-01-01

Increasingly, women simultaneously balance the roles of mother, parental carer and worker. However, individual role balance strategies among these working 'sandwich' generation women have not been thoroughly explored. Eighteen women combining these three roles were interviewed about their individual role balance strategies. Findings were identified through the framework analysis technique, underpinned by the Model of Juggling Occupations. Achieving and maintaining role balance was explained as a complex process accomplished through a range of strategies. Findings revealed the women used six within-role balance strategies: living with integrity, being the best you can, doing what you love, loving what you do, remembering why and searching for signs of success. The women also described six between-role balance strategies: maintaining health and wellbeing, repressing perfectionism, managing time and energy, releasing responsibility, nurturing social connection and reciprocating. These findings provide a basis for health care providers to understand and potentially support working 'sandwich' generation women.

Fostering development of nursing practices to support integrated care when implementing integrated care pathways: what levers to use?

PubMed

Longpré, Caroline; Dubois, Carl-Ardy

2017-11-29

Care integration has been the focus of recent health system reforms. Given their functions at all levels of the care continuum, nurses have a substantial and primordial role to play in such integration processes. The aim of this study was to identify levers and strategies that organizations can use to support the development of a nursing practice aligned with the requirements of care integration in a health and social services centre (HSSC) in Quebec. The research design was a cross-sectional descriptive qualitative study based on a single case study with nested levels of analysis. The case was a public, multi-disciplinary HSSC in a semi-urban region of Quebec. Semi-structured interviews with 37 persons (nurses, professionals, managers, administrators) allowed for data saturation and ensured theoretical representation by covering four care pathways constituting different care integration contexts. Analysis involved four steps: preparing a predetermined list of codes based on the reference framework developed by Minkman (2011); coding transcript content; developing general and summary matrices to group observations for each care pathway; and creating a general model showing the overall results for the four pathways. The organization's capacity for response with regard to developing an integrated system of services resulted in two types of complementary interventions. The first involved investing in key resources and renewing organizational structures; the second involved deploying a series of organizational and clinical-administrative processes. In resource terms, integration efforts resulted in setting up new strategic services, re-arranging physical infrastructures, and deploying new technological resources. Organizational and clinical-administrative processes to promote integration involved renewing governance, improving the flow of care pathways, fostering continuous quality improvement, developing new roles, promoting clinician collaboration, and strengthening care providers' capacities. However, progress in these areas was offset by persistent constraints. The results highlight key levers organizations can use to foster the implementation and institutionalization of integrative nursing practices. They show that progress in this area requires a combination of strategies using multiple complementary levers. They also suggest that such progress calls for rethinking not only the deployment of certain organizational resources and structures, but also a series of organizational and clinical processes.

EU Strategies of Integrating ICT into Initial Teacher Training

ERIC Educational Resources Information Center

Garapko, Vitaliya

2013-01-01

Education and learning are strongly linked with society and its evolution and knowledge. In the field of formal education, ICTs are increasingly deployed as tools to extend the learner's capacity to perceive, understand and communicate, as seen in the increase in online learning programs and the use of the computer as a learning support tool in…

The Role of Research Education Coordinators in Building Research Cultures in Doctoral Education

ERIC Educational Resources Information Center

Brew, Angela; Boud, David; Malfroy, Janne

2017-01-01

The development of cultures of support has become important in programmes for the preparation of research students. The paper draws on in-depth interviews with 21 research education coordinators from Australian and United Kingdom institutions to identify the strategies that they use to build research cultures and integrate research students into…

Motueka High School Storied Experience: Teaching and Learning Strategies

ERIC Educational Resources Information Center

Ellery, Tracey; Trafford, Jan

2006-01-01

In 2005 Motueka High School became involved in the Ministry of Education's Enhancing Effective Practice in Special Education (EEPiSE) project. The following is the story of how we integrated this action research project into our existing Enhanced Programme Funding (EPF). The project was supported by researcher Don Brown and led by our head of…

Supportability in Aircraft Systems through Technology and Acquisition Strategy Applications.

DTIC Science & Technology

1987-09-01

structures is their corrosion resistance. These integral structures are water impregnable. Also, the absence of rivet and fastener hole eliminates the...REPCRT SECURITY CLASS,F,CAT ON lb RESTR;CTIVE MARK.NGSU",CLAS S I7 F 15E Za. SECURITY CLASSiFICAT;ON AUTHORITY 3 DISTRiBUTiQN/ AVAILABILIT ’ OF REPORT

Is spiritual healing a valid and effective therapy?

PubMed Central

Hodges, R D; Scofield, A M

1995-01-01

This paper briefly reviews the evidence supporting the reality of healing as a scientifically-attested phenomenon, the techniques and mechanisms of healing and the potential value of this therapy if it were developed and integrated into the medical services. The need for further extensive research is indicated and strategies for such research are suggested. PMID:7745566

"Left to Your Own Devices"--The Missed Potential of Adult Career Guidance in Denmark

ERIC Educational Resources Information Center

Cort, Pia; Thomsen, Rie; Mariager-Anderson, Kristina

2015-01-01

In 2008, the European Council agreed on a Resolution on better integrating lifelong guidance into lifelong learning strategies. The Resolution promoted lifelong guidance as a policy to support people during the multiple transitions provoked by a more volatile labour market. However, when looking into the guidance policy of Denmark, the Resolution…

A municipal forest report card: Results for California, USA

Treesearch

E.Gregory McPherson; Louren Kotow

2013-01-01

This study integrates two existing computer programs, the Pest Vulnerability Matrix and i-Tree Streets, into a decision-support tool for assessing municipal forest stability and recommending strategies to mitigate risk of loss. A report card concept was developed to communicate levels of performance in terms that managers and the public easily understand. Grades were...

Empowering Staff in Dementia Long-Term Care: Towards a More Supportive Approach to Interventions

ERIC Educational Resources Information Center

Figueiredo, Daniela; Barbosa, Ana; Cruz, Joana; Marques, Alda; Sousa, Liliana

2013-01-01

This pilot-study aimed to assess a psychoeducational program for staff in care homes. The program was designed to increase knowledge regarding dementia care, promote skills to integrate motor and multisensory stimulation in daily care, and develop coping strategies to manage emotional work-related demands. Six staff members received eight…

Assessment of the core and support functions of the Integrated Disease Surveillance system in Maharashtra, India

PubMed Central

2013-01-01

Background Monitoring the progress of the Integrated Disease Surveillance (IDS) strategy is an important component to ensure its sustainability in the state of Maharashtra in India. The purpose of the study was to document the baseline performance of the system on its core and support functions and to understand the challenges for its transition from an externally funded “project” to a state owned surveillance “program”. Methods Multi-centre, retrospective cross-sectional evaluation study to assess the structure, core and support surveillance functions using modified WHO generic questionnaires. All 34 districts in the state and randomly identified 46 facilities and 25 labs were included in the study. Results Case definitions were rarely used at the periphery. Limited laboratory capacity at all levels compromised case and outbreak confirmation. Only 53% districts could confirm all priority diseases. Stool sample processing was the weakest at the periphery. Availability of transport media, trained staff, and rapid diagnostic tests were main challenges at the periphery. Data analysis was weak at both district and facility levels. Outbreak thresholds were better understood at facility level (59%) than at the district (18%). None of the outbreak indicator targets were met and submission of final outbreak report was the weakest. Feedback and training was significantly better (p < 0.0001) at district level (65%; 76%) than at facility level (15%; 37%). Supervision was better at the facility level (37%) than at district (18%) and so were coordination, communication and logistic resources. Contractual part time positions, administrative delays in recruitment, and vacancies (30%) were main human resource issues that hampered system performance. Conclusions Significant progress has been made in the core and support surveillance functions in Maharashtra, however some challenges exist. Support functions (laboratory, transport and communication equipment, training, supervision, human and other resources) are particularly weak at the district level. Structural integration and establishing permanent state and district surveillance officer positions will ensure leadership; improve performance; support continuity; and offer sustainability to the program. Institutionalizing the integrated disease surveillance strategy through skills based personnel development and infrastructure strengthening at district levels is the only way to avoid it from ending up isolated! Improving surveillance quality should be the next on agenda for the state. PMID:23764137

NASA Information Technology Implementation Plan

NASA Technical Reports Server (NTRS)

2000-01-01

NASA's Information Technology (IT) resources and IT support continue to be a growing and integral part of all NASA missions. Furthermore, the growing IT support requirements are becoming more complex and diverse. The following are a few examples of the growing complexity and diversity of NASA's IT environment. NASA is conducting basic IT research in the Intelligent Synthesis Environment (ISE) and Intelligent Systems (IS) Initiatives. IT security, infrastructure protection, and privacy of data are requiring more and more management attention and an increasing share of the NASA IT budget. Outsourcing of IT support is becoming a key element of NASA's IT strategy as exemplified by Outsourcing Desktop Initiative for NASA (ODIN) and the outsourcing of NASA Integrated Services Network (NISN) support. Finally, technology refresh is helping to provide improved support at lower cost. Recently the NASA Automated Data Processing (ADP) Consolidation Center (NACC) upgraded its bipolar technology computer systems with Complementary Metal Oxide Semiconductor (CMOS) technology systems. This NACC upgrade substantially reduced the hardware maintenance and software licensing costs, significantly increased system speed and capacity, and reduced customer processing costs by 11 percent.

On-Orbit Maintenance Operations Strategy for the International Space Station - Concept and Implementation

NASA Technical Reports Server (NTRS)

Patterson, Linda P.

2001-01-01

The International Space Station (ISS) has an operational mission and profile that makes it a Logistics and Maintenance (L&M) support challenge different from previous programs. It is permanently manned, assembled on orbit, and multi-national. With this technical and operational challenge, a unique approach is needed to support the hardware and crew. The key is the integration of on-orbit and ground analysis, supply, maintenance, and crew training into a coherent functional process that supports ISS goals and objectives. To integrate all the necessary aspects of hardware and personnel to support on-orbit maintenance, a myriad of products and processes must be created and coordinated, such that the right resources are in the right place at the right time to ensure continued ISS functionality. This paper will familiarize the audience with ISS On-Orbit Maintenance (OOM) concepts and capabilities for different maintenance tasks and discuss some of the logic behind their selection. It will also identify the operational maintenance support responsibility split between the U.S. and the various International Partners (IPs).

An Intelligent Polar Cyberinfrastrucuture to Support Spatiotemporal Decision Making

NASA Astrophysics Data System (ADS)

Song, M.; Li, W.; Zhou, X.

2014-12-01

In the era of big data, polar sciences have already faced an urgent demand of utilizing intelligent approaches to support precise and effective spatiotemporal decision-making. Service-oriented cyberinfrastructure has advantages of seamlessly integrating distributed computing resources, and aggregating a variety of geospatial data derived from Earth observation network. This paper focuses on building a smart service-oriented cyberinfrastructure to support intelligent question answering related to polar datasets. The innovation of this polar cyberinfrastructure includes: (1) a problem-solving environment that parses geospatial question in natural language, builds geoprocessing rules, composites atomic processing services and executes the entire workflow; (2) a self-adaptive spatiotemporal filter that is capable of refining query constraints through semantic analysis; (3) a dynamic visualization strategy to support results animation and statistics in multiple spatial reference systems; and (4) a user-friendly online portal to support collaborative decision-making. By means of this polar cyberinfrastructure, we intend to facilitate integration of distributed and heterogeneous Arctic datasets and comprehensive analysis of multiple environmental elements (e.g. snow, ice, permafrost) to provide a better understanding of the environmental variation in circumpolar regions.

ANL statement of site strategy for computing workstations

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

Fenske, K.R.; Boxberger, L.M.; Amiot, L.W.

1991-11-01

This Statement of Site Strategy describes the procedure at Argonne National Laboratory for defining, acquiring, using, and evaluating scientific and office workstations and related equipment and software in accord with DOE Order 1360.1A (5-30-85), and Laboratory policy. It is Laboratory policy to promote the installation and use of computing workstations to improve productivity and communications for both programmatic and support personnel, to ensure that computing workstations acquisitions meet the expressed need in a cost-effective manner, and to ensure that acquisitions of computing workstations are in accord with Laboratory and DOE policies. The overall computing site strategy at ANL is tomore » develop a hierarchy of integrated computing system resources to address the current and future computing needs of the laboratory. The major system components of this hierarchical strategy are: Supercomputers, Parallel computers, Centralized general purpose computers, Distributed multipurpose minicomputers, and Computing workstations and office automation support systems. Computing workstations include personal computers, scientific and engineering workstations, computer terminals, microcomputers, word processing and office automation electronic workstations, and associated software and peripheral devices costing less than $25,000 per item.« less

Simulation of the MELiSSA closed loop system as a tool to define its integration strategy

NASA Astrophysics Data System (ADS)

Poughon, Laurent; Farges, Berangere; Dussap, Claude-Gilles; Godia, Francesc; Lasseur, Christophe

Inspired from a terrestrial ecosystem, MELiSSA (Micro Ecological Life Support System Alternative) is a project of closed life support system future long-term manned missions (Moon and Mars bases). Started on ESA in 1989, this 5 compartments concept has evolved following a mechanistic engineering approach for acquiring both theoretical and technical knowledge. In its current state of development the project can now start to demonstrate the MELiSSA loop concept at a pilot scale. Thus an integration strategy for a MELiSSA Pilot Plant (MPP) was defined, describing the different phases for tests and connections between compartments. The integration steps should be started in 2008 and be completed with a complete operational loop in 2015, which final objective is to achieve a closed liquid and gas loop with 100 Although the integration logic could start with the most advanced processes in terms of knowledge and hardware development, this logic needs to be completed by high politic of simulation. Thanks to this simulation exercise, the effective demonstrations of each independent process and its progressive coupling with others will be performed in operational conditions as close as possible to the final configuration. The theoretical approach described in this paper is based on mass balance models of each of the MELiSSA biological compartments which are used to simulate each integration step and the complete MPP loop itself. These simulations will help to identify criticalities of each integration steps and to check the consistencies between objectives, flows, recycling efficiencies and sizing of the pilot reactors. A MPP scenario compatible with the current knowledge of the operation of the pilot reactors was investigated and the theoretical performances of the system compared to the objectives of the MPP. From this scenario the most important milestone steps in the integration are highlighted and their behaviour can be simulated.

Early brain development toward shaping of human mind: an integrative psychoneurodevelopmental model in prenatal and perinatal medicine.

PubMed

Hruby, Radovan; Maas, Lili M; Fedor-Freybergh, P G

2013-01-01

The article introduces an integrative psychoneurodevelopmental model of complex human brain and mind development based on the latest findings in prenatal and perinatal medicine in terms of integrative neuroscience. The human brain development is extraordinarily complex set of events and could be influenced by a lot of factors. It is supported by new insights into the early neuro-ontogenic processes with the help of structural 3D magnetic resonance imaging or diffusion tensor imaging of fetal human brain. Various factors and targets for neural development including birth weight variability, fetal and early-life programming, fetal neurobehavioral states and fetal behavioral responses to various stimuli and others are discussed. Molecular biology reveals increasing sets of genes families as well as transcription and neurotropic factors together with critical epigenetic mechanisms to be deeply employed in the crucial neurodevelopmental events. Another field of critical importance is psychoimmuno-neuroendocrinology. Various effects of glucocorticoids as well as other hormones, prenatal stress and fetal HPA axis modulation are thought to be of special importance for brain development. The early postnatal period is characterized by the next intense shaping of complex competences, induced mainly by the very unique mother - newborn´s interactions and bonding. All these mechanisms serve to shape individual human mind with complex abilities and neurobehavioral strategies. Continuous research elucidating these special competences of human fetus and newborn/child supports integrative neuroscientific approach to involve various scientific disciplines for the next progress in human brain and mind research, and opens new scientific challenges and philosophic attitudes. New findings and approaches in this field could establish new methods in science, in primary prevention and treatment strategies, and markedly contribute to the development of modern integrative and personalized medicine.

The Modular Modeling System (MMS): A toolbox for water- and environmental-resources management

USGS Publications Warehouse

Leavesley, G.H.; Markstrom, S.L.; Viger, R.J.; Hay, L.E.; ,

2005-01-01

The increasing complexity of water- and environmental-resource problems require modeling approaches that incorporate knowledge from a broad range of scientific and software disciplines. To address this need, the U.S. Geological Survey (USGS) has developed the Modular Modeling System (MMS). MMS is an integrated system of computer software for model development, integration, and application. Its modular design allows a high level of flexibility and adaptability to enable modelers to incorporate their own software into a rich array of built-in models and modeling tools. These include individual process models, tightly coupled models, loosely coupled models, and fully- integrated decision support systems. A geographic information system (GIS) interface, the USGS GIS Weasel, has been integrated with MMS to enable spatial delineation and characterization of basin and ecosystem features, and to provide objective parameter-estimation methods for models using available digital data. MMS provides optimization and sensitivity-analysis tools to analyze model parameters and evaluate the extent to which uncertainty in model parameters affects uncertainty in simulation results. MMS has been coupled with the Bureau of Reclamation object-oriented reservoir and river-system modeling framework, RiverWare, to develop models to evaluate and apply optimal resource-allocation and management strategies to complex, operational decisions on multipurpose reservoir systems and watersheds. This decision support system approach has been developed, tested, and implemented in the Gunnison, Yakima, San Joaquin, Rio Grande, and Truckee River basins of the western United States. MMS is currently being coupled with the U.S. Forest Service model SIMulating Patterns and Processes at Landscape Scales (SIMPPLLE) to assess the effects of alternative vegetation-management strategies on a variety of hydrological and ecological responses. Initial development and testing of the MMS-SIMPPLLE integration is being conducted on the Colorado Plateau region of the western United Sates.

Preprocessing Structured Clinical Data for Predictive Modeling and Decision Support

PubMed Central

Oliveira, Mónica Duarte; Janela, Filipe; Martins, Henrique M. G.

2016-01-01

Summary Background EHR systems have high potential to improve healthcare delivery and management. Although structured EHR data generates information in machine-readable formats, their use for decision support still poses technical challenges for researchers due to the need to preprocess and convert data into a matrix format. During our research, we observed that clinical informatics literature does not provide guidance for researchers on how to build this matrix while avoiding potential pitfalls. Objectives This article aims to provide researchers a roadmap of the main technical challenges of preprocessing structured EHR data and possible strategies to overcome them. Methods Along standard data processing stages – extracting database entries, defining features, processing data, assessing feature values and integrating data elements, within an EDPAI framework –, we identified the main challenges faced by researchers and reflect on how to address those challenges based on lessons learned from our research experience and on best practices from related literature. We highlight the main potential sources of error, present strategies to approach those challenges and discuss implications of these strategies. Results Following the EDPAI framework, researchers face five key challenges: (1) gathering and integrating data, (2) identifying and handling different feature types, (3) combining features to handle redundancy and granularity, (4) addressing data missingness, and (5) handling multiple feature values. Strategies to address these challenges include: cross-checking identifiers for robust data retrieval and integration; applying clinical knowledge in identifying feature types, in addressing redundancy and granularity, and in accommodating multiple feature values; and investigating missing patterns adequately. Conclusions This article contributes to literature by providing a roadmap to inform structured EHR data preprocessing. It may advise researchers on potential pitfalls and implications of methodological decisions in handling structured data, so as to avoid biases and help realize the benefits of the secondary use of EHR data. PMID:27924347

World Workshop on Oral Medicine VI: Utilization of Oral Medicine-specific software for support of clinical care, research, and education: current status and strategy for broader implementation.

PubMed

Brailo, Vlaho; Firriolo, Francis John; Tanaka, Takako Imai; Varoni, Elena; Sykes, Rosemary; McCullough, Michael; Hua, Hong; Sklavounou, Alexandra; Jensen, Siri Beier; Lockhart, Peter B; Mattsson, Ulf; Jontell, Mats

2015-08-01

To assess the current scope and status of Oral Medicine-specific software (OMSS) utilized to support clinical care, research, and education in Oral Medicine and to propose a strategy for broader implementation of OMSS within the global Oral Medicine community. An invitation letter explaining the objectives was sent to the global Oral Medicine community. Respondents were interviewed to obtain information about different aspects of OMSS functionality. Ten OMSS tools were identified. Four were being used for clinical care, one was being used for research, two were being used for education, and three were multipurpose. Clinical software was being utilized as databases developed to integrate of different type of clinical information. Research software was designed to facilitate multicenter research. Educational software represented interactive, case-orientated technology designed for clinical training in Oral Medicine. Easy access to patient data was the most commonly reported advantage. Difficulty of use and poor integration with other software was the most commonly reported disadvantage. The OMSS presented in this paper demonstrate how information technology (IT) can have an impact on the quality of patient care, research, and education in the field of Oral Medicine. A strategy for broader implementation of OMSS is proposed. Copyright © 2015 Elsevier Inc. All rights reserved.

Approaches and incentives to implement integrated pest management that addresses regional and environmental issues.

PubMed

Brewer, Michael J; Goodell, Peter B

2012-01-01

Agricultural, environmental, and social and policy interests have influenced integrated pest management (IPM) from its inception. The first 50 years of IPM paid special attention to field-based management and market-driven decision making. Concurrently, IPM strategies became available that were best applied both within and beyond the bounds of individual fields and that also provided environmental benefits. This generated an incentives dilemma for farmers: selecting IPM activities for individual fields on the basis of market-based economics versus selecting IPM activities best applied regionally that have longer-term benefits, including environmental benefits, that accrue to the broader community as well as the farmer. Over the past several decades, public-supported incentives, such as financial incentives available to farmers from conservation programs for farms, have begun to be employed to encourage use of conservation techniques, including strategies with IPM relevance. Combining private investments with public support may effectively address the incentives dilemma when advanced IPM strategies are used regionally and provide public goods such as those benefiting resource conservation. This review focuses on adaptation of IPM to these broader issues, on transitions of IPM from primarily individual field-based decision making to coordinated community decision making, and on the form of partnerships needed to gain long-lasting regional and environmental benefits. Copyright © 2012 by Annual Reviews. All rights reserved.

Scaffolding and working together: a qualitative exploration of strategies for everyday life with dementia.

PubMed

McCabe, Louise; Robertson, Jane; Kelly, Fiona

2018-03-01

living with dementia has been described as a process of continual change and adjustment, with people with dementia and their families adopting informal strategies to help manage everyday life. As dementia progresses, families increasingly rely on help from the wider community and formal support. this article reports on a secondary analysis of qualitative data from focus groups and individual interviews with people with dementia and their carers in the North of England. In total, 65 people with dementia and 82 carers took part in the research: 26 in interviews and 121 in focus groups. Focus group and interview audio recordings were transcribed verbatim. A qualitative, inductive, thematic approach was taken for data analysis. the article applies the metaphor of scaffolding to deepen understanding of the strategies used by families. Processes of scaffolding were evident across the data where families, communities, professionals and services worked together to support everyday life for people with dementia. Within this broad theme of scaffolding were three sub-themes characterising the experiences of families living with dementia: doing things together; evolving strategies; and fragility and fear of the future. families with dementia are resourceful but do need increasing support (scaffolding) to continue to live as well as possible as dementia progresses. More integrated, proactive work is required from services that recognises existing scaffolds and provides appropriate support before informal strategies become unsustainable; thus enabling people with dementia to live well for longer. © The Author(s) 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com

Accessing and integrating data and knowledge for biomedical research.

PubMed

Burgun, A; Bodenreider, O

2008-01-01

To review the issues that have arisen with the advent of translational research in terms of integration of data and knowledge, and survey current efforts to address these issues. Using examples form the biomedical literature, we identified new trends in biomedical research and their impact on bioinformatics. We analyzed the requirements for effective knowledge repositories and studied issues in the integration of biomedical knowledge. New diagnostic and therapeutic approaches based on gene expression patterns have brought about new issues in the statistical analysis of data, and new workflows are needed are needed to support translational research. Interoperable data repositories based on standard annotations, infrastructures and services are needed to support the pooling and meta-analysis of data, as well as their comparison to earlier experiments. High-quality, integrated ontologies and knowledge bases serve as a source of prior knowledge used in combination with traditional data mining techniques and contribute to the development of more effective data analysis strategies. As biomedical research evolves from traditional clinical and biological investigations towards omics sciences and translational research, specific needs have emerged, including integrating data collected in research studies with patient clinical data, linking omics knowledge with medical knowledge, modeling the molecular basis of diseases, and developing tools that support in-depth analysis of research data. As such, translational research illustrates the need to bridge the gap between bioinformatics and medical informatics, and opens new avenues for biomedical informatics research.

Ten clinician-driven strategies for maximising value of Australian health care.

PubMed

Scott, Ian

2014-05-01

To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low- or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia. What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low- to high-value care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

Real Time Data Management for Estimating Probabilities of Incidents and Near Misses

NASA Astrophysics Data System (ADS)

Stanitsas, P. D.; Stephanedes, Y. J.

2011-08-01

Advances in real-time data collection, data storage and computational systems have led to development of algorithms for transport administrators and engineers that improve traffic safety and reduce cost of road operations. Despite these advances, problems in effectively integrating real-time data acquisition, processing, modelling and road-use strategies at complex intersections and motorways remain. These are related to increasing system performance in identification, analysis, detection and prediction of traffic state in real time. This research develops dynamic models to estimate the probability of road incidents, such as crashes and conflicts, and incident-prone conditions based on real-time data. The models support integration of anticipatory information and fee-based road use strategies in traveller information and management. Development includes macroscopic/microscopic probabilistic models, neural networks, and vector autoregressions tested via machine vision at EU and US sites.

An Introduction to Intelligent Processing Programs Developed by the Air Force Manufacturing Technology Directorate

NASA Technical Reports Server (NTRS)

Sampson, Paul G.; Sny, Linda C.

1992-01-01

The Air Force has numerous on-going manufacturing and integration development programs (machine tools, composites, metals, assembly, and electronics) which are instrumental in improving productivity in the aerospace industry, but more importantly, have identified strategies and technologies required for the integration of advanced processing equipment. An introduction to four current Air Force Manufacturing Technology Directorate (ManTech) manufacturing areas is provided. Research is being carried out in the following areas: (1) machining initiatives for aerospace subcontractors which provide for advanced technology and innovative manufacturing strategies to increase the capabilities of small shops; (2) innovative approaches to advance machine tool products and manufacturing processes; (3) innovative approaches to advance sensors for process control in machine tools; and (4) efforts currently underway to develop, with the support of industry, the Next Generation Workstation/Machine Controller (Low-End Controller Task).

Chaplains' Engagement with Suicidality among Their Service Users: Findings from the VA/DoD Integrated Mental Health Strategy.

PubMed

Kopacz, Marek S; Nieuwsma, Jason A; Jackson, George L; Rhodes, Jeffrey E; Cantrell, William C; Bates, Mark J; Meador, Keith G

2016-04-01

Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users were examined. An online survey was used to collect data from 440 VA and 1,723 Department of Defense (DoD) chaplains as part of the VA/DoD Integrated Mental Health Strategy. Differences were noted for demographics, work setting characteristics, encountering suicidality, and self-perceived preparation for dealing with suicidality. Compared to DoD chaplains, VA chaplains encounter more at-risk service users, yet feel less prepared for dealing with suicidality. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Integrated Information Systems Across the Weather-Climate Continuum

NASA Astrophysics Data System (ADS)

Pulwarty, R. S.; Higgins, W.; Nierenberg, C.; Trtanj, J.

2015-12-01

The increasing demand for well-organized (integrated) end-to-end research-based information has been highlighted in several National Academy studies, in IPCC Reports (such as the SREX and Fifth Assessment) and by public and private constituents. Such information constitutes a significant component of the "environmental intelligence" needed to address myriad societal needs for early warning and resilience across the weather-climate continuum. The next generation of climate research in service to the nation requires an even more visible, authoritative and robust commitment to scientific integration in support of adaptive information systems that address emergent risks and inform longer-term resilience strategies. A proven mechanism for resourcing such requirements is to demonstrate vision, purpose, support, connection to constituencies, and prototypes of desired capabilities. In this presentation we will discuss efforts at NOAA, and elsewhere, that: Improve information on how changes in extremes in key phenomena such as drought, floods, and heat stress impact management decisions for resource planning and disaster risk reduction Develop regional integrated information systems to address these emergent challenges, that integrate observations, monitoring and prediction, impacts assessments and scenarios, preparedness and adaptation, and coordination and capacity-building. Such systems, as illustrated through efforts such as NIDIS, have strengthened the integration across the foundational research enterprise (through for instance, RISAs, Modeling Analysis Predictions and Projections) by increasing agility for responding to emergent risks. The recently- initiated Climate Services Information System, in support of the WMO Global Framework for Climate Services draws on the above models and will be introduced during the presentation.

How mothers mediate the social integration of their children conceived of forced marriage within the Lord's Resistance Army.

PubMed

Shanahan, Fiona; Veale, Angela

2016-01-01

This article aims to understand how formerly abducted young mothers mediate the social integration of their children conceived of forced marriage and sexual violence within the Lord's Resistance Army (LRA) in northern Uganda. Interviews and photographic methods were used in six Internally Displaced Persons Camps in northern Uganda. This article draws on data derived from ten mothers of thirteen children who were conceived in the LRA, five boys and eight girls. The analytic approach used was Interpretive Phenomenological Analysis (Smith & Osborn, 2008). The analysis identified turning points of sites of action where young formerly abducted mothers used diverse strategies to support the reintegration of their children born or conceived within the LRA. Six key turning points are identified, these are (a) participating in rituals and ceremonies, (b) naming, (c) adapting to changing family structures, (d) responding to discrimination against boys (e) managing disclosure and (f) sharing positive memories and identities. Formerly abducted young mothers mediate the social integration of their children by engaging in strategies to support and foster their wellbeing and social relationships. However, the contexts in which they are operating are highly constrained and the relational identities of children born in the LRA are fluid and potentially insecure within communities of return. Implications for policy and programming are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Heuristic-based information acquisition and decision making among pilots.

PubMed

Wiggins, Mark W; Bollwerk, Sandra

2006-01-01

This research was designed to examine the impact of heuristic-based approaches to the acquisition of task-related information on the selection of an optimal alternative during simulated in-flight decision making. The work integrated features of naturalistic and normative decision making and strategies of information acquisition within a computer-based, decision support framework. The study comprised two phases, the first of which involved familiarizing pilots with three different heuristic-based strategies of information acquisition: frequency, elimination by aspects, and majority of confirming decisions. The second stage enabled participants to choose one of the three strategies of information acquisition to resolve a fourth (choice) scenario. The results indicated that task-oriented experience, rather than the information acquisition strategies, predicted the selection of the optimal alternative. It was also evident that of the three strategies available, the elimination by aspects information acquisition strategy was preferred by most participants. It was concluded that task-oriented experience, rather than the process of information acquisition, predicted task accuracy during the decision-making task. It was also concluded that pilots have a preference for one particular approach to information acquisition. Applications of outcomes of this research include the development of decision support systems that adapt to the information-processing capabilities and preferences of users.

Ergonomics action research II: a framework for integrating HF into work system design.

PubMed

Neumann, W P; Village, J

2012-01-01

This paper presents a conceptual framework that can support efforts to integrate human factors (HF) into the work system design process, where improved and cost-effective application of HF is possible. The framework advocates strategies of broad stakeholder participation, linking of performance and health goals, and process focussed change tools that can help practitioners engage in improvements to embed HF into a firm's work system design process. Recommended tools include business process mapping of the design process, implementing design criteria, using cognitive mapping to connect to managers' strategic goals, tactical use of training and adopting virtual HF (VHF) tools to support the integration effort. Consistent with organisational change research, the framework provides guidance but does not suggest a strict set of steps. This allows more adaptability for the practitioner who must navigate within a particular organisational context to secure support for embedding HF into the design process for improved operator wellbeing and system performance. There has been little scientific literature about how a practitioner might integrate HF into a company's work system design process. This paper proposes a framework for this effort by presenting a coherent conceptual framework, process tools, design tools and procedural advice that can be adapted for a target organisation.

[Development and implementation of the Chronicity Strategy for the Basque Country (Spain): lessons learned].

PubMed

Nuño-Solinís, Roberto

2016-11-01

Public healthcare in the Basque Country (Spain) faces high rates of ageing and chronicity, which stress the sustainability of the system. In response to this situation, the Basque Chronicity Strategy was launched in 2010. This large-scale and far-reaching transformation initiative focused on changing the healthcare provision model towards integrated care of chronicity. Developed in the context of economic and financial crisis, strong political opposition and resistance or passivity of many relevant stakeholders, the design and implementation of the Strategy introduced some noteworthy elements, such as: a narrative of change different to the austerity discourse, which was the dominant narrative at that time; a strategic approach supported by an evidence base and solid theoretical references; and an implementation strategy that favoured local innovation and the "bottom up" approach. In spite of this, it was not possible to overcome the political barriers or bureaucratic immobility, which limited the implementation and scope of the changes, especially those related to the scalability of successful local innovations. However, some changes in the healthcare integration culture at clinical and managerial level have been introduced as a result of the Strategy, as well as organisational progression towards a chronicity-targeted healthcare model. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Testing the tenets of minority stress theory in workplace contexts.

PubMed

Velez, Brandon L; Moradi, Bonnie; Brewster, Melanie E

2013-10-01

The links of minority stressors (workplace discrimination, expectations of stigma, internalized heterosexism, and identity management strategies) with psychological distress and job satisfaction were examined in a sample of 326 sexual minority employees. Drawing from minority stress theory and the literature on the vocational experiences of sexual minority people, patterns of mediation and moderation were tested. Minority stressors were associated with greater distress and lower job satisfaction. A mediation model was supported in which the links of discrimination and internalized heterosexism with psychological distress were mediated by a concealment-focused identity management strategy (i.e., avoiding), and the links of discrimination, expectations of stigma, and internalized heterosexism with job satisfaction were mediated by a disclosure-focused identity management strategy (i.e., integrating). Tests of moderation indicated that for sexual minority women (but not men), the positive association of discrimination with distress was stronger at higher levels of internalized heterosexism than at lower levels. In addition, lower levels of internalized heterosexism and concealment strategies (i.e., counterfeiting and avoiding) and higher levels of a disclosure strategy (i.e., integrating) were associated with higher job satisfaction in the context of low discrimination, but this buffering effect disappeared as level of discrimination increased. The implications of these findings for minority stress research are discussed, and clinical recommendations are made.

Strategies in disability management. Corporate disability management programs implemented at the work site.

PubMed

Kalina, C M

1999-10-30

Managers are challenged to demonstrate all programs as economically essential to the business, generating an appreciable return on investment. Further challenge exists to blend and integrate clinical and business objectives in program development. Disability management programs must be viewed as economically essential to the financial success of the business to assure management support for clinical interventions and return-to-work strategies essential for a successful program. This paper discusses a disability management program integrating clinical and business goals and objectives in return-to-work strategies to effect positive clinical, social-cultural, and business results. Clinical, educational, social, and economic challenges in the development, implementation, and continued management of a disability program at a large corporation with multiple global work sites are defined. Continued discussion addresses the effective clinical interventions and educational strategies utilized successfully within the workplace environment in response to each defined challenge. A multiple disciplinary team approach, clinical and business outcome measures, and quality assurance indicators are discussed as major program components. This article discusses a successful program approach focusing on business process and methodology. These parameters are used to link resources to strategy, developing a product for implementing and managing a program demonstrating economic value added through effective clinical medical case management.

Influence of the social context on use of surgical-lengthening and group-empowering coping strategies among people with dwarfism.

PubMed

Fernández, Saulo; Branscombe, Nyla R; Gómez, Angel; Morales, J Francisco

2012-08-01

To assess the role that social contextual factors exert on the way people with disproportionate short stature (dwarfism) cope with the negative consequences of discrimination. Using multigroup structural equation modeling, we compare the coping process of people with dwarfism from Spain (N = 63) and the USA (N = 145), two countries that differ in the role played by organizations offering support to people with dwarfism. In Spain, where organizational support is recent, a coping approach aimed at achieving integration with the majority group through limb-lengthening surgery prevails; in the USA, where the long-standing organization of people with dwarfism encourages pride in being a "little person" and positive intragroup contact, a coping strategy based on empowering the minority group dominates. Both strategies, each in its own context, are effective at protecting psychological well-being from the negative consequences of stigmatization; however, they exert their positive effects through different processes.

Autism in Brazil: a systematic review of family challenges and coping strategies.

PubMed

Gomes, Paulyane T M; Lima, Leonardo H L; Bueno, Mayza K G; Araújo, Liubiana A; Souza, Nathan M

2015-01-01

To describe the challenges faced by families caring for children with autism spectrum disorder (ASD) in Brazil and the coping strategies employed. Systematic review of articles published until September of 2013, without language restrictions, using quality appraisal (AMSTAR and CASP/Oxford instruments). The literature shows parental emotional overload as one of the main challenges faced by families, especially mothers. The main stressors were diagnostic postponement, difficulty dealing with the diagnosis and associated symptoms, and poor access to health services and social support. The predominant coping strategies found included information exchange between affected families and integrated healthcare network for patient and family support. ASD exerts strong influence on family dynamics, resulting in caregiver overload, especially in mothers. The Brazilian Unified Health System needs to provide comprehensive, continuous, and coordinated care to strengthen the patient-family dyad and promote the full development and societal inclusion of children with ASD. Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

'Trying to do a jigsaw without the picture on the box': understanding the challenges of care integration in the context of single assessment for older people in England.

PubMed

Wilson, Rob; Baines, Susan; Cornford, James; Martin, Mike

2007-06-25

Demographic ageing is one of the major challenges for governments in developed countries because older people are the main users of health and social care services. More joined-up, partnership approaches supported by information and communications technologies (ICTs) have become key to managing these demands. This article discusses recent developments towards integrated care in the context of one of the arenas in which integration is being attempted, the Single Assessment Process (SAP) to support the care for older people in England. It draws upon accounts of local SAP implementations in order to assess and reflect upon some of the successes and limitations of service integration enabled by ICTs. At the Department of Health in England, policy and strategy are directed at the integration of services through a 'whole systems' approach, with services that are interdependent upon one another and organised around the person that uses them. The Single Assessment Processes (SAP) is an instance of inter-organisational and cross-sectoral sharing of information intended to improve communication and coordination amongst professions and agencies and so support more integrated care. The aim of SAP is to ensure that older people receive appropriate, effective and timely responses to their health and social care needs and that professionals do not duplicate each others efforts. This article examines examples from two programmes of work within the context of SAP in England: one with the direction coming from local government social services, the other where the momentum is coming from the National Health Service (NHS). Both examples show that the policy and practice of ICT-supported integration continues to represent a significant challenge. Although the notion of integrated care underpinned by ICT-enabled information sharing is persuasive, it has limitations in practice. The notion of an 'open systems' approach is proposed as an alternative way of improving communication and coordination across the domains of health and social care.

Strategic deployment of CHO expression platforms to deliver Pfizer's Monoclonal Antibody Portfolio.

PubMed

Scarcelli, John J; Shang, Tanya Q; Iskra, Tim; Allen, Martin J; Zhang, Lin

2017-11-01

Development of stable cell lines for expression of large-molecule therapeutics represents a significant portion of the time and effort required to advance a molecule to enabling regulatory toxicology studies and clinical evaluation. Our development strategy employs two different approaches for cell line development based on the needs of a particular project: a random integration approach for projects where high-level expression is critical, and a site-specific integration approach for projects in which speed and reduced employee time spend is a necessity. Here we describe both our random integration and site-specific integration platforms and their applications in support of monoclonal antibody development and production. We also compare product quality attributes of monoclonal antibodies produced with a nonclonal cell pool or clonal cell lines derived from the two platforms. Our data suggests that material source (pools vs. clones) does not significantly alter the examined product quality attributes. Our current practice is to leverage this observation with our site-specific integration platform, where material generated from cell pools is used for an early molecular assessment of a given candidate to make informed decisions around development strategy. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:1463-1467, 2017. © 2017 American Institute of Chemical Engineers.

Modelling future impacts of air pollution using the multi-scale UK Integrated Assessment Model (UKIAM).

PubMed

Oxley, Tim; Dore, Anthony J; ApSimon, Helen; Hall, Jane; Kryza, Maciej

2013-11-01

Integrated assessment modelling has evolved to support policy development in relation to air pollutants and greenhouse gases by providing integrated simulation tools able to produce quick and realistic representations of emission scenarios and their environmental impacts without the need to re-run complex atmospheric dispersion models. The UK Integrated Assessment Model (UKIAM) has been developed to investigate strategies for reducing UK emissions by bringing together information on projected UK emissions of SO2, NOx, NH3, PM10 and PM2.5, atmospheric dispersion, criteria for protection of ecosystems, urban air quality and human health, and data on potential abatement measures to reduce emissions, which may subsequently be linked to associated analyses of costs and benefits. We describe the multi-scale model structure ranging from continental to roadside, UK emission sources, atmospheric dispersion of emissions, implementation of abatement measures, integration with European-scale modelling, and environmental impacts. The model generates outputs from a national perspective which are used to evaluate alternative strategies in relation to emissions, deposition patterns, air quality metrics and ecosystem critical load exceedance. We present a selection of scenarios in relation to the 2020 Business-As-Usual projections and identify potential further reductions beyond those currently being planned. © 2013.

Nutrition and Supplementation Considerations to Limit Endotoxemia When Exercising in the Heat

PubMed Central

Guy, Joshua H.

2018-01-01

Exercise-induced heat production is further elevated by exercise performed in hot conditions and this can subsequently impact inflammation, and gastrointestinal (GI) health. Implementing nutrition and supplementation strategies under these conditions may support the hyperthermic response, the systemic inflammatory response, GI permeability and integrity, and exercise performance. Therefore, the aim of this brief review is to explore athletes’ inflammatory response of two key biomarkers, lipopolysaccharide (LPS), and interleukin-6 (IL-6), and provide nutrition and supplementation recommendations when exercising in hot conditions. There is emerging evidence that probiotics, glutamine, and vitamin C can preserve GI integrity, which may improve performance during exercise in the heat. Glucose rich food when consumed with water, before and during exercise in the heat, also appear to limit endotoxemia, preserve GI integrity, and reduce the incidence of GI disturbances compared with water alone. The use of non-steroidal anti-inflammatory drugs (NSAIDs) may compromise GI integrity and this may result in greater leakage of endotoxins during long duration exercise in the heat. Further work is required to elucidate the impact of nutrition and supplementation strategies, in particular the use of NSAIDs, when exercising in the heat.

Nutrition and Supplementation Considerations to Limit Endotoxemia When Exercising in the Heat.

PubMed

Guy, Joshua H; Vincent, Grace E

2018-02-06

Exercise-induced heat production is further elevated by exercise performed in hot conditions and this can subsequently impact inflammation, and gastrointestinal (GI) health. Implementing nutrition and supplementation strategies under these conditions may support the hyperthermic response, the systemic inflammatory response, GI permeability and integrity, and exercise performance. Therefore, the aim of this brief review is to explore athletes' inflammatory response of two key biomarkers, lipopolysaccharide (LPS), and interleukin-6 (IL-6), and provide nutrition and supplementation recommendations when exercising in hot conditions. There is emerging evidence that probiotics, glutamine, and vitamin C can preserve GI integrity, which may improve performance during exercise in the heat. Glucose rich food when consumed with water, before and during exercise in the heat, also appear to limit endotoxemia, preserve GI integrity, and reduce the incidence of GI disturbances compared with water alone. The use of non-steroidal anti-inflammatory drugs (NSAIDs) may compromise GI integrity and this may result in greater leakage of endotoxins during long duration exercise in the heat. Further work is required to elucidate the impact of nutrition and supplementation strategies, in particular the use of NSAIDs, when exercising in the heat.

The role of collaborative ontology development in the knowledge negotiation process

NASA Astrophysics Data System (ADS)

Rivera, Norma

Interdisciplinary research (IDR) collaboration can be defined as the process of integrating experts' knowledge, perspectives, and resources to advance scientific discovery. The flourishing of more complex research problems, together with the growth of scientific and technical knowledge has resulted in the need for researchers from diverse fields to provide different expertise and points of view to tackle these problems. These collaborations, however, introduce a new set of "culture" barriers as participating experts are trained to communicate in discipline-specific languages, theories, and research practices. We propose that building a common knowledge base for research using ontology development techniques can provide a starting point for interdisciplinary knowledge exchange, negotiation, and integration. The goal of this work is to extend ontology development techniques to support the knowledge negotiation process in IDR groups. Towards this goal, this work presents a methodology that extends previous work in collaborative ontology development and integrates learning strategies and tools to enhance interdisciplinary research practices. We evaluate the effectiveness of applying such methodology in three different scenarios that cover educational and research settings. The results of this evaluation confirm that integrating learning strategies can, in fact, be advantageous to overall collaborative practices in IDR groups.

Broadening Participation in Geosciences with Academic Year and Summer Research Experiences

NASA Astrophysics Data System (ADS)

Austin, S. A.; Howard, A.; Johnson, L. P.; Gutierrez, R.; Chow, Y.

2013-12-01

Medgar Evers College, City University of New York, has initiated a multi-tiered strategy aimed at increasing the number of under-represented minority and female students pursuing careers in the Geosciences, especially Earth and Atmospheric Sciences and related areas. The strategy incorporates research on the persistence of minority and female under-represented students in STEM disciplines. The initiatives include NASA and NSF-funded team-based undergraduate research activities during the summer and academic year as well as academic support (clustering, PTLT workshops for gatekeeper courses), curriculum integration modules, and independent study/special topics courses. In addition, high school students are integrated into summer research activities working with undergraduate and graduate students as well as faculty and other scientist mentors. An important initial component was the building of an infrastructure to support remote sensing, supported by NASA. A range of academic year and summer research experiences are provided to capture student interest in the geosciences. NYC-based research activities include urban impacts of global climate change, the urban heat island, ocean turbulence and general circulation models, and space weather: magnetic rope structure, solar flares and CMEs. Field-based investigations include atmospheric observations using BalloonSat sounding vehicles, observations of tropospheric ozone using ozonesondes, and investigations of the ionosphere using a CubeSat. This presentation provides a description of the programs, student impact, challenges and observations.

Tapping State College Research and Development Capacity in Support of State Economic Development. Policy Matters: A Higher Education Policy Brief

ERIC Educational Resources Information Center

Hurley, Daniel

2008-01-01

Applied research and development activities at regional state colleges and universities bolster their primary mission of undergraduate education as well as contribute to local and statewide economic growth. As states boost efforts to fund and stimulate research as part of an integrated economic development strategy, they should seek to fully…

Delivering Coordinated, Community-Based Services by Putting Networks into Action: New York City's Change Capital Fund. No. 3

ERIC Educational Resources Information Center

Aceves, Aurelia De La Rosa; Greenberg, David M.; Schell, Sarah

2016-01-01

This brief is the third in a series documenting the implementation of an economic mobility initiative supported by New York City's Change Capital Fund (CCF). CCF is a consortium of New York City donors formed to invest in local nonprofits that undertake data-driven antipoverty strategies integrating housing, education, and employment services. CCF…

Vision Integrating Strategies in Ophthalmology and Neurochemistry (VISION)

DTIC Science & Technology

2015-05-01

ischemia. Neuroprotection with non- feminizing estrogens: Estrogens are well known as female sex hormones, but recent evidence also supports their...neuroprotective activities, which often can be separated from their feminizing activities. Non- feminizing estrogens can protect cultured retinal... feminizing estrogen analogues in retinal neurons. 2011 Society for Neuroscience Abstract 895.01. Mueller B, Ma H-Y, Yorio T. Inhibition of NMDA

An Examination of the Role of Social Support, Coping Strategies, and Individual Characteristics in Students' Adaptation to College

ERIC Educational Resources Information Center

Bejerano, Arleen R.

2014-01-01

Adaptation, or adjustment, is a psycho-social process that occurs when an individual accepts and integrates into his or her life a transition from one situation to another situation (Schlossberg, 1981). Many individuals struggle with transitions because transitions involve changes in the environment, roles, routines, and/or ways of looking at the…

New Frontiers: Navigational Strategies for Integrating Technology into the School.

ERIC Educational Resources Information Center

Haney, Regina, Ed.; Zukowski, Angela Ann, Ed.

This book is an outgrowth of the New Frontiers for Catholic Schools project, a collaborative effort of the National Catholic Educational Association and the University of Dayton. The goal of the book is to support Catholic educators and schools to make technology a vital part of the future of Catholic education. The chapters are as follows: (1)…

Achieving Results through Community School Partnerships: How District and Community Leaders Are Building Effective, Sustainable Relationships

ERIC Educational Resources Information Center

Blank, Martin J.; Jacobson, Reuben; Melaville, Atelia

2012-01-01

A community school is a place and a set of partnerships connecting a school, the families of students, and the surrounding community. A community school is distinguished by an integrated focus on academics, youth development, family support, health and social services, and community development. The community school strategy is central to efforts…

Institutional Transformation Model

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

2015-10-19

Reducing the energy consumption of large institutions with dozens to hundreds of existing buildings while maintaining and improving existing infrastructure is a critical economic and environmental challenge. SNL's Institutional Transformation (IX) work integrates facilities and infrastructure sustainability technology capabilities and collaborative decision support modeling approaches to help facilities managers at Sandia National Laboratories (SNL) simulate different future energy reduction strategies and meet long term energy conservation goals.

Motivational Measure of the Instruction Compared: Instruction Based on the ARCS Motivation Theory vs Traditional Instruction in Blended Courses

ERIC Educational Resources Information Center

Colakoglu, Ozgur M.; Akdemir, Omur

2012-01-01

The ARCS Motivation Theory was proposed to guide instructional designers and teachers who develop their own instruction to integrate motivational design strategies into the instruction. There is a lack of literature supporting the idea that instruction for blended courses if designed based on the ARCS Motivation Theory provides different…

Rethinking Curriculum and Instruction: Lessons from an Integrated Learning Program and Its Impact on Students and Teachers

ERIC Educational Resources Information Center

Doyle, Dennis; Huie Hofstetter, Carolyn; Kendig, Julie; Strick, Betsy

2014-01-01

CoTA (Collaborations: Teachers and Artists) is a professional development program that empowers teachers to access the arts in everyday instruction to support student achievement. CoTA schools commit to intense, 3-year collaborations for ten weeks each year where teachers learn to capitalize on arts content and strategies to promote knowledge and…

Analytical Concept: Development of a Multinational Information Strategy

DTIC Science & Technology

2008-10-31

16 1.4.3 Training and Mentoring/ Coaching ............................................................. 16 1.5 Analysis Requirements...America. These priority focus areas will become subject to experimentation in a number of consecutive phases of the 2008 Major Integrating Event ( MIE ...factor in general, in the MNE 5 CD&E program, focused on supporting concept validation in the 2008 MIE . The Analytical Concept outlines processes and

A Leader's Understanding: Faculty Perception of Academic Quality and Effective Implementation of Online Modality in Higher Education

ERIC Educational Resources Information Center

Boyers, Jayson

2017-01-01

The study's purpose was to examine attitudes and perceptions of full-time faculty within colleges and universities that segregate or integrate the online modality. In examining the faculty attitudes, this research provided an understanding about how structure of an online strategy within an institution may affect the perceptions or support of…

Including Students with Learning Disabilities in Mainstream Classes: A 2-Year Spanish Study Using a Collaborative Approach to Intervention.

ERIC Educational Resources Information Center

Cardona, Cristina

This study evaluated the effectiveness of an inclusive program for students (grades 2 through 4) with mild learning disabilities (LD) in four elementary schools in Spain. It compared two support strategies, a within-class integrated program versus resource room approach with students having either high or low learning potential. The study also…

Integration of the Common Core State Standards into CTE: Challenges and Strategies of Career and Technical Teachers

ERIC Educational Resources Information Center

Asunda, Paul A.; Finnell, Alicia M.; Berry, Nicholas R.

2015-01-01

In recent years, conversations about the importance of education standards in our school systems have intensified. Common Core State Standards (CCSS) are being implemented across most of the country. The standards require a major shift in instruction and the needed supports really are not there. This study investigated the common barriers,…

Integration of Reading and Writing Strategies in Primary Level Special Education Resource Students To Improve Reading Performance.

ERIC Educational Resources Information Center

Peterson, Kathy S.

A program was developed for improving the reading level of primary special education resource students in a progressive suburban community in the midwest. The problem was originally noted by an increase in the need for support services and low standardized test scores. Analysis of probable cause data revealed that students lacked knowledge of the…

Resilience in nurses: an integrative review.

PubMed

Hart, Patricia L; Brannan, Jane D; De Chesnay, Mary

2014-09-01

To describe nursing research that has been conducted to understand the phenomenon of resilience in nurses. Resilience is the ability to bounce back or cope successfully despite adverse circumstances. Nurses deal with modern-day problems that affect their abilities to remain resilient. Nursing administrators/managers need to look for solutions not only to recruit nurses, but to become knowledgeable about how to support and retain nurses. A comprehensive search was undertaken for nursing research conducted between 1990 and 2011. Key search terms were nurse, resilience, resiliency and resilient. Whittemore and Knafl's integrative approach was used to conduct the methodological review. Challenging workplaces, psychological emptiness, diminishing inner balance and a sense of dissonance are contributing factors for resilience. Examples of intrapersonal characteristics include hope, self-efficacy and coping. Cognitive reframing, toughening up, grounding connections, work-life balance and reconciliation are resilience building strategies. This review provides information about the concept of resilience. Becoming aware of contributing factors to the need for resilience and successful strategies to build resilience can help in recruiting and retaining nurses. Understanding the concept of resilience can assist in providing support and developing programmes to help nurses become and stay resilient. © 2012 John Wiley & Sons Ltd.

Computer-aided acquisition and logistics support (CALS): Concept of Operations for Depot Maintenance

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

Bourgeois, N.C.; Greer, D.K.

1993-04-01

This CALS Concept of Operations for Depot Maintenance provides the foundation strategy and the near term tactical plan for CALS implementation in the depot maintenance environment. The user requirements enumerated and the overarching architecture outlined serve as the primary framework for implementation planning. The seamless integration of depot maintenance business processes and supporting information systems with the emerging global CALS environment will be critical to the efficient realization of depot user's information requirements, and as, such will be a fundamental theme in depot implementations.

Lifestyle and Self-Management by Those Who Live It: Patients Engaging Patients in a Chronic Disease Model.

PubMed

Jesse, Michelle T; Rubinstein, Elizabeth; Eshelman, Anne; Wee, Corinne; Tankasala, Mrunalini; Li, Jia; Abouljoud, Marwan

Patients pursuing organ transplantation have complex medical needs, undergo comprehensive evaluation for possible listing, and require extensive education. However, transplant patients and their supports frequently report the need for more lifestyle and self-management strategies for living with organ transplantation. First, to explore feasibility of a successful, patient-run transplant lifestyle educational group (Transplant Living Community), designed to complement medical care and integrated into the clinical setting; and second, to report the major themes of patients' and supports' qualitative and quantitative feedback regarding the group. Informal programmatic review and patient satisfaction surveys. A total of 1862 patient satisfaction surveys were disseminated and 823 were returned (response rate, 44.2%). Patients and their supports reported positive feedback regarding the group, including appreciation that the volunteer was a transplant recipient and gratitude for the lifestyle information. Five areas were associated with the success of Transplant Living Community: 1) a "champion" dedicated to the program and its successful integration into a multidisciplinary team; 2) a health care environment receptive to integration of a patient-led group with ongoing community development; 3) a high level of visibility to physicians and staff, patients, and supports; 4) a clearly presented and manageable lifestyle plan ("Play Your ACES"(a) [Attitude, Compliance, Exercise, and Support]), and 5) a strong volunteer structure with thoughtful training with the ultimate objective of volunteers taking ownership of the program. It is feasible to integrate a sustainable patient-led lifestyle and self-management educational group into a busy tertiary care clinic for patients with complex chronic illnesses.

Is health systems integration being advanced through Local Health District planning?

PubMed

Saunders, Carla; Carter, David J

2017-05-01

Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services. What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.

There will be some changes made: A survivor perspective on post-acquired brain injury residential transition.

PubMed

O'Neil-Pirozzi, Therese M; Lorenz, Laura S; Demore-Taber, Michelle; Samayoa, Sindi

2015-01-01

Brain injury survivors experience many transitions post-injury and it is important that they experience these in the most supportive and integrative ways possible. This study provided a group of chronic brain injury survivors the opportunity to share their insights and experience of residential transition and to suggest strategies to help maximize the transition experience and outcomes. This study used a qualitative design that consisted of semi-structured interviews. Twenty-one adults with chronic acquired brain injury residing in community-based supported group houses answered a series of scripted questions. Interviews were recorded and participant statements were transcribed and coded according to prospectively developed transition themes. Participants discussed positive and negative insights and experiences regarding residential transitions. Themes of balance between support and independence, life purpose and transition to more or less structure were frequently addressed. Participants suggested caregiver-targeted strategies to facilitate successful transitions before, during and after a move. The insights and suggestions shared by this group of chronic acquired brain injury survivors add to already existing knowledge of post-injury residential transitions and strategies professional caregivers may use to maximize the ease and success of the survivor's transitional experience.

You can go your own way: Effectiveness of participant-driven versus experimenter-driven processing strategies in memory training and transfer

PubMed Central

Flegal, Kristin E.; Lustig, Cindy

2016-01-01

Cognitive training programs that instruct specific strategies frequently show limited transfer. Open-ended approaches can achieve greater transfer, but may fail to benefit many older adults due to age deficits in self-initiated processing. We examined whether a compromise that encourages effort at encoding without an experimenter-prescribed strategy might yield better results. Older adults completed memory training under conditions that either 1) mandated a specific strategy to increase deep, associative encoding, 2) attempted to suppress such encoding by mandating rote rehearsal, or 3) encouraged time and effort towards encoding but allowed for strategy choice. The experimenter-enforced associative encoding strategy succeeded in creating integrated representations of studied items, but training-task progress was related to pre-existing ability. Independent of condition assignment, self-reported deep encoding was associated with positive training and transfer effects, suggesting that the most beneficial outcomes occur when environmental support guiding effort is provided but participants generate their own strategies. PMID:26549616

You can go your own way: effectiveness of participant-driven versus experimenter-driven processing strategies in memory training and transfer.

PubMed

Flegal, Kristin E; Lustig, Cindy

2016-07-01

Cognitive training programs that instruct specific strategies frequently show limited transfer. Open-ended approaches can achieve greater transfer, but may fail to benefit many older adults due to age deficits in self-initiated processing. We examined whether a compromise that encourages effort at encoding without an experimenter-prescribed strategy might yield better results. Older adults completed memory training under conditions that either (1) mandated a specific strategy to increase deep, associative encoding, (2) attempted to suppress such encoding by mandating rote rehearsal, or (3) encouraged time and effort toward encoding but allowed for strategy choice. The experimenter-enforced associative encoding strategy succeeded in creating integrated representations of studied items, but training-task progress was related to pre-existing ability. Independent of condition assignment, self-reported deep encoding was associated with positive training and transfer effects, suggesting that the most beneficial outcomes occur when environmental support guiding effort is provided but participants generate their own strategies.

Towards equity and sustainability of rural and remote health services access: supporting social capital and integrated organisational and professional development.

PubMed

Schoo, Adrian; Lawn, Sharon; Carson, Dean

2016-04-02

Access to rural health services is compromised in many countries including Australia due to workforce shortages. The issues that consequently impact on equity of access and sustainability of rural and remote health services are complex. The purpose of this paper is to describe a number of approaches from the literature that could form the basis of a more integrated approach to health workforce and rural health service enhancement that can be supported by policy. A case study is used to demonstrate how such an approach could work. Disjointed health services are common in rural areas due to the 'tyranny of distance.' Recruitment and retention of health professionals in rural areas and access to and sustainability of rural health services is therefore compromised. Strategies to address these issues tend to have a narrow focus. An integrated approach is needed to enhance rural workforce and health services; one that develops, acknowledges and accounts for social capital and social relations within the rural community.

Implementation of the NHLBI Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Rationale and Study Design for Young Hearts, Strong Starts, a Cluster-Randomized Trial Targeting Body Mass Index, Blood Pressure, and Tobacco

PubMed Central

LaBresh, Kenneth A.; Lazorick, Suzanne; Ariza, Adolfo J.; Furberg, Robert D.; Whetstone, Lauren; Hobbs, Connie; de Jesus, Janet; Bender, Randall H.; Salinas, Ilse G.; Binns, Helen J.

2014-01-01

Background Cardiovascular disease (CVD) and the underlying atherosclerosis begin in childhood, and their presence and intensity are related to known cardiovascular disease risk factors. Attention to risk factor control in childhood has the potential to reduce subsequent risk of CVD. Objective The Young Hearts Strong Starts Study was designed to test strategies facilitating adoption of the National, Heart, Lung and Blood Institute supported Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. This study compares guideline-based quality measures for body mass index, blood pressure, and tobacco using two strategies: a multifaceted, practice-directed intervention versus standard dissemination. Study Design Two primary care research networks recruited practices and provided support for the intervention and outcome evaluations. Individual practices were randomly assigned to the intervention or control groups using a cluster randomized design based on network affiliation, number of clinicians per practice, urban versus nonurban location, and practice type. The units of observation are individual children because measure adherence is abstracted from individual patient’s medical records. The units of randomization are physician practices. This results in a multilevel design in which patients are nested within practices. The intervention practices received toolkits and supported guideline implementation including academic detailing, an ongoing e-learning group. This project is aligned with the American Board of Pediatrics Maintenance of Certification requirements including monthly physician self-abstraction, webinars, and other elements of the trial. Significance This trial will provide an opportunity to demonstrate tools and strategies to enhance CV prevention in children by guideline-based interventions. PMID:24295879

Understanding Implementation of Complex Interventions in Primary Care Teams.

PubMed

Luig, Thea; Asselin, Jodie; Sharma, Arya M; Campbell-Scherer, Denise L

2018-01-01

The implementation of interventions to support practice change in primary care settings is complex. Pragmatic strategies, grounded in empiric data, are needed to navigate real-world challenges and unanticipated interactions with context that can impact implementation and outcomes. This article uses the example of the "5As Team" randomized control trial to explore implementation strategies to promote knowledge transfer, capacity building, and practice integration, and their interaction within the context of an interdisciplinary primary care team. We performed a qualitative evaluation of the implementation process of the 5As Team intervention study, a randomized control trial of a complex intervention in primary care. We conducted thematic analysis of field notes of intervention sessions, log books of the practice facilitation team members, and semistructured interviews with 29 interdisciplinary clinician participants. We used and further developed the Interactive Systems Framework for dissemination and implementation to interpret and structure findings. Three themes emerged that illuminate interactions between implementation processes, context, and outcomes: (1) facilitating team communication supported collective and individual sense-making and adoption of the innovation, (2) iterative evaluation of the implementation process and real-time feedback-driven adaptions of the intervention proved crucial for sustainable, context-appropriate intervention impact, (3) stakeholder engagement led to both knowledge exchange that contributes to local problem solving and to shaping a clinical context that is supportive to practice change. Our findings contribute pragmatic strategies that can help practitioners and researchers to navigate interactions between context, intervention, and implementation factors to increase implementation success. We further developed an implementation framework that includes sustained engagement with stakeholders, facilitation of team sense-making, and dynamic evaluation and intervention design as integral parts of complex intervention implementation. NCT01967797. 18 October 2013. © Copyright 2018 by the American Board of Family Medicine.

Maximizing reuse: Applying common sense and discipline

NASA Technical Reports Server (NTRS)

Waligora, Sharon; Langston, James

1992-01-01

Computer Sciences Corporation (CSC)/System Sciences Division (SSD) has maintained a long-term relationship with NASA/Goddard, providing satellite mission ground-support software and services for 23 years. As a partner in the Software Engineering Laboratory (SEL) since 1976, CSC has worked closely with NASA/Goddard to improve the software engineering process. This paper examines the evolution of reuse programs in this uniquely stable environment and formulates certain recommendations for developing reuse programs as a business strategy and as an integral part of production. It focuses on the management strategy and philosophy that have helped make reuse successful in this environment.

Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services.

PubMed

2012-11-09

This report summarizes current (as of 2011) guidelines or recommendations published by multiple agencies of the U.S. Department of Health and Human Services (DHHS) for prevention and control of human immunodeficiency virus (HIV) infection, viral hepatitis, sexually transmitted diseases (STDs), and tuberculosis (TB) for persons who use drugs illicitly. It also summarizes existing evidence of effectiveness for practices to support delivery of integrated prevention services. Implementing integrated services for prevention of HIV infection, viral hepatitis, STDs, and TB is intended to provide persons who use drugs illicitly with increased access to services, to improve timeliness of service delivery, and to increase effectiveness of efforts to prevent infectious diseases that share common risk factors, behaviors, and social determinants. This guidance is intended for use by decision makers (e.g., local and federal agencies and leaders and managers of prevention and treatment services), health-care providers, social service providers, and prevention and treatment support groups. Consolidated guidance can strengthen efforts of health-care providers and public health providers to prevent and treat infectious diseases and substance use and mental disorders, use resources efficiently, and improve health-care services and outcomes in persons who use drugs illicitly. An integrated approach to service delivery for persons who use drugs incorporates recommended science-based public health strategies, including 1) prevention and treatment of substance use and mental disorders; 2) outreach programs; 3) risk assessment for illicit use of drugs; 4) risk assessment for infectious diseases; 5) screening, diagnosis, and counseling for infectious diseases; 6) vaccination; 7) prevention of mother-to-child transmission of infectious diseases; 8) interventions for reduction of risk behaviors; 9) partner services and contact follow-up; 10) referrals and linkage to care; 11) medical treatment for infectious diseases; and 12) delivery of integrated prevention services. These strategies are science-based, public health strategies to prevent and treat infectious diseases, substance use disorders, and mental disorders. Treatment of infectious diseases and treatment of substance use and mental disorders contribute to prevention of transmission of infectious diseases. Integrating prevention services can increase access to and timeliness of prevention and treatment.

The Use of the Integrated Medical Model for Forecasting and Mitigating Medical Risks for a Near-Earth Asteroid Mission

NASA Technical Reports Server (NTRS)

Kerstman, Eric; Saile, Lynn; Freire de Carvalho, Mary; Myers, Jerry; Walton, Marlei; Butler, Douglas; Lopez, Vilma

2011-01-01

Introduction The Integrated Medical Model (IMM) is a decision support tool that is useful to space flight mission managers and medical system designers in assessing risks and optimizing medical systems. The IMM employs an evidence-based, probabilistic risk assessment (PRA) approach within the operational constraints of space flight. Methods Stochastic computational methods are used to forecast probability distributions of medical events, crew health metrics, medical resource utilization, and probability estimates of medical evacuation and loss of crew life. The IMM can also optimize medical kits within the constraints of mass and volume for specified missions. The IMM was used to forecast medical evacuation and loss of crew life probabilities, as well as crew health metrics for a near-earth asteroid (NEA) mission. An optimized medical kit for this mission was proposed based on the IMM simulation. Discussion The IMM can provide information to the space program regarding medical risks, including crew medical impairment, medical evacuation and loss of crew life. This information is valuable to mission managers and the space medicine community in assessing risk and developing mitigation strategies. Exploration missions such as NEA missions will have significant mass and volume constraints applied to the medical system. Appropriate allocation of medical resources will be critical to mission success. The IMM capability of optimizing medical systems based on specific crew and mission profiles will be advantageous to medical system designers. Conclusion The IMM is a decision support tool that can provide estimates of the impact of medical events on human space flight missions, such as crew impairment, evacuation, and loss of crew life. It can be used to support the development of mitigation strategies and to propose optimized medical systems for specified space flight missions. Learning Objectives The audience will learn how an evidence-based decision support tool can be used to help assess risk, develop mitigation strategies, and optimize medical systems for exploration space flight missions.

EUV mask defect inspection and defect review strategies for EUV pilot line and high volume manufacturing

NASA Astrophysics Data System (ADS)

Chan, Y. David; Rastegar, Abbas; Yun, Henry; Putna, E. Steve; Wurm, Stefan

2010-04-01

Reducing mask blank and patterned mask defects is the number one challenge for extreme ultraviolet lithography. If the industry succeeds in reducing mask blank defects at the required rate of 10X every year for the next 2-3 years to meet high volume manufacturing defect requirements, new inspection and review tool capabilities will soon be needed to support this goal. This paper outlines the defect inspection and review tool technical requirements and suggests development plans to achieve pilot line readiness in 2011/12 and high volume manufacturing readiness in 2013. The technical specifications, tooling scenarios, and development plans were produced by a SEMATECH-led technical working group with broad industry participation from material suppliers, tool suppliers, mask houses, integrated device manufacturers, and consortia. The paper summarizes this technical working group's assessment of existing blank and mask inspection/review infrastructure capabilities to support pilot line introduction and outlines infrastructure development requirements and tooling strategies to support high volume manufacturing.

Effective e-learning for health professional and medical students: the experience with SIAS-Intelligent Tutoring System.

PubMed

Muñoz, Diana C; Ortiz, Alexandra; González, Carolina; López, Diego M; Blobel, Bernd

2010-01-01

Current e-learning systems are still inadequate to support the level of interaction, personalization and engagement demanded by clinicians, care givers, and the patient themselves. For effective e-learning to be delivered in the health context, collaboration between pedagogy and technology is required. Furthermore, e-learning systems should be flexible enough to be adapted to the students' needs, evaluated regularly, easy to use and maintain and provide students' feedback, guidelines and supporting material in different formats. This paper presents the implementation of an Intelligent Tutoring System (SIAS-ITS), and its evaluation compared to a traditional virtual learning platform (Moodle). The evaluation was carried out as a case study, in which the participants were separated in two groups, each group attending a virtual course on the WHO Integrated Management of Childhood Illness (IMCI) strategy supported by one of the two e-learning platforms. The evaluation demonstrated that the participants' knowledge level, pedagogical strategies used, learning efficiency and systems' usability were improved using the Intelligent Tutoring System.

The consequences of nursing stress and need for integrated solutions.

PubMed

Roberts, Rashaun K; Grubb, Paula L

2014-01-01

In a 2011 survey sponsored by the American Nurses Association (ANA), nurses identified the acute and chronic effects of stress and overwork as one of their two top safety and health concerns. A review of the literature was conducted to investigate the impact that job stress has on the health and safety of nursing professionals and the role that working conditions and job characteristics play in fostering job stress. Strong evidence supporting links between job stress, safety and health in general and within different types of nursing populations exists. Working conditions also contribute to the development of job stress. Combining and integrating "person-focused" strategies designed to build nurses' ability to manage stress at the individual level with "organization-focused" strategies that eliminate stressful working conditions is critical to the reduction and prevention of job stress among nursing professionals. © 2013 Association of Rehabilitation Nurses.

Sox17 drives functional engraftment of endothelium converted from non-vascular cells.

PubMed

Schachterle, William; Badwe, Chaitanya R; Palikuqi, Brisa; Kunar, Balvir; Ginsberg, Michael; Lis, Raphael; Yokoyama, Masataka; Elemento, Olivier; Scandura, Joseph M; Rafii, Shahin

2017-01-16

Transplanting vascular endothelial cells (ECs) to support metabolism and express regenerative paracrine factors is a strategy to treat vasculopathies and to promote tissue regeneration. However, transplantation strategies have been challenging to develop, because ECs are difficult to culture and little is known about how to direct them to stably integrate into vasculature. Here we show that only amniotic cells could convert to cells that maintain EC gene expression. Even so, these converted cells perform sub-optimally in transplantation studies. Constitutive Akt signalling increases expression of EC morphogenesis genes, including Sox17, shifts the genomic targeting of Fli1 to favour nearby Sox consensus sites and enhances the vascular function of converted cells. Enforced expression of Sox17 increases expression of morphogenesis genes and promotes integration of transplanted converted cells into injured vessels. Thus, Ets transcription factors specify non-vascular, amniotic cells to EC-like cells, whereas Sox17 expression is required to confer EC function.

Integrated Evaluation of Reliability and Power Consumption of Wireless Sensor Networks.

PubMed

Dâmaso, Antônio; Rosa, Nelson; Maciel, Paulo

2017-11-05

Power consumption is a primary interest in Wireless Sensor Networks (WSNs), and a large number of strategies have been proposed to evaluate it. However, those approaches usually neither consider reliability issues nor the power consumption of applications executing in the network. A central concern is the lack of consolidated solutions that enable us to evaluate the power consumption of applications and the network stack also considering their reliabilities. To solve this problem, we introduce a fully automatic solution to design power consumption aware WSN applications and communication protocols. The solution presented in this paper comprises a methodology to evaluate the power consumption based on the integration of formal models, a set of power consumption and reliability models, a sensitivity analysis strategy to select WSN configurations and a toolbox named EDEN to fully support the proposed methodology. This solution allows accurately estimating the power consumption of WSN applications and the network stack in an automated way.

National Oceanic and Atmospheric Administration's Cetacean and Sound Mapping Effort: Continuing Forward with an Integrated Ocean Noise Strategy.

PubMed

Harrison, Jolie; Ferguson, Megan; Gedamke, Jason; Hatch, Leila; Southall, Brandon; Van Parijs, Sofie

2016-01-01

To help manage chronic and cumulative impacts of human activities on marine mammals, the National Oceanic and Atmospheric Administration (NOAA) convened two working groups, the Underwater Sound Field Mapping Working Group (SoundMap) and the Cetacean Density and Distribution Mapping Working Group (CetMap), with overarching effort of both groups referred to as CetSound, which (1) mapped the predicted contribution of human sound sources to ocean noise and (2) provided region/time/species-specific cetacean density and distribution maps. Mapping products were presented at a symposium where future priorities were identified, including institutionalization/integration of the CetSound effort within NOAA-wide goals and programs, creation of forums and mechanisms for external input and funding, and expanded outreach/education. NOAA is subsequently developing an ocean noise strategy to articulate noise conservation goals and further identify science and management actions needed to support them.

The Consequences of Nursing Stress and Need for Integrated Solutions

PubMed Central

Roberts, Rashaun K.; Grubb, Paula L.

2015-01-01

Purpose In a 2011 survey sponsored by the American Nurses Association (ANA), nurses identified the acute and chronic effects of stress and overwork as one of their two top safety and health concerns. Design/Methods A review of the literature was conducted to investigate the impact that job stress has on the health and safety of nursing professionals and the role that working conditions and job characteristics play in fostering job stress. Findings Strong evidence supporting links between job stress, safety and health in general and within different types of nursing populations exists. Working conditions also contribute to the development of job stress. Conclusion Combining and integrating “person-focused” strategies designed to build nurses’ ability to manage stress at the individual level with “organization-focused” strategies that eliminate stressful working conditions is critical to the reduction and prevention of job stress among nursing professionals. PMID:23696492

The struggle for dignity by people with severe functional disabilities.

PubMed

Wadensten, Barbro; Ahlström, Gerd

2009-07-01

The purpose of this study was to investigate what strategies people with severe functional disabilities who receive personal assistance in their homes use in their daily life to achieve autonomy, integrity, influence and participation. Qualitative interviews were carried out and subjected to qualitative latent content analysis. The main finding was expressed in terms of six subthemes: trying to keep a private sphere; striving to communicate; searching for possibilities; taking the initiative; striving to gain insight; and using one's temperament. These generated the overall theme: maintaining dignity in close relationships. This study contributes an understanding of the strategies used by people who are dependent on personal assistance. Future efforts in nursing must focus on supporting personal assistants with ethical knowledge and guidance in order that people with severe functional disabilities are empowered to achieve autonomy, integrity, influence and participation in their daily lives.

Hurricanes Katrina and Rita: role of individuals and collaborative networks in mobilizing/coordinating societal and professional resources for major disasters

PubMed Central

Mattox, Kenneth L

2006-01-01

The medical support for the coordinated effort for Harris County Texas (Houston) to rescue evacuees from New Orleans following Hurricane Katrina was part of an integrated collaborative network. Both public health and operational health care was structured to custom meet the needs of the evacuees and to create an exit strategy for the clinic and shelter. Integrating local hospital and physician resources into the Joint Incident Command was essential. Outside assistance, including federal and national resources must be coordinated through the local incident command. PMID:16420647

Airport Simulations Using Distributed Computational Resources

NASA Technical Reports Server (NTRS)

McDermott, William J.; Maluf, David A.; Gawdiak, Yuri; Tran, Peter; Clancy, Daniel (Technical Monitor)

2002-01-01

The Virtual National Airspace Simulation (VNAS) will improve the safety of Air Transportation. In 2001, using simulation and information management software running over a distributed network of super-computers, researchers at NASA Ames, Glenn, and Langley Research Centers developed a working prototype of a virtual airspace. This VNAS prototype modeled daily operations of the Atlanta airport by integrating measured operational data and simulation data on up to 2,000 flights a day. The concepts and architecture developed by NASA for this prototype are integral to the National Airspace Simulation to support the development of strategies improving aviation safety, identifying precursors to component failure.

Integrating complexity into data-driven multi-hazard supply chain network strategies

USGS Publications Warehouse

Long, Suzanna K.; Shoberg, Thomas G.; Ramachandran, Varun; Corns, Steven M.; Carlo, Hector J.

2013-01-01

Major strategies in the wake of a large-scale disaster have focused on short-term emergency response solutions. Few consider medium-to-long-term restoration strategies that reconnect urban areas to the national supply chain networks (SCN) and their supporting infrastructure. To re-establish this connectivity, the relationships within the SCN must be defined and formulated as a model of a complex adaptive system (CAS). A CAS model is a representation of a system that consists of large numbers of inter-connections, demonstrates non-linear behaviors and emergent properties, and responds to stimulus from its environment. CAS modeling is an effective method of managing complexities associated with SCN restoration after large-scale disasters. In order to populate the data space large data sets are required. Currently access to these data is hampered by proprietary restrictions. The aim of this paper is to identify the data required to build a SCN restoration model, look at the inherent problems associated with these data, and understand the complexity that arises due to integration of these data.

Effects of performance feedback and coaching on the problem-solving process: Improving the integrity of implementation and enhancing student outcomes

NASA Astrophysics Data System (ADS)

Lundahl, Allison A.

Schools implementing Response to Intervention (RtI) procedures frequently engage in team problem-solving processes to address the needs of students who require intensive and individualized services. Because the effectiveness of the problem-solving process will impact the overall success of RtI systems, the present study was designed to learn more about how to strengthen the integrity of the problem-solving process. Research suggests that school districts must ensure high quality training and ongoing support to enhance the effectiveness, acceptability, and sustainability of the problem-solving process within an RtI model; however, there is a dearth of research examining the effectiveness of methods to provide this training and support. Consequently, this study investigated the effects of performance feedback and coaching strategies on the integrity with which teams of educators conducted the problem-solving process in schools. In addition, the relationships between problem-solving integrity, teacher acceptability, and student outcomes were examined. Results suggested that the performance feedback increased problem-solving procedural integrity across two of the three participating schools. Conclusions about the effectiveness of the (a) coaching intervention and (b) interventions implemented in the third school were inconclusive. Regression analyses indicated that the integrity with which the teams conducted the problem-solving process was a significant predictor of student outcomes. However, the relationship between problem-solving procedural integrity and teacher acceptability was not statistically significant.

Preparing for the future: a review of tools and strategies to support autonomous goal setting for children and youth with autism spectrum disorders.

PubMed

Hodgetts, Sandra; Park, Elly

2017-03-01

Despite recognized benefits, current clinical practice rarely includes direct input from children and youth with autism spectrum disorder (ASD) in setting rehabilitation goals. This study reviews tools and evidence-based strategies to assist with autonomous goal settings for children and youth with ASD. This study included two components: (1) A scoping review of existing tools and strategies to assist with autonomous goal setting in individuals with ASD and (2) a chart review of inter-disciplinary service plan goals for children and youth with ASD. Eleven data sources, evaluating five different tools to assist with autonomous goal setting for children and youth with ASD, were found. Three themes emerged from the integration of the scoping review and chart review, which are discussed in the paper: (1) generalizability of findings, (2) adaptations to support participation and (3) practice implications. Children and youth with ASD can participate in setting rehabilitation goals, but few tools to support their participation have been evaluated, and those tools that do exist do not align well with current services foci. Visual aids appear to be one effective support, but further research on effective strategies for meaningful engagement in autonomous goal setting for children and youth with ASD is warranted. Implications for rehabilitation Persons with ASD are less self-determined than their peers. Input into one's own rehabilitation goals and priorities is an important component of self-determination. Few tools exist to help engage children and youth with ASD in setting their own rehabilitation goals. An increased focus on identifying, developing and evaluating effective tools and strategies to facilitate engagement of children and youth with ASD in setting their own rehabilitation goals is warranted.

Noninvasive dentistry: a dream or reality?

PubMed

Clarkson, B H; Exterkate, R A M

2015-01-01

Various caries prevention and repair strategies are reviewed in this article ranging from the use of fluoride to nanohydroxyapatite particles. Several of the strategies which combine fluoride and calcium and phosphate treatments have both in vitro and in vivo data showing them to be efficacious if the surface integrity of the lesion is not breached. Once this has occurred, the rationale for cutting off the nutrient supplies to the pathogenic bacteria without the removal of the infected dentine, a noninvasive restorative technique, is discussed using existing clinical studies as examples. Finally two novel noninvasive restorative techniques using fluorohydroxyapatite crystals are described. The need for clinical data in support of emerging caries-preventive and restorative strategies is emphasized. 2015 S. Karger AG, Basel

The Relative Effectiveness of Integrated Reading Study Strategy and Conceptual Physics Approach

ERIC Educational Resources Information Center

Taslidere, Erdal; Eryilmaz, Ali

2012-01-01

The primary purpose of this study was to investigate the combined and partial effects of the Integrated Reading/Study Strategy and Conceptual Physics Approach on ninth grade private high school students' achievement in and attitudes toward optics. The Integrated Reading/Study Strategy is a new strategy which was developed by integrating previously…

Systems medicine and integrated care to combat chronic noncommunicable diseases

PubMed Central

2011-01-01

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems. PMID:21745417

Modelling the urban water cycle as an integrated part of the city: a review.

PubMed

Urich, Christian; Rauch, Wolfgang

2014-01-01

In contrast to common perceptions, the urban water infrastructure system is a complex and dynamic system that is constantly evolving and adapting to changes in the urban environment, to sustain existing services and provide additional ones. Instead of simplifying urban water infrastructure to a static system that is decoupled from its urban context, new management strategies use the complexity of the system to their advantage by integrating centralised with decentralised solutions and explicitly embedding water systems into their urban form. However, to understand and test possible adaptation strategies, urban water modelling tools are required to support exploration of their effectiveness as the human-technology-environment system coevolves under different future scenarios. The urban water modelling community has taken first steps to developing these new modelling tools. This paper critically reviews the historical development of urban water modelling tools and provides a summary of the current state of integrated modelling approaches. It reflects on the challenges that arise through the current practice of coupling urban water management tools with urban development models and discusses a potential pathway towards a new generation of modelling tools.

Integrating on campus problem based learning and practice based learning: issues and challenges in using computer mediated communication.

PubMed

Conway, J; Sharkey, R

2002-10-01

The Faculty of Nursing, University of Newcastle, Australia, has been keen to initiate strategies that enhance student learning and nursing practice. Two strategies are problem based learning (PBL) and clinical practice. The Faculty has maintained a comparatively high proportion of the undergraduate hours in the clinical setting in times when financial constraints suggest that simulations and on campus laboratory experiences may be less expensive.Increasingly, computer based technologies are becoming sufficiently refined to support the exploration of nursing practice in a non-traditional lecture/tutorial environment. In 1998, a group of faculty members proposed that computer mediated instruction would provide an opportunity for partnership between students, academics and clinicians that would promote more positive outcomes for all and maintain the integrity of the PBL approach. This paper discusses the similarities between problem based and practice based learning and presents the findings of an evaluative study of the implementation of a practice based learning model that uses computer mediated communication to promote integration of practice experiences with the broader goals of the undergraduate curriculum.

Hospital nursing leadership-led interventions increased genomic awareness and educational intent in Magnet settings.

PubMed

Calzone, Kathleen A; Jenkins, Jean; Culp, Stacey; Badzek, Laurie

2017-11-13

The Precision Medicine Initiative will accelerate genomic discoveries that improve health care, necessitating a genomic competent workforce. This study assessed leadership team (administrator/educator) year-long interventions to improve registered nurses' (RNs) capacity to integrate genomics into practice. We examined genomic competency outcomes in 8,150 RNs. Awareness and intention to learn more increased compared with controls. Findings suggest achieving genomic competency requires a longer intervention and support strategies such as infrastructure and policies. Leadership played a role in mobilizing staff, resources, and supporting infrastructure to sustain a large-scale competency effort on an institutional basis. Results demonstrate genomic workforce competency can be attained with leadership support and sufficient time. Our study provides evidence of the critical role health-care leaders play in facilitating genomic integration into health care to improve patient outcomes. Genomics' impact on quality, safety, and cost indicate a leader-initiated national competency effort is achievable and warranted. Published by Elsevier Inc.

How older adults and their informal carers prevent falls: An integrative review of the literature.

PubMed

Wilkinson, Amanda; Meikle, Nicole; Law, Phoebe; Yong, Hui Jia; Butler, Philip; Kim, Justin; Mulligan, Hilda; Hale, Leigh

2018-06-01

Falls in older persons are prevalent and costly for the individual and the health system. Falls prevention guidelines have been developed from best evidence to minimise falls in older persons. To synthesise the literature on falls prevention strategies used by community dwelling older persons and/or their informal carers and to compare the commonly adopted strategies with those recommended by falls prevention guidelines. Health sciences databases for full text articles published in English plus reference list searching of included articles. An integrative review approach. Studies were included if they identified fall prevention management strategies used by community dwelling older adults and/or their informal carers. Quality appraisal was undertaken using appropriate Joanna Briggs Institute critical appraisal tools. Information relevant to the aim of the review were extracted and coded into categories then inductively sorted into sub-themes and themes. Of the seventeen studies included in the review, eleven identified older adults' falls prevention strategies, two investigated fall prevention strategies used by carers, and four explored perspectives of older persons together with their carers, representing the perspectives of an estimated 501 older persons and 102 carers. Strategies used by older adults arose because of self-awareness about their changing physical ability, and advice and support mainly from family or friends. Carer fall prevention strategy was predominantly around protection of the older adult from falling by discouraging independence. The fall self-management strategies adopted by older adults and their carers to prevent falls, in the main, do not align with international best practice fall prevention guidelines. Copyright © 2018. Published by Elsevier Ltd.

Accessing and Integrating Data and Knowledge for Biomedical Research

PubMed Central

Burgun, A.; Bodenreider, O.

2008-01-01

Summary Objectives To review the issues that have arisen with the advent of translational research in terms of integration of data and knowledge, and survey current efforts to address these issues. Methods Using examples form the biomedical literature, we identified new trends in biomedical research and their impact on bioinformatics. We analyzed the requirements for effective knowledge repositories and studied issues in the integration of biomedical knowledge. Results New diagnostic and therapeutic approaches based on gene expression patterns have brought about new issues in the statistical analysis of data, and new workflows are needed are needed to support translational research. Interoperable data repositories based on standard annotations, infrastructures and services are needed to support the pooling and meta-analysis of data, as well as their comparison to earlier experiments. High-quality, integrated ontologies and knowledge bases serve as a source of prior knowledge used in combination with traditional data mining techniques and contribute to the development of more effective data analysis strategies. Conclusion As biomedical research evolves from traditional clinical and biological investigations towards omics sciences and translational research, specific needs have emerged, including integrating data collected in research studies with patient clinical data, linking omics knowledge with medical knowledge, modeling the molecular basis of diseases, and developing tools that support in-depth analysis of research data. As such, translational research illustrates the need to bridge the gap between bioinformatics and medical informatics, and opens new avenues for biomedical informatics research. PMID:18660883

Advantages of integrated and sustainability based assessment for metabolism based strategic planning of urban water systems.

PubMed

Behzadian, Kourosh; Kapelan, Zoran

2015-09-15

Despite providing water-related services as the primary purpose of urban water system (UWS), all relevant activities require capital investments and operational expenditures, consume resources (e.g. materials and chemicals), and may increase negative environmental impacts (e.g. contaminant discharge, emissions to water and air). Performance assessment of such a metabolic system may require developing a holistic approach which encompasses various system elements and criteria. This paper analyses the impact of integration of UWS components on the metabolism based performance assessment for future planning using a number of intervention strategies. It also explores the importance of sustainability based criteria in the assessment of long-term planning. Two assessment approaches analysed here are: (1) planning for only water supply system (WSS) as a part of the UWS and (2) planning for an integrated UWS including potable water, stormwater, wastewater and water recycling. WaterMet(2) model is used to simulate metabolic type processes in the UWS and calculate quantitative performance indicators. The analysis is demonstrated on the problem of strategic level planning of a real-world UWS to where optional intervention strategies are applied. The resulting performance is assessed using the multiple criteria of both conventional and sustainability type; and optional intervention strategies are then ranked using the Compromise Programming method. The results obtained show that the high ranked intervention strategies in the integrated UWS are those supporting both water supply and stormwater/wastewater subsystems (e.g. rainwater harvesting and greywater recycling schemes) whilst these strategies are ranked low in the WSS and those targeting improvement of water supply components only (e.g. rehabilitation of clean water pipes and addition of new water resources) are preferred instead. Results also demonstrate that both conventional and sustainability type performance indicators are necessary for strategic planning in the UWS. Copyright © 2015 Elsevier B.V. All rights reserved.

Motivational techniques to improve self-care in hemophilia: the need to support autonomy in children.

PubMed

Bérubé, Sarah; Mouillard, Florine; Amesse, Claudine; Sultan, Serge

2016-01-11

In pediatric hemophilia, caregivers are facing unique challenges to adherence and self-care in children and adolescents with hemophilia. Hemophilia treatment requires adequate prophylaxis and on-demand treatment, as well as a clear behavioral strategy to limit risk-taking in terms of physical exercise and diet. Medication adherence rates of hemophilia patients have been reported to decrease during late childhood and adolescence. In the developing child, moving safely from parent-care to self-care is one of the greatest challenges of integrative care within this domain. There is a clear need for initiatives designed to increase an individual's motivation for treatment and self-care activities. Among motivational approaches, the self-determination perspective offers a useful framework to explain how the transition to self-care can be facilitated. We discuss how motivation regarding hemophilia treatment may be increased through parental autonomy support and we offer examples of applied communication techniques to facilitate autonomy-supportive caregiving. Although it has not yet been tested in the context of hemophilia, these communication techniques could potentially help caregivers promote adherence and self-care in children. Confronted by unique challenges to adherence and self-care, caregivers of children with hemophilia should move from an exclusive focus on illness-management education to an integrative strategy, including motivation-enhancing communication. The self-determination perspective provides important proximal objectives (e.g. autonomy support) to maintain optimal adherence in adolescents as they move from parent-care to self-care. Future research initiatives should address the practice of these communication techniques and evaluate them in the context of hemophilia.

One University Making a Difference in Graduate Education: Caring in the Online Learning Environment.

PubMed

Brown, Cynthia J; Wilson, Carol B

2016-12-01

As online education gains momentum, strategies to promote student engagement, develop social presence, and create a virtual community are essential for students' successful learning. A university with a philosophy grounded in caring developed two strategies for the graduate online education setting. These two strategies intentionally promote caring for self and others as a means to foster engagement, social presence, and a vibrant online community. One strategy was online Caring Groups, that is, small groups of four to five nursing students created each semester in one of the students' required courses in the online setting. The second strategy was the creation of two Caring Connections online sites, one for master of science in nursing students and one for doctorate in education nursing students. The sites were developed external to required courses to provide support for the online students throughout the graduate programs. Each site provides an ongoing space for students and faculty to post and discuss inspirational quotes, self-care tips, music, and photographs. The online Caring Groups and Caring Connections sites will be described, including how they were created, how they are used by students, how faculty support students, lessons learned, and how Caring Groups are integrated into the curriculum. © The Author(s) 2016.

Exploring the value and role of integrated supportive science courses in the reformed medical curriculum iMED: a mixed methods study.

PubMed

Eisenbarth, Sophie; Tilling, Thomas; Lueerss, Eva; Meyer, Jelka; Sehner, Susanne; Guse, Andreas H; Guse Nee Kurré, Jennifer

2016-04-29

Heterogeneous basic science knowledge of medical students is an important challenge for medical education. In this study, the authors aimed at exploring the value and role of integrated supportive science (ISS) courses as a novel approach to address this challenge and to promote learning basic science concepts in medical education. ISS courses were embedded in a reformed medical curriculum. The authors used a mixed methods approach including four focus groups involving ISS course lecturers and students (two each), and five surveys of one student cohort covering the results of regular student evaluations including the ISS courses across one study year. They conducted their study at the University Medical Center Hamburg-Eppendorf between December 2013 and July 2014. Fourteen first-year medical students and thirteen ISS course lecturers participated in the focus groups. The authors identified several themes focused on the temporal integration of ISS courses into the medical curriculum, the integration of ISS course contents into core curriculum contents, the value and role of ISS courses, and the courses' setting and atmosphere. The integrated course concept was positively accepted by both groups, with participants suggesting that it promotes retention of basic science knowledge. Values and roles identified by focus group participants included promotion of basic understanding of science concepts, integration of foundational and applied learning, and maximization of students' engagement and motivation. Building close links between ISS course contents and the core curriculum appeared to be crucial. Survey results confirmed qualitative findings regarding students' satisfaction, with some courses still requiring optimization. Integration of supportive basic science courses, traditionally rather part of premedical education, into the medical curriculum appears to be a feasible strategy to improve medical students' understanding of basic science concepts and to increase their motivation and engagement.

Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review.

PubMed

Savic, Michael; Best, David; Manning, Victoria; Lubman, Dan I

2017-04-07

There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care. We synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised. We identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians' primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening in areas beyond a clinician's primary area of practice was a common strategy for facilitating referral and integrated care, as was joint care planning. Despite considerable limitations and gaps in the literature in terms of the evaluation of integrated care strategies, particularly between AOD services, our review highlights several strategies that could be useful at multiple levels. Given the interconnectedness of integrated care strategies identified, implementation of multi-level strategies rather than single strategies is likely to be preferable.

Integrating Cloud-Based Strategies and Tools in Face-to-Face Training Sessions to Increase the Impact of Professional Development

ERIC Educational Resources Information Center

Gradel, Kathleen; Edson, Alden J.

2012-01-01

This article is based on the premise that face-to-face training can be augmented with cloud-based technology tools, to potentially extend viable training supports as higher education staff and faculty implement new content/skills in their jobs and classrooms. There are significant benefits to harnessing cloud-based tools that can facilitate both…

Quality assurance for kilo- and megavoltage in-room imaging and localization for off- and online setup error correction.

PubMed

Balter, James M; Antonuk, Larry E

2008-01-01

In-room radiography is not a new concept for image-guided radiation therapy. Rapid advances in technology, however, have made this positioning method convenient, and thus radiograph-based positioning has propagated widely. The paradigms for quality assurance of radiograph-based positioning include imager performance, systems integration, infrastructure, procedure documentation and testing, and support for positioning strategy implementation.

Working Sandwich Generation Women Utilize Strategies within and between Roles to Achieve Role Balance

PubMed Central

Girdler, Sonya J.

2016-01-01

Increasingly, women simultaneously balance the roles of mother, parental carer and worker. However, individual role balance strategies among these working ‘sandwich’ generation women have not been thoroughly explored. Eighteen women combining these three roles were interviewed about their individual role balance strategies. Findings were identified through the framework analysis technique, underpinned by the Model of Juggling Occupations. Achieving and maintaining role balance was explained as a complex process accomplished through a range of strategies. Findings revealed the women used six within-role balance strategies: living with integrity, being the best you can, doing what you love, loving what you do, remembering why and searching for signs of success. The women also described six between-role balance strategies: maintaining health and wellbeing, repressing perfectionism, managing time and energy, releasing responsibility, nurturing social connection and reciprocating. These findings provide a basis for health care providers to understand and potentially support working ‘sandwich’ generation women. PMID:27305074

Selecting essential information for biosurveillance--a multi-criteria decision analysis.

PubMed

Generous, Nicholas; Margevicius, Kristen J; Taylor-McCabe, Kirsten J; Brown, Mac; Daniel, W Brent; Castro, Lauren; Hengartner, Andrea; Deshpande, Alina

2014-01-01

The National Strategy for Biosurveillance defines biosurveillance as "the process of gathering, integrating, interpreting, and communicating essential information related to all-hazards threats or disease activity affecting human, animal, or plant health to achieve early detection and warning, contribute to overall situational awareness of the health aspects of an incident, and to enable better decision-making at all levels." However, the strategy does not specify how "essential information" is to be identified and integrated into the current biosurveillance enterprise, or what the metrics qualify information as being "essential". The question of data stream identification and selection requires a structured methodology that can systematically evaluate the tradeoffs between the many criteria that need to be taken in account. Multi-Attribute Utility Theory, a type of multi-criteria decision analysis, can provide a well-defined, structured approach that can offer solutions to this problem. While the use of Multi-Attribute Utility Theoryas a practical method to apply formal scientific decision theoretical approaches to complex, multi-criteria problems has been demonstrated in a variety of fields, this method has never been applied to decision support in biosurveillance.We have developed a formalized decision support analytic framework that can facilitate identification of "essential information" for use in biosurveillance systems or processes and we offer this framework to the global BSV community as a tool for optimizing the BSV enterprise. To demonstrate utility, we applied the framework to the problem of evaluating data streams for use in an integrated global infectious disease surveillance system.

Understanding palliative care on the heart failure care team: an innovative research methodology.

PubMed

Lingard, Lorelei A; McDougall, Allan; Schulz, Valerie; Shadd, Joshua; Marshall, Denise; Strachan, Patricia H; Tait, Glendon R; Arnold, J Malcolm; Kimel, Gil

2013-05-01

There is a growing call to integrate palliative care for patients with advanced heart failure (HF). However, the knowledge to inform integration efforts comes largely from interview and survey research with individual patients and providers. This work has been critically important in raising awareness of the need for integration, but it is insufficient to inform solutions that must be enacted not by isolated individuals but by complex care teams. Research methods are urgently required to support systematic exploration of the experiences of patients with HF, family caregivers, and health care providers as they interact as a care team. To design a research methodology that can support systematic exploration of the experiences of patients with HF, caregivers, and health care providers as they interact as a care team. This article describes in detail a methodology that we have piloted and are currently using in a multisite study of HF care teams. We describe three aspects of the methodology: the theoretical framework, an innovative sampling strategy, and an iterative system of data collection and analysis that incorporates four data sources and four analytical steps. We anticipate that this innovative methodology will support groundbreaking research in both HF care and other team settings in which palliative integration efforts are emerging for patients with advanced nonmalignant disease. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Extended device profiles and testing procedures for the approval process of integrated medical devices using the IEEE 11073 communication standard.

PubMed

Janß, Armin; Thorn, Johannes; Schmitz, Malte; Mildner, Alexander; Dell'Anna-Pudlik, Jasmin; Leucker, Martin; Radermacher, Klaus

2018-02-23

Nowadays, only closed and proprietary integrated operating room systems (IORS) from big manufacturers are available on the market. Hence, the interconnection of components from third-party vendors is only possible with increased time and costs. In the context of the German Federal Ministry of Education and Research (BMBF)-funded project OR.NET (2012-2016), the open integration of medical devices from different manufacturers was addressed. An integrated operating theater based on the open communication standard IEEE 11073 shall give clinical operators the opportunity to choose medical devices independently of the manufacturer. This approach would be advantageous especially for hospital operators and small- and medium-sized enterprises (SME) of medical devices. Actual standards and concepts regarding technical feasibility and the approval process do not cope with the requirements for a modular integration of medical devices in the operating room (OR), based on an open communication standard. Therefore, innovative approval strategies and corresponding certification and test procedures, which cover actual legal and normative standards, have to be developed in order to support the future risk management and the usability engineering process of open integrated medical devices in the OR. The use of standardized device and service profiles and a three-step testing procedure, including conformity, interoperability and integration tests are described in this paper and shall support the manufacturers to integrate their medical devices without disclosing the medical devices' risk analysis and related confidential expertise or proprietary information.

Strategies to increase research-based practice: interplay with unit culture.

PubMed

Pepler, Carolyn J; Edgar, Linda; Frisch, Sara; Rennick, Janet; Swidzinski, Marika; White, Carole; Brown, Thomas; Gross, Julie

2006-01-01

A major focus of clinical nurse specialist nursing practice is the integration of research findings into practice. The purpose of this study was to describe strategies used to facilitate research utilization (RU) by nurses in a practice setting. This multiple-case study identified the strategies that clinical nurse specialists and master's degree-prepared nurse educators, working collaboratively, used to facilitate RU. The setting included 8 units in 4 sites of a university hospital with all willing nurses participating. Open-ended focus groups and individual interviews and observational sessions were conducted using investigator-designed interview guides. Comprehensive qualitative analysis led to identification of categories and themes related to RU and the unit culture that supported it. Findings demonstrated that strategies to facilitate RU by staff at the unit level included conducting original research, supporting nurses participating in research, assessing and meeting staff learning needs, promoting staff attendance at conferences, stimulating goal-setting for presentations and publications, encouraging and responding to new ideas, questioning practice and stimulating inquiry, capitalizing on expertise in research knowledge and skills, and generating information and material resources. Characteristics of unit culture were linked to varying degrees of success with these strategies. The interplay of strategies with unit culture and research-based practice is described. A wide repertoire of strategies is needed to facilitate RU, and the outcome of these strategies is influenced by the unit culture. Consideration of the findings and the scope of the strategies used by nurses in the study can help clinical nurse specialist and other nursing leaders facilitate the building of practice on research.

Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention

PubMed Central

2011-01-01

Background Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial. Methods: Developing the intervention The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services. Results: Components of the intervention The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process. Discussion Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout. The STRETCH trial is registered with Current Control Trials ISRCTN46836853. PMID:21810242

Do personality traits of nurses have an effect on conflict management strategies?

PubMed

Erdenk, Nigar; Altuntaş, Serap

2017-07-01

This research was conducted in a descriptive, correlational and cross-sectional design to determine whether personality traits of nurses have an effect on conflict management strategies. It is known that integration, avoidance and compromise conflict management strategies are the most frequent strategies used among nurses and obligation and domination are the least frequent. However, the reasons behind their strategy choice are not known. It is predicted that one of the reasons is the personality characteristics of the nurses. The study was conducted with the participation of 237 nurses working in three different hospitals. Research data were collected by using the 'Personal Information Form', 'Rahim Organisational Conflict Inventory-II' and 'Five Factor Personality Inventory' between December 2013 and February 2014. Ethical approval and the organisations' approvals were obtained before data collection. The collected data were analysed using frequency and percentage distributions, descriptive statistics, Pearson product-moment correlation analysis, t-test, Cronbach's alpha coefficient and simple linear regression analysis tests. The majority of nurses had conflict especially with patients' relatives several times a month. It was found that the personality traits of nurses were mostly 'conscientiousness' and 'openness' and when they had a conflict, they tended to use 'integration' strategy. It was also found that the personality traits of nurses had an effect on some of the conflict management strategies adopted by them. It was found that the personality traits of nurses had an effect on some conflict management strategies adopted by them. Nurse managers should support nurses who adopt appropriate conflict management strategies and there should be conflict management programmes that can teach appropriate skills to other nurses. © 2017 John Wiley & Sons Ltd.

The Effects of an Integrated Reading Comprehension Strategy: A Culturally Responsive Teaching Approach for Fifth-Grade Students' Reading Comprehension

ERIC Educational Resources Information Center

Bui, Yvonne N.; Fagan, Yvette M.

2013-01-01

The study evaluated the effects of the Integrated Reading Comprehension Strategy on two levels. The Integrated Reading Comprehension Strategy integrated story grammar instruction and story maps, prior knowledge and prediction method, and word webs through a culturally responsive teaching framework; the Integrated Reading Comprehension Strategy…

Adherence-Specific Social Support Enhances Adherence to Calcium Supplementation Regimens among Pregnant Women.

PubMed

Martin, Stephanie L; Omotayo, Moshood O; Pelto, Gretel H; Chapleau, Gina M; Stoltzfus, Rebecca J; Dickin, Katherine L

2017-04-01

Background: WHO guidelines recommend integrating calcium supplementation into antenatal care (ANC) alongside iron and folic acid (IFA) to reduce maternal mortality. However, supplementation programs face multiple barriers, and strategies to improve adherence are needed. An adherence partner is someone whom pregnant women ask to support adherence at home. Objectives: This study 1 ) assessed adherence partner acceptability, feasibility, and associations with calcium and IFA supplement adherence and 2 ) examined relations between social support and adherence. Methods: This secondary analysis is from a trial integrating calcium supplementation into ANC in Kenya. ANC providers were trained on calcium and IFA supplementation and counseling, provided with behavior change materials, and given adequate supplement supplies. Pregnant women from 16 government health facilities were recruited ( n = 1036); sociodemographic and adherence data were collected at baseline and at 4- to 6-wk follow-up visits. Adherence was measured with pill counts and self-reports. Culturally adapted scales measured social support in general and specific to adherence. Mixed-effects regression analyses were used to examine factors associated with adherence partners, social support, and adherence. Results: Most participants received information about adherence partners (91%) and had a partner at follow-up (89%). Participants with adherence partners reported higher adherence support (OR: 2.10; 95% CI: 1.32, 3.34). Mean ± SD adherence was high for calcium (88.3% ± 20.7%) and IFA (86.1% ± 20.9%). Adherence support was positively associated with calcium adherence at follow-up by using pill counts (OR: 2.2; 95% CI: 1.1, 2.6) and self-report data (OR: 1.9; 95% CI: 1.2, 2.9), but there was not a direct relation between adherence partners and adherence. Conclusions: Adherence support enhanced adherence to calcium supplements. The adherence partner strategy was highly acceptable and feasible but warrants further study. This research demonstrates the importance of adherence support and suggests that interventions to increase household-level support for antenatal micronutrient supplementation may be needed to implement the WHO guidelines. This trial was registered at clinicaltrials.gov as NCT02238704. © 2017 American Society for Nutrition.

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review.

PubMed

Ngidi, Wilbroda H; Naidoo, Joanne R; Ncama, Busisiwe P; Luvuno, Zamasomi P B; Mashamba-Thompson, Tivani P

2017-05-29

Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included 'Sub-Saharan African countries', 'implementation strategies', 'interventions to bridge implementation gap', 'prevention of mother-to-child transmission of HIV' and 'closing implementation gap'. Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use - mHealth, family-centred approaches, male involvement, culturally appropriate interventions). There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency.

Bringing eCare platforms to the market.

PubMed

Vannieuwenborg, Frederic; Van der Auwermeulen, Thomas; Van Ooteghem, Jan; Jacobs, An; Verbugge, Sofie; Colle, Didier

2017-09-01

Due to changes in the demographic situation of most Western European countries, interest in Information and Communication Technologies (ICT)-supported care services is growing fast. eCare services that foster better care information exchange, social involvement, lifestyle monitoring services, etc., offered via ICT platforms, integrated in the homes of the elderly are believed to be cost-effective. Additionally, they could lead to an increased quality of life of both care receiver and (in)formal caregiver. Currently, adoption and integration of these eCare platforms (eCPs) is slowed down by several barriers such as unclear added value, a lack of regulations, or lack of sustainable financial models. In this work, the added value of eCPs is identified for the several involved key actors such as the care receiver, the (in)formal care providers, and the home care organizations. In a second step, several go-to-market strategies are formulated. Because the gap between the current way of providing home care and providing home care supported by a fully integrated eCP seems too big to bridge in one effort, a migration path is provided for stepwise integration and adoption of eCPs in the current way of home care provisioning.

Beyond "implementation strategies": classifying the full range of strategies used in implementation science and practice.

PubMed

Leeman, Jennifer; Birken, Sarah A; Powell, Byron J; Rohweder, Catherine; Shea, Christopher M

2017-11-03

Strategies are central to the National Institutes of Health's definition of implementation research as "the study of strategies to integrate evidence-based interventions into specific settings." Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term "implementation strategies." We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues' (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets). We build on Wandersman and colleagues' Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague's Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process). We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors), level and determinants targeted (action targets), and outcomes used to assess strategy effectiveness. We illustrate how each class would apply to efforts to improve colorectal cancer screening rates in Federally Qualified Health Centers. Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings. Organizing strategies into classes also will assist users in locating the strategies that best match their needs.

The medical home and integrated behavioral health: advancing the policy agenda.

PubMed

Ader, Jeremy; Stille, Christopher J; Keller, David; Miller, Benjamin F; Barr, Michael S; Perrin, James M

2015-05-01

There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patient-centered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration. Copyright © 2015 by the American Academy of Pediatrics.

Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation.

PubMed

Levac, Danielle E; Glegg, Stephanie M N; Sveistrup, Heidi; Colquhoun, Heather; Miller, Patricia; Finestone, Hillel; DePaul, Vincent; Harris, Jocelyn E; Velikonja, Diana

2016-01-01

Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision. The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.

Promoting Therapists’ Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation

PubMed Central

Levac, Danielle E.; Glegg, Stephanie M. N.; Sveistrup, Heidi; Colquhoun, Heather; Miller, Patricia; Finestone, Hillel; DePaul, Vincent; Harris, Jocelyn E.; Velikonja, Diana

2016-01-01

Purpose Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. Method A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists’ confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists’ perspectives on MLS use during VR-based therapy provision. Results The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists’ clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. Conclusion The KT intervention improved therapists’ confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy. PMID:27992492

Intentional research design in implementation science: implications for the use of nomothetic and idiographic assessment.

PubMed

Lyon, Aaron R; Connors, Elizabeth; Jensen-Doss, Amanda; Landes, Sara J; Lewis, Cara C; McLeod, Bryce D; Rutt, Christopher; Stanick, Cameo; Weiner, Bryan J

2017-09-01

The advancement of implementation science is dependent on identifying assessment strategies that can address implementation and clinical outcome variables in ways that are valid, relevant to stakeholders, and scalable. This paper presents a measurement agenda for implementation science that integrates the previously disparate assessment traditions of idiographic and nomothetic approaches. Although idiographic and nomothetic approaches are both used in implementation science, a review of the literature on this topic suggests that their selection can be indiscriminate, driven by convenience, and not explicitly tied to research study design. As a result, they are not typically combined deliberately or effectively. Thoughtful integration may simultaneously enhance both the rigor and relevance of assessments across multiple levels within health service systems. Background on nomothetic and idiographic assessment is provided as well as their potential to support research in implementation science. Drawing from an existing framework, seven structures (of various sequencing and weighting options) and five functions (Convergence, Complementarity, Expansion, Development, Sampling) for integrating conceptually distinct research methods are articulated as they apply to the deliberate, design-driven integration of nomothetic and idiographic assessment approaches. Specific examples and practical guidance are provided to inform research consistent with this framework. Selection and integration of idiographic and nomothetic assessments for implementation science research designs can be improved. The current paper argues for the deliberate application of a clear framework to improve the rigor and relevance of contemporary assessment strategies.

A Multifaceted Intervention to Improve Health Worker Adherence to Integrated Management of Childhood Illness Guidelines in Benin

PubMed Central

Onikpo, Faustin; Lama, Marcel; Osterholt, Dawn M.; Rowe, Samantha Y.; Deming, Michael S.

2009-01-01

Objectives. We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality. Methods. We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence. Results. We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P < .05), and both groups outperformed untrained workers. Conclusions. IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements. PMID:19299681

Understanding factors that influence the integration of acute malnutrition interventions into the national health system in Niger.

PubMed

Deconinck, Hedwig; Hallarou, Mahaman Elh; Pesonen, Anais; Gérard, Jean Christophe; Criel, Bart; Donnen, Philippe; Macq, Jean

2016-12-01

Since 2007 to address a high burden, integration of acute malnutrition has been promoted in Niger. This paper studies factors that influenced the integration process of acute malnutrition into the Niger national health system.We used qualitative methods of observation, key informant interviews and focus group discussions at national level, two districts and nine communities selected through convenience sampling, as well as document review. A framework approach constructed around the problem, intervention, adoption system, health system characteristics and broad context guided the analysis. Data were recorded on paper, transcribed in a descriptive record, coded by themes deduced by building on the framework and triangulated for comprehensiveness.Key facilitating factors identified were knowledge and recognition of the problem helped by accurate information; effectiveness of decentralized continuity of care; compatibility with goals, support and involvement of health actors; and leadership for aligning policies and partnerships and mobilizing resources within a favourable political context driven by multisectoral development goals. Key hindering factors identified were not fully understanding severity, causes and consequences of the problem; limited utilization and trust in health interventions; high workload, and health worker turnover and attrition; and high dependence on financial and technical support based on short-term emergency funding within a context of high demographic pressure.The study uncovered influencing factors of integrating acute malnutrition into the national health system and their complex dynamics and relationships. It elicited the need for goal-oriented strategies and alignment of health actors to achieve sustainability, and systems thinking to understand pathways that foster integration. We recommend that context-specific learning of integrating acute malnutrition may expand to include causal modelling and scenario testing to inform strategy designs. The method may also be applied to monitor progress of integrating nutrition by the multisectoral nutrition plan to guide change. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Shall we dance? — The effect of information presentations on negotiation processes and outcomes

PubMed Central

Gettinger, Johannes; Koeszegi, Sabine T.; Schoop, Mareike

2012-01-01

The way information is presented influences human decision making and is consequently highly relevant to electronically supported negotiations. The present study analyzes in a controlled laboratory experiment how information presentation in three alternative formats (table, history graph and dance graph) influences the negotiators' behavior and negotiation outcomes. The results show that graphical information presentation supports integrative behavior and the use of non-compensatory strategies. Furthermore, information about the opponents' preferences increases the quality of outcomes but decreases post-negotiation satisfaction of negotiators. The implications for system designers are discussed. PMID:23552280

[Implementing Inter-Professional Education (IPE): Challenges and Strategies].

PubMed

Lee, Chia-Lun; Hung, Chich-Hsiu

2017-12-01

Inter-professional practice (IPP), necessary in today's healthcare environment, should be guided and practiced through inter-professional education (IPE). Within the context of an effective IPE program, collaborative medical professionals must be cognizant of the demands of patients' integrated care, organize a collaborative inter-professional team, and achieve the objectives of patient-centered care. However, the many challenges of IPE include insufficient understanding of inter-professional care, occupational culture-related boundary issues, lack of a college education, and insufficient support from academic and medical institutions. This article suggests adopting effective strategies to promote inter-professional recognition, create a harmonious medical culture, eliminate barriers to education, and enhance support for academic and medical institutions. Inter-professional collaboration between academic and clinical institutions must provide resources and substantive professional training. Effectively implementing IPE and IPP is expected to elicit trust, respect, and efficient communication from team members.

Brownfields to green fields: Realising wider benefits from practical contaminant phytomanagement strategies.

PubMed

Cundy, A B; Bardos, R P; Puschenreiter, M; Mench, M; Bert, V; Friesl-Hanl, W; Müller, I; Li, X N; Weyens, N; Witters, N; Vangronsveld, J

2016-12-15

Gentle remediation options (GROs) are risk management strategies or technologies involving plant (phyto-), fungi (myco-), and/or bacteria-based methods that result in a net gain (or at least no gross reduction) in soil function as well as effective risk management. GRO strategies can be customised along contaminant linkages, and can generate a range of wider economic, environmental and societal benefits in contaminated land management (and in brownfields management more widely). The application of GROs as practical on-site remedial solutions is still limited however, particularly in Europe and at trace element (typically metal and metalloid) contaminated sites. This paper discusses challenges to the practical adoption of GROs in contaminated land management, and outlines the decision support tools and best practice guidance developed in the European Commission FP7-funded GREENLAND project aimed at overcoming these challenges. The GREENLAND guidance promotes a refocus from phytoremediation to wider GROs- or phyto-management based approaches which place realisation of wider benefits at the core of site design, and where gentle remediation technologies can be applied as part of integrated, mixed, site risk management solutions or as part of "holding strategies" for vacant sites. The combination of GROs with renewables, both in terms of biomass generation but also with green technologies such as wind and solar power, can provide a range of economic and other benefits and can potentially support the return of low-level contaminated sites to productive usage, while combining GROs with urban design and landscape architecture, and integrating GRO strategies with sustainable urban drainage systems and community gardens/parkland (particularly for health and leisure benefits), has large potential for triggering GRO application and in realising wider benefits in urban and suburban systems. Quantifying these wider benefits and value (above standard economic returns) will be important in leveraging funding for GRO application and soft site end-use more widely at vacant or underutilized sites. Copyright © 2016 Elsevier Ltd. All rights reserved.

Relationship between total quality management, critical paths, and outcomes management.

PubMed

Lynn, P A

1996-09-01

Total quality management (TQM), clinical paths, and outcomes management are high-profile strategies in today's health care environment. Each strategy is distinct, yet there are interrelationships among them. TQM supports a customer-focused organizational culture, providing tools and techniques to identify and solve problems. Clinical paths are tools for enhancing patient care coordination and for identifying system-wide and patient population specific issues. Outcomes management is an integrated system for measuring the results in patient populations over time. There is a recent shift in outcomes measurement towards expanding both the nature of the outcomes examined and the timeframes in which they are studied.

Emerging models for mobilizing family support for chronic disease management: a structured review.

PubMed

Rosland, Ann-Marie; Piette, John D

2010-03-01

We identify recent models for programmes aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified. Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease and rheumatologic disease. Programmes with three separate foci were identified: (1) Programmes that guide family members in setting goals for supporting patient self-care behaviours have led to improved implementation of family support roles, but have mixed success improving patient outcomes. (2) Programmes that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviours. (3) Programmes that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes. The next generation of programmes to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programmes, the most effective combinations of support strategies, and how best to integrate family support programmes into comprehensive models of chronic disease care.

Emerging Models for Mobilizing Family Support for Chronic Disease Management: A Structured Review

PubMed Central

Rosland, Ann-Marie; Piette, John D.

2015-01-01

Objectives We identify recent models for programs aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified. Methods Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches, and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease, and rheumatologic disease. Results Programs with three separate foci were identified: 1) Programs that guide family members in setting goals for supporting patient self-care behaviors have led to improved implementation of family support roles, but have mixed success improving patient outcomes. 2) Programs that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviors. 3) Programs that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes. Discussion The next generation of programs to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programs, the most effective combinations of support strategies, and how best to integrate family support programs into comprehensive models of chronic disease care. PMID:20308347

Community Palliative Care Nurses' Challenges and Coping Strategies on Delivering Home-Based Pediatric Palliative Care.

PubMed

Chong, LeeAi; Abdullah, Adina

2017-03-01

The aim of this study was to explore the experience of community palliative care nurses providing home care to children. A qualitative study was conducted at the 3 community palliative care provider organizations in greater Kuala Lumpur from August to October 2014. Data were collected with semistructured interviews with 16 nurses who have provided care to children and was analyzed using thematic analysis. Two categories were identified: (1) challenges nurses faced and (2) coping strategies. The themes identified from the categories are (1) communication challenges, (2) inadequate training and knowledge, (3) personal suffering, (4) challenges of the system, (5) intrapersonal coping skills, (6) interpersonal coping strategies, and (7) systemic supports. These results reinforces the need for integration of pediatric palliative care teaching and communication skills training into all undergraduate health care programs. Provider organizational support to meet the specific needs of the nurses in the community can help retain them in their role. It will also be important to develop standards for current and new palliative care services to ensure delivery of quality pediatric palliative care.

Intelligent support of e-management for consumer-focused virtual enterprises

NASA Astrophysics Data System (ADS)

Chandra, Charu; Smirnov, Alexander V.

2000-10-01

The interest in consumer-focused virtual enterprises (VE) decision-making problem is growing fast. The purpose of this type of enterprise is to transform incomplete information about customer orders and available resources into-co-ordinated plans for production and replenishment of goods and services in the temporal network formed by collaborating units. This implies that information in the consumer-focused VE can be shared via Internet, Intranet, and Extranet for business-to-consumer (B2C), business-to-business service (B2B-S), and business-to-business goods (B2B-G) transactions. One of the goals of Internet-Based Management (e-management) is to facilitate transfer and sharing of data and knowledge in the context of enterprise collaboration. This paper discusses a generic framework of e-management that integrates intelligent information support group-decision making, and agreement modeling for a VE network. It offers the platform for design and modeling of diverse implementation strategies related to the type of agreement, optimization policies, decision-making strategies, organization structures, and information sharing strategies and mechanisms, and business policies for the VE.

[Integrative approach in the psychotherapy of borderline personality disorder].

PubMed

Kuritárné Szabó, Ildikó

2012-01-01

In the last 20 years six psychotherapy methods have been developed specifically for borderline personality disorder. Solid RCT evidences suggests the efficacy of all the methods. Roughly equivalent improvement was obtained from the different types of psychotherapies. Today we have reached a new phase of the borderline "psychotherapy boom", the integrative approach. According to the integrative treatment advocates we should not choose among these effective treatments but we can incorporate in the therapy all the components that work. The integrative approach uses general factors common to all effective therapies, combined with specific treatment techniques taken from different therapies in order to treat the given patient's psychopathology. These common factors are: coherent framework; attention to strategies for building strong positive alliance and maintaining patient motivation; creating a safe and structured therapeutic environment; clear treatment frame; transparency of the goals and roles; focus upon presenting problems; higher level therapeutic activity; here-and-now focus; and facilitating self-reflection. Treatment focuses on change while maintaining a validating and supportive stance. General strategies can be supplemented by more specific techniques such as cognitive-behavioral interventions for reducing maladaptive behavior, training for developing emotion regulation skills and interpersonal skills coming from dialectical behavior therapy. Methods drawn from psychodynamic approaches can be used for the modification of underlying interpersonal cognitive-emotional schemas.

Smart EV Energy Management System to Support Grid Services

NASA Astrophysics Data System (ADS)

Wang, Bin

Under smart grid scenarios, the advanced sensing and metering technologies have been applied to the legacy power grid to improve the system observability and the real-time situational awareness. Meanwhile, there is increasing amount of distributed energy resources (DERs), such as renewable generations, electric vehicles (EVs) and battery energy storage system (BESS), etc., being integrated into the power system. However, the integration of EVs, which can be modeled as controllable mobile energy devices, brings both challenges and opportunities to the grid planning and energy management, due to the intermittency of renewable generation, uncertainties of EV driver behaviors, etc. This dissertation aims to solve the real-time EV energy management problem in order to improve the overall grid efficiency, reliability and economics, using online and predictive optimization strategies. Most of the previous research on EV energy management strategies and algorithms are based on simplified models with unrealistic assumptions that the EV charging behaviors are perfectly known or following known distributions, such as the arriving time, leaving time and energy consumption values, etc. These approaches fail to obtain the optimal solutions in real-time because of the system uncertainties. Moreover, there is lack of data-driven strategy that performs online and predictive scheduling for EV charging behaviors under microgrid scenarios. Therefore, we develop an online predictive EV scheduling framework, considering uncertainties of renewable generation, building load and EV driver behaviors, etc., based on real-world data. A kernel-based estimator is developed to predict the charging session parameters in real-time with improved estimation accuracy. The efficacy of various optimization strategies that are supported by this framework, including valley-filling, cost reduction, event-based control, etc., has been demonstrated. In addition, the existing simulation-based approaches do not consider a variety of practical concerns of implementing such a smart EV energy management system, including the driver preferences, communication protocols, data models, and customized integration of existing standards to provide grid services. Therefore, this dissertation also solves these issues by designing and implementing a scalable system architecture to capture the user preferences, enable multi-layer communication and control, and finally improve the system reliability and interoperability.

Relationship between alexithymia and coping strategies in patients with somatoform disorder

PubMed Central

Tominaga, Toshiyuki; Choi, Hyungin; Nagoshi, Yasuhide; Wada, Yoshihisa; Fukui, Kenji

2014-01-01

Purpose A multidimensional intervention integrating alexithymia, negative affect, and type of coping strategy is needed for the effective treatment of somatoform disorder; however, few studies have applied this approach to the three different dimensions of alexithymia in patients with somatoform disorder. The purpose of this study was to determine the relationship between type of coping strategy and three different dimensions of alexithymia expressed in patients. Patients and methods A total of 196 patients with somatoform disorder completed the 20-item Toronto Alexithymia Scale, the Zung Self-Rating Depression Scale, the Spielberger State–Trait Anxiety Inventory, the Somatosensory Amplification Scale, and the Lazarus Stress Coping Inventory. The relationships between alexithymia (Toronto Alexithymia Scale – 20 score and subscales), demographic variables, and psychological inventory scores were analyzed using Pearson’s correlation coefficients and stepwise multiple regression analysis. Results The mean Toronto Alexithymia Scale – 20 total score (56.1±10.57) was positively correlated with the number of physical symptoms as well as with psychopathology scores (Self-Rating Depression Scale, State–Trait Anxiety Inventory trait, state, and Somatosensory Amplification Scale), but negatively correlated with planful problem solving, confrontive coping, seeking social support, and positive reappraisal coping scores. With respect to coping strategy, multiple regression analyses revealed that “difficulty in identifying feelings” was positively associated with an escape–avoidance strategy, “difficulty in describing feelings” was negatively associated with a seeking social support strategy, and “externally oriented thinking” was negatively associated with a confrontive coping strategy. Conclusion Alexithymia was strongly associated with the number of somatic symptoms and negative affect. Patients with high “difficulty in describing feelings” tend to rely less on seeking social support, and patients with high “externally oriented thinking” tend to rely less on confrontive coping strategies. The coping skills intervention implemented should differ across individuals and should be based on the alexithymia dimension of each patient. PMID:24403835

[Hospital and organizational dynamics of the National Institutes of Health. Relationship with high-specialty hospitals].

PubMed

Gabilondo Navarro, Fernando

2011-01-01

In order to primarily encourage medical care, teaching and research activities in high specialty regional hospitals (HSRH), a number of strategies are explored to increase the number of patients cared for, improve the quality and timeliness of care and successfully integrate the function of these hospitals within the care and patient flow model expected by the Federal Government. These strategies include the use of information technology systems as platforms for telemedicine, including tele-imaging, tele-education and telepathology, thus fostering the quality and timeliness of medical care and narrow the relationship between these HSRH with the National Health Institutes. Other strategies such as extra-mural surgery, specific theme workshops, resident rotations, the use of simulators and "Science Weeks" are also explored so as to promote teaching and research. Finally, the reference and counter-reference system and the introduction of pension programs are evaluated as possible strategies supporting resource management.

Integration of Palliative Care in Chronic Critical Illness Management

PubMed Central

Nelson, Judith E; Hope, Aluko A

2016-01-01

Palliative care is an essential component of comprehensive care for all patients with chronic critical illness, including those receiving restorative or life-sustaining therapies. Core elements include alleviation of symptom distress, communication about care goals, alignment of treatment with the patient’s values and preferences, transitional planning, and family support. Here we address strategies for assessment and management of symptoms, including pain, dyspnea, and depression, and for assisting patients to communicate while endotracheally intubated. We also discuss approaches to optimize communication among clinicians, patients, and families about care goals. Challenges for supporting families and planning for transitions between care settings are identified, while the value of interdisciplinary input is emphasized. We review “consultative” and “integrative” models for integrating palliative care and restorative critical care. Finally, we highlight key ethical issues that arise in the care of chronically critically ill patients and their families. PMID:22663973

Effects of Social Determinants on Chinese Immigrant Food Service Workers' Work Performance and Injuries: Mental Health as a Mediator.

PubMed

Tsai, Jenny Hsin-Chun; Thompson, Elaine Adams

2015-07-01

The effects of social discrimination, job concerns, and social support on worker mental health and the influence of mental health on occupational health outcomes have been documented intermittently. We propose an integrated, theory-driven model to distinguish the impact of social determinants on work performance and injuries and the mediating effects of mental health problems. The US Chinese immigrant food service workers (N = 194) completed a multimeasure interview; we tested the integrated model using structural equation modeling. Mental health problems, which were associated with decreased work performance and increased injuries, also mediated relationships between job/employment concerns and both work performance and injuries but did not mediate the influences of discrimination and social support. This research reveals mechanisms by which social determinants influence immigrant worker health, pointing to complementary strategies for reducing occupational health disparities.

Initial evaluation of a student-run fruit and vegetable business in urban high schools.

PubMed

Sikic, Nicholas I; Erbstein, Nancy; Welch, Kearnan; Grundberg, Ethan; Miller, Elizabeth

2012-11-01

This study examined the acceptability and feasibility of Fresh Producers, a student-run fruit and vegetable distribution program at three urban high schools located in low-income neighborhoods, and its potential impact on the nutrition and professional development of participating students. Thirteen focus groups conducted with 72 students explored the program's impact on their dietary habits and professional skill development, and discussed program challenges. Responses were coded for common themes by multiple investigators. Participants reported increased fruit and vegetable consumption, and improved interpersonal, team-building, and organizational skills. Challenges included integration into the school schedule and environment and limited faculty support for business activities. This program is acceptable and feasible for secondary school students in a variety of school settings. Students reported positive changes in professional skills and nutrition. Training and support for students and faculty, including strategies to improve program integration into the school context, could increase participation.

The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals' perspectives on the implementation of the Baby-Friendly Hospital Initiative.

PubMed

Wieczorek, Christina C; Marent, Benjamin; Dorner, Thomas E; Dür, Wolfgang

2016-03-14

The health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice. In this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis. Midwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice. Differing approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter-professional teamwork and collaboration are widely espoused goals of contemporary healthcare improvement strategies. Yet, critical debate on how these goals can be integrated into practice is needed. To enable collaboration and facilitate the implementation of programs such as BFHI, the different perspectives of health professionals should be brought together and the potential for integrating different forms of knowledge and practices should be considered.

Teachers' Support and Pupils' Writing Strategies in a Networked Elementary-School Learning Environment Integrating a Blog

ERIC Educational Resources Information Center

Thériault, Pascale; Allaire, Stéphane; Gagnon, Vincent

2017-01-01

Although the affective dimension of writing is important and well documented, we know less about how teachers and students are making use of the blog in classrooms to advance specifically cognitive goals connected to writing. It is with this in mind that a case study was carried out to closely document the effect of classroom blogs on the…

Force on Force Modeling with Formal Task Structures and Dynamic Geometry

DTIC Science & Technology

2017-03-24

task framework, derived using the MMF methodology to structure a complex mission. It further demonstrated the integration of effects from a range of...application methodology was intended to support a combined developmental testing (DT) and operational testing (OT) strategy for selected systems under test... methodology to develop new or modify existing Models and Simulations (M&S) to: • Apply data from multiple, distributed sources (including test

Integrating Intelligence and Building Teams Within the Infantry Immersion Trainer

DTIC Science & Technology

2009-09-01

understanding that a motivated learner (trainee) has a potential to be the best learner (trainee). 30 Yuhas et al. (2008) provided a list of...unit member needs to be fully trained and engaged and directly supporting the strategy of “every Marine collector, every Marine reporter.” Marines also...recreation of the battlefield environment—physically, visually, aurally , and aromatically. Mission actions are carried out through interaction with

HOW THE MILITARY CAN INTEGRATE UNMANNED AERIAL SYSTEMS IN THE CIVIL RESERVE AIR FLEET

DTIC Science & Technology

2016-10-01

brings new capabilities and continues to fundamentally impact military doctrine and strategy, particularly in how civilian operators or contractors ...missions has stretched military personnel and resources thin. General Atomics, a California-based defense contractor , produces the highly successful MQ-1...and a large number of support personnel required to operate UAS missions. An already established civilian contractor presence AU/ACSC/2016 5

From micro to macro: assessing implementation of integrated care in Australia.

PubMed

Angus, Lisa; Valentijn, Pim P

2018-03-01

Many countries and health systems are pursuing integrated care as a means of achieving better outcomes. However, no standard approaches exist for comparing integration approaches across models or settings, and for evaluating whether the key components of integrated care are present in different initiatives. This study sheds light on how integrated care is being implemented in Australia, using a new tool to characterise and compare integration strategies at micro, meso and macro levels. In total, 114 staff from a purposive sample of 38 integrated care projects completed a survey based on the Rainbow Model of Integrated Care. Ten key informants gave follow-up interviews. Participating projects reported using multiple strategies to implement integrated care, but descriptions of implementation were often inconsistent. Micro-level strategies, including clinical-professional service coordination and person-centred care, were most commonly reported. A common vision was often described as an essential foundation for joint work. However, performance feedback appeared under-utilised, as did strategies requiring macro-level action such as data linkages or payment reform. The results suggest that current integrated care efforts are unevenly weighted towards micro-level strategies. Increased attention to macro-level strategies may be warranted in order to accelerate progress and sustain integrated care in Australia.

Dissemination and implementation of an educational tool for veterans on complementary and alternative medicine: a case study.

PubMed

Held, Rachel Forster; Santos, Susan; Marki, Michelle; Helmer, Drew

2016-09-02

We developed and disseminated an educational DVD to introduce U.S. Veterans to independently-practiced complementary and alternative medicine (CAM) techniques and encourage CAM experimentation. The project's goal was to determine optimal dissemination methods to facilitate implementation within the Veteran's Health Administration. In the first phase, the DVD was disseminated using four methods: passive, provider-mediated, active, and peer-mediated. In the second, implementation phase, "champion" providers who supported CAM integrated dissemination into clinical practice. Qualitative data came from Veteran focus groups and semi-structured provider interviews. Data from both phases was triangulated to identify common themes. Effective dissemination requires engaging patients. Providers who most successfully integrated the DVD into practice already had CAM knowledge, and worked in settings where CAM was accepted clinical practice, or with leadership or infrastructure that supported a culture of CAM use. Institutional buy-in allowed for provider networking and effective implementation of the tool. Providers were given autonomy to determine the most appropriate dissemination strategies, which increased enthusiasm and use. Many of the lessons learned from this project can be applied to dissemination of any new educational tool within a healthcare setting. Results reiterate the importance of utilizing best practices for introducing educational tools within the healthcare context and the need for thoughtful, multi-faceted dissemination strategies.

Self-Supported Crack-Free Conducting Polymer Films with Stabilized Wrinkling Patterns and Their Applications

PubMed Central

Xie, Jixun; Han, Xue; Ji, Haipeng; Wang, Juanjuan; Zhao, Jingxin; Lu, Conghua

2016-01-01

Self-supported conducting polymer films with controlled microarchitectures are highly attractive from fundamental and applied points of view. Here a versatile strategy is demonstrated to fabricate thin free-standing crack-free polyaniline (PANI)-based films with stable wrinkling patterns. It is based on oxidization polymerization of pyrrole inside a pre-wrinkled PANI film, in which the wrinkled PANI film is used both as a template and oxidizing agent for the first time. The subsequently grown polypyrrole (PPy) and the formation of interpenetrated PANI/PPy networks play a decisive role in enhancing the film integrity and the stability of wrinkles. This enhancing effect is attributed to the modification of internal stresses by the interpenetrated PANI/PPy microstructures. Consequently, a crack-free film with stable controlled wrinkles such as the wavelength, orientation and spatial location has been achieved. Moreover, the wrinkling PANI/PPy film can be removed from the initially deposited substrate to become free-standing. It can be further transferred onto target substrates to fabricate hierarchical patterns and functional devices such as flexible electrodes, gas sensors, and surface-enhanced Raman scattering substrates. This simple universal enhancing strategy has been extended to fabrication of other PANI-based composite systems with crack-free film integrity and stabilized surface patterns, irrespective of pattern types and film geometries. PMID:27827459

A capacity-building conceptual framework for public health nutrition practice.

PubMed

Baillie, Elizabeth; Bjarnholt, Christel; Gruber, Marlies; Hughes, Roger

2009-08-01

To describe a conceptual framework to assist in the application of capacity-building principles to public health nutrition practice. A review of the literature and consideration of the determinants of effective public health nutrition practice has been used to inform the development of a conceptual framework for capacity building in the context of public health nutrition practice. The limited literature supports a greater integration and application of capacity-building strategies and principles in public health nutrition practice, and that this application should be overt and strategic. A framework is proposed that identifies a number of determinants of capacity for effective public health nutrition action. The framework represents the key foundations for building capacity including leadership, resourcing and intelligence. Five key strategic domains supported by these foundation elements, including partnerships, organisational development, project management quality, workforce development and community development, are proposed. This framework can be used to assist the systematic assessment, development and evaluation of capacity-building activity within public health nutrition practice. Capacity building is a strategy within public health nutrition practice that needs to be central to public health nutrition intervention management. The present paper defines, contextualises and outlines a framework for integrating and making explicit the importance of capacity building within public health nutrition practice at many levels.

Evaluation of use of reading comprehension strategies to improve reading comprehension of adult college students with acquired brain injury.

PubMed

Griffiths, Gina G; Sohlberg, McKay Moore; Kirk, Cecilia; Fickas, Stephen; Biancarosa, Gina

2016-01-01

Adults with mild to moderate acquired brain injury (ABI) often pursue post-secondary or professional education after their injuries in order to enter or re-enter the job market. An increasing number of these adults report problems with reading-to-learn. The problem is particularly concerning given the growing population of adult survivors of ABI. Despite the rising need, empirical evaluation of reading comprehension interventions for adults with ABI is scarce. This study used a within-subject design to evaluate whether adult college students with ABI with no more than moderate cognitive impairments benefited from using reading comprehension strategies to improve comprehension of expository text. Integrating empirical support from the cognitive rehabilitation and special education literature, the researchers designed a multi-component reading comprehension strategy package. Participants read chapters from an introductory-level college anthropology textbook in two different conditions: strategy and no-strategy. The results indicated that reading comprehension strategy use was associated with recall of more correct information units in immediate and delayed free recall tasks; more efficient recall in the delayed free recall task; and increased accuracy recognising statements from a sentence verification task designed to reflect the local and global coherence of the text. The findings support further research into using reading comprehension strategies as an intervention approach for the adult ABI population. Future research needs include identifying how to match particular reading comprehension strategies to individuals, examining whether reading comprehension performance improves further through the incorporation of systematic training, and evaluating texts from a range of disciplines and genres.

Integrating community health workers within Patient Protection and Affordable Care Act implementation.

PubMed

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C; Trinh-Shevrin, Chau

2015-01-01

The Patient Protection and Affordable Care Act's (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers' role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers' unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models.

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

PubMed Central

Islam, Nadia; Nadkarni, Smiti Kapadia; Zahn, Deborah; Skillman, Megan; Kwon, Simona C.; Trinh-Shevrin, Chau

2015-01-01

Context The Patient Protection and Affordable Care Act’s (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. Objective This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Results Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers’ role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers’ unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Conclusion Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models. PMID:25414955

Integrated Decision Strategies for Skin Sensitization Hazard

PubMed Central

Strickland, Judy; Zang, Qingda; Kleinstreuer, Nicole; Paris, Michael; Lehmann, David M.; Choksi, Neepa; Matheson, Joanna; Jacobs, Abigail; Lowit, Anna; Allen, David; Casey, Warren

2016-01-01

One of the top priorities of ICCVAM is the identification and evaluation of non-animal alternatives for skin sensitization testing. Although skin sensitization is a complex process, the key biological events of the process have been well characterized in an adverse outcome pathway (AOP) proposed by OECD. Accordingly, ICCVAM is working to develop integrated decision strategies based on the AOP using in vitro, in chemico, and in silico information. Data were compiled for 120 substances tested in the murine local lymph node assay (LLNA), direct peptide reactivity assay (DPRA), human cell line activation test (h-CLAT), and KeratinoSens assay. Data for six physicochemical properties that may affect skin penetration were also collected, and skin sensitization read-across predictions were performed using OECD QSAR Toolbox. All data were combined into a variety of potential integrated decision strategies to predict LLNA outcomes using a training set of 94 substances and an external test set of 26 substances. Fifty-four models were built using multiple combinations of machine learning approaches and predictor variables. The seven models with the highest accuracy (89–96% for the test set and 96–99% for the training set) for predicting LLNA outcomes used a support vector machine (SVM) approach with different combinations of predictor variables. The performance statistics of the SVM models were higher than any of the non-animal tests alone and higher than simple test battery approaches using these methods. These data suggest that computational approaches are promising tools to effectively integrate data sources to identify potential skin sensitizers without animal testing. PMID:26851134

Integrated analysis for population estimation, management impact evaluation, and decision-making for a declining species

USGS Publications Warehouse

Crawford, Brian A.; Moore, Clinton; Norton, Terry M.; Maerz, John C.

2018-01-01

A challenge for making conservation decisions is predicting how wildlife populations respond to multiple, concurrent threats and potential management strategies, usually under substantial uncertainty. Integrated modeling approaches can improve estimation of demographic rates necessary for making predictions, even for rare or cryptic species with sparse data, but their use in management applications is limited. We developed integrated models for a population of diamondback terrapins (Malaclemys terrapin) impacted by road-associated threats to (i) jointly estimate demographic rates from two mark-recapture datasets, while directly estimating road mortality and the impact of management actions deployed during the study; and (ii) project the population using population viability analysis under simulated management strategies to inform decision-making. Without management, population extirpation was nearly certain due to demographic impacts of road mortality, predators, and vegetation. Installation of novel flashing signage increased survival of terrapins that crossed roads by 30%. Signage, along with small roadside barriers installed during the study, increased population persistence probability, but the population was still predicted to decline. Management strategies that included actions targeting multiple threats and demographic rates resulted in the highest persistence probability, and roadside barriers, which increased adult survival, were predicted to increase persistence more than other actions. Our results support earlier findings showing mitigation of multiple threats is likely required to increase the viability of declining populations. Our approach illustrates how integrated models may be adapted to use limited data efficiently, represent system complexity, evaluate impacts of threats and management actions, and provide decision-relevant information for conservation of at-risk populations.

Common Data Servers as a Foundation for Specialized Services

NASA Astrophysics Data System (ADS)

Burger, E. F.; Schweitzer, R.; O'Brien, K.; Manke, A. B.; Smith, K. M.

2017-12-01

NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a broad range of research efforts that span many scientific and environmental research disciplines. Many of these research projects have their own data streams that are as diverse as the research. Data are collected using various platforms, including innovative new platforms such as Saildrones and autonomous profilers. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data landscape for Federal agencies. In 2015, with support from the PMEL Director, the PMEL Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. The PMEL integrated data management strategy will provide data access, visualization and some archive services to PMEL data and use existing and proven frameworks for this capability. In addition to these foundational data services, these data access and visualization frameworks are also leveraged to provide enhanced services to scientists. One enhanced service developed is a data management "dashboard". This application provides scientists with a snapshot of their data assets, access to these data, a map view of data locations, and information on the archival status. Ideally, information on the dashboard continually updates to accurately reflect the project's data asset status. This poster explains how frameworks such as ERDDAP and LAS were used as a foundation for the development of custom services, as well as an explanation of the PMEL data management dashboard functionality. We will also highlight accomplishments of the PMEL Integrated data management strategy implementation.

Integration of the Opportunity-Ability-Motivation behavior change framework into a coaching-based WHO Safe Childbirth Checklist program in India.

PubMed

Hirschhorn, Lisa R; Krasne, Margaret; Maisonneuve, Jenny; Kara, Nabihah; Kalita, Tapan; Henrich, Natalie; Rana, Darpan; Maji, Pinki; Delaney, Megan M; Firestone, Rebecca; Sharma, Narender; Kumar, Vishwajeet; Gawande, Atul A; Semrau, Katherine E A

2018-06-03

To evaluate whether integration of the Opportunity-Ability-Motivation plus Supplies (OAMS) framework into coaching improved the delivery of essential birth practices in a low-resource setting. This prospective mixed-methods study used routine coaching visit data obtained from the first eight intervention facilities of the BetterBirth trial in Uttar Pradesh, India, between December 19, 2014, and October 21, 2015. The 8-month intervention was peer coaching that integrated the OAMS framework to support uptake of the WHO Safe Childbirth Checklist. Descriptive statistics were used to measure nonadherence to essential birth practices. The frequency and accuracy of coaches' coding of barriers and the appropriateness of chosen resolution strategies to measure feasibility, acceptability, and fidelity of using OAMS, were assessed. Coaches observed 666 deliveries, including 12 602 practices. Overall, essential practice nonadherence decreased from 15.6% (262/1675 practices observed) to 4.5% (4/88 practices) (P<0.001). Of the 1048 barriers identified, opportunity (556 [53.1%]) and motivation (287 [27.4%]) were the most frequently reported categories; the frequency of both decreased over time (P=0.003 and P<0.001, respectively). The coaches appropriately categorized 930 (99.8%) of 932 barriers and provided an appropriate strategy for 800 (85.8%). The commonest reason for unaddressed barriers was lack of coaching opportunities. Successful integration of OAMS framework into delivery attendant coaching enabled coaches to rapidly diagnose barriers to practice adherence and develop responsive strategies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Activating people to address their health care needs: learning from people with lived experience of chronic illnesses.

PubMed

Stanhope, Victoria; Henwood, Benjamin F

2014-08-01

One of the primary goals of health care reform is improving the quality and reducing the costs of care for people with co-morbid mental health and physical health conditions. One strategy is to integrate primary and behavioral health care through care coordination and patient activation. This qualitative study using community based participatory research methods informs the development of integrated care by presenting the perspectives of those with lived experience of chronic illnesses and homelessness. Themes presented include the internal and external barriers to addressing health needs and the key role of peer support in overcoming these barriers.

[Study of defense styles, defenses and coping strategies in alcohol-dependent population].

PubMed

Ribadier, A; Varescon, I

2017-05-01

Defense mechanisms have been seen to greatly change over time and across different definitions made by different theoretical currents. Recently with the definition provided by the DSM IV, defense mechanisms have integrated the concept of coping as a defensive factor. These mechanisms are no longer considered just through a psychodynamic approach but also through a cognitive and behavioral one. In recent years, new theories have therefore integrated these two components of the defensive operation. According to Chabrol and Callahan (2013), defense mechanisms precede coping strategies. In individuals with psychopathological disorders, these authors indicate a relative stability of these mechanisms. Also, we asked about the presence of unique characteristics among people with alcohol dependence. Indeed, studies conducted with people with alcohol dependence highlight the presence of a neurotic defense style and some highly immature defenses (projection, acting out, splitting and somatization). In terms of coping strategies, persons with alcohol dependence preferentially use avoidant strategies and strategies focused on emotion. However, although several studies have been conducted to assess coping strategies and defense styles within a population of individuals with an alcohol problem, at the present time none of them has taken into account all these aspects of defense mechanisms. The aim of this study is therefore to study the defenses and defense styles and coping strategies in an alcohol-dependent population. This multicenter study (3 CHU, 1 center of supportive care and prevention in addiction and 1 clinic) received a favorable opinion of an Institutional Review Board (IRB Registration #: 00001072). Eighty alcohol-dependent individuals responded to a questionnaire assessing sociodemographic characteristics and elements related to the course of consumption. Coping strategies were assessed by means of a questionnaire validated in French: the Brief Cope. The Defense Style Questionnaire-40 translated into French, but not validated, assessed defenses and defense style. Descriptive, comparative and correlational analysis was carried out using Statistica software - version 10. The alcohol-dependent people preferentially use emotion focused coping blame and less the problem focused coping humor. The highest immature defense is acting out. Correlational analyses confirm the presence of some significant relationships between defense style and some coping strategies. Thus, the mature style is the only defense style, which is linked with the problem focused strategy humor, and another one coping called distraction. Some singular relationships were found with these two dimensions of coping. Alcohol and drug disengagement show particularly strong relationships with immature defenses such as projection and somatization. Another singular result is indicated by a negative relationship between immature defenses autistic fantasy with the strategy expression of feelings. This study found a significant number of relationships between defensive styles, defenses and coping strategies. This research also highlights the value of an integrative approach of defense mechanisms for the analysis of defensive functioning of people with alcohol dependence. Indeed, the relationships between these elements are consistent and allow understanding the defensive operation as a whole to promote a new adapted means of support. Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Mental disorders and work integration: a retrospective study in a northern italian town.

PubMed

Buizza, Chiara; Pioli, Rosaria; Lecchi, Sara; Bonetto, Chiara; Bartoli, Anna; Taglietti, Renzo; Ghilardi, Alberto; Riva, Eugenio

2013-01-01

THE PRESENT STUDY WAS CONDUCTED IN A VOCATIONAL INTEGRATION SERVICE OF A NORTHERN ITALIAN TOWN WITH TWO MAJOR AIMS: to assess vocational integration programs undertaken from 1(st) January 2004 to 1(st) January 2007; and to identify job tenure-associated predictors. This is a retrospective study; we collected data such as gender, age, duration, type and outcome of the vocational integration program, and number of interventions performed by the vocational integration service. Self-report questionnaires were also used to assess the satisfaction of users, caregivers, practitioners, and of the company contacts involved in the study. The service has enrolled 84 users during the observation period. Out of these users, 64.3% of them still had their jobs after three years. Users, caregivers and company contacts expressed high levels of satisfaction for the support received by the vocational integration service. The company expressed less satisfaction for the collaboration received by the Departments of Mental Health (DMHs) that coached the users. The only variable associated to the outcome was the number of interventions that the users received before their placement on the job. Despite all the limits of this study, its results show that the chance of taking advantage of a supported job placement service has likely proven itself effective in helping people with mental disorders to obtain and maintain a competitive employment. Our results, however, also point to the necessity of implementing newer strategies meant to develop a greater integration among all services dealing with mentally ill people.

How to get the most bang for your buck: the evolution and physiology of nutrition-dependent resource allocation strategies.

PubMed

Ng'oma, Enoch; Perinchery, Anna M; King, Elizabeth G

2017-06-28

All organisms use resources to grow, survive and reproduce. The supply of these resources varies widely across landscapes and time, imposing ultimate constraints on the maximal trait values for allocation-related traits. In this review, we address three key questions fundamental to our understanding of the evolution of allocation strategies and their underlying mechanisms. First, we ask: how diverse are flexible resource allocation strategies among different organisms? We find there are many, varied, examples of flexible strategies that depend on nutrition. However, this diversity is often ignored in some of the best-known cases of resource allocation shifts, such as the commonly observed pattern of lifespan extension under nutrient limitation. A greater appreciation of the wide variety of flexible allocation strategies leads directly to our second major question: what conditions select for different plastic allocation strategies? Here, we highlight the need for additional models that explicitly consider the evolution of phenotypically plastic allocation strategies and empirical tests of the predictions of those models in natural populations. Finally, we consider the question: what are the underlying mechanisms determining resource allocation strategies? Although evolutionary biologists assume differential allocation of resources is a major factor limiting trait evolution, few proximate mechanisms are known that specifically support the model. We argue that an integrated framework can reconcile evolutionary models with proximate mechanisms that appear at first glance to be in conflict with these models. Overall, we encourage future studies to: (i) mimic ecological conditions in which those patterns evolve, and (ii) take advantage of the 'omic' opportunities to produce multi-level data and analytical models that effectively integrate across physiological and evolutionary theory. © 2017 The Author(s).

How to get the most bang for your buck: the evolution and physiology of nutrition-dependent resource allocation strategies

PubMed Central

2017-01-01

All organisms use resources to grow, survive and reproduce. The supply of these resources varies widely across landscapes and time, imposing ultimate constraints on the maximal trait values for allocation-related traits. In this review, we address three key questions fundamental to our understanding of the evolution of allocation strategies and their underlying mechanisms. First, we ask: how diverse are flexible resource allocation strategies among different organisms? We find there are many, varied, examples of flexible strategies that depend on nutrition. However, this diversity is often ignored in some of the best-known cases of resource allocation shifts, such as the commonly observed pattern of lifespan extension under nutrient limitation. A greater appreciation of the wide variety of flexible allocation strategies leads directly to our second major question: what conditions select for different plastic allocation strategies? Here, we highlight the need for additional models that explicitly consider the evolution of phenotypically plastic allocation strategies and empirical tests of the predictions of those models in natural populations. Finally, we consider the question: what are the underlying mechanisms determining resource allocation strategies? Although evolutionary biologists assume differential allocation of resources is a major factor limiting trait evolution, few proximate mechanisms are known that specifically support the model. We argue that an integrated framework can reconcile evolutionary models with proximate mechanisms that appear at first glance to be in conflict with these models. Overall, we encourage future studies to: (i) mimic ecological conditions in which those patterns evolve, and (ii) take advantage of the ‘omic’ opportunities to produce multi-level data and analytical models that effectively integrate across physiological and evolutionary theory. PMID:28637856

Toward a Broader Role for Occupational Therapy in Supportive Oncology Care.

PubMed

Sleight, Alix G; Duker, Leah I Stein

2016-01-01

Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care. Copyright © 2016 by the American Occupational Therapy Association, Inc.

Toward a Broader Role for Occupational Therapy in Supportive Oncology Care

PubMed Central

Duker, Leah I. Stein

2016-01-01

Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care. PMID:27295001

‘Trying to do a jigsaw without the picture on the box’: understanding the challenges of care integration in the context of single assessment for older people in England

PubMed Central

Wilson, Rob; Baines, Susan; Cornford, James; Martin, Mike

2007-01-01

Introduction Demographic ageing is one of the major challenges for governments in developed countries because older people are the main users of health and social care services. More joined-up, partnership approaches supported by information and communications technologies (ICTs) have become key to managing these demands. This article discusses recent developments towards integrated care in the context of one of the arenas in which integration is being attempted, the Single Assessment Process (SAP) to support the care for older people in England. It draws upon accounts of local SAP implementations in order to assess and reflect upon some of the successes and limitations of service integration enabled by ICTs. Description of care practice At the Department of Health in England, policy and strategy are directed at the integration of services through a ‘whole systems’ approach, with services that are interdependent upon one another and organised around the person that uses them. The Single Assessment Processes (SAP) is an instance of inter-organisational and cross-sectoral sharing of information intended to improve communication and coordination amongst professions and agencies and so support more integrated care. The aim of SAP is to ensure that older people receive appropriate, effective and timely responses to their health and social care needs and that professionals do not duplicate each others efforts. This article examines examples from two programmes of work within the context of SAP in England: one with the direction coming from local government social services, the other where the momentum is coming from the National Health Service (NHS). Conclusion and discussion Both examples show that the policy and practice of ICT-supported integration continues to represent a significant challenge. Although the notion of integrated care underpinned by ICT-enabled information sharing is persuasive, it has limitations in practice. The notion of an ‘open systems’ approach is proposed as an alternative way of improving communication and coordination across the domains of health and social care. PMID:17637871

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.

PubMed

Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J

2015-01-01

This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. © Copyright 2015 by the American Board of Family Medicine.

An Integrated Web-based Decision Support System in Disaster Risk Management

NASA Astrophysics Data System (ADS)

Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

2012-04-01

Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact-probability matrix in terms of socio-economic dimension.