Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.

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Ruiz-Ramos, Jesus; Frasquet, Juan; Romá, Eva; Poveda-Andres, Jose Luis; Salavert-Leti, Miguel; Castellanos, Alvaro; Ramirez, Paula

2017-06-01

To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

Tiered Models of Integrated Academic and Behavioral Support: Effect of Implementation Level on Academic Outcomes

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Noltemeyer, Amity; Sansosti, Frank J.

2012-01-01

This exploratory study examined (a) Integrated Systems Model (ISM) implementation levels, and (b) the effect of implementation of the academic and behavioral components of ISM on student academic outcomes. Participants included 2,660 students attending six suburban elementary schools. Hierarchical linear regression was conducted using a control…

Key Enablers of Effective Implementation of TQM in Royal Jet Airways

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Moza Tahnoon Al Nahyan

2017-01-01

Full Text Available Total quality management (TQM is a unified management approach that concentrates on the consecutive improvement of processes, products, and methods to surpass client expectations. This paper aims to highlight the advantages of implementing TQM in the airline industry by examining the key enablers of TQM. This study was based on a research model including six factors that were found to have a profound influence in implementing TQM. The data needed for the study was collected with the aid of questionnaires and secondary sources. The study discovered that procedures, policies, and a culture of knowledge transfer were the most significant enablers of successful TQM initiatives in Royal Jet Airways. In order to effectively implement TQM, the study suggests that management should offer appropriate recognition and rewards to employees. This will motivate them to adopt and practice TQM initiatives. Apart from that, management should also arrange seminars or workshops to accustom the employees to the basic procedures and objectives of effective TQM.

Working conditions and effects of ISO 9000 in six furniture-making companies: implementation and processes.

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Karltun, J; Axelsson, J; Eklund, J

1998-08-01

What effects will the implementation of the quality standard ISO 9000 have regarding working conditions and competitive advantages? Which are the most important change process characteristics for assuring improved working conditions and other desired effects? These are the main questions behind this study of six furniture-making companies which implemented ISO 9000 during the period 1991-1994. The results show that customer requirement was the dominant goal to implement ISO 9000. Five of the six companies succeeded in gaining certification. The influence on working conditions was limited, but included better order and housekeeping, more positive attitudes towards discussing quality shortcomings, a few workplace improvements, work enrichment caused by additional tasks within the quality system and a better understanding of external customer demands. Among the negative effects were new, apparently meaningless, tasks for individual workers as well as more stress and more physically strenuous work. The effects on the companies included a decrease in external quality-related costs and improved delivery precision. The study confirms the importance for efficient change of the design of the change process, and identifies 'improvement methodology' as the most important process characteristic. Improved working conditions are enhanced by added relevant strategic goals and by a participative implementation process.

PRINCIPLES OF ASSESSING THE SOCIAL EFFECTS BY IMPLEMENTING INVESTMENT PROJECTS

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Denis SIMOV

2013-12-01

Full Text Available Financial instruments are efficient – in terms of resource – mobilization of cohesion policy resources to achieve the objectives of the strategy. Rules of forming the investment strategy, particularly in State structures, by using the budget funds of the Republic of Moldova, must include as one of the criteria for project selection, the achieve of a positive social effect associated with its implementation.

A framework for effective implementation of lean production in Small and Medium-sized Enterprises

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Amine Belhadi

2016-09-01

Full Text Available Purpose: The present paper aims at developing an effective framework including all the components necessary for implementing lean production properly in Small and Medium-sized Enterprises. Design/methodology/approach: The paper begins with the review of the main existing framework of lean implementation in order to highlight shortcomings in the literature through a lack of suitable framework for small companies. To overcome this literature gap, data of successful initiatives of lean implementation were collected based on a multiple case study approach. These initiatives has been juxtaposed in order to develop a new, practical and effective framework that includes all the components (process, tools, success factors that are necessary to implement lean in Small and Medium-sized Enterprises. Findings: The proposed framework presents many significant contributions: First, it provides an overcoming for the limitations of the existing frameworks by proposing for consultants, researchers and organizations an effective framework for lean implementation in SMEs that allows SMEs to benefit from competitive advantages  gained by lean. Second, it brings together a set of the more essential and critical elements of lean implementation commonly used by SMEs and derived from the practical experiences of them in lean implementation. Finally, it highlights the successful experiences of small companies in implementing lean programs and then proves that lean can give a relevant results even for SMEs. Research limitations/implications: The proposed framework presents a number of limitations and still evokes extension for further researches: Although it was derived from practical experiences of SMEs, the proposed framework is not supported by practical implementation. On the other hand and even though the elements in the proposed framework from the practical experiences of four SMEs, the identified elements need to be generalized and enriching by conducting

Implementation of nonseparable exact exchange effects in the first-order nondegenerate adiabatic theory

International Nuclear Information System (INIS)

Abdolsalami, M.; Abdolsalami, F.; Gonzalez, H.R.

1994-01-01

We have implemented nonlocal exchange effects rigorously in the first-order nondegenerate adiabatic (FONDA) theory. This implementation requires solving integrodifferential equations that involve double integrals. Separable and model exchange approximations that simplify the inclusion of exchange in the scattering calculations have been previously implemented in the FONDA theory. The discrepancy between the exact exchange FONDA cross sections and the separable and model exchange results suggests that one needs to include exchange rigorously to obtain accurate results over a wide range of energies. Specifically, a difference of up to 30% is observed between the exact and separable exchange FONDA cross sections at near-threshold energies. At higher energies the FONDA results from the rigorous and model exchange implementations disagree by as much as 10%

Path-integral isomorphic Hamiltonian for including nuclear quantum effects in non-adiabatic dynamics

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Tao, Xuecheng; Shushkov, Philip; Miller, Thomas F.

2018-03-01

We describe a path-integral approach for including nuclear quantum effects in non-adiabatic chemical dynamics simulations. For a general physical system with multiple electronic energy levels, a corresponding isomorphic Hamiltonian is introduced such that Boltzmann sampling of the isomorphic Hamiltonian with classical nuclear degrees of freedom yields the exact quantum Boltzmann distribution for the original physical system. In the limit of a single electronic energy level, the isomorphic Hamiltonian reduces to the familiar cases of either ring polymer molecular dynamics (RPMD) or centroid molecular dynamics Hamiltonians, depending on the implementation. An advantage of the isomorphic Hamiltonian is that it can easily be combined with existing mixed quantum-classical dynamics methods, such as surface hopping or Ehrenfest dynamics, to enable the simulation of electronically non-adiabatic processes with nuclear quantum effects. We present numerical applications of the isomorphic Hamiltonian to model two- and three-level systems, with encouraging results that include improvement upon a previously reported combination of RPMD with surface hopping in the deep-tunneling regime.

Evaluation of an effective multifaceted implementation strategy for elective single-embryo transfer after in vitro fertilization.

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Kreuwel, I A M; van Peperstraten, A M; Hulscher, M E J L; Kremer, J A M; Grol, R P T M; Nelen, W L D M; Hermens, R P M G

2013-02-01

What is the relationship between the rate of elective single-embryo transfer (eSET) and couples' exposure to different elements of a multifaceted implementation strategy? Additional elements in a multifaceted implementation strategy do not result in an increased eSET rate. A multifaceted eSET implementation strategy with four different elements is effective in increasing the eSET rate by 11%. It is unclear whether every strategy element contributes equally to the strategy's effectiveness. An observational study was performed among 222 subfertile couples included in a previously performed randomized controlled trial. Of the 222 subfertile couples included, 109 couples received the implementation strategy and 113 couples received standard IVF care. A multivariate regression analysis assessed the effectiveness of four different strategy elements on the decision about the number embryos to be transferred. Questionnaires evaluated the experiences of couples with the different elements. Of the couples who received the implementation strategy, almost 50% (52/109) were exposed to all the four elements of the strategy. The remaining 57 couples who received two or three elements of the strategy could be divided into two further classes of exposure. Our analysis demonstrated that additional elements do not result in an increased eSET rate. In addition to the physician's advice, couples rated a decision aid and a counselling session as more important for their decision to transfer one or two embryos, compared with a phone call and a reimbursement offer (P implementation strategy does not always result in an increased effectiveness, which is in concordance with recent literature. This in-depth evaluation of a multifaceted intervention strategy could therefore help to modify strategies, by making them more effective and less expensive.

Improving contraceptive choice: fidelity of implementation and the gap between effectiveness and efficacy.

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Garbers, Samantha; Flandrick, Kathleen; Bermudez, Dayana; Meserve, Allison; Chiasson, Mary Ann

2014-11-01

Interventions to reduce unintended pregnancy through improved contraceptive use are a public health priority. A comprehensive process evaluation of a contraceptive assessment module intervention with demonstrated efficacy was undertaken. The 12-month process evaluation goal was to describe the extent to which the intervention was implemented as intended over time, and to identify programmatic adjustments to improve implementation fidelity. Quantitative and qualitative methods included staff surveys, electronic health record data, usage monitoring, and observations. Fidelity of implementation was low overall (framework enabled the research team to identify and address complexities inherent in effectiveness studies and facilitated the alignment of program and context. © 2014 Society for Public Health Education.

Policies for including disabled people in education. obstacles and facilitating factors for their implementation: Bucaramanga, 2010

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Claudia P. Serrano R

2011-07-01

Full Text Available Objective: to explore the factors enabling or hindering the implementation of inclusive education policies for the disabled population of Bucaramanga. Methodology: a descriptive study, involving representatives from governmental agencies (EG, members of the faculty boards of educational institutions (DIE and guardians of disabled individuals (APSD. Physical, social, and political obstacles and facilitating factors that could potentially determine the implementation of these policies were analyzed. Data was collected through interviews. Results: there was a total of 2, 32, and 34 participants from the EG, DIE, and APSD groups respectively. Identified obstacles included: lack of strategies to support educational institutions, poor or limited teacher training, high tuition fees, and negative attitude towards disability. The facilitating factors included: availability of places, inclusion of this issue in the political agenda, and desire of the disabled individuals’ families to provide them with education. Discussion: These findings provide useful information for further research on this issue and show how action has been taken, as well as how urgent it is to establish a direct relationship between academia and the public sector to propose strategies for assessing and modifying these policies.

Role, implementation, and effectiveness of advanced allied health assistants: a systematic review

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Stanhope J

2013-12-01

Full Text Available Jessica Stanhope,1 Claire Pearce21International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia; 2ACT (Australian Capital Territory Government Health Directorate, Canberra, ACT, AustraliaBackground: The purpose of this systematic review was to determine the effectiveness and implementation of advanced allied health assistant roles.Methods: A systematic search of seven databases and Google Scholar was conducted to identify studies published in English peer-reviewed journals from 2003 to 2013 and reporting on the effectiveness and implementation of advanced allied health assistant (A/AHA roles. Reference lists were also screened to identify additional studies, and the authors’ personal collections of studies were searched. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, and appraisal of higher-level studies (III-1 and above conducted using the Centre for Evidence Based Medicine Systematic Review Critical Appraisal Sheet for included systematic reviews or the PEDro scale for level II and III-1 studies. Data regarding country, A/AHA title, disciplines, competencies, tasks, level of autonomy, clients, training, and issues regarding the implementation of these roles were extracted, as were outcomes used and key findings for studies investigating their effectiveness.Results: Fifty-three studies were included, and most because they reported background information rather than investigating A/AHA roles, this representing low-level information. A/AHAs work in a range of disciplines, with a variety of client groups, and in a number of different settings. Little was reported regarding the training available for A/AHAs. Four studies investigated the effectiveness of these roles, finding that they were generally well accepted by clients, and provided more therapy time. Issues in integrating these new roles into existing health systems were also reported.Conclusion: A

Evaluating the effectiveness of implementing quality management practices in the medical industry.

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Yeh, T-M; Lai, H-P

2015-01-01

To discuss the effectiveness of 30 quality management practices (QMP) including Strategic Management, Balanced ScoreCard, Knowledge Management, and Total Quality Management in the medical industry. A V-shaped performance evaluation matrix is applied to identify the top ten practices that are important but not easy to use or implement. Quality Function Deployment (QFD) is then utilized to find key factors to improve the implementation of the top ten tools. The questionnaires were sent to the nursing staff and administrators in a hospital through e-mail and posts. A total of 250 copies were distributed and 217 copies were valid. The importance, easiness, and achievement (i.e., implementation level) of 30 quality management practices were used. Key factors for QMP implementation were sequenced in order of importance as top management involvement, inter-department communication and coordination, teamwork, hospital-wide participation, education and training, consultant professionalism, continuous internal auditing, computerized process, and incentive compensation. Top management can implement the V-shaped performance matrix to determine whether quality management practices need improvement and if so, utilize QFD to find the key factors for improvement.

A method for including external feed in depletion calculations with CRAM and implementation into ORIGEN

International Nuclear Information System (INIS)

Isotalo, A.E.; Wieselquist, W.A.

2015-01-01

Highlights: • A method for handling external feed in depletion calculations with CRAM. • Source term can have polynomial or exponentially decaying time-dependence. • CRAM with source term and adjoint capability implemented to ORIGEN in SCALE. • The new solver is faster and more accurate than the original solver of ORIGEN. - Abstract: A method for including external feed with polynomial time dependence in depletion calculations with the Chebyshev Rational Approximation Method (CRAM) is presented and the implementation of CRAM to the ORIGEN module of the SCALE suite is described. In addition to being able to handle time-dependent feed rates, the new solver also adds the capability to perform adjoint calculations. Results obtained with the new CRAM solver and the original depletion solver of ORIGEN are compared to high precision reference calculations, which shows the new solver to be orders of magnitude more accurate. Furthermore, in most cases, the new solver is up to several times faster due to not requiring similar substepping as the original one

Strategy Implementation Style and Public Service Effectiveness, Efficiency, and Equity

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Rhys Andrews

2017-02-01

Full Text Available Strategic decision-making theories suggest that organizations that combine rational and incremental strategy implementation styles are likely to perform better than those that emphasize a single style. To assess whether these arguments apply to the public sector; we explore the strategy implementation style and perceived service effectiveness, efficiency and equity of Turkish municipal government departments. Using fuzzy cluster analysis, we identify four distinctive though inter-related styles of strategy implementation in our sample organizations: logical-incremental; mostly rational; mostly incremental; and no clear approach. A logical-incremental and mostly rational style of implementation are associated with better effectiveness, efficiency and equity; with the absence of an implementation style associated with worse performance. Theoretical and practical implications are discussed.

A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes.

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Trogrlić, Zoran; van der Jagt, Mathieu; Bakker, Jan; Balas, Michele C; Ely, E Wesley; van der Voort, Peter H J; Ista, Erwin

2015-04-09

Despite recommendations from professional societies and patient safety organizations, the majority of ICU patients worldwide are not routinely monitored for delirium, thus preventing timely prevention and management. The purpose of this systematic review is to summarize what types of implementation strategies have been tested to improve ICU clinicians' ability to effectively assess, prevent and treat delirium and to evaluate the effect of these strategies on clinical outcomes. We searched PubMed, Embase, PsychINFO, Cochrane and CINAHL (January 2000 and April 2014) for studies on implementation strategies that included delirium-oriented interventions in adult ICU patients. Studies were suitable for inclusion if implementation strategies' efficacy, in terms of a clinical outcome, or process outcome was described. We included 21 studies, all including process measures, while 9 reported both process measures and clinical outcomes. Some individual strategies such as "audit and feedback" and "tailored interventions" may be important to establish clinical outcome improvements, but otherwise robust data on effectiveness of specific implementation strategies were scarce. Successful implementation interventions were frequently reported to change process measures, such as improvements in adherence to delirium screening with up to 92%, but relating process measures to outcome changes was generally not possible. In meta-analyses, reduced mortality and ICU length of stay reduction were statistically more likely with implementation programs that employed more (six or more) rather than less implementation strategies and when a framework was used that either integrated current evidence on pain, agitation and delirium management (PAD) or when a strategy of early awakening, breathing, delirium screening and early exercise (ABCDE bundle) was employed. Using implementation strategies aimed at organizational change, next to behavioral change, was also associated with reduced mortality

The effect of health information technology implementation in Veterans Health Administration hospitals on patient outcomes.

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Spetz, Joanne; Burgess, James F; Phibbs, Ciaran S

2014-03-01

The impact of health information technology (HIT) in hospitals is dependent in large part on how it is used by nurses. This study examines the impact of HIT on the quality of care in hospitals in the Veterans Health Administration (VA), focusing on nurse-sensitive outcomes from 1995 to 2005. Data were obtained from VA databases and original data collection. Fixed-effects Poisson regression was used, with the dependent variables measured using the Agency for Healthcare Research and Quality Inpatient Quality Indicators and Patient Safety Indicators software. Dummy variables indicated when each facility began and completed implementation of each type of HIT. Other explanatory variables included hospital volume, patient characteristics, nurse characteristics, and a quadratic time trend. The start of computerized patient record implementation was associated with significantly lower mortality for two diagnoses but significantly higher pressure ulcer rates, and full implementation was associated with significantly more hospital-acquired infections. The start of bar-code medication administration implementation was linked to significantly lower mortality for one diagnosis, but full implementation was not linked to any change in patient outcomes. The commencement of HIT implementation had mixed effects on patient outcomes, and the completion of implementation had little or no effect on outcomes. This longitudinal study provides little support for the perception of VA staff and leaders that HIT has improved mortality rates or nurse-sensitive patient outcomes. Future research should examine patient outcomes associated with specific care processes affected by HIT. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of a Tier 3 Self-Management Intervention Implemented with and without Treatment Integrity

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Lower, Ashley; Young, K. Richard; Christensen, Lynnette; Caldarella, Paul; Williams, Leslie; Wills, Howard

2016-01-01

This study investigated the effects of a Tier 3 peer-matching self-management intervention on two elementary school students who had previously been less responsive to Tier 1 and Tier 2 interventions. The Tier 3 self-management intervention, which was implemented in the general education classrooms, included daily electronic communication between…

Effects of a multifaceted implementation intervention to increase utilization of pharmacological treatments for alcohol use disorders in the US Veterans Health Administration.

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Harris, Alex H S; Brown, Randall; Dawes, Michael; Dieperink, Eric; Myrick, Donald Hugh; Gerould, Heather; Wagner, Todd H; Wisdom, Jennifer P; Hagedorn, Hildi J

2017-11-01

Over 16 million Americans meet diagnostic criteria for alcohol use disorder (AUD), but only 7.8% of them receive formal treatment each year. Safe and effective pharmacological treatments for AUD exist; however, they are rarely prescribed. Therefore, we developed and pilot tested a multifaceted implementation intervention to improve consideration and receipt of effective pharmacologic treatments for AUD, focusing on primary care settings where patients have the most frequent contact with healthcare systems. The intervention included training of local providers to serve as champions and a website for primary care providers that included educational materials, a case-finding dashboard, and contact information for local and national clinical experts. We also mailed patients educational material about treatment options. The intervention was implemented at three large facilities of the Veterans Health Administration (VHA). An interrupted time series design, analyzed with segmented logistic regression, was used to evaluate the intervention's effects. The odds of a patient with AUD receiving one of the AUD medications was increasing throughout the pre-implementation period, and the rate of change (slope) increased significantly in the implementation period. Translating these numbers into percentages, at baseline 2.9% of patients filled a prescription for an AUD medication within 30days of a primary care visit. This increased to 3.8% by the end of the pre-implementation period (increasing 0.037% per month), and increased to 5.2% by the end of the implementation period (increasing 0.142% per month). However, the intervention effect was not significant when control sites were added, suggesting that improvement may have been driven by secular trends rather than solely by this intervention. Although the intervention was feasible, it was not effective. Continued analysis of process and implementation data including qualitative interviews with key stakeholders, may elucidate the

Perception of Science Standards' Effectiveness and Their Implementation by Science Teachers

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Klieger, Aviva; Yakobovitch, Anat

2011-06-01

The introduction of standards into the education system poses numerous challenges and difficulties. As with any change, plans should be made for teachers to understand and implement the standards. This study examined science teachers' perceptions of the effectiveness of the standards for teaching and learning, and the extent and ease/difficulty of implementing science standards in different grades. The research used a mixed methods approach, combining qualitative and quantitative research methods. The research tools were questionnaires that were administered to elementary school science teachers. The majority of the teachers perceived the standards in science as effective for teaching and learning and only a small minority viewed them as restricting their pedagogical autonomy. Differences were found in the extent of implementation of the different standards and between different grades. The teachers perceived a different degree of difficulty in the implementation of the different standards. The standards experienced as easiest to implement were in the field of biology and materials, whereas the standards in earth sciences and the universe and technology were most difficult to implement, and are also those evaluated by the teachers as being implemented to the least extent. Exposure of teachers' perceptions on the effectiveness of standards and the implementation of the standards may aid policymakers in future planning of teachers' professional development for the implementation of standards.

Improving quality through effective implementation of information technology in healthcare.

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Øvretveit, John; Scott, Tim; Rundall, Thomas G; Shortell, Stephen M; Brommels, Mats

2007-10-01

To describe an implementation of one information technology system (electronic medical record, EMR) in one hospital, the perceived impact, the factors thought to help and hinder implementation and the success of the system and compare this with theories of effective IT implementation. To draw on previous research, empirical data from this study is used to develop IT implementation theory. Qualitative case study, replicating the methods and questions of a previously published USA EMR implementation study using semi-structured interviews and documentation. Large Swedish teaching hospital shortly after a merger of two hospital sites. Thirty senior clinicians, managers, project team members, doctors and nurses. The Swedish implementation was achieved within a year and for under half the budget, with a generally popular EMR which was thought to save time and improve the quality of patient care. Evidence from this study and findings from the more problematic USA implementation case suggests that key factors for cost effective implementation and operation were features of the system itself, the implementation process and the conditions under which the implementation was carried out. There is empirical support for the IT implementation theory developed in this study, which provides a sound basis for future research and successful implementation. Successful implementation of an EMR is likely with an intuitive system, requiring little training, already well developed for clinical work but allowing flexibility for development, where clinicians are involved in selection and in modification for their department needs and where a realistic timetable is made using an assessment of the change-capability of the organization. Once a system decision is made, the implementation should be driven by top and departmental leaders assisted by competent project teams involving information technology specialists and users. Corrections for unforeseen eventualities will be needed, especially

An effective implementation scheme of just-in-time protocol for optical burst switching networks

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Wu, Guiling; Li, Xinwan; Chen, Jian-Ping; Wang, Hui

2005-02-01

Optical burst switching (OBS) has been emerging as a promising technology that can effectively support the next generation IP-oriented transportation networks. JIT signaling protocol for OBS is relatively simple and easy to be implemented by hardware. This paper presented an effective scheme to implement the JIT protocol, which not only can effectively implement reservation and release of optical channels based on JIT, but also can process the failure of channel reservation and release due to loss of burst control packets. The scheme includes: (1) a BHP (burst head packet) path table is designed and built at each OBS node. It is used to guarantee the corresponding burst control packet, i.e. BHP, BEP (burst end packet) and BEP_ACK (BEP acknowledgement), to be transmitted in the same path. (2) The timed retransmission of BEP and the reversed deletion of the item in BHP path tables triggered by the corresponding BEP_ACK are combined to solve the problems caused by the loss of the signaling messages in channel reservation and release process. (3) Burst head packets and BEP_ACK are transmitted using "best-effort" method. Related signaling messages and their formats for the proposed scheme are also given.

Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials.

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Brookman-Frazee, Lauren; Stahmer, Aubyn C

2018-05-09

The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS

Planning what not to eat: ironic effects of implementation intentions negating unhealthy habits.

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Adriaanse, Marieke A; van Oosten, Johanna M F; de Ridder, Denise T D; de Wit, John B F; Evers, Catharine

2011-01-01

The present studies tested the effectiveness of implementation intentions with an "if [situation], then not [habitual response]" structure. Based on ironic process theory and the literature on the processing of negations, it was expected that these "negation implementation intentions" would, ironically, strengthen the habit (situation-response association) one aims to break. In line with the hypotheses, forming negation implementation intentions resulted in cognitive ironic rebound effects as well as behavioral ironic rebound effects compared to an intention only condition or a replacement implementation intention. Additionally, it was found that negation implementation intentions are most likely to result in ironic rebound effects when the habit to be negated is strong. Although implementation intentions are generally highly effective in facilitating behavior change even when this involves breaking unwanted habits, the present research suggests that they are ineffective when they have a negating structure.

Issues for effective implementation of burnup credit

International Nuclear Information System (INIS)

Parks, C.V.; Wagner, J.C.

2001-01-01

In the United States, burnup credit has been used in the criticality safety evaluation for storage pools at pressurized water reactors (PWRs) and considerable work has been performed to lay the foundation for use of burnup credit in dry storage and transport cask applications and permanent disposal applications. Many of the technical issues related to the basic physics phenomena and parameters of importance are similar in each of these applications. However, the nuclear fuel cycle in the United States has never been fully integrated and the implementation of burnup credit to each of these applications is dependent somewhat on the specific safety bases developed over the history of each operational area. This paper will briefly review the implementation status of burnup credit for each application area and explore some of the remaining issues associated with effective implementation of burnup credit. (author)

Finite element modeling of contaminant transport in soils including the effect of chemical reactions.

Science.gov (United States)

Javadi, A A; Al-Najjar, M M

2007-05-17

The movement of chemicals through soils to the groundwater is a major cause of degradation of water resources. In many cases, serious human and stock health implications are associated with this form of pollution. Recent studies have shown that the current models and methods are not able to adequately describe the leaching of nutrients through soils, often underestimating the risk of groundwater contamination by surface-applied chemicals, and overestimating the concentration of resident solutes. Furthermore, the effect of chemical reactions on the fate and transport of contaminants is not included in many of the existing numerical models for contaminant transport. In this paper a numerical model is presented for simulation of the flow of water and air and contaminant transport through unsaturated soils with the main focus being on the effects of chemical reactions. The governing equations of miscible contaminant transport including advection, dispersion-diffusion and adsorption effects together with the effect of chemical reactions are presented. The mathematical framework and the numerical implementation of the model are described in detail. The model is validated by application to a number of test cases from the literature and is then applied to the simulation of a physical model test involving transport of contaminants in a block of soil with particular reference to the effects of chemical reactions. Comparison of the results of the numerical model with the experimental results shows that the model is capable of predicting the effects of chemical reactions with very high accuracy. The importance of consideration of the effects of chemical reactions is highlighted.

The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: a systematic review.

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Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Lane, Haylee; Haines, Terry P

2017-11-14

It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors. An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1

Estimating the Cost-Effectiveness of Implementation: Is Sufficient Evidence Available?

Science.gov (United States)

Whyte, Sophie; Dixon, Simon; Faria, Rita; Walker, Simon; Palmer, Stephen; Sculpher, Mark; Radford, Stefanie

2016-01-01

Timely implementation of recommended interventions can provide health benefits to patients and cost savings to the health service provider. Effective approaches to increase the implementation of guidance are needed. Since investment in activities that improve implementation competes for funding against other health generating interventions, it should be assessed in term of its costs and benefits. In 2010, the National Institute for Health and Care Excellence released a clinical guideline recommending natriuretic peptide (NP) testing in patients with suspected heart failure. However, its implementation in practice was variable across the National Health Service in England. This study demonstrates the use of multi-period analysis together with diffusion curves to estimate the value of investing in implementation activities to increase uptake of NP testing. Diffusion curves were estimated based on historic data to produce predictions of future utilization. The value of an implementation activity (given its expected costs and effectiveness) was estimated. Both a static population and a multi-period analysis were undertaken. The value of implementation interventions encouraging the utilization of NP testing is shown to decrease over time as natural diffusion occurs. Sensitivity analyses indicated that the value of the implementation activity depends on its efficacy and on the population size. Value of implementation can help inform policy decisions of how to invest in implementation activities even in situations in which data are sparse. Multi-period analysis is essential to accurately quantify the time profile of the value of implementation given the natural diffusion of the intervention and the incidence of the disease. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Towards an Effective Management Strategy for Passive RFID Implementation

National Research Council Canada - National Science Library

Fisch, John N; Koch, David M

2004-01-01

.... However, many issues central to passive RFID implementation remain unresolved. First and foremost, a comprehensive management strategy, including a complete redesign of business practices, must be developed...

Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

Directory of Open Access Journals (Sweden)

Hage Eveline

2013-01-01

Full Text Available Abstract Background An ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities? Methods We conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption. Results Of the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the

Water quality management and climate change mitigation: cost-effectiveness of joint implementation in the Baltic Sea region

DEFF Research Database (Denmark)

Nainggolan, Doan; Hasler, Berit; Andersen, Hans Estrup

2018-01-01

of contrasting strategies: single environmental objective management versus joint implementation strategy. The results show that implementing land-based measures with a sole focus on water quality (to meet the HELCOM's 2013 Baltic Sea Action Plan nutrient abatement targets) can produce climate change mitigation......This paper explores the scope for simultaneously managing nutrient abatement and climate change mitigation in the Baltic Sea (BS) region through the implementation of a selection of measures. The analysis is undertaken using a cost-minimisation model for the entire BS region, the BALTCOST model....... In the present research, the model has been extended to include greenhouse gas (GHG) emissions effects, enabling us to analyse the tradeoffs between cost-effective GHG and nutrient load reductions. We run the model for four different scenarios in order to compare the environmental and economic consequences...

Implementation aspects of the Boundary Element Method including viscous and thermal losses

DEFF Research Database (Denmark)

Cutanda Henriquez, Vicente; Juhl, Peter Møller

2014-01-01

The implementation of viscous and thermal losses using the Boundary Element Method (BEM) is based on the Kirchhoff’s dispersion relation and has been tested in previous work using analytical test cases and comparison with measurements. Numerical methods that can simulate sound fields in fluids...

Implementation Strategies for Educational Intranet Resources.

Science.gov (United States)

Herson, Katie; Sosabowski, Michael; Lloyd, Andrew; Flowers, Stephen; Paine, Cameron; Newton, Becci

2000-01-01

Describes two alternative strategies for intranet implementation based on experiences at the University of Brighton (United Kingdom). Highlights include differing degrees of staff and student utilization; barriers to success; a unified strategy for effective intranet implementation; and how to manage organizational resistance to change.…

Pilot implementation Driven by Effects Specifications and Formative Usability Evaluation

DEFF Research Database (Denmark)

Barlach, Anders; Hertzum, Morten; Simonsen, Jesper

2013-01-01

This chapter reports on the usability-engineering work performed throughout the pilot implementation of an Electronic Healthcare Record (EHR). The case describes and analyzes the use of pilot implementations to formatively evaluate whether the usability of the EHR meets the effects specified for ...

Forest Strategy in Republic of Macedonia: Barriers to Effective Implementation

Directory of Open Access Journals (Sweden)

Jana Baumgartner

2014-06-01

Full Text Available Background and Purpose: In recent years, implementation of forest strategies and programs has been acknowledged as an important phase of the forest policy process. Forest policies such as conflict management concepts between deferent interests of stakeholders, are a dynamic route that needs to be managed carefully to achieve its goals. Creation of the forest policy document entitled “Strategy for sustainable development of forestry in Republic of Macedonia” was introduced for the first time in 2005 as cooperation between the Government and United Nations Food and Agriculture Organization (FAO. Action Plan was brought in the same year including the strategy and validity until the end of the year 2009 now is out of date for undetermined reasons, due to lack of analysis of the level of implementation, monitoring and evaluation. Materials and Methods: Through exploratory qualitative method using a case study, this paper attempts to explore different stakeholders perception of the most common barriers for implementation of the Strategy for sustainable development of forests in Republic of Macedonia and ascertain if implementation variables are identified as barriers in the implementation stage. Results: The research showed that environmental and organisational barriers such as legal restrictions, political willingness, social change, control, leadership and clear responsibility are the most common barriers impeding forest strategy implementation in Macedonia. Conclusions: The paper concluded that the three year action plan was too ambitious, given the existing human and technical capacities in the forestry sector, recommending participation of all included stakeholders in the implementation as an important fact in overcoming the current barriers and moving forward the process.

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

Science.gov (United States)

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

2018-04-01

To conduct a systematic review of the effectiveness of consultation recordings and identify factors contributing to their successful implementation in health-care settings. A systematic review was conducted for quantitative studies examining the effectiveness of consultation recordings in health care. Two independent reviewers assessed the relevance and quality of retrieved quantitative studies by using standardized criteria. Study findings were examined to determine consultation recording effectiveness and to identify barriers and facilitators to implementation. A supplementary review of qualitative evidence was performed to further explicate implementation factors. Of the 3373 articles retrieved in the quantitative search, 26 satisfied the standardized inclusion criteria (12 randomized controlled trials, 1 quasi-experiment, and 13 cross-sectional studies). Most patients found consultation recordings beneficial. Statistically significant evidentiary support was found for the beneficial impact of consultation recordings on the following patient reported outcomes: knowledge, perception of being informed, information recall, decision-making factors, anxiety, and depression. Implementation barriers included strength of evidence concerns, patient distress, impact of the recording on consultation quality, clinic procedures, medico-legal issues, and resource costs. Facilitators included comfort with being recorded, clinical champions, legal strategies, efficient recording procedures, and a positive consultation recording experience. Consultation recordings are valuable to patients and positively associated with patient-reported outcomes. Successful integration of consultation recording use into clinical practice requires an administratively supported, systematic approach to addressing implementation factors. Copyright © 2017 John Wiley & Sons, Ltd.

Tuberculosis active case finding in Cambodia: a pragmatic, cost-effectiveness comparison of three implementation models.

Science.gov (United States)

James, Richard; Khim, Keovathanak; Boudarene, Lydia; Yoong, Joanne; Phalla, Chea; Saint, Saly; Koeut, Pichenda; Mao, Tan Eang; Coker, Richard; Khan, Mishal Sameer

2017-08-22

Globally, almost 40% of tuberculosis (TB) patients remain undiagnosed, and those that are diagnosed often experience prolonged delays before initiating correct treatment, leading to ongoing transmission. While there is a push for active case finding (ACF) to improve early detection and treatment of TB, there is extremely limited evidence about the relative cost-effectiveness of different ACF implementation models. Cambodia presents a unique opportunity for addressing this gap in evidence as ACF has been implemented using different models, but no comparisons have been conducted. The objective of our study is to contribute to knowledge and methodology on comparing cost-effectiveness of alternative ACF implementation models from the health service perspective, using programmatic data, in order to inform national policy and practice. We retrospectively compared three distinct ACF implementation models - door to door symptom screening in urban slums, checking contacts of TB patients, and door to door symptom screening focusing on rural populations aged above 55 - in terms of the number of new bacteriologically-positive pulmonary TB cases diagnosed and the cost of implementation assuming activities are conducted by the national TB program of Cambodia. We calculated the cost per additional case detected using the alternative ACF models. Our analysis, which is the first of its kind for TB, revealed that the ACF model based on door to door screening in poor urban areas of Phnom Penh was the most cost-effective (249 USD per case detected, 737 cases diagnosed), followed by the model based on testing contacts of TB patients (308 USD per case detected, 807 cases diagnosed), and symptomatic screening of older rural populations (316 USD per case detected, 397 cases diagnosed). Our study provides new evidence on the relative effectiveness and economics of three implementation models for enhanced TB case finding, in line with calls for data from 'routine conditions' to be included

The effect of motor imagery with specific implement in expert badminton player.

Science.gov (United States)

Wang, Z; Wang, S; Shi, F-Y; Guan, Y; Wu, Y; Zhang, L-L; Shen, C; Zeng, Y-W; Wang, D-H; Zhang, J

2014-09-05

Motor skill can be improved with mental simulation. Implements are widely used in daily life and in various sports. However, it is unclear whether the utilization of implements enhances the effect of mental simulation. The present study was designed to investigate the different effects of motor imagery in athletes and novices when they handled a specific implement. We hypothesize that athletes have better motor imagery ability than novices when they hold a specific implement for the sport. This is manifested as higher motor cortical excitability in athletes than novices during motor imagery with the specific implement. Sixteen expert badminton players and 16 novices were compared when they held a specific implement such as a badminton racket and a non-specific implement such as a a plastic bar. Motor imagery ability was measured with a self-evaluation questionnaire. Transcranial magnetic stimulation was used to test the motor cortical excitability during motor imagery. Motor-evoked potentials (MEPs) in the first dorsal interosseous (FDI) and extensor carpi radialis muscles were recorded. Athletes reported better motor imagery than novices when they held a specific implement. Athletes exhibited more MEP facilitation than novices in the FDI muscle with the specific implement applied during motor imagery. The MEP facilitation is correlated with motor imagery ability in athletes. We conclude that the effects of motor imagery with a specific implement are enhanced in athletes compared to novices and the difference between two groups is caused by long-term physical training of athletes with the specific implement. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.

Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework.

Science.gov (United States)

Little, Elizabeth A; Presseau, Justin; Eccles, Martin P

2015-06-17

Behavioural theory can be used to better understand the effects of behaviour change interventions targeting healthcare professional behaviour to improve quality of care. However, the explicit use of theory is rarely reported despite interventions inevitably involving at least an implicit idea of what factors to target to implement change. There is a quality of care gap in the post-fracture investigation (bone mineral density (BMD) scanning) and management (bisphosphonate prescription) of patients at risk of osteoporosis. We aimed to use the Theoretical Domains Framework (TDF) within a systematic review of interventions to improve quality of care in post-fracture investigation. Our objectives were to explore which theoretical factors the interventions in the review may have been targeting and how this might be related to the size of the effect on rates of BMD scanning and osteoporosis treatment with bisphosphonate medication. A behavioural scientist and a clinician independently coded TDF domains in intervention and control groups. Quantitative analyses explored the relationship between intervention effect size and total number of domains targeted, and as number of different domains targeted. Nine randomised controlled trials (RCTs) (10 interventions) were analysed. The five theoretical domains most frequently coded as being targeted by the interventions in the review included "memory, attention and decision processes", "knowledge", "environmental context and resources", "social influences" and "beliefs about consequences". Each intervention targeted a combination of at least four of these five domains. Analyses identified an inverse relationship between both number of times and number of different domains coded and the effect size for BMD scanning but not for bisphosphonate prescription, suggesting that the more domains the intervention targeted, the lower the observed effect size. When explicit use of theory to inform interventions is absent, it is possible to

Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission.

Science.gov (United States)

Lea, Marianne; Barstad, Ingeborg; Mathiesen, Liv; Mowe, Morten; Molden, Espen

2016-02-01

Medication discrepancies at hospital admission is an extensive problem and knowledge is limited regarding improvement strategies. To investigate the effect of teaching and checklist implementation on accuracy of medication history recording during hospitalization. Patients admitted to an internal medicine ward were prospectively included in two consecutive periods. Between the periods, non-mandatory teaching lessons were provided and a checklist assisting medication history recording implemented. Discrepancies between the recorded medications at admission and the patient's actual drug use, as revealed by pharmacist-conducted medication reconciliation, were compared between the periods. The primary endpoint was difference between the periods in proportion of patients with minimum one discrepancy. Difference in median number of discrepancies was included as a secondary endpoint. 56 and 119 patients were included in period 1 (P1) and period 2 (P2), respectively. There was no significant difference in proportion of patients with minimum one discrepancy in P2 (68.9 %) versus P1 (76.8 %, p = 0.36), but a tendency of lower median number of discrepancies was observed in P2 than P1, i.e. 1 and 2, respectively (p = 0.087). More powerful strategies than non-mandatory teaching activities and checklist implementation are required to achieve sufficient improvements in medication history recording during hospitalization.

Effective Implementation of Counselling Curriculum and National ...

African Journals Online (AJOL)

This study looked at the effective implementation of counselling curriculum and national policy on education in Cross River State public secondary schools. It employed the descriptive survey method. It made use of three hypotheses, 230 secondary schools as its population, 1,900 students (854 boys and 1,046 girls) as ...

Optimal Design and Real Time Implementation of Autonomous Microgrid Including Active Load

OpenAIRE

Mohamed A. Hassan; Muhammed Y. Worku; Mohamed A. Abido

2018-01-01

Controller gains and power-sharing parameters are the main parameters affect the dynamic performance of the microgrid. Considering an active load to the autonomous microgrid, the stability problem will be more involved. In this paper, the active load effect on microgrid dynamic stability is explored. An autonomous microgrid including three inverter-based distributed generations (DGs) with an active load is modeled and the associated controllers are designed. Controller gains of the inverters ...

Assessing and comparing the short-term effects of TPB only and TPB plus implementation intentions interventions on snacking behavior in Iranian adolescent girls: a cluster randomized trial.

Science.gov (United States)

Karimi-Shahanjarini, Akram; Rashidian, Arash; Omidvar, Nasrin; Majdzadeh, Reza

2013-01-01

The evidence for the effectiveness of theory of planned behavior (TPB)-based interventions is mixed. There is also mixed evidence on the effectiveness of adding implementation intentions to TPB-based interventions. In this study we assessed and compared the short-term effects of TPB-only intervention and TPB plus implementation intentions intervention on snacking behavior and intention to consume unhealthy snacks in Iranian adolescent girls. Three-arm cluster randomized controlled trial. Ten middle schools in Tehran (Iran). A total of 29 classes included 739 female adolescents (age range: 12-15 years). Intervention. Two brief interventions including TPB-only intervention and TPB plus implementation intentions intervention. Food frequency questionnaire and intentions at baseline, 10 days, and 3 months measuring snacking behavior and cognitions about unhealthy snack consumption, respectively. Hierarchical linear modeling to assess the interventions' effects. Both interventions successfully decreased intention to consume and consumption of unhealthy snacks at postintervention. Calculation of the effect sizes revealed that the TPB plus implementation intentions intervention was more effective than the TPB-only intervention. The effects remained significant at 3-month follow-up in the TPB plus implementation intentions intervention group only, although the effect size decreased. Overall, the study suggests that adding implementation intentions on top of TPB-based persuasive messages improves effectiveness and sustainability of desirable changes.

pH-Free Measurement of Relative Acidities, Including Isotope Effects.

Science.gov (United States)

Perrin, Charles L

2017-01-01

A powerful pH-free multicomponent NMR titration method can measure relative acidities, even of closely related compounds, with excellent accuracy. The history of the method is presented, along with details of its implementation and a comparison with earlier NMR titrations using a pH electrode. Many of its areas of applicability are described, especially equilibrium isotope effects. The advantages of the method, some practical considerations, and potential pitfalls are considered. © 2017 Elsevier Inc. All rights reserved.

Implementation and Effectiveness of Student Affairs Services Program in One Polytechnic College

Directory of Open Access Journals (Sweden)

Jose Ariel R. Ibarrientos

2015-12-01

Full Text Available Descriptive survey using questionnaire was employed to determine the extent of implementation and effectiveness of the Student Affairs Services Program of Camarines Sur Polytechnic Colleges in the Philippines for School Year 2012-2013. Generally, administrators, teachers and students articulated that CSPC’s Student Affairs Services Program was effectively implemented. Of the services provided, Guidance and Counselling and Housing Services show lower significant results in terms of effectiveness. T-test shows that there is no significant difference between its implementation and effectiveness. Significant agreements between the three groups of respondents were identified using the Kendall Coefficient of Concordance. Improvement of the delivery of CSPC’s Student Affairs Services Program will be effective upon adopting the researcher’s Comprehensive Development Plan.

Microfluidic System Simulation Including the Electro-Viscous Effect

Science.gov (United States)

Rojas, Eileen; Chen, C. P.; Majumdar, Alok

2007-01-01

This paper describes a practical approach using a general purpose lumped-parameter computer program, GFSSP (Generalized Fluid System Simulation Program) for calculating flow distribution in a network of micro-channels including electro-viscous effects due to the existence of electrical double layer (EDL). In this study, an empirical formulation for calculating an effective viscosity of ionic solutions based on dimensional analysis is described to account for surface charge and bulk fluid conductivity, which give rise to electro-viscous effect in microfluidics network. Two dimensional slit micro flow data was used to determine the model coefficients. Geometry effect is then included through a Poiseuille number correlation in GFSSP. The bi-power model was used to calculate flow distribution of isotropically etched straight channel and T-junction microflows involving ionic solutions. Performance of the proposed model is assessed against experimental test data.

Effects of implementing electronic medical records on primary care billings and payments: a before-after study.

Science.gov (United States)

Jaakkimainen, R Liisa; Shultz, Susan E; Tu, Karen

2013-09-01

billings or government payments for office visits. Further economic analyses are needed to measure the effects of EMR implementation on productivity and the costs of implementing an EMR system, including the costs of nonclinical work by physicians and their staff.

Effects of implementing electronic medical records on primary care billings and payments: a before–after study

Science.gov (United States)

Shultz, Susan E.; Tu, Karen

2013-01-01

primary care physicians did not result in decreased billings or government payments for office visits. Further economic analyses are needed to measure the effects of EMR implementation on productivity and the costs of implementing an EMR system, including the costs of nonclinical work by physicians and their staff. PMID:25077111

Cost basis for implementing ALARA programs

International Nuclear Information System (INIS)

Kent, C.E.

1985-01-01

A method of implementing effective ALARA programs is discussed. A basic element of the cost benefit methodology is the valuation of a man-rem. In the program, this is derived from an assessment of radiation exposure risk and societal valuation of harmful effects. The man-rem value is used as an element in the cost benefit analysis. The analysis includes an assessment of the differential man-rem resulting from the action, implementation cost, and operational savings

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

Science.gov (United States)

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

2018-03-01

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

Evaluating the effect of structural dimensions on the successful implementation of strategies in Payam-e-noor University of Iran

Directory of Open Access Journals (Sweden)

Hamidreza Shahhosseini

2013-07-01

Full Text Available This study aims to assess the relationship between structural dimensions of organization including centralization, complexity and formalization on one side and strategy effectiveness on the other side. Structural dimensions are determined based on Robbins theory, and each of them is considered as independent variables of research. Strategy effectiveness, which includes achieving strategic goals or successful implementation of strategies are the independent variable of the research, based on Noble’s strategy implementation model. One primary thesis and three secondary these are defined. This is a descriptive research of two variable correlation. The target population includes 600 senior managers of Payam-e-noor university around the country, including staff administrative managers, province and unit headmasters, of Iran at the time of data collection. Simple random sampling is used, with sample size of 120. Library resources are used for theoretical foundation data collection and note-taking. Questionnaires are used to collect data and evaluate research theses. Inferential Statistics and Pearson correlation coefficient are used to analyze the research theses. The first two theses are confirmed, at 95% and 99% respectively, but the third thesis is rejected based on the collected data. Therefore, based on this study, complexity and formalization have respectively inverse and direct effect on strategy effectiveness, but centralization does not affect strategy effectiveness in Payam-e-noor University.

Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.

Science.gov (United States)

Becker, Annette; Held, Heiko; Redaelli, Marcus; Chenot, Jean F; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M; Donner-Banzhoff, Norbert; Strauch, Konstantin

2012-04-15

Cost-effectiveness analysis alongside a cluster randomized controlled trial. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking. This analysis was performed alongside a cluster randomized controlled trial on the effectiveness of 2 GI strategies (physician education alone [GI] or physician education in combination with motivational counseling [MC] by practice nurses)--both compared with the postal dissemination of the guideline (control group, C). Sociodemographic data, pain characteristics, and cost data were collected by interview at baseline and after 6 and 12 months. low back pain-related health care costs were valued for 2004 from the societal perspective. For the cost analysis, 1322 patients from 126 general practices were included. Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls. In addition, both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data. Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.

Implementation and effectiveness of antiretroviral therapy in Greenland

DEFF Research Database (Denmark)

Lohse, N.; Ladefoged, K.; Obel, N.

2008-01-01

Analyses from the Danish HIV Cohort Study showed that, despite comparable economic means and general education of healthcare personnel, antiretroviral treatment of HIV in Greenland began later and has been implemented at a slower pace with lower therapeutic effectiveness than in Denmark. However...

Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care : A systematic review

NARCIS (Netherlands)

Suman, Arnela; Dikkers, Marije F.; Schaafsma, Frederieke G.; van Tulder, Maurits W.; Anema, Johannes R.

2016-01-01

Background: For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no

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

Science.gov (United States)

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

2014-11-01

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

Classroom Teachers' Perceptions of the Implementation and Effects of Full Inclusion.

Science.gov (United States)

Sardo-Brown, Deborah; Hinson, Stephanie

1995-01-01

Describes a survey of 51 graduate students/full-time teachers at schools implementing full inclusion programs. Participants expressed their views concerning implementation methods, effects on instructional practices, community reactions, and advantages and disadvantages. Schools need to do a better job of explaining the rationale for full…

Slideline verification for multilayer pressure vessel and piping analysis including tangential motion

International Nuclear Information System (INIS)

Van Gulick, L.A.

1984-01-01

Nonlinear finite element method (FEM) computer codes with slideline algorithm implementations should be useful for the analysis of prestressed multilayer pressure vessels and piping. This paper presents closed form solutions including the effects of tangential motion useful for verifying slideline implementations for this purpose. The solutions describe stresses and displacements of a long internally pressurized elastic-plastic cylinder initially separated from an elastic outer cylinder by a uniform gap. Comparison of closed form and FEM results evaluates the usefulness of the closed form solution and the validity of the sideline implementation used

COSMOS--improving the quality of life in nursing home patients: protocol for an effectiveness-implementation cluster randomized clinical hybrid trial.

Science.gov (United States)

Husebo, Bettina S; Flo, Elisabeth; Aarsland, Dag; Selbaek, Geir; Testad, Ingelin; Gulla, Christine; Aasmul, Irene; Ballard, Clive

2015-09-15

Nursing home patients have complex mental and physical health problems, disabilities and social needs, combined with widespread prescription of psychotropic drugs. Preservation of their quality of life is an important goal. This can only be achieved within nursing homes that offer competent clinical conditions of treatment and care. COmmunication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, Safety (COSMOS) is an effectiveness-implementation hybrid trial that combines and implements organization of activities evidence-based interventions to improve staff competence and thereby the patients' quality of life, mental health and safety. The aim of this paper is to describe the development, content and implementation process of the COSMOS trial. COSMOS includes a 2-month pilot study with 128 participants distributed among nine Norwegian nursing homes, and a 4-month multicenter, cluster randomized effectiveness-implementation clinical hybrid trial with follow-up at month 9, including 571 patients from 67 nursing home units (one unit defined as one cluster). Clusters are randomized to COSMOS intervention or current best practice (control group). The intervention group will receive a 2-day education program including written guidelines, repeated theoretical and practical training (credited education of caregivers, physicians and nursing home managers), case discussions and role play. The 1-day midway evaluation, information and interviews of nursing staff and a telephone hotline all support the implementation process. Outcome measures include quality of life in late-stage dementia, neuropsychiatric symptoms, activities of daily living, pain, depression, sleep, medication, cost-utility analysis, hospital admission and mortality. Despite complex medical and psychosocial challenges, nursing home patients are often treated by staff possessing low level skills, lacking education and in facilities with a high staff turnover

BIOLOGIC AND ECONOMIC EFFECTS OF INCLUDING DIFFERENT ...

African Journals Online (AJOL)

The biologic and economic effects of including three agro-industrial by-products as ingredients in turkey poult diets were investigated using 48 turkey poults in a completely randomised design experiment. Diets were formulated to contain the three by-products – wheat offal, rice husk and palm kernel meal, each at 20% level ...

LTRACK: Beam-transport calculation including wakefield effects

International Nuclear Information System (INIS)

Chan, K.C.D.; Cooper, R.K.

1988-01-01

LTRACK is a first-order beam-transport code that includes wakefield effects up to quadrupole modes. This paper will introduce the readers to this computer code by describing the history, the method of calculations, and a brief summary of the input/output information. Future plans for the code will also be described

Implementing effective and sustainable multidisciplinary clinical thoracic oncology programs.

Science.gov (United States)

Osarogiagbon, Raymond U; Freeman, Richard K; Krasna, Mark J

2015-08-01

Three models of care are described, including two models of multidisciplinary care for thoracic malignancies. The pros and cons of each model are discussed, the evidence supporting each is reviewed, and the need for more (and better) research into care delivery models is highlighted. Key stakeholders in thoracic oncology care delivery outcomes are identified, and the need to consider stakeholder perspectives in designing, validating and implementing multidisciplinary programs as a vehicle for quality improvement in thoracic oncology is emphasized. The importance of reconciling stakeholder perspectives, and identify meaningful stakeholder-relevant benchmarks is also emphasized. Metrics for measuring program implementation and overall success are proposed.

Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.

Directory of Open Access Journals (Sweden)

K M Holtzer-Goor

Full Text Available Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS located with the general practitioner (GP. This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer, home care, informal care, and implementation costs.With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%, or receive care for containment only. In both of these groups no health gains were achieved.Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

An Effective Implementation of K-opt Moves for the Lin-Kernighan TSP Heuristic

DEFF Research Database (Denmark)

Helsgaun, Keld

Local search with k-change neighborhoods, k-opt, is the most widely used heuristic method for the traveling salesman problem (TSP). This report presents an effective implementation of k-opt for the Lin- Kernighan TSP heuristic. The effectiveness of the implementation is demonstrated with extensive...

Designing systematic conservation assessments that promote effective implementation: best practice from South Africa.

Science.gov (United States)

Knight, Andrew T; Driver, Amanda; Cowling, Richard M; Maze, Kristal; Desmet, Philip G; Lombard, Amanda T; Rouget, Mathieu; Botha, Mark A; Boshoff, Andre F; Castley, J Guy; Goodman, Peter S; Mackinnon, Kathy; Pierce, Shirley M; Sims-Castley, Rebecca; Stewart, Warrick I; von Hase, Amrei

2006-06-01

Systematic conservation assessment and conservation planning are two distinct fields of conservation science often confused as one and the same. Systematic conservation assessment is the technical, often computer-based, identification of priority areas for conservation. Conservation planning is composed of a systematic conservation assessment coupled with processes for development of an implementation strategy and stakeholder collaboration. The peer-reviewed conservation biology literature abounds with studies analyzing the performance of assessments (e.g., area-selection techniques). This information alone, however can never deliver effective conservation action; it informs conservation planning. Examples of how to translate systematic assessment outputs into knowledge and then use them for "doing" conservation are rare. South Africa has received generous international and domestic funding for regional conservation planning since the mid-1990s. We reviewed eight South African conservation planning processes and identified key ingredients of best practice for undertaking systematic conservation assessments in a way that facilitates implementing conservation action. These key ingredients include the design of conservation planning processes, skills for conservation assessment teams, collaboration with stakeholders, and interpretation and mainstreaming of products (e.g., maps) for stakeholders. Social learning institutions are critical to the successful operationalization of assessments within broader conservation planning processes and should include not only conservation planners but also diverse interest groups, including rural landowners, politicians, and government employees.

Including nonadditive genetic effects in mating programs to maximize dairy farm profitability.

Science.gov (United States)

Aliloo, H; Pryce, J E; González-Recio, O; Cocks, B G; Goddard, M E; Hayes, B J

2017-02-01

We compared the outcome of mating programs based on different evaluation models that included nonadditive genetic effects (dominance and heterozygosity) in addition to additive effects. The additive and dominance marker effects and the values of regression on average heterozygosity were estimated using 632,003 single nucleotide polymorphisms from 7,902 and 7,510 Holstein cows with calving interval and production (milk, fat, and protein yields) records, respectively. Expected progeny values were computed based on the estimated genetic effects and genotype probabilities of hypothetical progeny from matings between the available genotyped cows and the top 50 young genomic bulls. An index combining the traits based on their economic values was developed and used to evaluate the performance of different mating scenarios in terms of dollar profit. We observed that mating programs with nonadditive genetic effects performed better than a model with only additive effects. Mating programs with dominance and heterozygosity effects increased milk, fat, and protein yields by up to 38, 1.57, and 1.21 kg, respectively. The inclusion of dominance and heterozygosity effects decreased calving interval by up to 0.70 d compared with random mating. The average reduction in progeny inbreeding by the inclusion of nonadditive genetic effects in matings compared with random mating was between 0.25 to 1.57 and 0.64 to 1.57 percentage points for calving interval and production traits, respectively. The reduction in inbreeding was accompanied by an average of A$8.42 (Australian dollars) more profit per mating for a model with additive, dominance, and heterozygosity effects compared with random mating. Mate allocations that benefit from nonadditive genetic effects can improve progeny performance only in the generation where it is being implemented, and the gain from specific combining abilities cannot be accumulated over generations. Continuous updating of genomic predictions and mate

Planning to break unwanted habits: habit strength moderates implementation intention effects on behaviour change.

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Webb, Thomas L; Sheeran, Paschal; Luszczynska, Aleksandra

2009-09-01

Implementation intention formation promotes effective goal striving and goal attainment. However, little research has investigated whether implementation intentions promote behaviour change when people possess strong antagonistic habits. Experiment 1 developed relatively habitual responses that, after a task switch, had a detrimental impact on task performance. Forming an if-then plan reduced the negative impact of habit on performance. However, the effect of forming implementation intentions was smaller among participants who possessed strong habits as compared to participants who had weaker habits. Experiment 2 provided a field test of the role of habit strength in moderating the relationship between implementation intentions and behaviour in the context of smoking. Implementation intentions reduced smoking among participants with weak or moderate smoking habits, but not among participants with strong smoking habits. In summary, habit strength moderates the effectiveness of if-then plan formation in breaking unwanted habits.

Taylor Series Trajectory Calculations Including Oblateness Effects and Variable Atmospheric Density

Science.gov (United States)

Scott, James R.

2011-01-01

Taylor series integration is implemented in NASA Glenn's Spacecraft N-body Analysis Program, and compared head-to-head with the code's existing 8th- order Runge-Kutta Fehlberg time integration scheme. This paper focuses on trajectory problems that include oblateness and/or variable atmospheric density. Taylor series is shown to be significantly faster and more accurate for oblateness problems up through a 4x4 field, with speedups ranging from a factor of 2 to 13. For problems with variable atmospheric density, speedups average 24 for atmospheric density alone, and average 1.6 to 8.2 when density and oblateness are combined.

On the effectiveness in implementing a waste-management-plan method in construction

International Nuclear Information System (INIS)

Tam, Vivian W.Y.

2008-01-01

The increasing awareness of waste management concerns from construction and demolition waste has led to the development of waste management as an important function of construction project management. The Hong Kong government started employing the implementation of a waste-management-plan (WMP) method for all construction projects in 2003. During the trial period, the government received different version of feedback from the industry. It also came out that detailed descriptions of waste management procedures in the WMP method largely affect the productivity of companies. This paper investigates the effectiveness of the existing implementation of the WMP method in the Hong Kong construction industry. A questionnaire survey and structured interviews were conducted. The result showed that 'Propose methods for on-site reuse of materials' and 'Propose methods for reducing waste' are the main benefits gained from the implementation of the WMP method. However, 'Low financial incentive' and 'Increase in overhead cost' are considered as the major difficulties in the implementation. From that, 'Use of prefabricated building components' is considered as the major effective measure to encourage the implementation of the WMP method

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Directory of Open Access Journals (Sweden)

Alexander Jeffery A

2009-08-01

Full Text Available Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality, four constructs were identified related to outer setting (e.g., patient needs and resources, 12 constructs were identified related to inner setting (e.g., culture

Effects of peer-mediated implementation of visual scripts in middle school.

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Ganz, Jennifer B; Heath, Amy K; Lund, Emily M; Camargo, Siglia P H; Rispoli, Mandy J; Boles, Margot; Plaisance, Lauren

2012-05-01

Although research has investigated the impact of peer-mediated interventions and visual scripts on social and communication skills in children with autism spectrum disorders, no studies to date have investigated peer-mediated implementation of scripts. This study investigated the effects of peer-implemented scripts on a middle school student with autism, intellectual impairments, and speech-language impairment via a multiple baseline single-case research design across behaviors. The target student demonstrated improvements in three communicative behaviors when implemented by a trained peer; however, behaviors did not generalize to use with an untrained typically developing peer.

Political control of implementation agencies - Effects of political consensus on agency compliance

NARCIS (Netherlands)

Torenvlied, R

This article describes a positive model of the implementation of policy decisions. The model combines the salience of implementation agencies for policy decisions with the extent to which these agencies are effectively controlled, in order to predict agency deviations from policy decisions. Special

Quantifying short run cost-effectiveness during a gradual implementation process.

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van de Wetering, Gijs; Woertman, Willem H; Verbeek, Andre L; Broeders, Mireille J; Adang, Eddy M M

2013-12-01

This paper examines the short run inefficiencies that arise during gradual implementation of a new cost-effective technology in healthcare. These inefficiencies arise when health gains associated with the new technology cannot be obtained immediately because the new technology does not yet supply all patients, and when there is overcapacity for the old technology in the short run because the supply of care is divided among two mutually exclusive technologies. Such efficiency losses are not taken into account in standard textbook cost-effectiveness analysis in which a steady state is presented where costs and effects are assumed to be unchanging over time. A model is constructed to quantify such short run inefficiencies as well as to inform the decision maker about the optimal implementation pattern for the new technology. The model operates by integrating the incremental net benefit equations for both the period of co-existence of mutually exclusive technologies and the period after complete substitution of the old technology. It takes into account the rate of implementation of the new technology, depreciation of capital of the old technology as well as the demand curves for both technologies. The model is applied to the real world case of converting from screen film to digital mammography in the Netherlands.

Adult vaccination strategies for the control of pertussis in the United States: an economic evaluation including the dynamic population effects.

Directory of Open Access Journals (Sweden)

Laurent Coudeville

Full Text Available BACKGROUND: Prior economic evaluations of adult and adolescent vaccination strategies against pertussis have reached disparate conclusions. Using static approaches only, previous studies failed to analytically include the indirect benefits derived from herd immunity as well as the impact of vaccination on the evolution of disease incidence over time. METHODS: We assessed the impact of different pertussis vaccination strategies using a dynamic compartmental model able to consider pertussis transmission. We then combined the results with economic data to estimate the relative cost-effectiveness of pertussis immunization strategies for adolescents and adults in the US. The analysis compares combinations of programs targeting adolescents, parents of newborns (i.e. cocoon strategy, or adults of various ages. RESULTS: In the absence of adolescent or adult vaccination, pertussis incidence among adults is predicted to more than double in 20 years. Implementing an adult program in addition to childhood and adolescent vaccination either based on 1 a cocoon strategy and a single booster dose or 2 a decennial routine vaccination would maintain a low level of pertussis incidence in the long run for all age groups (respectively 30 and 20 cases per 100,000 person years. These strategies would also result in significant reductions of pertussis costs (between -77% and -80% including additional vaccination costs. The cocoon strategy complemented by a single booster dose is the most cost-effective one, whereas the decennial adult vaccination is slightly more effective in the long run. CONCLUSIONS: By providing a high level of disease control, the implementation of an adult vaccination program against pertussis appears to be highly cost-effective and often cost-saving.

Policy Options for Effective REDD+ Implementation in Indonesia

DEFF Research Database (Denmark)

Saito-Jensen, Moeko; Sikor, Thomas; Kurniawan, Y.

2015-01-01

Indonesia, which contains the third-largest area of tropical forest in the world, is currently exploring policy options for the effective implementation of REDD+, the global initiative to reduce emissions from deforestation and forest degradation. This article analyses the major questions regarding...... degradation, due to high opportunity costs. REDD+ finance may be more effectively used to reward small-scale dispersed activities that enhance carbon stocks, such as those already happening under Indonesia's community nursery programme. The analysis indicates the necessity for forest tenure reform...

Cost reducing code implementation strategies

International Nuclear Information System (INIS)

Kurtz, Randall L.; Griswold, Michael E.; Jones, Gary C.; Daley, Thomas J.

1995-01-01

Sargent and Lundy's Code consulting experience reveals a wide variety of approaches toward implementing the requirements of various nuclear Codes Standards. This paper will describe various Code implementation strategies which assure that Code requirements are fully met in a practical and cost-effective manner. Applications to be discussed includes the following: new construction; repair, replacement and modifications; assessments and life extensions. Lessons learned and illustrative examples will be included. Preferred strategies and specific recommendations will also be addressed. Sargent and Lundy appreciates the opportunity provided by the Korea Atomic Industrial Forum and Korean Nuclear Society to share our ideas and enhance global cooperation through the exchange of information and views on relevant topics

Exploring the Role of Network Effects in IT Implementation: The Case of Knowledge Repositories

DEFF Research Database (Denmark)

Bansler, Jørgen P.; Havn, Erling C.

2004-01-01

This paper seeks to analyze the role of network effects in relation to the adoption and use of systems for knowledge sharing in organizations and draws on recent developments within network economics to outline a theoretical perspective on the implementation of knowledge repositories in organizat......This paper seeks to analyze the role of network effects in relation to the adoption and use of systems for knowledge sharing in organizations and draws on recent developments within network economics to outline a theoretical perspective on the implementation of knowledge repositories...... and communication technologies are introduced. The analysis of the field study data shows that knowledge repositories exhibit strong network effects, which can complicate the implementation process in multiple ways. The research is based on a single, in-depth case study. Future research should study the role...... of network effects in relation to other technologies and organizational contexts. It underscores the need to be aware of – and try to manage – network effects when implementing knowledge repositories and other "networked" technologies. By and large, IS researchers have overlooked the role of network effects...

Is the implementation of quality improvement methods in hospitals subject to the neighbourhood effect?

Science.gov (United States)

Yu, Tsung-Hsien; Chung, Kuo-Piao

2014-06-01

Quality improvement (QI) methods have been fashionable in hospitals for decades. Previous studies have discussed the relationships between the implementation of QI methods and various external and internal factors, but there has been no examination to date of whether the neighbourhood effect influences such implementation. The aim of this study was to use a multilevel model to investigate whether and how the neighbourhood effect influences the implementation of QI methods in the hospital setting in Taiwan. This is a retrospective questionnaire-based survey. All medical centres, regional hospitals and district teaching hospitals in Taiwan. Directors or persons in charge of implementing QI methods in hospitals. None. The breadth and depth of QI method implementation. Seventy-two of the 139 hospitals contacted returned the questionnaire, yielding a 52% response rate. The breadth and depth of QI method implementation increased over the 10-year study period, particularly between 2004 and 2006. The breadth and depth of the QI methods implemented in the participating hospitals were significantly associated with the average breadth and depth of those implemented by their competitors in the same medical area during the previous period. In addition, time was positively associated with the breadth and depth of QI method implementation. In summary, the findings of this study show that hospitals' QI implementation status is influenced by that of their neighbours. Hence, the neighbourhood effect is an important factor in understanding hospital behaviour. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Development of Evaluation Procedure for Effective Implementation of Cdio

DEFF Research Database (Denmark)

Christensen, Jørgen Erik; Rode, Carsten; Borchersen, Egil

2009-01-01

One of the challenges in modern engineering education is the demand for teaching of high quality where the subject is presented in an interesting and engaging way. By integrating and involving the students in the teaching process, the learning can be increased. At the Technical University...... of Denmark (DTU), the CDIO approach was started in the autumn of 2008 in the process of reforming the engineering education in order to educate the students to become more effective engineers. One of the goals is to effectively implement CDIO practices and reduce time for implementation. One of the ways...... for individual comments on the reverse side of the page. In addition to the paper inquiry form there was the traditional electronic inquiry at the CampusNet. The two forms show significant difference in response rate since the paper inquiry form gave a response rate of 84% (=100% of all students attending...

Community characteristics and implementation factors associated with effective systems of care.

Science.gov (United States)

Lunn, Laurel M; Heflinger, Craig Anne; Wang, Wei; Greenbaum, Paul E; Kutash, Krista; Boothroyd, Roger A; Friedman, Robert M

2011-07-01

How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.

Effects of implementing time-variable postgraduate training programmes on the organization of teaching hospital departments.

Science.gov (United States)

van Rossum, Tiuri R; Scheele, Fedde; Sluiter, Henk E; Paternotte, Emma; Heyligers, Ide C

2018-01-31

As competency-based education has gained currency in postgraduate medical education, it is acknowledged that trainees, having individual learning curves, acquire the desired competencies at different paces. To accommodate their different learning needs, time-variable curricula have been introduced making training no longer time-bound. This paradigm has many consequences and will, predictably, impact the organization of teaching hospitals. The purpose of this study was to determine the effects of time-variable postgraduate education on the organization of teaching hospital departments. We undertook exploratory case studies into the effects of time-variable training on teaching departments' organization. We held semi-structured interviews with clinical teachers and managers from various hospital departments. The analysis yielded six effects: (1) time-variable training requires flexible and individual planning, (2) learners must be active and engaged, (3) accelerated learning sometimes comes at the expense of clinical expertise, (4) fast-track training for gifted learners jeopardizes the continuity of care, (5) time-variable training demands more of supervisors, and hence, they need protected time for supervision, and (6) hospital boards should support time-variable training. Implementing time-variable education affects various levels within healthcare organizations, including stakeholders not directly involved in medical education. These effects must be considered when implementing time-variable curricula.

Policy options for effective REDD+ implementation in Indonesia

DEFF Research Database (Denmark)

Saito, Moeko; Sikor, T.; Kurniawan, Y.

2015-01-01

Indonesia, which contains the third-largest area of tropical forest in the world, is currently exploring policy options for the effective implementation of REDD+, the global initiative to reduce emissions from deforestation and forest degradation. This article analyses the major questions regarding...... the effective distribution of benefits on the basis of three village case studies in Kutai Barat district in the province of East Kalimantan. The case studies demonstrate that companies are unlikely to take up compensation payments for stopping large-scale activities that cause deforestation and forest...

The VOICES/VOCES success story: effective strategies for training, technical assistance and community-based organization implementation.

Science.gov (United States)

Hamdallah, Myriam; Vargo, Sue; Herrera, Jennifer

2006-08-01

The Centers for Disease Control and Prevention's Diffusion of Effective Behavioral Interventions (DEBI) project successfully disseminated VOICES/VOCES, a brief video-based HIV risk reduction intervention targeting African American and Latino heterosexual men and women at risk for HIV infection. Elements of the dissemination strategy included a comprehensive and user-friendly intervention kit, comprising (a) an implementationmanual and othermaterials necessary for conducting the intervention (b) a Training of Facilitators (TOF) curriculum used to teach agency staff how to implement the EBI in their setting, (c) a network of expert trainers who attend a training institute to become adept at using the TOF curriculum to train facilitators, (d) a comprehensive training coordination center to plan and deliver TOF trainings, (e) proactive technical assistance to trainers, and (f) post-TOF technical assistance for local implementers. This article reports on those strategies and a local CBO's successful participation in DEBI, resulting implementation of VOICES/VOCES, with unique approaches to adaptation and tailoring.

Mandatory influenza vaccination for all healthcare personnel: a review on justification, implementation and effectiveness.

Science.gov (United States)

Wang, Tiffany L; Jing, Ling; Bocchini, Joseph A

2017-10-01

As healthcare-associated influenza is a serious public health concern, this review examines legal and ethical arguments supporting mandatory influenza vaccination policies for healthcare personnel, implementation issues and evidence of effectiveness. Spread of influenza from healthcare personnel to patients can result in severe harm or death. Although most healthcare personnel believe that they should be vaccinated against seasonal influenza, the Centers for Disease Control and Prevention (CDC) report that only 79% of personnel were vaccinated during the 2015-2016 season. Vaccination rates were as low as 44.9% in institutions that did not promote or offer the vaccine, compared with rates of more than 90% in institutions with mandatory vaccination policies. Policies that mandate influenza vaccination for healthcare personnel have legal and ethical justifications. Implementing such policies require multipronged approaches that include education efforts, easy access to vaccines, vaccine promotion, leadership support and consistent communication emphasizing patient safety. Mandatory influenza vaccination for healthcare personnel is a necessary step in protecting patients. Patients who interact with healthcare personnel are often at an elevated risk of complications from influenza. Vaccination is the best available strategy for protecting against influenza and evidence shows that institutional policies and state laws can effectively increase healthcare personnel vaccination rates, decreasing the risk of transmission in healthcare settings. There are legal and ethical precedents for institutional mandatory influenza policies and state laws, although successful implementation requires addressing both administrative and attitudinal barriers.

A Model Of The Underlying Philosophy And Criteria For Effective Implementation Of Performance Management

Directory of Open Access Journals (Sweden)

C. M. Whitford

2006-11-01

Full Text Available The objective of this study was to develop a model that assists organisations in implementing performance management effectively. A model describing the philosophical paradigm underpinning best practice in performance management and the criteria for effective implementation of performance management was developed. The sample used in this study was a convenience sample of 615 employees. Exploratory factor analysis revealed three reliable philosophical dimensions. Moderate correlations were found between the three dimensions and some of the implementation criteria.

Societal costs and effects of implementing population-based mammography screening in Greenland

DEFF Research Database (Denmark)

Christensen, Maria Klitgaard; Niclasen, Birgit; Moesgaard Iburg, Kim

2017-01-01

With a low breast cancer incidence and low population density, Greenland is geographically and organisationally challenged in implementing a cost effective breast cancer screening programme where a large proportion of the Greenlandic women will have to travel far to attend. The aim of this paper ...... transportation and accommodation costs and loss of productivity, and none would be accepted as cost-effective per YLS/QALY gained within a conventional threshold level. The least expensive strategy was regional screening with hotel accommodation.......With a low breast cancer incidence and low population density, Greenland is geographically and organisationally challenged in implementing a cost effective breast cancer screening programme where a large proportion of the Greenlandic women will have to travel far to attend. The aim of this paper...... is to evaluate the cost effectiveness and cost utility of different strategies for implementing population-based breast cancer screening in Greenland. Two strategies were evaluated: Centralised screening in the capital Nuuk and decentralised screening in the five municipal regions of Greenland. A cost...

[Effectiveness of mental health training including active listening for managers].

Science.gov (United States)

Ikegami, Kazunori; Tagawa, Yoshimasa; Mafune, Kosuke; Hiro, Hisanori; Nagata, Shoji

2008-07-01

We carried out mental health training with Active Listening for managers of A company, which was the electronics manufacturing company with 1,900 employees. The purpose of the present study was to examine the effect on managers and employees in the workplace on the training. The subjects were all persons who managed regular employees directly in A company. We performed the investigation from May 2006 to February 2007 and carried out the training from September to November in 2006. The contents of the training were from the chapter on "The education and training of managers" in the "The guideline for maintenance and promotion of mental health for workers" issued by the Ministry of Health, Labour and Welfare in Japan in 2006. We divided the contents and implemented them in two sessions. "Responding to worker consultation" was one of the contents of Active Listening. In the first session, we explained about Active Listening, and in the second session we ran a practical involving Inventive Experiential Listening. One month later, we distributed material summarizing the training to all the participants. To evaluate the effect of the training, we conducted surveys of the participants using the Active Listening Attitude Scale (ALAS), prior to and after the training, and distributed questionnaires, post-training about the contents of the training and changes of consciousness and action. Furthermore, we performed surveys pre- and post-training using the Brief Job Stress Questionnaire (BJSQ) 12 items version, distributed to all employees. We evaluated the effect of the training on 124 managers and 908 workers by the investigation. The score of each subscale was analyzed by repeated measures analysis of variance. There were no significant differences in the scores of both the "Listening attitude" and "Listening skill" subscales of ALAS between pre-training and post-training, but the mean scores post-training were higher than those pre-training on both subscales. There were

Implementing a benchmarking and feedback concept decreases postoperative pain after total knee arthroplasty: A prospective study including 256 patients.

Science.gov (United States)

Benditz, A; Drescher, J; Greimel, F; Zeman, F; Grifka, J; Meißner, W; Völlner, F

2016-12-05

Perioperative pain reduction, particularly during the first two days, is highly important for patients after total knee arthroplasty (TKA). Problems are not only caused by medical issues but by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent benchmarking. All patients included into the study had undergone total knee arthroplasty. Outcome parameters were analyzed by means of a questionnaire on the first postoperative day. A multidisciplinary team implemented a regular procedure of data analyzes and external benchmarking by participating in a nationwide quality improvement project. At the beginning of the study, our hospital ranked 16 th in terms of activity-related pain and 9 th in patient satisfaction among 47 anonymized hospitals participating in the benchmarking project. At the end of the study, we had improved to 1 st activity-related pain and to 2 nd in patient satisfaction. Although benchmarking started and finished with the same standardized pain management concept, results were initially pure. Beside pharmacological treatment, interdisciplinary teamwork and benchmarking with direct feedback mechanisms are also very important for decreasing postoperative pain and for increasing patient satisfaction after TKA.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals.

Science.gov (United States)

Blando, James; Ridenour, Marilyn; Hartley, Daniel; Casteel, Carri

2015-01-01

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

The effect of organizational climate on patient-centered medical home implementation.

Science.gov (United States)

Reddy, Ashok; Shea, Judy A; Canamucio, Anne; Werner, Rachel M

2015-01-01

Organizational climate is a key determinant of successful adoption of innovations; however, its relation to medical home implementation is unknown. This study examined the association between primary care providers' (PCPs') perception of organization climate and medical home implementation in the Veterans Health Administration. Multivariate regression was used to test the hypothesis that organizational climate predicts medical home implementation. This analysis of 191 PCPs found that higher scores in 2 domains of organizational climate (communication and cooperation, and orientation to quality improvement) were associated with a statistically significantly higher percentage (from 7 to 10 percentage points) of PCPs implementing structural changes to support the medical home model. In addition, some aspects of a better organizational climate were associated with improved organizational processes of care, including a higher percentage of patients contacted within 2 days of hospital discharge (by 2 to 3 percentage points) and appointments made within 3 days of a patient request (by 2 percentage points). © The Author(s) 2014.

Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies.

Science.gov (United States)

Gold, Rachel; Hollombe, Celine; Bunce, Arwen; Nelson, Christine; Davis, James V; Cowburn, Stuart; Perrin, Nancy; DeVoe, Jennifer; Mossman, Ned; Boles, Bruce; Horberg, Michael; Dearing, James W; Jaworski, Victoria; Cohen, Deborah; Smith, David

2015-10-16

Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting. This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics' ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the "how" and "why" underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in "real-world" practices. Having a better understanding of how different

Challenges of implementation and implementation research: Learning from an intervention study designed to improve tumor registry reporting

Directory of Open Access Journals (Sweden)

Ann Scheck McAlearney

2016-08-01

Full Text Available Objectives: Implementation of interventions designed to improve the quality of medical care often proceeds differently from what is planned. Improving existing conceptual models to better understand the sources of these differences can help future projects avoid these pitfalls and achieve desired effectiveness. To inform an adaptation of an existing theoretical model, we examined unanticipated changes that occurred in an intervention designed to improve reporting of adjuvant therapies for breast cancer patients at a large, urban academic medical center. Methods: Guided by the complex innovation implementation conceptual framework, our study team observed and evaluated the implementation of an intervention designed to improve reporting to a tumor registry. Findings were assessed against the conceptual framework to identify boundary conditions and modifications that could improve implementation effectiveness. Results: The intervention successfully increased identification of the managing medical oncologist and treatment reporting. During implementation, however, unexpected external challenges including hospital acquisitions of community practices and practices’ responses to government incentives to purchase electronic medical record systems led to unanticipated changes and associated threats to implementation. We present a revised conceptual model that incorporates the sources of these unanticipated challenges. Conclusion: This report of our experience highlights the importance of monitoring implementation over time and accounting for changes that affect both implementation and measurement of intervention impact. In this article, we use our study to examine the challenges of implementation research in health care, and our experience can help future implementation efforts.

Effects of performance measure implementation on clinical manager and provider motivation.

Science.gov (United States)

Damschroder, Laura J; Robinson, Claire H; Francis, Joseph; Bentley, Douglas R; Krein, Sarah L; Rosland, Ann-Marie; Hofer, Timothy P; Kerr, Eve A

2014-12-01

Clinical performance measurement has been a key element of efforts to transform the Veterans Health Administration (VHA). However, there are a number of signs that current performance measurement systems used within and outside the VHA may be reaching the point of maximum benefit to care and in some settings, may be resulting in negative consequences to care, including overtreatment and diminished attention to patient needs and preferences. Our research group has been involved in a long-standing partnership with the office responsible for clinical performance measurement in the VHA to understand and develop potential strategies to mitigate the unintended consequences of measurement. Our aim was to understand how the implementation of diabetes performance measures (PMs) influences management actions and day-to-day clinical practice. This is a mixed methods study design based on quantitative administrative data to select study facilities and quantitative data from semi-structured interviews. Sixty-two network-level and facility-level executives, managers, front-line providers and staff participated in the study. Qualitative content analyses were guided by a team-based consensus approach using verbatim interview transcripts. A published interpretive motivation theory framework is used to describe potential contributions of local implementation strategies to unintended consequences of PMs. Implementation strategies used by management affect providers' response to PMs, which in turn potentially undermines provision of high-quality patient-centered care. These include: 1) feedback reports to providers that are dissociated from a realistic capability to address performance gaps; 2) evaluative criteria set by managers that are at odds with patient-centered care; and 3) pressure created by managers' narrow focus on gaps in PMs that is viewed as more punitive than motivating. Next steps include working with VHA leaders to develop and test implementation approaches to help

Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East.

Science.gov (United States)

Babiker, Amir; Amer, Yasser S; Osman, Mohamed E; Al-Eyadhy, Ayman; Fatani, Solafa; Mohamed, Sarar; Alnemri, Abdulrahman; Titi, Maher A; Shaikh, Farheen; Alswat, Khalid A; Wahabi, Hayfaa A; Al-Ansary, Lubna A

2018-02-01

Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI. This is a prospective study of a qualitative/quantitative design. Our FMEA included (1) process review and recording of the steps and activities of CPGI; (2) hazard analysis by recording activity-related failure modes and their effects, identification of actions required, assigned severity, occurrence, and detection scores for each failure mode and calculated the risk priority number (RPN) by using an online interactive FMEA tool; (3) planning: RPNs were prioritized, recommendations, and further planning for new interventions were identified; and (4) monitoring: after reduction or elimination of the failure mode. The calculated RPN will be compared with subsequent analysis in post-implementation phase. The data were scrutinized from a feedback of quality team members using a FMEA framework to enhance the implementation of 29 adapted CPGs. The identified potential common failure modes with the highest RPN (≥ 80) included awareness/training activities, accessibility of CPGs, fewer advocates from clinical champions, and CPGs auditing. Actions included (1) organizing regular awareness activities, (2) making CPGs printed and electronic copies accessible, (3) encouraging senior practitioners to get involved in CPGI, and (4) enhancing CPGs auditing as part of the quality sustainability plan. In our experience, FMEA could be a useful tool to enhance CPGI. It helped us to identify potential barriers and prepare relevant solutions. © 2017 John Wiley & Sons, Ltd.

Evaluation of plant-wide WWTP control strategies including the effects of filamentous bulking sludge

DEFF Research Database (Denmark)

Flores Alsina, Xavier; Comas, J.S.; Rodríguez Roda, I.

2009-01-01

The main objective of this paper is to evaluate the effect of filamentous bulking sludge on the predicted performance of simulated plant-wide WWTP control strategies. First, as a reference case, several control strategies are implemented, simulated and evaluated using the IWA Benchmark Simulation...

Identifying the effects of Enterprise System implementation and use

DEFF Research Database (Denmark)

Rikhardsson, Pall M.; Kræmmergaard, Pernille

This paper reports the results of an explorative study of six large Danish companies regarding the effects of ERP implementation and use. The study is part of a larger ERP study programme at the Aarhus School of Business. The data collection approach applied was based on interviews and management...

Evidence that implementation intentions can overcome the effects of smoking habits.

Science.gov (United States)

Armitage, Christopher J

2016-09-01

In this study, the aim was to (a) test for the first time whether implementation intentions formed outside the laboratory can overcome the effects of habits, and (b) see whether the operation of implementation intentions could be improved by asking people to form certain "when-then" plans as opposed to uncertain "if-then" plans. The study employed a 2 × 2 fully factorial design with baseline and follow-up measures of smoking status and habits. Smokers (N = 168; circa 33 years of age; 79 women, 89 men) were randomly allocated to 1 of 2 intervention groups to form either if-then plans or when-then plans using supporting tools, or to 1 of 2 control conditions in which they were exposed to identical supporting tools but were not asked to form if-then plans or when-then plans. Certainty did not affect the operation of implementation intentions, but smokers who formed implementation intentions were significantly more likely to quit, χ2(1, N = 168) = 8.86, p smoking habits (95% CI [0.02, 0.14]). Similar effects were observed when cigarettes smoked per day, nicotine dependence, and craving served as the dependent variables. The findings demonstrate that people who have formed implementation intentions can overcome habits, such as smoking, outside the laboratory. The supporting tools described in the present research could be deployed at low cost with high public health reach to support behavior change. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Effects of a strategy to improve offender assessment practices: Staff perceptions of implementation outcomes.

Science.gov (United States)

Welsh, Wayne N; Lin, Hsiu-Ju; Peters, Roger H; Stahler, Gerald J; Lehman, Wayne E K; Stein, Lynda A R; Monico, Laura; Eggers, Michele; Abdel-Salam, Sami; Pierce, Joshua C; Hunt, Elizabeth; Gallagher, Colleen; Frisman, Linda K

2015-07-01

This implementation study examined the impact of an organizational process improvement intervention (OPII) on a continuum of evidence based practices related to assessment and community reentry of drug-involved offenders: Measurement/Instrumentation, Case Plan Integration, Conveyance/Utility, and Service Activation/Delivery. To assess implementation outcomes (staff perceptions of evidence-based assessment practices), a survey was administered to correctional and treatment staff (n=1509) at 21 sites randomly assigned to an Early- or Delayed-Start condition. Hierarchical linear models with repeated measures were used to examine changes in evidence-based assessment practices over time, and organizational characteristics were examined as covariates to control for differences across the 21 research sites. Results demonstrated significant intervention and sustainability effects for three of the four assessment domains examined, although stronger effects were obtained for intra- than inter-agency outcomes. No significant effects were found for Conveyance/Utility. Implementation interventions such as the OPII represent an important tool to enhance the use of evidence-based assessment practices in large and diverse correctional systems. Intra-agency assessment activities that were more directly under the control of correctional agencies were implemented most effectively. Activities in domains that required cross-systems collaboration were not as successfully implemented, although longer follow-up periods might afford detection of stronger effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

PrEP implementation in the Asia-Pacific region: opportunities, implementation and barriers

Science.gov (United States)

Zablotska, Iryna; Grulich, Andrew E; Phanuphak, Nittaya; Anand, Tarandeep; Janyam, Surang; Poonkasetwattana, Midnight; Baggaley, Rachel; van Griensven, Frits; Lo, Ying-Ru

2016-01-01

Introduction HIV epidemics in the Asia-Pacific region are concentrated among men who have sex with men (MSM) and other key populations. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention intervention and could be a potential game changer in the region. We discuss the progress towards PrEP implementation in the Asia-Pacific region, including opportunities and barriers. Discussion Awareness about PrEP in the Asia-Pacific is still low and so are its levels of use. A high proportion of MSM who are aware of PrEP are willing to use it. Key PrEP implementation barriers include poor knowledge about PrEP, limited access to PrEP, weak or non-existent HIV prevention programmes for MSM and other key populations, high cost of PrEP, stigma and discrimination against key populations and restrictive laws in some countries. Only several clinical trials, demonstration projects and a few larger-scale implementation studies have been implemented so far in Thailand and Australia. However, novel approaches to PrEP implementation have emerged: researcher-, facility- and community-led models of care, with PrEP services for fee and for free. The WHO consolidated guidelines on HIV testing, treatment and prevention call for an expanded access to PrEP worldwide and have provided guidance on PrEP implementation in the region. Some countries like Australia have released national PrEP guidelines. There are growing community leadership and consultation processes to initiate PrEP implementation in Asia and the Pacific. Conclusions Countries of the Asia-Pacific region will benefit from adding PrEP to their HIV prevention packages, but for many this is a critical step that requires resourcing. Having an impact on the HIV epidemic requires investment. The next years should see the region transitioning from limited PrEP implementation projects to growing access to PrEP and expansion of HIV prevention programmes. PMID:27760688

Technical and economic effect analysis of advanced MMIS implementation in KNGR

International Nuclear Information System (INIS)

Choe, Il Nam

1997-01-01

KNGR MMIS design approaches are summarized as follows: 1) compact workstation type operator console design to reduce the operators' physical and cognitive work loads by implementing Factors Engineering (HFE) principles and advanced graphic user interface technologies. 2) Full digital control and protection system design to enhance the reliability operability and maintainability. 3) Remote signal multiplexer implementation to reduce the hard-wired cable and cable installation cost and time. 4) Licensable design to meet latest licensing requirements including HFE and safety software validation and verification. 5 refs., 1 tab., 1 fig

Implementation-effectiveness trial of an ecological intervention for physical activity in ethnically diverse low income senior centers

Directory of Open Access Journals (Sweden)

Porchia Rich

2017-07-01

Full Text Available Abstract Background As the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, particularly in ethnically diverse, low income senior centers where access is limited. Methods/design The Peer Empowerment Program 4 Physical Activity’ (PEP4PA is a hybrid Type II implementation-effectiveness trial that is a peer-led physical activity (PA intervention based on the ecological model of behavior change. The initial phase is a cluster randomized control trial randomized to either a peer-led PA intervention or usual center programming. After 18 months, the intervention sites are further randomized to continued support or no support for another 6 months. This study will be conducted at twelve senior centers in San Diego County in low income, diverse communities. In the intervention sites, 24 peer health coaches and 408 adults, aged 50 years and older, are invited to participate. Peer health coaches receive training and support and utilize a tablet computer for delivery and tracking. There are several levels of intervention. Individual components include pedometers, step goals, counseling, and feedback charts. Interpersonal components include group walks, group sharing and health tips, and monthly celebrations. Community components include review of PA resources, walkability audit, sustainability plan, and streetscape improvements. The primary outcome of interest is intensity and location of PA minutes per day, measured every 6 months by wrist and hip accelerometers and GPS devices. Secondary outcomes include blood pressure, physical, cognitive, and emotional functioning. Implementation measures include appropriateness & acceptability (perceived and actual fit, adoption & penetration (reach, fidelity (quantity & quality of intervention delivered, acceptability (satisfaction, costs, and sustainability. Discussion Using a peer led implementation strategy to deliver a multi-level community based PA

Simple implementation of general dark energy models

International Nuclear Information System (INIS)

Bloomfield, Jolyon K.; Pearson, Jonathan A.

2014-01-01

We present a formalism for the numerical implementation of general theories of dark energy, combining the computational simplicity of the equation of state for perturbations approach with the generality of the effective field theory approach. An effective fluid description is employed, based on a general action describing single-scalar field models. The formalism is developed from first principles, and constructed keeping the goal of a simple implementation into CAMB in mind. Benefits of this approach include its straightforward implementation, the generality of the underlying theory, the fact that the evolved variables are physical quantities, and that model-independent phenomenological descriptions may be straightforwardly investigated. We hope this formulation will provide a powerful tool for the comparison of theoretical models of dark energy with observational data

Planning what not to eat: ironic effects of implementation intentions negating unhealthy habits

NARCIS (Netherlands)

Adriaanse, M.A.; van Oosten, J.M.F.; de Ridder, D.T.D.; de Wit, J.B.F.; Evers, C.

2011-01-01

The present studies tested the effectiveness of implementation intentions with an "if [situation], then not [habitual response]" structure. Based on ironic process theory and the literature on the processing of negations, it was expected that these "negation implementation intentions" would,

Cost-effective implementation of intelligent systems

Science.gov (United States)

Lum, Henry, Jr.; Heer, Ewald

1990-01-01

Significant advances have occurred during the last decade in knowledge-based engineering research and knowledge-based system (KBS) demonstrations and evaluations using integrated intelligent system technologies. Performance and simulation data obtained to date in real-time operational environments suggest that cost-effective utilization of intelligent system technologies can be realized. In this paper the rationale and potential benefits for typical examples of application projects that demonstrate an increase in productivity through the use of intelligent system technologies are discussed. These demonstration projects have provided an insight into additional technology needs and cultural barriers which are currently impeding the transition of the technology into operational environments. Proposed methods which addresses technology evolution and implementation are also discussed.

A pragmatic cluster randomised trial evaluating three implementation interventions

Directory of Open Access Journals (Sweden)

Rycroft-Malone Jo

2012-08-01

Full Text Available Abstract Background Implementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice. Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience. The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting. Methods A pragmatic cluster randomised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis. Hospitals were randomised to one of three interventions: standard dissemination (SD of a guideline package, SD plus a web-based resource championed by an opinion leader, and SD plus plan-do-study-act (PDSA. The primary outcome was duration of fluid fast prior to induction of anaesthesia. Secondary outcomes included duration of food fast, patients’ experiences, and stakeholders’ experiences of implementation, including influences. ANOVA was used to test differences over time and interventions. Results Nineteen acute NHS hospitals participated. Across timepoints, 3,505 duration of fasting observations were recorded. No significant effect of the interventions was observed for either fluid or food fasting times. The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone. The process evaluation showed different types of impact, including changes to practices, policies, and attitudes. A rich picture of the implementation challenges emerged, including inter-professional tensions and a lack of clarity for decision-making authority and responsibility. Conclusions This was a large, complex study and one of the first

Surviving the Implementation of a New Science Curriculum

Science.gov (United States)

Lowe, Beverly; Appleton, Ken

2015-12-01

Queensland schools are currently teaching with the first National Curriculum for Australia. This new curriculum was one of a number of political responses to address the recurring low scores in literacy, mathematics, and science that continue to hold Australia in poor international rankings. Teachers have spent 2 years getting to know the new science curriculum through meetings, training, and exploring the new Australian curriculum documents. This article examines the support and preparation for implementation provided in two regional schools, with a closer look at six specific teachers and their science teaching practices as they attempted to implement the new science curriculum. The use of a survey, field observations, and interviews revealed the schools' preparation practices and the teachers' practices, including the support provided to implement the new science curriculum. A description and analysis of school support and preparation as well as teachers' views of their experiences implementing the new science curriculum reveal both achievements and shortcomings. Problematic issues for the two schools and teachers include time to read and comprehend the curriculum documents and content expectations as well as time to train and change the current processes effectively. The case teachers' experiences reveal implications for the successful and effective implementation of new curriculum and curriculum reform.

Effectiveness Of Implementation Of Corporate Social Responsibility (CSR) In The Environmental Law Enforcement

OpenAIRE

Irwansyah; Gianto; Andi Syahwia

2016-01-01

Development in Indonesia refers to the concept of sustainable development (sustainable development ) and responsibility for the environment . Companies have a social responsibility to social and environmental consequences of environmental damage that caused . Implementation of corporate social responsibility ( Cooperate Social Responsibility ) is an important part in the framework part of the enforcement of environmental law . Implementation of CSR growing rapidly , including in Indonesia . T...

Effect of implementation intentions to change behaviour: moderation by intention stability.

Science.gov (United States)

Godin, Gaston; Bélanger-Gravel, Ariane; Amireault, Steve; Gallani, Maria-Cecilia B J; Vohl, Marie-Claude; Pérusse, Louis

2010-02-01

The aim of this study was to assess the effects of implementation intentions on leisure-time physical activity, taking into account the stability of intention. At baseline (T0), 349 participants completed a psychosocial questionnaire and were randomly assigned to implementation intention or control condition. Three months after baseline assessment (T1), participants in the experimental group were asked to plan where, when, and how they would exercise. Leisure-time physical activity was assessed 3 mo. later (i.e., at 6-mo. follow-up; T2). The intervention had no significant effect on physical activity at 6-mo. follow-up. However, a significant interaction of group and intention stability was observed, with the effect of the intervention on behaviour statistically significant only among those with unstable intention. Intention stability thus moderated the effect of the intervention, i.e., the intervention was more successful among individuals who needed support to change (unstable intenders).

Guideline implementation strategies for specialist mental healthcare.

Science.gov (United States)

Girlanda, Francesca; Fiedler, Ines; Ay, Esra; Barbui, Corrado; Koesters, Markus

2013-07-01

Clinical practice guidelines in mental healthcare are viewed as an essential asset if appropriately developed and implemented. The purpose of this article was to review the existing literature on how guidelines should be implemented to optimize their impact on provider performance and patient outcomes in specialist mental healthcare settings. Findings from recent studies suggest a trend toward an improvement in process and patient outcomes following guideline implementation. However, studies are heterogeneous in terms of design, implementation strategies and outcome measures, making it very difficult to draw firm conclusions about which implementation strategy is effective in different healthcare contexts. Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.

Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study.

Science.gov (United States)

Quanbeck, Andrew; Gustafson, David H; Marsch, Lisa A; Chih, Ming-Yuan; Kornfield, Rachel; McTavish, Fiona; Johnson, Roberta; Brown, Randall T; Mares, Marie-Louise; Shah, Dhavan V

2018-01-30

Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The outcomes according to the RE-AIM framework are as follows: Reach-Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness-Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption-Patients sustained high levels of Seva use-between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among

Double-photoionization of helium including quadrupole radiation effects

Energy Technology Data Exchange (ETDEWEB)

Colgan, James [Los Alamos National Laboratory; Ludlow, J A [AUBURN UNIV; Lee, Teck - Ghee [AUBURN UNIV; Pindzola, M S [AUBURN UNIV; Robicheaux, F [AUBURN UNIV

2009-01-01

Non-perturbative time-dependent close-coupling calculations are carried out for the double photoionization of helium including both dipole and quadrupole radiation effects. At a photon energy of 800 eV, accessible at CUlTent synchrotron light sources, the quadrupole interaction contributes around 6% to the total integral double photoionization cross section. The pure quadrupole single energy differential cross section shows a local maxima at equal energy sharing, as opposed to the minimum found in the pure dipole single energy differential cross section. The sum of the pure dipole and pure quadrupole single energy differentials is insensitive to non-dipole effects at 800 eV. However, the triple differential cross section at equal energy sharing of the two ejected electrons shows strong non-dipole effects due to the quadrupole interaction that may be experimentally observable.

The effectiveness and implementation of mentoring program for newly graduated nurses: A systematic review.

Science.gov (United States)

Zhang, Yuanyuan; Qian, Yan; Wu, Juemin; Wen, Fule; Zhang, Yaqing

2016-02-01

Newly graduated nurses suffer from occupational stress during the transition from school to employment as a result of inadequacy, interpersonal relationships, and the overwhelming workload. Mentoring programs have proved effective in facilitating this transition. To evaluate the effectiveness of a mentoring program on the mentor, mentee, and organization. The Cochrane Library, Medline, Ovid, Elsevier, Embase, CINAHL, CBM, CNKI, and WanFang Data databases were searched to identify relevant publications in English or Chinese up to October 2014. This is a systematic review. This review identified nine potentially eligible studies, and the methodological quality levels of the included studies were all ranked as level B. These studies revealed that the turnover rate can be decreased through a mentoring program. Additionally, mentoring can enhance nursing competency and establish a supportive workforce environment, resulting in positive outcomes. This review reveals that a mentoring program has positive effects on the mentors, mentees, and organizations. A successful mentorship program should include rigorous mentor selection and adequate training. Additionally, potential barriers such as time constraints and scheduling limitations should be taken into consideration during implementation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Quantifying short run cost-effectiveness during a gradual implementation process

NARCIS (Netherlands)

Wetering, G. van de; Woertman, W.H.; Verbeek, A.L.M.; Broeders, M.J.M.; Adang, E.M.M.

2013-01-01

This paper examines the short run inefficiencies that arise during gradual implementation of a new cost-effective technology in healthcare. These inefficiencies arise when health gains associated with the new technology cannot be obtained immediately because the new technology does not yet supply

The Effect of Teacher Performance in Implementation of The 2013 Curriculum Toward Chemistry Learning Achievement

Science.gov (United States)

Dewi, L. P.; Djohar, A.

2018-04-01

This research is a study about implementation of the 2013 Curriculum on Chemistry subject. This study aims to determine the effect of teacher performance toward chemistry learning achievement. The research design involves the independent variable, namely the performance of Chemistry teacher, and the dependent variable that is Chemistry learning achievement which includes the achievement in knowledge and skill domain. The subject of this research are Chemistry teachers and High School students in Bandung City. The research data is obtained from questionnaire about teacher performance assessed by student and Chemistry learning achievement from the students’ report. Data were analyzed by using MANOVA test. The result of multivariate significance test shows that there is a significant effect of teacher performance toward Chemistry learning achievement in knowledge and skill domain with medium effect size.

Implementation of a Psychoeducational Program for Cancer Survivors and Family Caregivers at a Cancer Support Community Affiliate: A Pilot Effectiveness Study.

Science.gov (United States)

Dockham, Bonnie; Schafenacker, Ann; Yoon, Hyojin; Ronis, David L; Kershaw, Trace; Titler, Marita; Northouse, Laurel

2016-01-01

Psychoeducational interventions, tested for efficacy in randomized clinical trials, are seldom implemented in clinical practice where cancer survivors and their family caregivers can benefit from them. This study examined the effectiveness of the FOCUS Program on cancer survivors' and their family caregivers' outcomes when implemented at a Cancer Support Community (CSC) affiliate by agency social workers. Study aims were to (1) test effects of the program on survivor and caregiver outcomes as a unit and (2) determine program feasibility in terms of enrollment, retention, intervention fidelity, and satisfaction. A preintervention and postintervention pilot effectiveness study was conducted with 34 cancer survivor-caregiver dyads (ie, pairs). The FOCUS Program, originally delivered by nurses in dyads' homes, was modified to a small-group format and delivered by CSC social workers. The primary outcome was quality of life (QOL). Intermediary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included repeated-measures analysis of variance. Dyads had significant improvements in total QOL; physical, emotional, and functional QOL; benefits of illness; and self-efficacy. Effect sizes were similar to prior randomized clinical trial findings. Although dyads were difficult to recruit (enrollment, 60%), both retention (92%) and intervention fidelity (94%) were high. It was possible to implement the FOCUS Program at a CSC affiliate by agency staff, obtain positive intervention effects, and maintain intervention fidelity. Researchers and clinicians need to collaborate to implement more evidence-based interventions in practice settings for cancer survivors and their family caregivers.

Strategic environmental assessment implementation in China - Five-year review and prospects

International Nuclear Information System (INIS)

Wu Jing; Chang, I-Shin; Bina, Olivia; Lam, Kin-Che; Xu He

2011-01-01

Through literature review and questionnaire survey, the purpose of this study is to understand current status and major fields of SEA implementation in China, and then to provide advice for future improvement of SEA system, according to objective evaluation of the effectiveness of SEA implementation. Major types and fields of SEA implementation were firstly studied to conclude that the attitude of decision-makers and competent authority of SEA implementation does generate direct impacts on SEA implementation. Current status of SEA implementation were then studied, in terms of timing, techniques and methodologies, public participation, information disclosure, alternative, and review organization, to conclude that SEA implementation in China is 'impact-based SEA' and the major problems of SEA implementation are resulted from deficient and defective management of SEA system, such as laws, regulations, and means of management. In order to have objective evaluation on the effectiveness of SEA implementation, to understand good practice of SEA implementation, and to provide advice for future improvement of SEA system, it is necessary to establish reasonable and feasible evaluation criteria for the effectiveness of SEA implementation, based upon foreign experience and political, legislative, administrative and cultural characteristics of China. Various types and stages of SEA should be carefully considered to be included into the evaluation criteria for the effectiveness of SEA implementation.

Methods for implementing revisions to emergency operating procedures. Final report

International Nuclear Information System (INIS)

Myers, L.B.; Bell, A.J.

1984-05-01

In response to the Three Mile Island (TMI) accident, the US Nuclear Regulatory Commission (NRC) has published the TMI Action Plan. The TMI Action Plan Item I.C.1 called for the upgrading of Emergency Operating Procedures (EOPs) at nuclear power plants. The program developed from this Action Plan item has resulted in utility efforts to: (1) revise EOPs; (2) train personnel in the use of the EOPs; and (3) implement the revised EOPs. The NRC supported the study presented in this report to identify factors which influence the effectiveness of training and implementation of revised EOPs. The NRC's major concern was the possible effects of negative transfer of training. The report includes a summary of existing methods for implementing revisions to procedures based on interviews of plant personnel, a review of the training literature applicable to the effect of previously learned procedures on the learning of and performance with revised procedures (i.e., negative transfer) and recommendations of methods and schedules for implementing revised EOPs. While the study found that the concern over negative transfer of training was not as great as anticipated, several recommendations were made. These include: (1) overtraining of operators to reduce the effect of observed negative transfer; and (2) implementation of the revised EOPs as soon as possible after training to minimize the time operators must rely upon the old EOPs after having been trained on the revised EOPs. The results of the study should be useful both to the utilities and the NRC in the development and review of EOP implementation programs

Variation in Research Designs Used to Test the Effectiveness of Dissemination and Implementation Strategies: A Review

Directory of Open Access Journals (Sweden)

Stephanie Mazzucca

2018-02-01

Full Text Available BackgroundThe need for optimal study designs in dissemination and implementation (D&I research is increasingly recognized. Despite the wide range of study designs available for D&I research, we lack understanding of the types of designs and methodologies that are routinely used in the field. This review assesses the designs and methodologies in recently proposed D&I studies and provides resources to guide design decisions.MethodsWe reviewed 404 study protocols published in the journal Implementation Science from 2/2006 to 9/2017. Eligible studies tested the efficacy or effectiveness of D&I strategies (i.e., not effectiveness of the underlying clinical or public health intervention; had a comparison by group and/or time; and used ≥1 quantitative measure. Several design elements were extracted: design category (e.g., randomized; design type [e.g., cluster randomized controlled trial (RCT]; data type (e.g., quantitative; D&I theoretical framework; levels of treatment assignment, intervention, and measurement; and country in which the research was conducted. Each protocol was double-coded, and discrepancies were resolved through discussion.ResultsOf the 404 protocols reviewed, 212 (52% studies tested one or more implementation strategy across 208 manuscripts, therefore meeting inclusion criteria. Of the included studies, 77% utilized randomized designs, primarily cluster RCTs. The use of alternative designs (e.g., stepped wedge increased over time. Fewer studies were quasi-experimental (17% or observational (6%. Many study design categories (e.g., controlled pre–post, matched pair cluster design were represented by only one or two studies. Most articles proposed quantitative and qualitative methods (61%, with the remaining 39% proposing only quantitative. Half of protocols (52% reported using a theoretical framework to guide the study. The four most frequently reported frameworks were Consolidated Framework for Implementing Research and RE

Variation in Research Designs Used to Test the Effectiveness of Dissemination and Implementation Strategies: A Review.

Science.gov (United States)

Mazzucca, Stephanie; Tabak, Rachel G; Pilar, Meagan; Ramsey, Alex T; Baumann, Ana A; Kryzer, Emily; Lewis, Ericka M; Padek, Margaret; Powell, Byron J; Brownson, Ross C

2018-01-01

The need for optimal study designs in dissemination and implementation (D&I) research is increasingly recognized. Despite the wide range of study designs available for D&I research, we lack understanding of the types of designs and methodologies that are routinely used in the field. This review assesses the designs and methodologies in recently proposed D&I studies and provides resources to guide design decisions. We reviewed 404 study protocols published in the journal Implementation Science from 2/2006 to 9/2017. Eligible studies tested the efficacy or effectiveness of D&I strategies (i.e., not effectiveness of the underlying clinical or public health intervention); had a comparison by group and/or time; and used ≥1 quantitative measure. Several design elements were extracted: design category (e.g., randomized); design type [e.g., cluster randomized controlled trial (RCT)]; data type (e.g., quantitative); D&I theoretical framework; levels of treatment assignment, intervention, and measurement; and country in which the research was conducted. Each protocol was double-coded, and discrepancies were resolved through discussion. Of the 404 protocols reviewed, 212 (52%) studies tested one or more implementation strategy across 208 manuscripts, therefore meeting inclusion criteria. Of the included studies, 77% utilized randomized designs, primarily cluster RCTs. The use of alternative designs (e.g., stepped wedge) increased over time. Fewer studies were quasi-experimental (17%) or observational (6%). Many study design categories (e.g., controlled pre-post, matched pair cluster design) were represented by only one or two studies. Most articles proposed quantitative and qualitative methods (61%), with the remaining 39% proposing only quantitative. Half of protocols (52%) reported using a theoretical framework to guide the study. The four most frequently reported frameworks were Consolidated Framework for Implementing Research and RE-AIM ( n  = 16 each), followed by

Adapting the Consolidated Framework for Implementation Research to Create Organizational Readiness and Implementation Tools for Project ECHO.

Science.gov (United States)

Serhal, Eva; Arena, Amanda; Sockalingam, Sanjeev; Mohri, Linda; Crawford, Allison

2018-03-01

The Project Extension for Community Healthcare Outcomes (ECHO) model expands primary care provider (PCP) capacity to manage complex diseases by sharing knowledge, disseminating best practices, and building a community of practice. The model has expanded rapidly, with over 140 ECHO projects currently established globally. We have used validated implementation frameworks, such as Damschroder's (2009) Consolidated Framework for Implementation Research (CFIR) and Proctor's (2011) taxonomy of implementation outcomes, combined with implementation experience to (1) create a set of questions to assess organizational readiness and suitability of the ECHO model and (2) provide those who have determined ECHO is the correct model with a checklist to support successful implementation. A set of considerations was created, which adapted and consolidated CFIR constructs to create ECHO-specific organizational readiness questions, as well as a process guide for implementation. Each consideration was mapped onto Proctor's (2011) implementation outcomes, and questions relating to the constructs were developed and reviewed for clarity. The Preimplementation list included 20 questions; most questions fall within Proctor's (2001) implementation outcome domains of "Appropriateness" and "Acceptability." The Process Checklist is a 26-item checklist to help launch an ECHO project; items map onto the constructs of Planning, Engaging, Executing, Reflecting, and Evaluating. Given that fidelity to the ECHO model is associated with robust outcomes, effective implementation is critical. These tools will enable programs to work through key considerations to implement a successful Project ECHO. Next steps will include validation with a diverse sample of ECHO projects.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited

The role of Nigerian youths in effective implementation of security ...

African Journals Online (AJOL)

... effective implementation of security and social development intervention in Nigeria cannot be over-emphasized. This is because youths have been deeply involved in various self-help projects in various Local and State Governments in Nigeria. Their areas of interventions cover projects involving trade, commerce, security ...

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

Science.gov (United States)

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

2015-05-07

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

A parallel implementation of particle tracking with space charge effects on an INTEL iPSC/860

International Nuclear Information System (INIS)

Chang, L.; Bourianoff, G.; Cole, B.; Machida, S.

1993-05-01

Particle-tracking simulation is one of the scientific applications that is well-suited to parallel computations. At the Superconducting Super Collider, it has been theoretically and empirically demonstrated that particle tracking on a designed lattice can achieve very high parallel efficiency on a MIMD Intel iPSC/860 machine. The key to such success is the realization that the particles can be tracked independently without considering their interaction. The perfectly parallel nature of particle tracking is broken if the interaction effects between particles are included. The space charge introduces an electromagnetic force that will affect the motion of tracked particles in 3-D space. For accurate modeling of the beam dynamics with space charge effects, one needs to solve three-dimensional Maxwell field equations, usually by a particle-in-cell (PIC) algorithm. This will require each particle to communicate with its neighbor grids to compute the momentum changes at each time step. It is expected that the 3-D PIC method will degrade parallel efficiency of particle-tracking implementation on any parallel computer. In this paper, we describe an efficient scheme for implementing particle tracking with space charge effects on an INTEL iPSC/860 machine. Experimental results show that a parallel efficiency of 75% can be obtained

Directions in implementation research methods for behavioral and social science.

Science.gov (United States)

Irwin, Molly; Supplee, Lauren H

2012-10-01

There is a growing interest, by researchers, policymakers, and practitioners, in evidence-based policy and practice. As a result, more dollars are being invested in program evaluation in order to establish "what works," and in some cases, funding is specifically tied to those programs found to be effective. However, reproducing positive effects found in research requires more than simply adopting an evidence-based program. Implementation research can provide guidance on which components of an intervention matter most for program impacts and how implementation components can best be implemented. However, while the body of rigorous research on effective practices continues to grow, research on implementation lags behind. To address these issues, the Administration for Children and Families and federal partners convened a roundtable meeting entitled, Improving Implementation Research Methods for Behavioral and Social Science, in the fall of 2010. This special section of the Journal of Behavioral Health Services & Research includes papers from the roundtable and highlights the role implementation science can play in shedding light on the difficult task of taking evidence-based practices to scale.

Using implementation tools to design and conduct quality improvement projects for faster and more effective improvement.

Science.gov (United States)

Ovretveit, John; Mittman, Brian; Rubenstein, Lisa; Ganz, David A

2017-10-09

Purpose The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights the importance of converting research findings into practical tools and guidance for improvers so as to make research easier to apply in practice. Design/methodology/approach This study provides an illustration of how a quality improvement (QI) team project can make use of recent findings from implementation research so as to make their improvement changes more effective and sustainable. The guidance is based on a review and synthesis of improvement and implementation methods. Findings The paper illustrates how research can help a quality project team in the phases of problem definition and preparation, in design and planning, in implementation, and in sustaining and spreading a QI. Examples of the use of different ideas and methods are cited where they exist. Research limitations/implications The example is illustrative and there is little limited experimental evidence of whether using all the steps and tools in the one approach proposed do enable a quality team to be more effective. Evidence supporting individual guidance proposals is cited where it exists. Practical implications If the steps proposed and illustrated in the paper were followed, it is possible that quality projects could avoid waste by ensuring the conditions they need for success are in place, and sustain and spread improvement changes more effectively. Social implications More patients could benefit more quickly from more effective implementation of proven interventions. Originality/value The paper is the first to describe how improvement and implementation science can be combined in a tangible way that practical improvers can use in their projects. It shows how QI project teams can take advantage of recent advances in improvement and implementation science to make their work more effective and sustainable.

Relativistic effects in local inertial frames including parametrized-post-Newtonian effects

International Nuclear Information System (INIS)

Shahid-Saless, B.; Ashby, N.

1988-01-01

We use the concept of a generalized Fermi frame to describe relativistic effects, due to local and distant sources of gravitation, on a body placed in a local inertial frame of reference. In particular we have considered a model of two spherically symmetric gravitating point sources, moving in circular orbits around a common barycenter where one of the bodies is chosen to be the local and the other the distant one. This has been done using the slow-motion, weak-field approximation and including four of the parametrized-post-Newtonian (PPN) parameters. The position of the classical center of mass must be modified when the PPN parameter zeta 2 is included. We show that the main relativistic effect on a local satellite is described by the Schwarzschild field of the local body and the nonlinear term corresponding to the self-interaction of the local source with itself. There are also much smaller terms that are proportional, respectively, to the product of the potentials of local and distant bodies and to the distant body's self-interactions. The spatial axes of the local frame undergo geodetic precession. In addition we have an acceleration of the order of 10/sup -11/ cm sec -2 that vanish in the case of general relativity, which is discussed in detail

40 CFR 60.2065 - What should I include in my waste management plan?

Science.gov (United States)

2010-07-01

... Management Plan § 60.2065 What should I include in my waste management plan? A waste management plan must... additional waste management measures and implement those measures the source considers practical and feasible, considering the effectiveness of waste management measures already in place, the costs of additional measures...

The perceived influence of diversity factors on effective strategy implementation in a higher education institution

Directory of Open Access Journals (Sweden)

K. Strydom

2018-04-01

Full Text Available Managing diversity is one of the major challenges in higher education institutions in South Africa. Additionally, effective strategy implementation is vital for an institution to be successful and sustainable. Questionnaires were distributed to the management of Walter Sisulu University, South Africa, to investigate the relationship between diversity factors and effective strategy implementation. The questionnaires interrogated the effect of the acculturation process, the degree of structural integration, the degree of informal integration, institutional bias and intergroup conflict, and how these factors influence strategy implementation. Structural equation modelling (SEM was employed as the statistical tool to confirm the hypothetical model. Results of this study revealed that there is no statistically significant relationship between diversity and strategy implementation at the institution, and imply that diversity among staff do not impact on the successful achievement of strategic objectives in the institution. The findings of the study are contrary to empirical evidence by other studies. Keywords: Education, Sociology, Political science, Psychology

Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care.

Science.gov (United States)

Döpp, Carola M E; Graff, Maud J L; Rikkert, Marcel G M Olde; Nijhuis van der Sanden, Maria W G; Vernooij-Dassen, Myrra J F J

2013-11-07

A multifaceted implementation (MFI) strategy was used to implement an evidence-based occupational therapy program for people with dementia (COTiD program). This strategy was successful in increasing the number of referrals, but not in improving occupational therapists' (OTs) adherence. Therefore, a process evaluation was conducted to identify factors that influenced the effectiveness of the MFI strategy. A mixed-method approach of qualitative and quantitative research was used to evaluate the implementation process. The MFI strategy as planned and as executed were reported and evaluated based on the framework of Hulscher et al. (2003; 2006). Data on OTs attitudes and expected barriers were collected at baseline from 94 OTs using a 19-item questionnaire. Data on the experiences were collected after finishing the implementation using focus groups with OTs and telephone interviews with physicians and managers. For quantitative data, frequencies and correlations were calculated and qualitative data were analyzed using inductive content analysis. The implementation strategy as executed had a stronger focus than planned on increasing OTs promotional skills due to an initial lack of referrals. This resulted in less attention for increasing OTs' skills in using the COTiD program as initially intended. At baseline, OTs had a positive attitude toward the program, however, 75% did not feel experienced enough and only 14.3% felt competent in using the program. Focus groups and interviews revealed various determinants that influenced implementation. Most managers were positive about the program. However, the degree of operational support of managers for OTs regarding the implementation was not always adequate. Managers stated that a well-defined place for occupational therapy within the dementia care network was lacking although this was perceived necessary for successful implementation. Several physicians perceived psychosocial interventions not to be in their area of

Evaluation of effectiveness of information systems implementation in organization (by example of ERP-systems)

Science.gov (United States)

Demyanova, O. V.; Andreeva, E. V.; Sibgatullina, D. R.; Kireeva-Karimova, A. M.; Gafurova, A. Y.; Zakirova, Ch S.

2018-05-01

ERP in a modern enterprise information system allowed optimizing internal business processes, reducing production costs and increasing the attractiveness of enterprises for investors. It is an important component of success in the competition and an important condition for attracting investments in the key sector of the state. A vivid example of these systems are enterprise information systems using the methodology of ERP (Enterprise Resource Planning - enterprise resource planning). ERP is an integrated set of methods, processes, technologies and tools. It is based on: supply chain management; advanced planning and scheduling; sales automation; tool responsible for configuring; final resource planning; intelligence business; OLAP technology; block e- Commerce; management of product data. The main purpose of ERP systems is the automation of interrelated processes of planning, accounting and management in key areas of the company. ERP systems are automated systems that effectively address complex problems, including optimal allocation of business resources, ensuring quick and efficient delivery of goods and services to the consumer. Knowledge embedded in ERP systems provided enterprise-wide automation to introduce the activities of all functional departments of the company as a single complex system. At the level of quality estimates, most managers understand that the implementations of ERP systems is a necessary and useful procedure. Assessment of the effectiveness of the information systems implementation is relevant.

Implementing Delirium Screening in the Intensive Care Unit: Secrets to Success

Science.gov (United States)

Brummel, Nathan E.; Vasilevskis, Eduard E.; Han, Jin Ho; Boehm, Leanne; Pun, Brenda T.; Ely, E. Wesley

2013-01-01

Objective To review delirium screening tools available for use in the adult and pediatric ICU, review evidence-based delirium screening implementation and to discuss common pitfalls encountered during delirium screening in the ICU. Data Sources Review of delirium screening literature and expert opinion. Results Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICUs settings. Keys to effective implementation include addressing barriers to routine screening, multi-faceted training such as lectures, case-based scenarios, one-on-one teaching and real-time feedback of delirium screening and interdisciplinary communication through discussion of a patient’s delirium status during bedside rounds and through documentation systems. If delirium is present clinicians should search for reversible or treatable causes since it is often multifactorial. Conclusion Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances. PMID:23896832

Consensus on Training and Implementation of Enhanced Recovery After Surgery

DEFF Research Database (Denmark)

Francis, Nader K; Walker, Thomas; Carter, Fiona

2018-01-01

ERAS programmes. Teaching modalities exist, but there remains no agreement regarding the optimal training curriculum or how its effectiveness is assessed. We aimed to draw consensus from an expert panel regarding the successful training and implementation of ERAS. METHODS: A modified Delphi technique...... and the structure of training courses; (2) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (3) a framework to assess the effectiveness of training; (4) criteria to define ERAS training centres of excellence. RESULTS: An ERAS training course must cover...... the evidence-based principles of ERAS with team-oriented training. Successful implementation requires strong leadership, an ERAS facilitator and an effective MDT. Effectiveness of training can be measured by improved compliance. A training centre of excellence should show a willingness to teach...

Effectiveness Of Implementation Of Corporate Social Responsibility (CSR In The Environmental Law Enforcement

Directory of Open Access Journals (Sweden)

Irwansyah

2016-09-01

Full Text Available Development in Indonesia refers to the concept of sustainable development (sustainable development and responsibility for the environment . Companies have a social responsibility to social and environmental consequences of environmental damage that caused . Implementation of corporate social responsibility ( Cooperate Social Responsibility is an important part in the framework part of the enforcement of environmental law . Implementation of CSR growing rapidly , including in Indonesia . Through Law No. 40 Year 2007 regarding Limited Liability Company , specifically in Article 74, in response to the action of the business world to social and environmental causes damages to society . But in application / CSR implementation will be undertaken by the company is not maximized with implications for the enforcement of environmental law.

Promoting the translation of intentions into action by implementation intentions: Behavioral effects and physiological correlates

Directory of Open Access Journals (Sweden)

Frank eWieber

2015-07-01

Full Text Available The present review addresses the physiological correlates of planning effects on behavior. Although intentions to act qualify as predictors of behavior, accumulated evidence indicates that there is a substantial gap between even strong intentions and subsequent action. One effective strategy to reduce this intention-behavior gap is the formation of implementation intentions that specify when, where, and how to act on a given goal in an if-then format (If I encounter situation Y, then I will initiate action Z!. It has been proposed that implementation intentions render the mental representation of the situation highly accessible and establish a strong associative link between the mental representations of the situation and the action. These process assumptions have been examined in behavioral research, and in physiological research, a field that has begun to investigate the temporal dynamics of and brain areas involved in implementation intention effects. In the present review, we first summarize studies on the cognitive processes that are central to the strategic automation of action control by implementation intentions. We then examine studies involving critical samples with impaired self-regulation. Lastly, we review studies that have applied physiological measures such as heart rate, cortisol level, and eye movement, as well as electroencephalography (EEG and functional magnetic resonance imaging (fMRI studies on the neural correlates of implementation intention effects. In support of the assumed processes, implementation intentions increased goal attainment in studies on cognitive processes and in critical samples, modulated brain waves related to perceptual and decision processes, and generated less activity in brain areas associated with effortful action control. In our discussion, we reflect on the status quo of physiological research on implementation intentions, methodological and conceptual issues, related research, and propose future

Maintenance implementation plan for fuel supply shutdown

International Nuclear Information System (INIS)

Stephenson, R.L.

1995-06-01

This Maintenance Implementation Plan is written to satisfy the requirements of DOE Order 4330.4B, ''MAINTENANCE MANAGEMENT PROGRAM'', that specifies the general policy and objectives for the establishment of DOE controlled maintenance programs. These Programs provide for the management and performance of cost-effective maintenance and repair of Department of Energy (DOE) property, which includes facilities. A review of DOE Order 4330.4B, particularly Chapter II the nuclear portion, against existing WHC site programs and policies has provided assurance that most requirements of this order have already been implemented by existing WHC programs. Applicable requirements and guidelines of 4330.4B that are deficient or not implemented are presently being developed and implemented through WHC site policies and programs. Where no program is presently identified or being developed for 4330.4B requirements, responsibility for implementation has been assigned within this plan

[Implementing evidence and implementation research: two different and prime realities].

Science.gov (United States)

Rumbo Prieto, José María; Martínez Ques, Ángel Alfredo; Sobrido Prieto, María; Raña Lama, Camilo Daniel; Vázquez Campo, Miriam; Braña Marcos, Beatriz

Scientific research can contribute to more efficient health care, enhance care quality and safety of persons. In order for this to happen, the knowledge gained must be put into practice. Implementation is known as the introduction of a change or innovation to daily practice, which requires effective communication and the elimination of barriers that hinder this process. Best practice implementation experiences are being used increasingly in the field of nursing. The difficulty in identifying the factors that indicate the success or failure of implementation has led to increased studies to build a body of differentiated knowledge, recognized as implementation science or implementation research. Implementation research is the scientific study whose objective is the adoption and systematic incorporation of research findings into clinical practice to improve the quality and efficiency of health services. The purpose of implementation research is to improve the health of the population through equitable and effective implementation of rigorously evaluated scientific knowledge, which involves gathering the evidence that has a positive impact on the health of the community. In this text, we set out the characteristics of nursing implementation research, providing a synthesis of different methods, theories, key frameworks and implementation strategies, along with the terminology proposed for greater conceptual clarity. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Implementation Processes and Pay for Performance in Healthcare: A Systematic Review.

Science.gov (United States)

Kondo, Karli K; Damberg, Cheryl L; Mendelson, Aaron; Motu'apuaka, Makalapua; Freeman, Michele; O'Neil, Maya; Relevo, Rose; Low, Allison; Kansagara, Devan

2016-04-01

Over the last decade, various pay-for-performance (P4P) programs have been implemented to improve quality in health systems, including the VHA. P4P programs are complex, and their effects may vary by design, context, and other implementation processes. We conducted a systematic review and key informant (KI) interviews to better understand the implementation factors that modify the effectiveness of P4P. We searched PubMed, PsycINFO, and CINAHL through April 2014, and reviewed reference lists. We included trials and observational studies of P4P implementation. Two investigators abstracted data and assessed study quality. We interviewed P4P researchers to gain further insight. Among 1363 titles and abstracts, we selected 509 for full-text review, and included 41 primary studies. Of these 41 studies, 33 examined P4P programs in ambulatory settings, 7 targeted hospitals, and 1 study applied to nursing homes. Related to implementation, 13 studies examined program design, 8 examined implementation processes, 6 the outer setting, 18 the inner setting, and 5 provider characteristics. Results suggest the importance of considering underlying payment models and using statistically stringent methods of composite measure development, and ensuring that high-quality care will be maintained after incentive removal. We found no conclusive evidence that provider or practice characteristics relate to P4P effectiveness. Interviews with 14 KIs supported limited evidence that effective P4P program measures should be aligned with organizational goals, that incentive structures should be carefully considered, and that factors such as a strong infrastructure and public reporting may have a large influence. There is limited evidence from which to draw firm conclusions related to P4P implementation. Findings from studies and KI interviews suggest that P4P programs should undergo regular evaluation and should target areas of poor performance. Additionally, measures and incentives should align

Matrix formulations of radiative transfer including the polarization effect in a coupled atmosphere-ocean system

International Nuclear Information System (INIS)

Ota, Yoshifumi; Higurashi, Akiko; Nakajima, Teruyuki; Yokota, Tatsuya

2010-01-01

A vector radiative transfer model has been developed for a coupled atmosphere-ocean system. The radiative transfer scheme is based on the discrete ordinate and matrix operator methods. The reflection/transmission matrices and source vectors are obtained for each atmospheric or oceanic layer through the discrete ordinate solution. The vertically inhomogeneous system is constructed using the matrix operator method, which combines the radiative interaction between the layers. This radiative transfer scheme is flexible for a vertically inhomogeneous system including the oceanic layers as well as the ocean surface. Compared with the benchmark results, the computational error attributable to the radiative transfer scheme has been less than 0.1% in the case of eight discrete ordinate directions. Furthermore, increasing the number of discrete ordinate directions has produced computations with higher accuracy. Based on our radiative transfer scheme, simulations of sun glint radiation have been presented for wavelengths of 670 nm and 1.6 μm. Results of simulations have shown reasonable characteristics of the sun glint radiation such as the strongly peaked, but slightly smoothed radiation by the rough ocean surface and depolarization through multiple scattering by the aerosol-loaded atmosphere. The radiative transfer scheme of this paper has been implemented to the numerical model named Pstar as one of the OpenCLASTR/STAR radiative transfer code systems, which are widely applied to many radiative transfer problems, including the polarization effect.

Implementering & Performative Potentialer

DEFF Research Database (Denmark)

Damkjer, Annemarie

organizational boundaries. Furthermore, the analysis reflect how specific modes of ordering in the local process of implementation perform and displace the technology of performance management. The study provides an alternative view of the performative potentials in implementation processes and specifically...... challenge the traditional models of implementation. It is suggested, that we view implementation practices as performative in relation to the co-configuration of technology and organizational practices and that both the co-configurative perspective and the materiality of implementation practices is included......This thesis investigates how technology is constituted as an object of implementation. Using the theoretical lens of actor-network theory the thesis investigates how the technology of performance management becomes a matter of implementation in the Danish Defence and how the technology...

[Implementation of "5S" methodology in laboratory safety and its effect on employee satisfaction].

Science.gov (United States)

Dogan, Yavuz; Ozkutuk, Aydan; Dogan, Ozlem

2014-04-01

Health institutions use the accreditation process to achieve improvement across the organization and management of the health care system. An ISO 15189 quality and efficiency standard is the recommended standard for medical laboratories qualification. The "safety and accommodation conditions" of this standard covers the requirement to improve working conditions and maintain the necessary safety precautions. The most inevitable precaution for ensuring a safe environment is the creation of a clean and orderly environment to maintain a potentially safe surroundings. In this context, the 5S application which is a superior improvement tool that has been used by the industry, includes some advantages such as encouraging employees to participate in and to help increase the productivity. The main target of this study was to implement 5S methods in a clinical laboratory of a university hospital for evaluating its effect on employees' satisfaction, and correction of non-compliance in terms of the working environment. To start with, first, 5S education was given to management and employees. Secondly, a 5S team was formed and then the main steps of 5S (Seiri: Sort, Seiton: Set in order, Seiso: Shine, Seiketsu: Standardize, and Shitsuke: Systematize) were implemented for a duration of 3 months. A five-point likert scale questionnaire was used in order to determine and assess the impact of 5S on employees' satisfaction considering the areas such as facilitating the job, the job satisfaction, setting up a safe environment, and the effect of participation in management. Questionnaire form was given to 114 employees who actively worked during the 5S implementation period, and the data obtained from 63 (52.3%) participants (16 male, 47 female) were evaluated. The reliability of the questionnaire's Cronbach's alpha value was determined as 0.858 (p5S it was observed and determined that facilitating the job and setting up a safe environment created a statistically significant effect on

Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial.

Science.gov (United States)

Garner, Bryan R; Zehner, Mark; Roosa, Mathew R; Martino, Steve; Gotham, Heather J; Ball, Elizabeth L; Stilen, Patricia; Speck, Kathryn; Vandersloot, Denna; Rieckmann, Traci R; Chaple, Michael; Martin, Erika G; Kaiser, David; Ford, James H

2017-11-17

Improving the extent to which evidence-based practices (EBPs)-treatments that have been empirically shown to be efficacious or effective-are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness-implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration-preparation-implementation-sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome). Although not without limitations, the ISF

Homework in Physical Education: Benefits and Implementation

Science.gov (United States)

Novak, Benjamin Edward; Lynott, Francis John, III.

2015-01-01

This article identifies homework as an underutilized strategy in physical education. It reviews the benefits associated with the use of homework in the physical education setting, and provides guidelines for the effective implementation of this strategy. The guidelines include practical application examples and define structured active homework…

A radiological control implementation guide

International Nuclear Information System (INIS)

Hamley, S.A.

1993-01-01

A manual is being developed to explain to line managers how radiological controls are designed and implemented. The manual also fills a gap in the Health Physics literature between textbooks and on-the-floor procedures. It may be helpful to new Health Physicists with little practical experience and to those wishing to improve self-assessment, audit, and appraisal processes. Many audits, appraisals, and evaluations have indicated a need for cultural change, increased vigor and example, and more effective oversight by line management. Inadequate work controls are a frequent and recurring problem identified in occurrence reports and accident investigations. Closer study frequently indicates that many line managers are willing to change and want to achieve excellence, but no effective guidance exists that will enable them to understand and implement a modern radiological control program. The manual is now in draft form and includes information that will be of use to line managers dealing with improving radiological performance and the practical aspects of radiological controls implementation. The manual is expected to be completed by the fall of 1993 and to be used in conjunction with a performance-based self-assessment training program at the Oak Ridge National Laboratory

Community-based implementation and effectiveness in a randomized trial of a risk reduction intervention for HIV-serodiscordant couples: study protocol.

Science.gov (United States)

Hamilton, Alison B; Mittman, Brian S; Williams, John K; Liu, Honghu H; Eccles, Alicia M; Hutchinson, Craig S; Wyatt, Gail E

2014-06-20

The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of 'Eban II,' an evidence-based risk reduction intervention for African-American heterosexual, serodiscordant couples. This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level; staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi

Effectiveness and implementation of an obesity prevention intervention: the HeLP-her Rural cluster randomised controlled trial.

Science.gov (United States)

Lombard, Catherine B; Harrison, Cheryce L; Kozica, Samantha L; Zoungas, Sophia; Keating, Catherine; Teede, Helena J

2014-06-16

To impact on the obesity epidemic, interventions that prevent weight gain across populations are urgently needed. However, even the most efficacious interventions will have little impact on obesity prevention unless they are successfully implemented in diverse populations and settings. Implementation research takes isolated efficacy studies into practice and policy and is particularly important in obesity prevention where there is an urgent need to accelerate the evidence to practice cycle. Despite the recognised need, few obesity prevention interventions have been implemented in real life settings and to our knowledge rarely target rural communities. Here we describe the rationale, design and implementation of a Healthy Lifestyle Program for women living in small rural communities (HeLP-her Rural). The primary goal of HeLP-her Rural is to prevent weight gain using a low intensity, self-management intervention. Six hundred women from 42 small rural communities in Australia will be randomised as clusters (n-21 control towns and n = 21 intervention towns). A pragmatic randomised controlled trial methodology will test efficacy and a comprehensive mixed methods community evaluation and cost analysis will inform effectiveness and implementation of this novel prevention program. Implementing population interventions to prevent obesity is complex, costly and challenging. To address these barriers, evidence based interventions need to move beyond isolated efficacy trials and report outcomes related to effectiveness and implementation. Large pragmatic trials provide an opportunity to inform both effectiveness and implementation leading to potential for greater impact at the population level. Pragmatic trials should incorporate both effectiveness and implementation outcomes and a multidimensional methodology to inform scale-up to population level. The learnings from this trial will impact on the design and implementation of population obesity prevention strategies

Risk Reducing Effect of AIS Implementation on Collision Risk

DEFF Research Database (Denmark)

Lützen, Marie; Friis-Hansen, Peter

2003-01-01

AIS (Automatic Identification System) is a transponder system developed for sea traffic purposes. The system sends and receives important ship information and other safety-related information between other ships and shore-based AIS stations. The implementation of AIS has now been initiated and......, as a result, the community will undoubtedly observe an increase in navigational safety. However, to the authors? knowledge, no study has so far rigorously quantified the risk reducing effect of using AIS as an integrated part of the navigational system. The objective of this study is to fill this gap....... The risk reducing effect of AIS is quantified by building a Bayesian network facilitating an evaluation of the effect of AIS on the navigational officer?s reaction ability in a potential, critical collision situation. The time-dependent change in the risk reducing effect on ship collisions is analysed...

Integrative review of implementation strategies for translation of research-based evidence by nurses.

Science.gov (United States)

Wuchner, Staci S

2014-01-01

The purpose of this review was to synthesize and critique experimental and/or quasi-experimental research that has evaluated implementation strategies for translation of research-based evidence into nursing practice. Successfully implementing evidence-based research can improve patient outcomes. Identifying successful implementation strategies is imperative to move research-based evidence into practice. As implementation science gains popularity, it is imperative to understand the strategies that most effectively translate research-based evidence into practice. The review used the CINAHL and MEDLINE (Ovid) databases. Articles were included if they were experimental and/or quasi-experimental research designs, were written in English, and measured nursing compliance to translation of research-based evidence. An independent review was performed to select and critique the included articles. A wide array of interventions were completed, including visual cues, audit and feedback, educational meetings and materials, reminders, outreach, and leadership involvement. Because of the complex multimodal nature of the interventions and the variety of research topics, comparison across interventions was difficult. Many difficulties exist in determining what implementation strategies are most effective for translation of research-based evidence into practice by nurses. With these limited findings, further research is warranted to determine which implementation strategies most successfully translate research-based evidence into practice.

Less is more : The effect of multiple implementation intentions targeting unhealthy snacking habits

NARCIS (Netherlands)

Verhoeven, A.A.C.; Adriaanse, M.A.; de Ridder, D.T.D.; de Vet, E.; Fennis, B.M.

Implementation intentions have been shown to effectively change counter-intentional habits. Research has, however, almost solely been concerned with the effectiveness of a single plan. In the present research, we investigated the behavioral and cognitive implications of making multiple

Less is more: The effect of multiple implementation intentions targeting unhealthy snacking habits

NARCIS (Netherlands)

Verhoeven, A.A.C.; Adriaanse, M.A.; Ridder, de D.T.D.; Vet, de E.W.M.L.; Fennis, B.M.

2013-01-01

Implementation intentions have been shown to effectively change counter-intentional habits. Research has, however, almost solely been concerned with the effectiveness of a single plan. In the present research, we investigated the behavioral and cognitive implications of making multiple

Design and Implementation of a Cyber-Defense Exercise

OpenAIRE

Adrian Furtuna

2010-01-01

Learning by practice is a very effective way of education in some activity domains, including information security. The article explores this idea by showing how a cyber-defense exercise can be designed and implemented in order to reach its educational goals.

Implemented or not implemented? Process evaluation of the school-based obesity prevention program DOiT and associations with program effectiveness

NARCIS (Netherlands)

van Nassau, F.; Singh, A.S.; Hoekstra, T.; van Mechelen, W.; Brug, J.; Chinapaw, M.J.M.

This study investigates if and to what extent the Dutch Obesity Intervention in Teenagers (DOiT) program was implemented as intended and how this affected program effectiveness. We collected data at 20 prevocational education schools in the Netherlands. We assessed seven process indicators:

Implemented or not implemented? : Process evaluation of the school-based obesity prevention program DOiT and associations with program effectiveness

NARCIS (Netherlands)

van Nassau, Femke; Singh, Amika S; Hoekstra, T.; van Mechelen, Willem; Brug, Johannes; Chinapaw, Mai J M

This study investigates if and to what extent the Dutch Obesity Intervention in Teenagers (DOiT) program was implemented as intended and how this affected program effectiveness. We collected data at 20 prevocational education schools in the Netherlands. We assessed seven process indicators:

Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting

DEFF Research Database (Denmark)

Risoer, Bettina Wulff; Lisby, Marianne; Soerensen, Jan

2017-01-01

Objectives To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. Methods An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary...... outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent...... variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number...

Six sigma implementation and its effects on configuration management related to metal industry

International Nuclear Information System (INIS)

Tariq, M.M.; Ahmad, S.F.; Mahmoo, A.; Kalsoom, T.

2006-01-01

This paper discusses the implementation of Six Sigma and its effects on Configuration Management (CM) of metal industry. The basic idea behind the Six Sigma philosophy is to continuously reduce product and process variation. Design for Six Sigma (DFSS) methodology generates new processes, products, services, plants, etc., whereas Define, Measure, Analyze, Improve and Control (DMAIC) methodology improves existing processes, products, services, designs, plants, etc. The DFSS project stages are summarized as Identify, Design, Optimize, and Validate (IDOV). Role of CM for DFSS and DMAIC will be discussed. Seven steps for Six Sigma introduction in new management strategy and the other seven steps for Six Sigma improvement implementation shall be discussed indicating possible role of CM. Tasks of Black Belt leader in Six Sigma implementation are very important. The expected outcomes of Six Sigma efforts are: Faster and more robust product development. More efficient and capable manufacturing processes and, more confident overall business performance. The investigation and knowledge of Six Sigma effects produced in metals industry on CM will increase the effectiveness of each other, and it will be a better, reliable and well documented approach towards Six Sigma. (author)

Zγ production at NNLO including anomalous couplings

Science.gov (United States)

Campbell, John M.; Neumann, Tobias; Williams, Ciaran

2017-11-01

In this paper we present a next-to-next-to-leading order (NNLO) QCD calculation of the processes pp → l + l -γ and pp\\to ν \\overline{ν}γ that we have implemented in MCFM. Our calculation includes QCD corrections at NNLO both for the Standard Model (SM) and additionally in the presence of Zγγ and ZZγ anomalous couplings. We compare our implementation, obtained using the jettiness slicing approach, with a previous SM calculation and find broad agreement. Focusing on the sensitivity of our results to the slicing parameter, we show that using our setup we are able to compute NNLO cross sections with numerical uncertainties of about 0.1%, which is small compared to residual scale uncertainties of a few percent. We study potential improvements using two different jettiness definitions and the inclusion of power corrections. At √{s}=13 TeV we present phenomenological results and consider Zγ as a background to H → Zγ production. We find that, with typical cuts, the inclusion of NNLO corrections represents a small effect and loosens the extraction of limits on anomalous couplings by about 10%.

Implementing Green Walls in Schools.

Science.gov (United States)

McCullough, Michael B; Martin, Michael D; Sajady, Mollika A

2018-01-01

Numerous studies in applied pedagogical design have shown that, at all educational levels, direct exposure to the natural environment can enhance learning by improving student attention and behaviors. Implementing green walls-a "vertical garden," or "living wall" interior wall that typically includes greenery, a growing medium (soil or substrate) and a water delivery system-provides environmental health benefits, but also provides a practical application within classrooms for minimizing directed attention fatigue in students by connecting them to "outdoor nature" within the indoor environment. Hands-on "project-based" learning is another pedagogical strategy that has proved to be effective across the spectrum of educational levels and across subject areas. Green walls have the potential to inspire critical thinking through a combination of project-based learning strategies and environmental education. The authors have outlined a curriculum involving the implementation of an indoor living wall system within a classroom-learning environment, incorporating project-based learning modules that interact with the wall. In conjunction with the passive health benefits of a green wall, project-based curriculum models can connect students interactively with indoor nature and have the potential to inspire real-world thinking related to science, technology, engineering, art, and mathematics fields within the indoor learning environment. Through a combination of these passive and interactive modes, students are connected to nature in the indoor environment regardless of weather conditions outdoors. Future research direction could include post-construction studies of the effectiveness of project-based curricula related to living walls, and the long-term impacts of implementing green walls in classrooms on school achievement and student behaviors.

The science of quality improvement implementation: developing capacity to make a difference.

Science.gov (United States)

Alexander, Jeffrey A; Hearld, Larry R

2011-12-01

Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. To critically review the empirical research on QI implementation in health care organizations. A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.

Toward implementation of a national ground water monitoring network

Science.gov (United States)

Schreiber, Robert P.; Cunningham, William L.; Copeland, Rick; Frederick, Kevin D.

2008-01-01

The Federal Advisory Committee on Water Information's (ACWI) Subcommittee on Ground Water (SOGW) has been working steadily to develop and encourage implementation of a nationwide, long-term ground-water quantity and quality monitoring framework. Significant progress includes the planned submission this fall of a draft framework document to the full committee. The document will include recommendations for implementation of the network and continued acknowledgment at the federal and state level of ACWI's potential role in national monitoring toward an improved assessment of the nation's water reserves. The SOGW mission includes addressing several issues regarding network design, as well as developing plans for concept testing, evaluation of costs and benefits, and encouraging the movement from pilot-test results to full-scale implementation within a reasonable time period. With the recent attention to water resource sustainability driven by severe droughts, concerns over global warming effects, and persistent water supply problems, the SOGW mission is now even more critical.

Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program.

Science.gov (United States)

Kilbourne, Amy M; Almirall, Daniel; Eisenberg, Daniel; Waxmonsky, Jeanette; Goodrich, David E; Fortney, John C; Kirchner, JoAnn E; Solberg, Leif I; Main, Deborah; Bauer, Mark S; Kyle, Julia; Murphy, Susan A; Nord, Kristina M; Thomas, Marshall R

2014-09-30

Despite the availability of psychosocial evidence-based practices (EBPs), treatment and outcomes for persons with mental disorders remain suboptimal. Replicating Effective Programs (REP), an effective implementation strategy, still resulted in less than half of sites using an EBP. The primary aim of this cluster randomized trial is to determine, among sites not initially responding to REP, the effect of adaptive implementation strategies that begin with an External Facilitator (EF) or with an External Facilitator plus an Internal Facilitator (IF) on improved EBP use and patient outcomes in 12 months. This study employs a sequential multiple assignment randomized trial (SMART) design to build an adaptive implementation strategy. The EBP to be implemented is life goals (LG) for patients with mood disorders across 80 community-based outpatient clinics (N = 1,600 patients) from different U.S. regions. Sites not initially responding to REP (defined as implementation costs, and organizational change. This study design will determine whether an off-site EF alone versus the addition of an on-site IF improves EBP uptake and patient outcomes among sites that do not respond initially to REP. It will also examine the value of delaying the provision of EF/IF for sites that continue to not respond despite EF. ClinicalTrials.gov identifier: NCT02151331.

Effectiveness and implementation aspects of interventions for preventing falls in elderly people in long-term care facilities: a systematic review of RCTs.

Science.gov (United States)

Neyens, Jacques C; van Haastregt, Jolanda C; Dijcks, Béatrice P; Martens, Mark; van den Heuvel, Wim J; de Witte, Luc P; Schols, Jos M

2011-07-01

There is extensive literature on interventions to prevent or reduce falls in elderly people. These findings, however, were based mainly on studies of community-living persons. The primary aim of the present study was to report the effectiveness and implementation aspects of interventions aimed at reducing falls in elderly residents in long-term care facilities: a systematic review of randomized controlled trials (RCTs). MEDLINE, EMBASE, CINAHL, and hand searching of reference lists of included RCTs. RCTs that assessed fall incidents (falls, fallers, recurrent fallers, fall-related injuries) among elderly residents in long-term care facilities were included in this narrative review. Two independent reviewers abstracted data: general program characteristics (setting, population, intervention program) and outcomes, detailed program characteristics (assessment, intervention content, individually tailored, multidisciplinary), and implementation aspects (feasibility, implications for practice). The CONSORT Statement 2001 Checklist was used regarding the quality of reporting RCTs. Twenty trials met the inclusion criteria. Seven trials, 4 multifactorial and 3 monofactorial, showed a significant reduction in the fall rate, the percentage of recurrent fallers, or both the fall rate and the percentage of persons sustaining femoral fractures. The positive effective programs were as follows: a comprehensive structured individual assessment with specific safety recommendations; a multidisciplinary program including general strategies tailored to the setting and strategies tailored specifically to residents; a multifaceted intervention including education, environmental adaptation, balance, resistance training, and hip protector; calcium plus vitamin D supplementation; vitamin D supplementation; a clinical medication review; and a multifactorial intervention (fall risk evaluation, specific and general interventions). In general, because of the limited number of included trials

Two-dimensional analysis of motion artifacts, including flow effects

International Nuclear Information System (INIS)

Litt, A.M.; Brody, A.S.; Spangler, R.A.; Scott, P.D.

1990-01-01

The effects of motion on magnetic resonance images have been theoretically analyzed for the case of a point-like object in simple harmonic motion and for other one-dimensional trajectories. The authors of this paper extend this analysis to a generalized two-dimensional magnetization with an arbitrary motion trajectory. The authors provide specific solutions for the clinically relevant cases of the cross-sections of cylindrical objects in the body, such as the aorta, which has a roughly one-dimensional, simple harmonic motion during respiration. By extending the solution to include inhomogeneous magnetizations, the authors present a model which allows the effects of motion artifacts and flow artifacts to be analyzed simultaneously

Analysis of Member State RED implementation. Final Report (Task 2)

Energy Technology Data Exchange (ETDEWEB)

Peters, D.; Alberici, S.; Toop, G. [Ecofys, Utrecht (Netherlands); Kretschmer, B. [Institute for European Environmental Policy IEEP, London (United Kingdom)

2012-12-15

This report describes the way EU Member States have transposed the sustainability and chain of custody requirements for biofuels as laid down in the Renewable Energy Directive (RED) and Fuel Quality Directive (FQD). In the assessment of Member States' implementation, the report mainly focuses on effectiveness and administrative burden. Have Member States transposed the Directives in such a way that compliance with the sustainability criteria can be ensured as effectively as possible? To what extent does the Member States' implementation lead to unnecessary administrative burden for economic operators in the (bio)fuel supply chain? The report focuses specifically on the transposition of the sustainability and chain of custody requirements, not on the target for renewables on transport. This means that for example the double counting provision is not included as part of the scope of this report. This report starts with an introduction covering the implementation of the Renewable Energy (and Fuel Quality) Directive into national legislation, the methodology by which Member States were assessed against effectiveness and administrative burden and the categorisation of Member State's national systems for RED-implementation (Chapter 1). The report continues with a high level description of each Member State system assessed (Chapter 2). Following this, the report includes analysis of the Member States on the effectiveness and administrative burden of a number of key ('major') measures (Chapter 3). The final chapter presents the conclusions and recommendations (Chapter 4)

Development of calculation method for one-dimensional kinetic analysis in fission reactors, including feedback effects

International Nuclear Information System (INIS)

Paixao, S.B.; Marzo, M.A.S.; Alvim, A.C.M.

1986-01-01

The calculation method used in WIGLE code is studied. Because of the non availability of such a praiseworthy solution, expounding the method minutely has been tried. This developed method has been applied for the solution of the one-dimensional, two-group, diffusion equations in slab, axial analysis, including non-boiling heat transfer, accountig for feedback. A steady-state program (CITER-1D), written in FORTRAN 4, has been implemented, providing excellent results, ratifying the developed work quality. (Author) [pt

Never the twain shall meet?--a comparison of implementation science and policy implementation research.

Science.gov (United States)

Nilsen, Per; Ståhl, Christian; Roback, Kerstin; Cairney, Paul

2013-06-10

Many of society's health problems require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies. However, there has been limited knowledge exchange between implementation science and policy implementation research, which has been conducted since the early 1970s. Based on a narrative review of selective literature on implementation science and policy implementation research, the aim of this paper is to describe the characteristics of policy implementation research, analyze key similarities and differences between this field and implementation science, and discuss how knowledge assembled in policy implementation research could inform implementation science. Following a brief overview of policy implementation research, several aspects of the two fields were described and compared: the purpose and origins of the research; the characteristics of the research; the development and use of theory; determinants of change (independent variables); and the impact of implementation (dependent variables). The comparative analysis showed that there are many similarities between the two fields, yet there are also profound differences. Still, important learning may be derived from several aspects of policy implementation research, including issues related to the influence of the context of implementation and the values and norms of the implementers (the healthcare practitioners) on implementation processes. Relevant research on various associated policy topics, including The Advocacy Coalition Framework, Governance Theory, and Institutional Theory, may also contribute to improved understanding of the difficulties of implementing evidence in healthcare. Implementation science is at a relatively early stage of development, and advancement of the field would benefit from accounting for knowledge beyond the parameters of the immediate implementation science literature. There are many common issues in

Never the twain shall meet? - a comparison of implementation science and policy implementation research

Science.gov (United States)

2013-01-01

Background Many of society’s health problems require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies. However, there has been limited knowledge exchange between implementation science and policy implementation research, which has been conducted since the early 1970s. Based on a narrative review of selective literature on implementation science and policy implementation research, the aim of this paper is to describe the characteristics of policy implementation research, analyze key similarities and differences between this field and implementation science, and discuss how knowledge assembled in policy implementation research could inform implementation science. Discussion Following a brief overview of policy implementation research, several aspects of the two fields were described and compared: the purpose and origins of the research; the characteristics of the research; the development and use of theory; determinants of change (independent variables); and the impact of implementation (dependent variables). The comparative analysis showed that there are many similarities between the two fields, yet there are also profound differences. Still, important learning may be derived from several aspects of policy implementation research, including issues related to the influence of the context of implementation and the values and norms of the implementers (the healthcare practitioners) on implementation processes. Relevant research on various associated policy topics, including The Advocacy Coalition Framework, Governance Theory, and Institutional Theory, may also contribute to improved understanding of the difficulties of implementing evidence in healthcare. Implementation science is at a relatively early stage of development, and advancement of the field would benefit from accounting for knowledge beyond the parameters of the immediate implementation science literature. Summary

Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions

Science.gov (United States)

Egan, M; Bambra, C; Petticrew, M; Whitehead, M

2009-01-01

Background: The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account. Methods: Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text. Results: 103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist. Conclusions: Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further

Implementation of strategies to improve programme effectiveness ...

African Journals Online (AJOL)

of care is also a key component of the right to health and the route to equity and dignity for ... 1 outlines the factors that influence programme effectiveness, including the stakeholders ..... Table 4. Effect of EOST exercises. Submitted data.

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

Directory of Open Access Journals (Sweden)

Graeme Kohler

2017-11-01

Full Text Available n a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs at decision-making points in primary healthcare (PHC based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.

Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: a systematic review of mixed evidence.

Science.gov (United States)

Reilly, Rachel; Evans, Katharine; Gomersall, Judith; Gorham, Gillian; Peters, Micah D J; Warren, Steven; O'Shea, Rebekah; Cass, Alan; Brown, Alex

2016-04-06

Indigenous peoples in Australia, New Zealand and Canada carry a greater burden of chronic kidney disease (CKD) than the general populations in each country, and this burden is predicted to increase. Given the human and economic cost of dialysis, understanding how to better manage CKD at earlier stages of disease progression is an important priority for practitioners and policy-makers. A systematic review of mixed evidence was undertaken to examine the evidence relating to the effectivness, cost-effectiveness and acceptability of chronic kidney disease management programs designed for Indigenous people, as well as barriers and enablers of implementation of such programs. Published and unpublished studies reporting quantitative and qualitative data on health sector-led management programs and models of care explicitly designed to manage, slow progression or otherwise improve the lives of Indigenous people with CKD published between 2000 and 2014 were considered for inclusion. Data on clinical effectiveness, ability to self-manage, quality of life, acceptability, cost and cost-benefit, barriers and enablers of implementation were of interest. Quantitative data was summarized in narrative and tabular form and qualitative data was synthesized using the Joanna Briggs Institute meta-aggregation approach. Ten studies were included. Six studies provided evidence of clinical effectiveness of CKD programs designed for Indigenous people, two provided evidence of cost and cost-effectiveness of a CKD program, and two provided qualitative evidence of barriers and enablers of implementation of effective and/or acceptable CKD management programs. Common features of effective and acceptable programs were integration within existing services, nurse-led care, intensive follow-up, provision of culturally-appropriate education, governance structures supporting community ownership, robust clinical systems supporting communication and a central role for Indigenous Health Workers. Given

Evaluation of physical activity interventions in youth via the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework: A systematic review of randomised and non-randomised trials.

Science.gov (United States)

McGoey, Tara; Root, Zach; Bruner, Mark W; Law, Barbi

2015-07-01

An identified limitation of existing reviews of physical activity interventions in school-aged youth is the lack of reporting on issues related to the translatability of the research into health promotion practice. This review used the Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance framework to determine the extent to which intervention studies promoting physical activity in youth report on factors that inform generalizability across settings and populations. A systematic search for controlled interventions conducted within the last ten years identified 50 studies that met the selection criteria. Based on Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance criteria, most of these studies focused on statistically significant findings and internal validity rather than on issues of external validity. Due to this lack of information, it is difficult to determine whether or not reportedly successful interventions are feasible and sustainable in an uncontrolled, real-world setting. Areas requiring further research include costs associated with recruitment and implementation, adoption rate, and representativeness of participants and settings. This review adds data to support recommendations that interventions promoting physical activity in youth should include assessment of adoption and implementation issues. Copyright © 2015 Elsevier Inc. All rights reserved.

77 FR 749 - General Services Administration Acquisition Regulation; Implementation of Information Technology...

Science.gov (United States)

2012-01-06

... Acquisition Regulation; Implementation of Information Technology Security Provision AGENCY: Office of... orders that include information technology (IT) supplies, services and systems. DATES: Effective Date... 6, 2012 that include information technology (IT) supplies, services and systems with security...

Implementing NLO DGLAP evolution in parton showers

Energy Technology Data Exchange (ETDEWEB)

Höche, Stefan; Krauss, Frank; Prestel, Stefan

2017-10-01

We present a parton shower which implements the DGLAP evolution of parton densities and fragmentation functions at next-to-leading order precision up to effects stemming from local four-momentum conservation. The Monte-Carlo simulation is based on including next-to-leading order collinear splitting functions in an existing parton shower and combining their soft enhanced contributions with the corresponding terms at leading order. Soft double counting is avoided by matching to the soft eikonal. Example results from two independent realizations of the algorithm, implemented in the two event generation frameworks Pythia and Sherpa, illustrate the improved precision of the new formalism.

Companion of choice at birth: factors affecting implementation.

Science.gov (United States)

Kabakian-Khasholian, Tamar; Portela, Anayda

2017-08-31

Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators. Forty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors. Women and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers. Prior to introducing companion of choice at birth, understanding providers' attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women's privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of

Modeling and implementation of wind shear data

Science.gov (United States)

Frost, Walter

1987-01-01

The problems of implementing the JAWS wind shear data are discussed. The data sets are described from the view of utilizing them in an aircraft performance computer program. Then, some of the problems of nonstandard procedures are described in terms of programming the equations of aircraft motion when the effects of temporal and spatially variable winds are included. Finally, some of the computed effects of the various wind shear terms are shown.

Analysis of Smart Composite Structures Including Debonding

Science.gov (United States)

Chattopadhyay, Aditi; Seeley, Charles E.

1997-01-01

Smart composite structures with distributed sensors and actuators have the capability to actively respond to a changing environment while offering significant weight savings and additional passive controllability through ply tailoring. Piezoelectric sensing and actuation of composite laminates is the most promising concept due to the static and dynamic control capabilities. Essential to the implementation of these smart composites are the development of accurate and efficient modeling techniques and experimental validation. This research addresses each of these important topics. A refined higher order theory is developed to model composite structures with surface bonded or embedded piezoelectric transducers. These transducers are used as both sensors and actuators for closed loop control. The theory accurately captures the transverse shear deformation through the thickness of the smart composite laminate while satisfying stress free boundary conditions on the free surfaces. The theory is extended to include the effect of debonding at the actuator-laminate interface. The developed analytical model is implemented using the finite element method utilizing an induced strain approach for computational efficiency. This allows general laminate geometries and boundary conditions to be analyzed. The state space control equations are developed to allow flexibility in the design of the control system. Circuit concepts are also discussed. Static and dynamic results of smart composite structures, obtained using the higher order theory, are correlated with available analytical data. Comparisons, including debonded laminates, are also made with a general purpose finite element code and available experimental data. Overall, very good agreement is observed. Convergence of the finite element implementation of the higher order theory is shown with exact solutions. Additional results demonstrate the utility of the developed theory to study piezoelectric actuation of composite

Implementing guidelines in nursing homes: a systematic review.

Science.gov (United States)

Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte; Lund, Hans

2016-07-25

Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROSPERO 2014: CRD42014007664.

Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children.

Science.gov (United States)

Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Stinson, Jennifer; Harrison, Denise; Victor, J Charles

2014-11-25

Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation. Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period. Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership

Implementing Green Walls in Schools

Directory of Open Access Journals (Sweden)

Michael B. McCullough

2018-06-01

Full Text Available Numerous studies in applied pedagogical design have shown that, at all educational levels, direct exposure to the natural environment can enhance learning by improving student attention and behaviors. Implementing green walls—a “vertical garden,” or “living wall” interior wall that typically includes greenery, a growing medium (soil or substrate and a water delivery system—provides environmental health benefits, but also provides a practical application within classrooms for minimizing directed attention fatigue in students by connecting them to “outdoor nature” within the indoor environment. Hands-on “project-based” learning is another pedagogical strategy that has proved to be effective across the spectrum of educational levels and across subject areas. Green walls have the potential to inspire critical thinking through a combination of project-based learning strategies and environmental education. The authors have outlined a curriculum involving the implementation of an indoor living wall system within a classroom-learning environment, incorporating project-based learning modules that interact with the wall. In conjunction with the passive health benefits of a green wall, project-based curriculum models can connect students interactively with indoor nature and have the potential to inspire real-world thinking related to science, technology, engineering, art, and mathematics fields within the indoor learning environment. Through a combination of these passive and interactive modes, students are connected to nature in the indoor environment regardless of weather conditions outdoors. Future research direction could include post-construction studies of the effectiveness of project-based curricula related to living walls, and the long-term impacts of implementing green walls in classrooms on school achievement and student behaviors.

Assessment of the effectiveness of the LEU Reform Rule and its implementation

International Nuclear Information System (INIS)

Moran, B.W.; Nations, J.O.; Hammond, G.A.

1993-11-01

The US Nuclear Regulatory Commission (NRC) amended its material control and accounting (MC ampersand A) requirements in 1985 for licensees possessing and using special nuclear material (SNM) of low strategic significance in quantities larger than one effective kilogram (kg). The goal of the Low-Enriched Uranium (LEU) Reform Rule (i.e., 10CFR 74.31) was to establish MC ampersand A requirements for the LEU licensees at a level consistent with the safeguards risk associated with the relatively low strategic importance of such material. The amended requirements were written in a performance-oriented manner, rather than a prescriptive one, in an effort to allow the licensees the opportunity to choose the most cost-effective means of satisfying the requirements. The LEU Reform Rule was implemented in January 1988 and the fuel cycle facilities have had sufficient experience in implementing the rule to allow a meaningful review of its effectiveness. This document provides technical analysis and recommendations to assist the NRC in making a determination if the rule is achieving its intended purpose, and if not, to make the necessary changes to accomplish this

BPR implementation process: an analysis of key success and failure factors

Directory of Open Access Journals (Sweden)

Mohamad Reza Khoshlafz

2016-08-01

Full Text Available This paper investigates the effects of different factors influencing on the successful implementation of the business process re-engineering (BPR in Iran. The study selects 386 experts randomly and using some statistical tests examines the effects of four groups of factors including strategic, organizational, methodologic and technological & educational issues on the success of the BPR implementation in Iran. The study designs a questionnaire in Likert scale and distributes it among some experts where Cronbach alpha was calculated as 0.71. The implementation of Pearson correlation ratio has confirmed that technological and educational factors marinated the highest effects (r = 0.523, Sig. = 0.000 followed by strategic (r = 0.505, Sig. = 0.000, organizational (r = 0.352, Sig. = 0.000 and methodologic issues (r = 0.267, Sig. = 0.000. In addition, the implementation of Stepwise regression has confirmed that technological & educational, strategic and methodologic factors influence on BPR in Iran.

Effectiveness and equity of the Tanzania National Voucher Scheme for mosquito nets over 10 years of implementation.

Science.gov (United States)

Kramer, Karen; Mandike, Renata; Nathan, Rose; Mohamed, Ally; Lynch, Matthew; Brown, Nick; Mnzava, Ally; Rimisho, Wilhelmina; Lengeler, Christian

2017-06-15

The Tanzania National Voucher Scheme (TNVS) was a public private partnership managed by the Ministry of Health that provided pregnant women and infants with highly subsidized (long-lasting) insecticide-treated nets between 2004 and 2014. It was implemented in the context of the National Insecticide Treated Nets (NATNETS) Programme and was the main keep up strategy for vulnerable populations. The programme design was adjusted considerably over time to incorporate new evidence, shifting public health policies, and changing donor priorities. Three TNVS models can be distinguished: (1) the fixed discount; (2) the fixed top-up; (3) the hybrid voucher model. The changes improved equity and effectiveness, but also had a profound effect on how the programme was managed and implemented. The TNVS reached the majority of beneficiaries with vouchers, and significantly increased household ownership and use of LLINs. While two mass distribution campaigns implemented between 2009 and 2011 achieved universal coverage and equity, the TNVS ensured continuous protection of the vulnerable populations before, during and after the campaigns. The TNVS stimulated and maintained a large national retail network which managed the LLIN supply chain. The effectiveness of the TNVS was a function of several interdependent factors, including the supply chain of vouchers through the public health system; the supply chain of nets in the commercial sector; the demand for nets from voucher recipients; management and risk mitigation measures; and the influence of global and donor objectives. The TNVS was a highly innovative and globally influential programme, which stimulated the thinking around effectively and equitably distributing ITNs, and contributed directly to the evolution of global policy. It was a fundamental component of the NATNETS programme which protected a malaria-vulnerable population for over a decade.

Implementing a centralized institutional peer tutoring program.

Science.gov (United States)

Gaughf, Natalie White; Foster, Penni Smith

2016-01-01

Peer tutoring has been found to be beneficial to both students and peer tutors in health sciences education programs. This article describes the implementation of a centralized, institutional peer tutoring program at the University of Mississippi Medical Center, an academic health science center in the U.S. The Program: This multispecialty peer tutoring program paired students experiencing academic difficulties with peer tutors who showed prior academic success, professionalism and effective communication skills. The program allowed students and peer tutors to coordinate their own tutoring services. Evaluations by both students and peer tutors showed satisfaction with the program. Recommendations for developing and implementing an effective peer tutoring program are presented, including utilization of an online system, consistent program policy with high professionalism expectations, funding, program evaluation and data tracking.

The effectiveness of principal’s competencies implementation at SMAN 3 and Internasional Budi Mulia Dua Yogyakarta

OpenAIRE

Vikate Phannalath; Lantip Diat Prasojo

2017-01-01

This study aimed to evaluate the effectiveness of principal’s competencies implementation at SMA Negeri 3 Yogyakarta and SMA Internasional Budi Mulia Dua Yogyakarta, Indonesia. The research was an evaluation research using the discrepancy model of evaluation. The respondents were vice principals, teachers, as well as administrative officers. The data was collected through the questionnaires, the results of the study showed that the effectiveness of the principal’s competencies implementation ...

76 FR 34886 - General Services Administration Acquisition Regulation; Implementation of Information Technology...

Science.gov (United States)

2011-06-15

... Acquisition Regulation; Implementation of Information Technology Security Provision AGENCY: Office of... information technology (IT) supplies, services and systems with security requirements. DATES: Effective Date... effective date that include information technology (IT) supplies, services and systems with security...

A Study of Synchronous Machine Model Implementations in Matlab/Simulink Simulations for New and Renewable Energy Systems

DEFF Research Database (Denmark)

Chen, Zhe; Blaabjerg, Frede; Iov, Florin

2005-01-01

A direct phase model of synchronous machines implemented in MA TLAB/SIMULINK is presented. The effects of the machine saturation have been included. Simulation studies are performed under various conditions. It has been demonstrated that the MATLAB/SIMULINK is an effective tool to study the compl...... synchronous machine and the implemented model could be used for studies of various applications of synchronous machines including in renewable and DG generation systems....

The effect of an active implementation of a disease management programme for chronic obstructive pulmonary disease on healthcare utilization--a cluster-randomised controlled trial.

Science.gov (United States)

Smidth, Margrethe; Christensen, Morten Bondo; Fenger-Grøn, Morten; Olesen, Frede; Vedsted, Peter

2013-10-03

The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD. The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary outcome was

The effect of the implementation of low price medicine policy on medicine price in China: A retrospective study.

Science.gov (United States)

Guan, Xiaodong; Yang, Mingchun; Man, Chunxia; Tian, Ye; Shi, Luwen

2018-04-30

In an effort to relieve the pressure of drug shortages, the Chinese government implemented Low-price Medicines (LPM) policy to raise the price cap in July 2014. The purpose of this study is to examine the effect of the implementation of this policy on drug price in China. Price data of 491 LPM, including 218 low-price chemical medicines (LPCM) and 273 low-price traditional Chinese medicines (LPTCM), were collected from 699 hospitals. We used interrupted time series design to identify the variation of monthly Laspeyres Indexes (LI) and Paasche Indexes (PI) for LPM, LPCM, and LPTCM. The result demonstrated that although LPM expenditures increased, the proportion of LPM expenditures accounting for all medicine expenditures fell from 3.6% to 3.2%. After the implementation of LPM policy, there was a significant increasing trend in LPM-PI, LPCM-PI, and LPTCM-PI. The trend in LPM-LI and LPCM-LI was found from descending to rising. However, for LPTCM, the trend in the LI remained to decrease after the policy implementation. Despite the LPM policy had an increasing impact on the LPM drug price, the proportion of LPM expenditures accounting for all medicine expenditures did not increase. More efforts are needed in the future to promote the rational drug use in China. Copyright © 2018 John Wiley & Sons, Ltd.

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes.

Science.gov (United States)

Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

2017-03-06

Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to

Effective implementation of health information technologies in U.S. hospitals.

Science.gov (United States)

Khatri, Naresh; Gupta, Vishal

2016-01-01

Two issues pertaining to the effective implementation of health information technologies (HITs) in U.S. hospitals are examined. First, which information technology (IT) system is better--a homegrown or an outsourced one? In the second issue, the critical role of in-house IT expertise/capabilities in the effective implementation of HITs is investigated. The data on type of HIT system and IT expertise/capabilities were collected from a national sample of senior executives of U.S. hospitals. The data on quality of patient care were gathered from the Hospital Compare Web site. The quality of patient care was significantly higher in hospitals deploying a homegrown HIT system than hospitals deploying an outsourced HIT system. Furthermore, the professional competence and compelling vision of the chief information officer was found to be a major driver of another key IT capability of hospitals-professionalism of IT staff. The positive relationship of professionalism of IT staff with quality of patient care was mediated by proactive employee behavior. A homegrown HIT system achieves better quality of patient care than an outsourced one. The chief information officer's IT vision and the professional expertise and professionalism of IT staff are important IT capabilities in U.S. hospitals.

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial.

Science.gov (United States)

Tello-Bernabé, Eugenia; Sanz-Cuesta, Teresa; del Cura-González, Isabel; de Santiago-Hernando, María L; Jurado-Sueiro, Montserrat; Fernández-Girón, Mercedes; García-de Blas, Francisca; Pensado-Freire, Higinio; Góngora-Maldonado, Francisco; de la Puente-Chamorro, María J; Rodríguez-Pasamontes, Carmen; Martín-Iglesias, Susana

2011-12-01

Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low. This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion. The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling. The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive. ISRCTN: ISRCTN83365316.

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial

Directory of Open Access Journals (Sweden)

Tello-Bernabé Eugenia

2011-12-01

Full Text Available Abstract Background Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low. Method/design This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain. The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion. The number of patients required is 296 (148 in each arm, all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV. They are chosen by consecutive sampling. The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D, and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. Discussion There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care

Improvement of prediction ability for genomic selection of dairy cattle by including dominance effects.

Directory of Open Access Journals (Sweden)

Chuanyu Sun

Full Text Available Dominance may be an important source of non-additive genetic variance for many traits of dairy cattle. However, nearly all prediction models for dairy cattle have included only additive effects because of the limited number of cows with both genotypes and phenotypes. The role of dominance in the Holstein and Jersey breeds was investigated for eight traits: milk, fat, and protein yields; productive life; daughter pregnancy rate; somatic cell score; fat percent and protein percent. Additive and dominance variance components were estimated and then used to estimate additive and dominance effects of single nucleotide polymorphisms (SNPs. The predictive abilities of three models with both additive and dominance effects and a model with additive effects only were assessed using ten-fold cross-validation. One procedure estimated dominance values, and another estimated dominance deviations; calculation of the dominance relationship matrix was different for the two methods. The third approach enlarged the dataset by including cows with genotype probabilities derived using genotyped ancestors. For yield traits, dominance variance accounted for 5 and 7% of total variance for Holsteins and Jerseys, respectively; using dominance deviations resulted in smaller dominance and larger additive variance estimates. For non-yield traits, dominance variances were very small for both breeds. For yield traits, including additive and dominance effects fit the data better than including only additive effects; average correlations between estimated genetic effects and phenotypes showed that prediction accuracy increased when both effects rather than just additive effects were included. No corresponding gains in prediction ability were found for non-yield traits. Including cows with derived genotype probabilities from genotyped ancestors did not improve prediction accuracy. The largest additive effects were located on chromosome 14 near DGAT1 for yield traits for both

Meta-regression analyses to explain statistical heterogeneity in a systematic review of strategies for guideline implementation in primary health care.

Directory of Open Access Journals (Sweden)

Susanne Unverzagt

Full Text Available This study is an in-depth-analysis to explain statistical heterogeneity in a systematic review of implementation strategies to improve guideline adherence of primary care physicians in the treatment of patients with cardiovascular diseases. The systematic review included randomized controlled trials from a systematic search in MEDLINE, EMBASE, CENTRAL, conference proceedings and registers of ongoing studies. Implementation strategies were shown to be effective with substantial heterogeneity of treatment effects across all investigated strategies. Primary aim of this study was to explain different effects of eligible trials and to identify methodological and clinical effect modifiers. Random effects meta-regression models were used to simultaneously assess the influence of multimodal implementation strategies and effect modifiers on physician adherence. Effect modifiers included the staff responsible for implementation, level of prevention and definition pf the primary outcome, unit of randomization, duration of follow-up and risk of bias. Six clinical and methodological factors were investigated as potential effect modifiers of the efficacy of different implementation strategies on guideline adherence in primary care practices on the basis of information from 75 eligible trials. Five effect modifiers were able to explain a substantial amount of statistical heterogeneity. Physician adherence was improved by 62% (95% confidence interval (95% CI 29 to 104% or 29% (95% CI 5 to 60% in trials where other non-medical professionals or nurses were included in the implementation process. Improvement of physician adherence was more successful in primary and secondary prevention of cardiovascular diseases by around 30% (30%; 95% CI -2 to 71% and 31%; 95% CI 9 to 57%, respectively compared to tertiary prevention. This study aimed to identify effect modifiers of implementation strategies on physician adherence. Especially the cooperation of different health

Governments should implement energy-efficiency standards and labels--cautiously

International Nuclear Information System (INIS)

Wiel, Stephen; McMahon, James E.

2003-01-01

Energy-efficiency standards and labels can be the most effective long-term energy-efficiency policy any government can implement. This paper describes: (1) the benefits that can be obtained through this policy, (2) which countries are implementing standards and labels and for which products, (3) the processes they are using at each step along the way including the reasons why each step must be done carefully and thoroughly, and (4) the relationship of standard-setting and labeling to other energy-efficiency policies

The role of strategic leadership in effective strategy implementation ...

African Journals Online (AJOL)

A review of the literature reveals that strategy implementation is an important component of the strategic management process. Research indicates that the ability to implement a strategy is viewed as considerably more important than strategy formulation, and that strategy implementation, rather than strategy formulation, is

The effectiveness of an implementation intentions intervention for fruit and vegetable consumption as moderated by self-schema status.

Science.gov (United States)

Kendzierski, Deborah; Ritter, Rebecca L; Stump, Tammy K; Anglin, Chelsea L

2015-12-01

Two experiments were conducted to determine whether self-schema status moderates the effectiveness of an implementation intentions intervention on nutrition behavior among university students not meeting relevant dietary guidelines. In Experiment 1, students were asked to eat at least 2 servings of fruit and 3 of vegetables daily for a week. Implementation intention condition participants listed what fruits and vegetables they would eat and when and where they would eat them; control condition participants did not. Among those who did not initially meet vegetable targets (n = 108), implementation intentions increased the vegetable consumption of healthy eater schematics, but not of nonschematics. There were no significant effects for fruit consumption among those initially not meeting fruit targets (n = 83). Experiment 2 replicated the moderating effect of healthy eater self-schema status in regard to the effectiveness of an implementation intentions intervention for vegetable consumption among undergraduates who were not initially eating at least 3 servings of vegetables daily (n = 62). Findings are discussed in regard to promoting healthy eating among university students, as well as the implementation intention, self-schema, and self-concordance literatures. Copyright © 2015 Elsevier Ltd. All rights reserved.

Knowledge translation and implementation in spinal cord injury: a systematic review.

Science.gov (United States)

Noonan, V K; Wolfe, D L; Thorogood, N P; Park, S E; Hsieh, J T; Eng, J J

2014-08-01

To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.

Filling potholes on the implementation highway: Evaluating the implementation of Parent-Child Interaction Therapy in Los Angeles County.

Science.gov (United States)

Timmer, Susan G; Urquiza, Anthony J; Boys, Deanna K; Forte, Lindsay A; Quick-Abdullah, Daphne; Chan, Sam; Gould, William

2016-03-01

In October 2012, first 5 LA funded a unique collaboration between Los Angeles County Department of Mental Health (DMH) and UC Davis PCIT Training Center (UCD PCIT) to train county-contracted agencies to provide Parent-Child Interaction Therapy (PCIT). This $20 million dollar, 5-year grant represented the largest implementation effort of an empirically based treatment to date. The purpose of this paper was to describe the first 2 years of the implementation process of this project, beginning with project start up and pre-implementation phases, and to present agency training and client performance outcomes from our first year of training. Results presented in this evaluation suggest that it is possible to train LA County providers in PCIT, and that PCIT is an effective intervention for DMH-contracted providers in LA County. This evaluation also discusses challenges to successful implementation. Barriers to progress included unanticipated delays building county infrastructure, trainee attrition, and insufficient client referrals. We discuss the results of the current implementation with respect to theory, research, and others' training models, with the aim of evaluating and prioritizing different implementation drivers, noting the ongoing competition between knowing what to do and the need for action. Copyright © 2015 Elsevier Ltd. All rights reserved.

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities

Science.gov (United States)

Hager, Erin R.; Rubio, Diana S.; Eidel, G. Stewart; Penniston, Erin S.; Lopes, Megan; Saksvig, Brit I.; Fox, Renee E.; Black, Maureen M.

2016-01-01

Background: Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and…

Aerodynamic analysis of the Darrieus rotor including secondary effects

Science.gov (United States)

Paraschivoiu, I.; Delclaux, F.; Fraunie, P.; Beguier, C.

1983-10-01

An aerodynamic analysis is made of two variants of the two-actuator-disk theory for modeling the Darrieus wind turbine. The double-multiple-streamtube model with constant and variable interference factors, including secondary effects, is examined for a Darrieus rotor. The influence of the secondary effects, namely, the blade geometry and profile type, the rotating tower, and the presence of struts and aerodynamic spoilers, is relatively significant, especially at high tip-speed ratios. Variation of the induced velocity as a function of the azimuthal angle allows a more accurate calculation of the aerodynamic loads on the downwind zone of the rotor with respect to the assumed constant interference factors. The theoretical results were compared with available experimental data for the Magdalen Islands wind turbine and Sandia-type machines (straight-line/circular-arc shape).

IAEA's Implementation of the State-Level Concept

International Nuclear Information System (INIS)

Trimble, D.; Ballenger, J.; Levis, G.

2015-01-01

The International Atomic Energy Agency (IAEA) has taken several steps over the years to strengthen its safeguards program, including successfully encouraging more countries to bring an Additional Protocol into force, increasing the number of countries that are subject to a broader range of safeguards measures, and upgrading its safeguards analytical laboratories. IAEA's latest strategy to further improve the effectiveness and efficiency of the safeguards programme is to expand implementation of the 'state-level concept' to all countries with safeguards agreements. The state-level concept is an approach in which IAEA considers a broad range of information about a country's nuclear capabilities and tailors its safeguards activities in each country accordingly. IAEA officials have stated that broader implementation of this approach will allow the agency to better allocate resources by reducing safeguards activities where there is no indication of undeclared nuclear activities and to focus its efforts on any issues of safeguards concern. Several member countries, including the United States, support IAEA's plans to broaden implementation of the state- level concept, but other member countries - including some countries with significant nuclear activities - have raised concerns that the agency has not clearly defined and communicated how the state-level concept will be implemented or how it will stay within bounds of the agency's existing legal authorities. In September 2012, the General Conference passed a resolution that included a request for IAEA's Secretariat to report to the Board of Governors on the conceptualization and development of the state-level concept. In August 2013, IAEA released that report to the Board of Governors and started briefing member states on its content. Our paper will discuss (1) IAEA's efforts to clearly define and communicate how IAEA will implement the state-level concept and (2) the status of its

10 CFR 850 Implementation of Requirements

Energy Technology Data Exchange (ETDEWEB)

Lee, S

2012-01-05

10 CFR 850 defines a contractor as any entity, including affiliated entities, such as a parent corporation, under contract with DOE, including a subcontractor at any tier, with responsibility for performing work at a DOE site in furtherance of a DOE mission. The Chronic Beryllium Disease Prevention Program (CBDPP) applies to beryllium-related activities that are performed at the Lawrence Livermore National Laboratory (LLNL). The CBDPP or Beryllium Safety Program is integrated into the LLNL Worker Safety and Health Program and, thus, implementation documents and responsibilities are integrated in various documents and organizational structures. Program development and management of the CBDPP is delegated to the Environment, Safety and Health (ES&H) Directorate, Worker Safety and Health Functional Area. As per 10 CFR 850, Lawrence Livermore National Security, LLC (LLNS) periodically submits a CBDPP to the National Nuclear Security Administration/Livermore Site Office (NNSA/LSO). The requirements of this plan are communicated to LLNS workers through ES&H Manual Document 14.4, 'Working Safely with Beryllium.' 10 CFR 850 is implemented by the LLNL CBDPP, which integrates the safety and health standards required by the regulation, components of the LLNL Integrated Safety Management System (ISMS), and incorporates other components of the LLNL ES&H Program. As described in the regulation, and to fully comply with the regulation, specific portions of existing programs and additional requirements are identified in the CBDPP. The CBDPP is implemented by documents that interface with the workers, principally through ES&H Manual Document 14.4. This document contains information on how the management practices prescribed by the LLNL ISMS are implemented, how beryllium hazards that are associated with LLNL work activities are controlled, and who is responsible for implementing the controls. Adherence to the requirements and processes described in the ES&H Manual ensures

Implementation of effective alcohol control strategies is needed at large sports and entertainment events.

Science.gov (United States)

Lyne, Mark; Galloway, Andrew

2012-02-01

To assess the implementation and effectiveness of strategies and actions to eliminate and/or reduce alcohol-related problems at large sports and entertainment events in New Zealand. We conducted site visits and monitoring observations at venues before, during and after a variety of large events between March 2009 and November 2010. Thirteen events were attended at nine different venues. Events included rugby, rugby league and cricket matches, motor racing, rowing, horse racing, an outdoor music festival, and food and wine festivals. Most large events appeared to pass with few or no alcohol-related problems. The exceptions were one of the horse-race meetings, a rugby league match and one food and wine festival. Common contexts at events where alcohol-related problems were seen included: inadequate alcohol control and management by security staff; the ability to purchase four alcoholic drinks (rather than two) at a time; inexperienced bar staff untrained in responsible alcohol service; no or little promotion of low and non-alcoholic drinks; and a lack of monitoring and enforcement of the law on intoxication. An important approach to prevent and reduce alcohol-related problems at large spots and entertainment events is the use of specific alcohol-control strategies. The management of alcohol consumption is a major part of event management that must be planned with harm-minimisation strategies well in advance of the event itself. If strategies and actions are not properly implemented to manage the sale and supply of alcohol at large events, there is significant risk of alcohol-related problems and harm resulting from them. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Implementation of computer-based patient records in primary care: the societal health economic effects.

OpenAIRE

Arias-Vimárlund, V.; Ljunggren, M.; Timpka, T.

1996-01-01

OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland...

Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

Science.gov (United States)

Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Modeling of Temperature-Dependent Noise in Silicon Nanowire FETs including Self-Heating Effects

Directory of Open Access Journals (Sweden)

P. Anandan

2014-01-01

Full Text Available Silicon nanowires are leading the CMOS era towards the downsizing limit and its nature will be effectively suppress the short channel effects. Accurate modeling of thermal noise in nanowires is crucial for RF applications of nano-CMOS emerging technologies. In this work, a perfect temperature-dependent model for silicon nanowires including the self-heating effects has been derived and its effects on device parameters have been observed. The power spectral density as a function of thermal resistance shows significant improvement as the channel length decreases. The effects of thermal noise including self-heating of the device are explored. Moreover, significant reduction in noise with respect to channel thermal resistance, gate length, and biasing is analyzed.

Qualitative evaluation of the implementation of the Interdisciplinary Management Tool: a reflective tool to enhance interdisciplinary teamwork using Structured, Facilitated Action Research for Implementation.

Science.gov (United States)

Nancarrow, Susan A; Smith, Tony; Ariss, Steven; Enderby, Pamela M

2015-07-01

Reflective practice is used increasingly to enhance team functioning and service effectiveness; however, there is little evidence of its use in interdisciplinary teams. This paper presents the qualitative evaluation of the Interdisciplinary Management Tool (IMT), an evidence-based change tool designed to enhance interdisciplinary teamwork through structured team reflection. The IMT incorporates three components: an evidence-based resource guide; a reflective implementation framework based on Structured, Facilitated Action Research for Implementation methodology; and formative and summative evaluation components. The IMT was implemented with intermediate care teams supported by independent facilitators in England. Each intervention lasted 6 months and was evaluated over a 12-month period. Data sources include interviews, a focus group with facilitators, questionnaires completed by team members and documentary feedback from structured team reports. Data were analysed qualitatively using the Framework approach. The IMT was implemented with 10 teams, including 253 staff from more than 10 different disciplines. Team challenges included lack of clear vision; communication issues; limited career progression opportunities; inefficient resource use; need for role clarity and service development. The IMT successfully engaged staff in the change process, and resulted in teams developing creative strategies to address the issues identified. Participants valued dedicated time to focus on the processes of team functioning; however, some were uncomfortable with a focus on teamwork at the expense of delivering direct patient care. The IMT is a relatively low-cost, structured, reflective way to enhance team function. It empowers individuals to understand and value their own, and others' roles and responsibilities within the team; identify barriers to effective teamwork, and develop and implement appropriate solutions to these. To be successful, teams need protected time to take

Kangaroo mother care in resource-limited settings: implementation, health benefits, and cost-effectiveness

Directory of Open Access Journals (Sweden)

Uwaezuoke SN

2017-06-01

Full Text Available Samuel N Uwaezuoke Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku–Ozalla, Enugu, Nigeria Abstract: Kangaroo mother care (KMC represents an intervention in low birth weight infants for resource-limited settings which aims to reduce mortality rates by thermoregulation, supporting breastfeeding, and promoting early hospital discharge. In terms of cost and impact on neonatal survival, it has comparative advantages over the conventional method of care (CMC. This paper aimed to review the evidence concerning the progress of KMC implementation, its health benefits, and its cost-effectiveness, especially in developing countries. From the synthesized evidence, KMC was shown to be a useful adjunct to CMC particularly with respect to improving neonatal survival, supporting breastfeeding, and promoting early discharge from the hospital. Substantial progress has been made in its implementation in many developing countries where facility-based KMC has been institutionalized. Despite the cost-effectiveness of KMC in neonatal care, its global implementation is bedeviled with country-specific, multifaceted challenges. In developed countries, there is an implementation gap due to easy accessibility to technology-based CMC. Nevertheless, many developing countries have initiated national policies to scale up KMC services in their domain. Given the major constraints to program implementation peculiar to these resource-limited countries, it has become imperative to boost caregiver confidence and experience using dedicated spaces in the hospital, as well as dedicated staff meant for adequate ambulatory follow-up and continuous health education. Capacity training for health professionals and provision of space infrastructure thus constitute the basic needs which could be funded by International Aid Agencies in order to scale up the program in these settings. Keywords: neonatal care, low birth weight infants, thermoregulation, breastfeeding

Conception, implementation and effect of the consumption-dependent billing of heating and hot-water costs

International Nuclear Information System (INIS)

Rieder, S.; Schwenkel, Ch.

2008-01-01

This comprehensive report for the Swiss Federal Office of Energy (SFOE) discusses the experience gained from the operation of the consumption-dependent billing of heating and hot-water costs (Verbrauchsabhaengigen Heiz- und Warmwasserkostenabrechnung, VHKA), a system introduced in Switzerland as one of the first energy-policy measures in the nineteen-eighties. The study examines the strategic possibilities of the VHKA within the framework of future efficiency strategies. Also, as an operative goal, the study takes a look at the acceptance of the VHKA and its effectiveness. In this way, an indication on how the instrument can be optimised can be obtained. The report consists of five chapters that look at the concept and implementation of the VHKA, its effect on the lessees of apartments and real estate owners and, finally, presents a cost-benefit analysis of the VHKA. The methods used in the study include the analysis of documents, personal and telephone interviews and the evaluation of billing data and other data collected.

Testing the implementation and sustainment facilitation (ISF strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC strategy: study protocol for a cluster randomized trial

Directory of Open Access Journals (Sweden)

Bryan R. Garner

2017-11-01

Full Text Available Abstract Background Improving the extent to which evidence-based practices (EBPs—treatments that have been empirically shown to be efficacious or effective—are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness–implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI for substance use as an adjunct to usual care within AIDS service organizations (ASOs as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF as an adjunct to the Addiction Technology Transfer Center (ATTC model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Methods Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition or the ATTC + ISF strategy (experimental condition. The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation. The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change. Building upon the exploration–preparation–implementation–sustainment (EPIS framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1 time-to-proficiency (i.e., preparation phase outcome, (2 implementation effectiveness (i.e., implementation phase outcome, and (3 level of sustainment (i.e., sustainment phase outcome

Robust variance estimation with dependent effect sizes: practical considerations including a software tutorial in Stata and spss.

Science.gov (United States)

Tanner-Smith, Emily E; Tipton, Elizabeth

2014-03-01

Methodologists have recently proposed robust variance estimation as one way to handle dependent effect sizes in meta-analysis. Software macros for robust variance estimation in meta-analysis are currently available for Stata (StataCorp LP, College Station, TX, USA) and spss (IBM, Armonk, NY, USA), yet there is little guidance for authors regarding the practical application and implementation of those macros. This paper provides a brief tutorial on the implementation of the Stata and spss macros and discusses practical issues meta-analysts should consider when estimating meta-regression models with robust variance estimates. Two example databases are used in the tutorial to illustrate the use of meta-analysis with robust variance estimates. Copyright © 2013 John Wiley & Sons, Ltd.

A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care.

Science.gov (United States)

Quanbeck, Andrew; Brown, Randall T; Zgierska, Aleksandra E; Jacobson, Nora; Robinson, James M; Johnson, Roberta A; Deyo, Brienna M; Madden, Lynn; Tuan, Wen-Jan; Alagoz, Esra

2018-01-25

This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation. The study compares four intervention clinics to four control clinics in a randomized matched-pairs design. Each systems consultant aided clinics on implementing the guidelines during a 6-month intervention consisting of monthly site visits and teleconferences/videoconferences. The mixed-methods evaluation employs the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative outcomes are compared using time series analysis. Qualitative methods included focus groups, structured interviews, and ethnographic field techniques. Seven clinics were randomly approached to recruit four intervention clinics. Each clinic designated a project team consisting of six to eight staff members, each with at least one prescriber. Attendance at intervention meetings was 83%. More than 80% of staff respondents agreed or strongly agreed with the statements: "I am more familiar with guidelines for safe opioid prescribing" and "My clinic's workflow for opioid prescribing is easier." At 6 months, statistically significant improvements were noted in intervention clinics in the percentage of patients with mental health screens, treatment agreements, urine drug tests, and opioid-benzodiazepine co-prescribing. At 12 months, morphine-equivalent daily dose was significantly reduced in intervention clinics compared to controls. The cost to deliver the strategy was $7345 per clinic. Adaptations were

Cost-effectiveness analysis for the implementation of the EU Water Framework Directive

NARCIS (Netherlands)

van Engelen, D.M.; Seidelin, Christian; van der Veeren, Rob; Barton, David N.; Queb, Kabir

2008-01-01

The EU Water Framework Directive (WFD) prescribes cost-effectiveness analysis (CEA) as an economic tool for the minimisation of costs when formulating programmes of measures to be implemented in the European river basins by the year 2009. The WFD does not specify, however, which approach to CEA has

Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice

Directory of Open Access Journals (Sweden)

Gagliardi Anna R

2012-07-01

Full Text Available Abstract Background Guidelines are important tools that inform healthcare delivery based on best available research evidence. Guideline use is in part based on quality of the guidelines, which includes advice for implementation and has been shown to vary. Others hypothesized this is due to limited instructions in guideline development manuals. The purpose of this study was to examine manual instructions for implementation advice. Methods We used a directed and summative content analysis approach based on an established framework of guideline implementability. Six manuals identified by another research group were examined to enumerate implementability domains and elements. Results Manuals were similar in content but lacked sufficient detail in particular domains. Most frequently this was Accomodation, which includes information that would help guideline users anticipate and/or overcome organizational and system level barriers. In more than one manual, information was also lacking for Communicability, information that would educate patients or facilitate their involvement in shared decision making, and Applicability, or clinical parameters to help clinicians tailor recommendations for individual patients. Discussion Most manuals that direct guideline development lack complete information about incorporating implementation advice. These findings can be used by those who developed the manuals to consider expanding their content in these domains. It can also be used by guideline developers as they plan the content and implementation of their guidelines so that the two are integrated. New approaches for guideline development and implementation may need to be developed. Use of guidelines might be improved if they included implementation advice, but this must be evaluated through ongoing research.

Effective organizational solutions for implementation of DBMS software packages

Science.gov (United States)

Jones, D.

1984-01-01

The space telescope management information system development effort is a guideline for discussing effective organizational solutions used in implementing DBMS software. Focus is on the importance of strategic planning. The value of constructing an information system architecture to conform to the organization's managerial needs, the need for a senior decision maker, dealing with shifting user requirements, and the establishment of a reliable working relationship with the DBMS vendor are examined. Requirements for a schedule to demonstrate progress against a defined timeline and the importance of continued monitoring for production software control, production data control, and software enhancements are also discussed.

The Cascading Effects of Multiple Dimensions of Implementation on Program Outcomes: a Test of a Theoretical Model.

Science.gov (United States)

Berkel, Cady; Mauricio, Anne M; Sandler, Irwin N; Wolchik, Sharlene A; Gallo, Carlos G; Brown, C Hendricks

2017-12-14

This study tests a theoretical cascade model in which multiple dimensions of facilitator delivery predict indicators of participant responsiveness, which in turn lead to improvements in targeted program outcomes. An effectiveness trial of the 10-session New Beginnings Program for divorcing families was implemented in partnership with four county-level family courts. This study included 366 families assigned to the intervention condition who attended at least one session. Independent observers provided ratings of program delivery (i.e., fidelity to the curriculum and process quality). Facilitators reported on parent attendance and parents' competence in home practice of program skills. At pretest and posttest, children reported on parenting and parents reported child mental health. We hypothesized effects of quality on attendance, fidelity and attendance on home practice, and home practice on improvements in parenting and child mental health. Structural Equation Modeling with mediation and moderation analyses were used to test these associations. Results indicated quality was significantly associated with attendance, and attendance moderated the effect of fidelity on home practice. Home practice was a significant mediator of the links between fidelity and improvements in parent-child relationship quality and child externalizing and internalizing problems. Findings provide support for fidelity to the curriculum, process quality, attendance, and home practice as valid predictors of program outcomes for mothers and fathers. Future directions for assessing implementation in community settings are discussed.

The measurement and effect of implementation fidelity in the multi component smoking intervention: The X:IT study

DEFF Research Database (Denmark)

Bast, Lotus Sofie

2016-01-01

-based smoking prevention programs have been launched over the past three decades, and generally multi component initiatives are recommended. The effects have been inconclusive, though, which may partly be due to lack of implementation, but little evidence exists on the implementation of school-based smoking....... Methods: My three papers were based on the school-randomized X:IT study, which tested a multi component intervention to prevent smoking among adolescents in 94 Danish elementary schools (51 intervention and 43 control schools). Participants were grade 7 pupils (mean age: 12.5 years). We collected data......Title: The measurement and effect of implementation fidelity in the multi component smoking intervention: The X:IT study Background: Careful measurement of implementation fidelity is crucial in the examination of whether an intervention worked as intended or not. A large number of school...

Implementing a pressure ulcer prevention bundle in an adult intensive care.

Science.gov (United States)

Tayyib, Nahla; Coyer, Fiona; Lewis, Peter A

2016-12-01

The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change. The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance. An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist. Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants. The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the

Identifying the effects of Enterprise System implementation and use: Examples from Denmark

DEFF Research Database (Denmark)

Rikhardsson, Pall M.; Kræmmergaard, Pernille

2005-01-01

case writing. The main results show that the effects of ERP implementation and use are seldom fully predictable by management. The ERP system can be seen as an organisational actor in its own right as it to a large extent influences values, culture, behaviour, processes and procedures of other actors...

Effectiveness of implementing a dyadic psychoeducational intervention for cancer patients and family caregivers.

Science.gov (United States)

Titler, Marita G; Visovatti, Moira A; Shuman, Clayton; Ellis, Katrina R; Banerjee, Tanima; Dockham, Bonnie; Yakusheva, Olga; Northouse, Laurel

2017-11-01

This study examined the effectiveness, feasibility, and satisfaction with implementation of the FOCUS program in two US Cancer Support Community affiliates in Ohio and California as well as the cost to deliver the program. FOCUS is an evidence-based psychoeducational intervention for dyads (cancer patients and caregivers). A pre-post-intervention design was employed. Eleven, five-session Focus programs were delivered by licensed professionals in a small group format (three-four dyads/group) to 36 patient-caregiver dyads. An Implementation Training Manual, a FOCUS Intervention Protocol Manual, and weekly conference calls were used to foster implementation. Participants completed questionnaires prior to and following completion of each five-session FOCUS program to measure primary (emotional distress, quality of life) and secondary outcomes (benefits of illness, self-efficacy, and dyadic communication). Enrollment and retention rates and fidelity to FOCUS were used to measure feasibility. Cost estimates were based on time and median hourly wages. Repeated analysis of variance was used to analyze the effect of FOCUS on outcomes for dyads. Descriptive statistics were used to examine feasibility, satisfaction, and cost estimates. FOCUS had positive effects on QOL (p = .014), emotional (p = .012), and functional (p = .049) well-being, emotional distress (p = .002), benefits of illness (p = .013), and self-efficacy (p = .001). Intervention fidelity was 85% with enrollment and retention rates of 71.4 and 90%, respectively. Participants were highly satisfied. Cost for oversight and delivery of the five-session FOCUS program was $168.00 per dyad. FOCUS is an economic and effective intervention to decrease distress and improve the quality of life for dyads.

Effective implementation of wavelet Galerkin method

Science.gov (United States)

Finěk, Václav; Šimunková, Martina

2012-11-01

It was proved by W. Dahmen et al. that an adaptive wavelet scheme is asymptotically optimal for a wide class of elliptic equations. This scheme approximates the solution u by a linear combination of N wavelets and a benchmark for its performance is the best N-term approximation, which is obtained by retaining the N largest wavelet coefficients of the unknown solution. Moreover, the number of arithmetic operations needed to compute the approximate solution is proportional to N. The most time consuming part of this scheme is the approximate matrix-vector multiplication. In this contribution, we will introduce our implementation of wavelet Galerkin method for Poisson equation -Δu = f on hypercube with homogeneous Dirichlet boundary conditions. In our implementation, we identified nonzero elements of stiffness matrix corresponding to the above problem and we perform matrix-vector multiplication only with these nonzero elements.

Implementing enhanced recovery pathways: a literature review with realist synthesis.

Science.gov (United States)

Coxon, Astrid; Nielsen, Karina; Cross, Jane; Fox, Chris

2017-10-01

Enhanced Recovery Pathways (ERPs) are an increasingly popular, evidenced-based approach to surgery, designed to improve patient outcomes and reduce costs. Despite evidence demonstrating the benefits of these pathways, implementation and adherence have been inconsistent. Using realist synthesis, this review explored the current literature surrounding the implementation of ERPs in the UK. Knowledge consolidation between authors and consulting with field experts helped to guide the search strategy. Relevant medical and social science databases were searched from 2000 to 2016, as well as a general web search. A total of 17 papers were identified, including original research, reviews, case studies and guideline documents. Full texts were analysed, cross-examined, and data extracted and synthesised. Several implementation strategies were identified, including the contexts in which these operated, the subsequent mechanisms of action that were triggered, and the outcome patterns they produced. Context-Mechanism-Outcome (CMO) configurations were generated, tested, and refined. These were grouped to develop two programme theories concerning ERP implementation, one related to the strategy of consulting with staff, the other with appointing a change agent to coordinate and drive the implementation process. These theories highlight instances in which implementation could be improved. Current literature in ERP research is primarily focussed on measuring patient outcomes and cost effectiveness, and as a result, important detail regarding the implementation process is often not reported or described robustly. This review not only provides recommendations for future improvements in ERP implementation, but also highlights specific areas of focus for furthering ERP implementation research.

Toward the Effective and Efficient Measurement of Implementation Fidelity

OpenAIRE

Schoenwald, Sonja K.; Garland, Ann F.; Chapman, Jason E.; Frazier, Stacy L.; Sheidow, Ashli J.; Southam-Gerow, Michael A.

2011-01-01

Implementation science in mental health is informed by other academic disciplines and industries. Conceptual and methodological territory charted in psychotherapy research is pertinent to two elements of the conceptual model of implementation posited by Aarons and colleagues (2010)—implementation fidelity and innovation feedback systems. Key characteristics of scientifically validated fidelity instruments, and of the feasibility of their use in routine care, are presented. The challenges of e...

THE EFFECT OF IMPLEMENTATION MAINTENANCE CARDS IN PERFORMANCE OF MACHINES IN SELECTED PRODUCTION COMPANY

Directory of Open Access Journals (Sweden)

Michał ZASADZIEŃ

2015-10-01

Full Text Available Intelligent development should become an inherent part of the policy of each enterprise which wants to develop and maintain its position on the competitive market. The article presents investigations related to the implementation of one of Total Productive Maintenance system elements. Reasons for introducing a new procedure for circulating information about machine inspections and overhauls planned, the major element of which are work sheets for key machines taking part in the production process, have been presented. The effectiveness of the new procedure was subjected to analysis by comparing particular machines’ work times and downtimes before and after the implementation of new procedures. The conducted research revealed an increased effectiveness of machines’ work, which resulted from shortened down-times, especially the duration of a failure.

SU-E-T-181: Clinical Implementation of Task Group 176

Energy Technology Data Exchange (ETDEWEB)

Burgdorf, B [University of Pennsylvania, Philadelphia, PA (United States); Yeager, C; Zhou, F; Hand, C [Albert Einstein Medical Center, Philadelphia, PA (United States)

2015-06-15

Purpose: The implementation of TG-176 with regards to immobilization devices and couch tops as they effect dosimetric treatment planning. Methods: The external devices used clinically were scanned to measure their HU values. Plans were created in the Eclipse treatment planning system (TPS) using these devices, one that accounted for the correct HU value of the each device and another that did not include the device as a structure. A dose subtraction was performed between the two plans to evaluate the dosimetric differences. The metrics used for evaluation included attenuation and surface dose. Plan parameters were varied to evaluate the impact of the devices in different clinical scenarios. Results: While the exact HU values of our results are clinic-dependent, the protocol being implemented is widely applicable. We recommend a four step process for implementing this task group. First, physics should scan each treatment device to determine accurate HU values. Second, CT therapists should include in the setup note which table top was used during patient CT simulation and are asked to make immobilization devices as uniform in thickness as possible. Therapists should also index the devices whenever possible so beam will traverse the same area of the device. Third, the dosimetrist should manually correct the HU value for any external device, including the couch. For H&N cases, the rails must be removed from the couch structure. When rails are used during treatments, it is important to make note of their exact position in the setup notes. Finally, physicians should be made aware that there could be changes in surface doses depending on whether or not immobilization devices or couch tops are in the beam path. Conclusion: The protocol outlined above was implemented to reduce the errors that arise from ignoring effects of external devices, thus ensuring safer, more accurate patient treatments.

Effects of Hot Streak and Phantom Cooling on Heat Transfer in a Cooled Turbine Stage Including Particulate Deposition

Energy Technology Data Exchange (ETDEWEB)

Bons, Jeffrey [The Ohio State Univ., Columbus, OH (United States); Ameri, Ali [The Ohio State Univ., Columbus, OH (United States)

2016-01-08

The objective of this research effort was to develop a validated computational modeling capability for the characterization of the effects of hot streaks and particulate deposition on the heat load of modern gas turbines. This was accomplished with a multi-faceted approach including analytical, experimental, and computational components. A 1-year no cost extension request was approved for this effort, so the total duration was 4 years. The research effort succeeded in its ultimate objective by leveraging extensive experimental deposition studies complemented by computational modeling. Experiments were conducted with hot streaks, vane cooling, and combinations of hot streaks with vane cooling. These studies contributed to a significant body of corporate knowledge of deposition, in combination with particle rebound and deposition studies funded by other agencies, to provide suitable conditions for the development of a new model. The model includes the following physical phenomena: elastic deformation, plastic deformation, adhesion, and shear removal. It also incorporates material property sensitivity to temperature and tangential-normal velocity rebound cross-dependencies observed in experiments. The model is well-suited for incorporation in CFD simulations of complex gas turbine flows due to its algebraic (explicit) formulation. This report contains model predictions compared to coefficient of restitution data available in the open literature as well as deposition results from two different high temperature turbine deposition facilities. While the model comparisons with experiments are in many cases promising, several key aspects of particle deposition remain elusive. The simple phenomenological nature of the model allows for parametric dependencies to be evaluated in a straightforward manner. This effort also included the first-ever full turbine stage deposition model published in the open literature. The simulations included hot streaks and simulated vane cooling

Partnerships for the Design, Conduct, and Analysis of Effectiveness, and Implementation Research: Experiences of the Prevention Science and Methodology Group

Science.gov (United States)

Brown, C. Hendricks; Kellam, Sheppard G.; Kaupert, Sheila; Muthén, Bengt O.; Wang, Wei; Muthén, Linda K.; Chamberlain, Patricia; PoVey, Craig L.; Cady, Rick; Valente, Thomas W.; Ogihara, Mitsunori; Prado, Guillermo J.; Pantin, Hilda M.; Gallo, Carlos G.; Szapocznik, José; Czaja, Sara J.; McManus, John W.

2012-01-01

What progress prevention research has made comes through strategic partnerships with communities and institutions that host this research, as well as professional and practice networks that facilitate the diffusion of knowledge about prevention. We discuss partnership issues related to the design, analysis, and implementation of prevention research and especially how rigorous designs, including random assignment, get resolved through a partnership between community stakeholders, institutions, and researchers. These partnerships shape not only study design, but they determine the data that can be collected and how results and new methods are disseminated. We also examine a second type of partnership to improve the implementation of effective prevention programs into practice. We draw on social networks to studying partnership formation and function. The experience of the Prevention Science and Methodology Group, which itself is a networked partnership between scientists and methodologists, is highlighted. PMID:22160786

The Implementation of Enrollment Management at Two Public Universities Experiencing Demographic and Funding Challenges

Science.gov (United States)

Lee, Stephen

2010-01-01

The purpose of this study was to evaluate the implementation of enrollment management at two public universities. The theoretical framework was conceptual and centered on the effectiveness of the implementation process as a pivotal factor in the development of a comprehensive enrollment management operation. This multi-site case study included 14…

Effect of systematic ergonomic hazard identification and control implementation on musculoskeletal disorder and injury risk.

Science.gov (United States)

Cantley, Linda F; Taiwo, Oyebode A; Galusha, Deron; Barbour, Russell; Slade, Martin D; Tessier-Sherman, Baylah; Cullen, Mark R

2014-01-01

This study aimed to examine the effect of an ergonomic hazard control (HC) initiative, undertaken as part of a company ergonomics standard, on worker injury risk. Using the company's ergonomic hazards database to identify jobs with and without ergonomic HC implementation and linking to individual job and injury histories, injury risk among person-jobs with HC implementation (the HC group) was compared to those without HC (NoHC group) using random coefficient models. Further analysis of the HC group was conducted to determine the effect of additional ergonomic hazards controlled on injury risk. Among 123 jobs at 17 plant locations, 347 ergonomic hazards were quantitatively identified during the study period. HC were implemented for 204 quantified ergonomic hazards in 84 jobs, impacting 10 385 persons (12 967 person-jobs). No HC were implemented for quantified ergonomic hazards in the remaining 39 jobs affecting 4155 persons (5046 person-jobs). Adjusting for age, sex, plant origin, and year to control for any temporal trend in injury risk, the relative risk (RR) for musculoskeletal disorder (MSD) was 0.85 and the RR for any injury or MSD was 0.92 in the HC compared to NoHC group. Among the HC group, each ergonomic hazard controlled was associated with risk reduction for MSD and acute injury outcomes (RR 0.93). Systematic ergonomic HC through participatory ergonomics, as part of a mandatory company ergonomics standard, is associated with MSD and injury risk reduction among workers in jobs with HC implemented.

Adapting Certified Safe Farm to North Carolina Agriculture: An Implementation Study.

Science.gov (United States)

Storm, Julia F; LePrevost, Catherine E; Tutor-Marcom, Robin; Cope, W Gregory

2016-01-01

Certified Safe Farm (CSF) is a multimodal safety and health program developed and assessed through multiple controlled intervention studies in Iowa. Although developed with the intent to be broadly applicable to agriculture, CSF has not been widely implemented outside the midwestern United States. This article describes the CSF implementation process in North Carolina (NC), as piloted on a large-scale in three agriculturally diverse and productive counties of NC, and reports its effectiveness using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Implementation involved (1) capacity building through safety and health training, (2) adaptation of components of Iowa's CSF model to NC agriculture, (3) marketing and recruitment, and (4) formative evaluation, including an online survey and focus group discussion. From 2009 to 2012, 113 farms participated in at least one component of the CSF intervention, representing a NC farm participation rate of 3.1% in the study area. A major adaptation of NC implementation was the utilization of NC Cooperative Extension as the local driver of implementation in contrast to local AgriSafe clinics in Iowa. The most innovative adaptation to CSF components was the development of a defined economic incentive in the form of a cost-share program. The RE-AIM framework was found to be useful and relevant to the field of agricultural health and safety translational research. This study provides effectiveness measures and implementation alternatives useful for those considering implementing CSF. It informs current efforts to move CSF from research to practice through the National Sustainable Model CSF Program initiative.

Effects of policy measures implemented in Denmark on nitrogen pollution of the aquatic environment

DEFF Research Database (Denmark)

Kronvang, Brian; Andersen, Hans Estrup; Børgesen, Christen Duus

2008-01-01

Since 1985, seven national Action Plans (AP) have been implemented in Denmark to reduce nitrogen discharges from point sources and nitrogen losses from agriculture. The instruments applied include regulations on point source discharges from waste water treatment plants, area-related measures, e.g...... to delays in travel time in groundwater. Until now, the regulation has been performed on a national scale. A more regional or local approach is believed to be necessary in future to meet the demands of the EU Water Framework Directive......Since 1985, seven national Action Plans (AP) have been implemented in Denmark to reduce nitrogen discharges from point sources and nitrogen losses from agriculture. The instruments applied include regulations on point source discharges from waste water treatment plants, area-related measures, e...... indicators were defined: nitrogen discharges from point sources, nitrogen surplus in agriculture, nitrogen leaching from agricultural land and nitrogen concentrations and loads in surface waters. Since the introduction of mitigation programmes, discharges of nitrogen from point sources have been reduced...

The cost-effectiveness of quality improvement projects: a conceptual framework, checklist and online tool for considering the costs and consequences of implementation-based quality improvement.

Science.gov (United States)

Thompson, Carl; Pulleyblank, Ryan; Parrott, Steve; Essex, Holly

2016-02-01

In resource constrained systems, decision makers should be concerned with the efficiency of implementing improvement techniques and technologies. Accordingly, they should consider both the costs and effectiveness of implementation as well as the cost-effectiveness of the innovation to be implemented. An approach to doing this effectively is encapsulated in the 'policy cost-effectiveness' approach. This paper outlines some of the theoretical and practical challenges to assessing policy cost-effectiveness (the cost-effectiveness of implementation projects). A checklist and associated (freely available) online application are also presented to help services develop more cost-effective implementation strategies. © 2015 John Wiley & Sons, Ltd.

Designing Caregiver-Implemented Shared-Reading Interventions to Overcome Implementation Barriers

Science.gov (United States)

Logan, Jessica R.; Damschroder, Laura

2015-01-01

Purpose This study presents an application of the theoretical domains framework (TDF; Michie et al., 2005), an integrative framework drawing on behavior-change theories, to speech-language pathology. Methods A multistep procedure was used to identify barriers affecting caregivers' implementation of shared-reading interventions with their children with language impairment (LI). The authors examined caregiver-level data corresponding to implementation issues from two randomized controlled trials and mapped these to domains in the TDF as well as empirically validated behavior-change techniques. Results Four barriers to implementation were identified as potentially affecting caregivers' implementation: time pressures, reading difficulties, discomfort with reading, and lack of awareness of benefits. These were mapped to 3 TDF domains: intentions, beliefs about capabilities, and skills. In turn, 4 behavior-change techniques were identified as potential vehicles for affecting these domains: reward, feedback, model, and encourage. An ongoing study is described that is determining the effects of these techniques for improving caregivers' implementation of a shared-reading intervention. Conclusions A description of the steps to identifying barriers to implementation, in conjunction with an ongoing experiment that will explicitly determine whether behavior-change techniques affect these barriers, provides a model for how implementation science can be used to identify and overcome implementation barriers in the treatment of communication disorders. PMID:26262941

Effectiveness of Expanded Implementation of STAR-VA for Managing Dementia-Related Behaviors Among Veterans.

Science.gov (United States)

Karel, Michele J; Teri, Linda; McConnell, Eleanor; Visnic, Stephanie; Karlin, Bradley E

2016-02-01

Nonpharmacological, psychosocial approaches are first-line treatments for managing behavioral symptoms in dementia, but they can be challenging to implement in long-term care settings. The Veterans Health Administration implemented STAR-VA, an interdisciplinary behavioral approach for managing challenging dementia-related behaviors in its Community Living Center (CLCs, nursing home care) settings. This study describes how the program was implemented and provides an evaluation of Veteran clinical outcomes and staff feedback on the intervention. One mental health professional and registered nurse team from 17 CLCs completed STAR-VA training, which entailed an experiential workshop followed by 6 months of expert consultation as they worked with their teams to implement STAR-VA with Veterans identified to have challenging dementia-related behaviors. The frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation were evaluated at baseline and at intervention completion. Staff provided feedback regarding STAR-VA feasibility and impact. Seventy-one Veterans completed the intervention. Behaviors clustered into 6 types: care refusal or resistance, agitation, aggression, vocalization, wandering, and other. Frequency and severity of target behaviors and symptoms of depression, anxiety, and agitation all significantly decreased, with overall effect sizes of 1 or greater. Staff rated both benefits for Veterans and program feasibility favorably. This evaluation supports the feasibility and effectiveness of STAR-VA, an interdisciplinary, behavioral intervention for managing challenging behaviors among residents with dementia in CLCs. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

Double-gate junctionless transistor model including short-channel effects

International Nuclear Information System (INIS)

Paz, B C; Pavanello, M A; Ávila-Herrera, F; Cerdeira, A

2015-01-01

This work presents a physically based model for double-gate junctionless transistors (JLTs), continuous in all operation regimes. To describe short-channel transistors, short-channel effects (SCEs), such as increase of the channel potential due to drain bias, carrier velocity saturation and mobility degradation due to vertical and longitudinal electric fields, are included in a previous model developed for long-channel double-gate JLTs. To validate the model, an analysis is made by using three-dimensional numerical simulations performed in a Sentaurus Device Simulator from Synopsys. Different doping concentrations, channel widths and channel lengths are considered in this work. Besides that, the series resistance influence is numerically included and validated for a wide range of source and drain extensions. In order to check if the SCEs are appropriately described, besides drain current, transconductance and output conductance characteristics, the following parameters are analyzed to demonstrate the good agreement between model and simulation and the SCEs occurrence in this technology: threshold voltage (V TH ), subthreshold slope (S) and drain induced barrier lowering. (paper)

How to Disable Mortal Loops of Enterprise Resource Planning (ERP Implementation: A System Dynamics Analysis

Directory of Open Access Journals (Sweden)

Kaveh M. Cyrus

2018-01-01

Full Text Available Successful Enterprise Resource Planning (ERP implementation depends upon various factors known as critical success factors (CSFs. This study developed a system dynamics model of ERP implementation based on CSFs to discuss ERP implementation complexities, which identifies the effect of CSF interrelations on different aspects of ERP project failure. Based on the model hypothesis, CSF interrelations include many causal loop dependencies. Some of these causal loops are called mortal loops, because they may cause the failure of risk reduction efforts to a more severe failure in effect of lack of system thinking on CSFs interrelations. This study discusses how system thinking works as a leverage point for overcoming ERP implementation challenges.

Implementing factors on finance information systems: How do they influence usage?

Directory of Open Access Journals (Sweden)

David Kiwana

2018-04-01

Full Text Available Finance information systems (FISs store and provide timely, accurate and consistent financial data for management and decision-making. Many organizations especially in developing world however fail to attain desired success during implementation and usage of the FISs despite the fact that many success factors for implementation have been suggested. This study thus investigated the usage of FISs with the aim of finding out how factors presumed to influence implementation impact usage. The presumed factors included; top management support, effective communication, evaluation of staff performance, technical support, project management, change management program, effectiveness of IT unit and flexibility of consultants. The study focused on universities in Uganda, which is a developing country. Out of the nine factors that were investigated only top management support, technical training and flexibility of consultants exhibited a positive impact with only top management support being significant. The rest of the factors exhibited negative impact and only effective IT unit being significant.

Mechanical behaviour of cracked welded structures including mismatch effect

International Nuclear Information System (INIS)

Hornet, P.

2002-01-01

The most important parameters for predicting more precisely the fracture behaviour of welded structures have been identified. In particular, the plasticity development at the crack tip in the ligament appeared as a major parameter to evaluate the yield load of such a complex structure. In this way defect assessments procedures have been developed or modified to take into account the mismatch effect that is to say the mechanical properties of the different material constituting the weld joint. This paper is a synthesis of the work done in the past at Electricite de France on this topic in regards with other work done in France or around the World. The most important parameters which control the plasticity development at the crack tip and so mainly influence the fracture behaviour of welded structures are underlined: the mismatch ratio (weld to base metal yield strength ratio), the mismatch ratio (weld to base metal yield strength ratio), the ligament size and the weld width. Moreover, commonly used fracture toughness testing procedures developed in case of homogeneous specimens cannot be used in a straight forward manner and so has to be modified to take into account the mismatch effect. Number or defect assessment procedures taking into account the mismatch effect by considering the yield load of the welded structure are shortly described. Then, the 'Equivalent Material Method' developed at EDF which allows a good prediction of the applied J-Integral at the crack tip is more detailed. This procedure includes not only both weld and base metal yield strength, the structure geometry, the crack size and the weld dimension using the yield load of the real structures but also includes the effect of both weld and base metal strain hardening exponents. Some validations of this method are proposed. Finally, the ability of finite element modelling to predict the behaviour of such welded structures is demonstrated by modelling real experiments: crack located in the middle of

Implementation of school based physical activity interventions: a systematic review.

Science.gov (United States)

Naylor, Patti-Jean; Nettlefold, Lindsay; Race, Douglas; Hoy, Christa; Ashe, Maureen C; Wharf Higgins, Joan; McKay, Heather A

2015-03-01

Implementation science is an emerging area in physical activity (PA) research. We sought to establish the current state of the evidence related to implementation of school-based PA models to explore 1) the relationship between implementation and health outcomes, and 2) factors that influence implementation. We searched 7 electronic databases (1995-2014) and included controlled studies of school-based PA programmes for healthy youth (6-18 y) measuring at least one physical health-related outcome. For objective 1, studies linked implementation level to student-level health outcome(s). For objective 2, studies reported factors associated with implementation. There was substantial variability in how health outcomes and implementation were assessed. Few studies linked implementation and health outcomes (n=15 interventions). Most (11/15) reported a positive relationship between implementation and at least one health outcome. Implementation factors were reported in 29 interventions. Of 22 unique categories, time was the most prevalent influencing factor followed by resource availability/quality and supportive school climate. Implementation evaluation supports scale-up of effective school-based PA interventions and thus population-level change. Our review serves as a call to action to 1) address the link between implementation and outcome within the school-based PA literature and 2) improve and standardize definitions and measurement of implementation. Copyright © 2015 Elsevier Inc. All rights reserved.

Effectiveness of implementing a best practice primary healthcare model for low back pain (BetterBack) compared with current routine care in the Swedish context: an internal pilot study informed protocol for an effectiveness-implementation hybrid type 2 trial

Science.gov (United States)

Abbott, Allan; Schröder, Karin; Enthoven, Paul; Nilsen, Per; Öberg, Birgitta

2018-01-01

Introduction Low back pain (LBP) is a major health problem commonly requiring healthcare. In Sweden, there is a call from healthcare practitioners (HCPs) for the development, implementation and evaluation of a best practice primary healthcare model for LBP. Aims (1) To improve and understand the mechanisms underlying changes in HCP confidence, attitudes and beliefs for providing best practice coherent primary healthcare for patients with LBP; (2) to improve and understand the mechanisms underlying illness beliefs, self-care enablement, pain, disability and quality of life in patients with LBP; and (3) to evaluate a multifaceted and sustained implementation strategy and the cost-effectiveness of the BetterBack☺ model of care (MOC) for LBP from the perspective of the Swedish primary healthcare context. Methods This study is an effectiveness-implementation hybrid type 2 trial testing the hypothesised superiority of the BetterBack☺ MOC compared with current routine care. The trial involves simultaneous testing of MOC effects at the HCP, patient and implementation process levels. This involves a prospective cohort study investigating implementation at the HCP level and a patient-blinded, pragmatic, cluster, randomised controlled trial with longitudinal follow-up at 3, 6 and 12 months post baseline for effectiveness at the patient level. A parallel process and economic analysis from a healthcare sector perspective will also be performed. Patients will be allocated to routine care (control group) or the BetterBack☺ MOC (intervention group) according to a stepped cluster dogleg structure with two assessments in routine care. Experimental conditions will be compared and causal mediation analysis investigated. Qualitative HCP and patient experiences of the BetterBack☺ MOC will also be investigated. Dissemination The findings will be published in peer-reviewed journals and presented at national and international conferences. Further national dissemination and

Numerical optimization of conical flow waveriders including detailed viscous effects

Science.gov (United States)

Bowcutt, Kevin G.; Anderson, John D., Jr.; Capriotti, Diego

1987-01-01

A family of optimized hypersonic waveriders is generated and studied wherein detailed viscous effects are included within the optimization process itself. This is in contrast to previous optimized waverider work, wherein purely inviscid flow is used to obtain the waverider shapes. For the present waveriders, the undersurface is a streamsurface of an inviscid conical flowfield, the upper surface is a streamsurface of the inviscid flow over a tapered cylinder (calculated by the axisymmetric method of characteristics), and the viscous effects are treated by integral solutions of the boundary layer equations. Transition from laminar to turbulent flow is included within the viscous calculations. The optimization is carried out using a nonlinear simplex method. The resulting family of viscous hypersonic waveriders yields predicted high values of lift/drag, high enough to break the L/D barrier based on experience with other hypersonic configurations. Moreover, the numerical optimization process for the viscous waveriders results in distinctly different shapes compared to previous work with inviscid-designed waveriders. Also, the fine details of the viscous solution, such as how the shear stress is distributed over the surface, and the location of transition, are crucial to the details of the resulting waverider geometry. Finally, the moment coefficient variations and heat transfer distributions associated with the viscous optimized waveriders are studied.

Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease.

Science.gov (United States)

Wolfenden, Luke; Nathan, Nicole K; Sutherland, Rachel; Yoong, Sze Lin; Hodder, Rebecca K; Wyse, Rebecca J; Delaney, Tessa; Grady, Alice; Fielding, Alison; Tzelepis, Flora; Clinton-McHarg, Tara; Parmenter, Benjamin; Butler, Peter; Wiggers, John; Bauman, Adrian; Milat, Andrew; Booth, Debbie; Williams, Christopher M

2017-11-29

A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children. All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We

User participation in implementation

DEFF Research Database (Denmark)

Fleron, Benedicte; Rasmussen, Rasmus; Simonsen, Jesper

2012-01-01

Systems development has been claimed to benefit from user participation, yet user participation in implementation activities may be more common and is a growing focus of participatory-design work. We investigate the effect of the extensive user participation in the implementation of a clinical...... experienced more uncertainty and frustration than management and non-participating staff, especially concerning how to run an implementation process and how to understand and utilize the configuration possibilities of the system. This suggests that user participation in implementation introduces a need...

Gen IV Materials Handbook Implementation Plan

International Nuclear Information System (INIS)

Rittenhouse, P.; Ren, W.

2005-01-01

A Gen IV Materials Handbook is being developed to provide an authoritative single source of highly qualified structural materials information and materials properties data for use in design and analyses of all Generation IV Reactor Systems. The Handbook will be responsive to the needs expressed by all of the principal government, national laboratory, and private company stakeholders of Gen IV Reactor Systems. The Gen IV Materials Handbook Implementation Plan provided here addresses the purpose, rationale, attributes, and benefits of the Handbook and will detail its content, format, quality assurance, applicability, and access. Structural materials, both metallic and ceramic, for all Gen IV reactor types currently supported by the Department of Energy (DOE) will be included in the Gen IV Materials Handbook. However, initial emphasis will be on materials for the Very High Temperature Reactor (VHTR). Descriptive information (e.g., chemical composition and applicable technical specifications and codes) will be provided for each material along with an extensive presentation of mechanical and physical property data including consideration of temperature, irradiation, environment, etc. effects on properties. Access to the Gen IV Materials Handbook will be internet-based with appropriate levels of control. Information and data in the Handbook will be configured to allow search by material classes, specific materials, specific information or property class, specific property, data parameters, and individual data points identified with materials parameters, test conditions, and data source. Details on all of these as well as proposed applicability and consideration of data quality classes are provided in the Implementation Plan. Website development for the Handbook is divided into six phases including (1) detailed product analysis and specification, (2) simulation and design, (3) implementation and testing, (4) product release, (5) project/product evaluation, and (6) product

Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol.

Science.gov (United States)

Van Spall, Harriette G C; Shanbhag, Deepti; Gabizon, Itzhak; Ibrahim, Quazi; Graham, Ian D; Harlos, Karen; Haynes, R Brian; Connolly, Stuart J

2016-03-31

The uptake of Clinical Practice Guideline (CPG) recommendations that improve outcomes in heart failure (HF) remains suboptimal. We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations, those with clear evidence that benefits outweigh the risks. We will use American, Canadian and European HF guidelines as our reference. We will conduct a literature search in the databases of MEDLINE, EMBASE, HEALTHSTAR, CINAHL, Cochrane Library, Campbell Collaboration, Joanna Briggs Institute Evidence Based Practice, Centre for Reviews and Dissemination and Evidence Based Practice Centres. We will include prospective studies evaluating implementation interventions aimed at improving uptake of class I CPG recommendations in HF. We will extract data in duplicate. We will classify interventions according to their level of application (ie, provider, organisation, systems level) and common underlying characteristics (eg, education, decision-support, financial incentives) using the Cochrane Effective Practice and Organisation of Care Taxonomy. We will assess the impact of the intervention on adherence to the CPGs. Outcomes will include proportion of eligible patients who were: prescribed a CPG-recommended pharmacological treatment; referred for device consideration; provided self-care education at discharge; and provided left ventricular function assessment. We will include clinical outcomes such as hospitalisations, readmissions and mortality, if data is available. We will identify the common elements of successful and failing interventions, and examine the context in which they were applied, using the Process Redesign contextual framework. We will synthesise the results narratively and, if appropriate, will pool results for meta-analysis. In this review, we will assess the impact of implementation strategies and contextual factors on physician adherence to HF CPGs. We will explore why some interventions may

Integrating addiction treatment into primary care using mobile health technology: protocol for an implementation research study.

Science.gov (United States)

Quanbeck, Andrew R; Gustafson, David H; Marsch, Lisa A; McTavish, Fiona; Brown, Randall T; Mares, Marie-Louise; Johnson, Roberta; Glass, Joseph E; Atwood, Amy K; McDowell, Helene

2014-05-29

Healthcare reform in the United States is encouraging Federally Qualified Health Centers and other primary-care practices to integrate treatment for addiction and other behavioral health conditions into their practices. The potential of mobile health technologies to manage addiction and comorbidities such as HIV in these settings is substantial but largely untested. This paper describes a protocol to evaluate the implementation of an E-Health integrated communication technology delivered via mobile phones, called Seva, into primary-care settings. Seva is an evidence-based system of addiction treatment and recovery support for patients and real-time caseload monitoring for clinicians. Our implementation strategy uses three models of organizational change: the Program Planning Model to promote acceptance and sustainability, the NIATx quality improvement model to create a welcoming environment for change, and Rogers's diffusion of innovations research, which facilitates adaptations of innovations to maximize their adoption potential. We will implement Seva and conduct an intensive, mixed-methods assessment at three diverse Federally Qualified Healthcare Centers in the United States. Our non-concurrent multiple-baseline design includes three periods - pretest (ending in four months of implementation preparation), active Seva implementation, and maintenance - with implementation staggered at six-month intervals across sites. The first site will serve as a pilot clinic. We will track the timing of intervention elements and assess study outcomes within each dimension of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, including effects on clinicians, patients, and practices. Our mixed-methods approach will include quantitative (e.g., interrupted time-series analysis of treatment attendance, with clinics as the unit of analysis) and qualitative (e.g., staff interviews regarding adaptations to implementation protocol) methods, and assessment of

Study of a diffusion flamelet model, with preferential diffusion effects included

NARCIS (Netherlands)

Delhaye, S.; Somers, L.M.T.; Bongers, H.; Oijen, van J.A.; Goey, de L.P.H.; Dias, V.

2005-01-01

The non-premixed flamelet model of Peters [1] (model1), which does not include preferential diffusion effects is investigated. Two similar models are presented, but without the assumption of unity Lewis numbers. One of these models was derived by Peters & Pitsch [2] (model2), while the other one was

Langevin simulations of QCD, including fermions

International Nuclear Information System (INIS)

Kronfeld, A.S.

1986-02-01

We encounter critical slow down in updating when xi/a -> infinite and in matrix inversion (needed to include fermions) when msub(q)a -> 0. A simulation that purports to solve QCD numerically will encounter these limits, so to face the challenge in the title of this workshop, we must cure the disease of critical slow down. Physically, this critical slow down is due to the reluctance of changes at short distances to propagate to large distances. Numerically, the stability of an algorithm at short wavelengths requires a (moderately) small step size; critical slow down occurs when the effective long wavelength step size becomes tiny. The remedy for this disease is an algorithm that propagates signals quickly throughout the system; i.e. one whose effective step size is not reduced for the long wavelength conponents of the fields. (Here the effective ''step size'' is essentially an inverse decorrelation time.) To do so one must resolve various wavelengths of the system and modify the dynamics (in CPU time) of the simulation so that all modes evolve at roughly the same rate. This can be achieved by introducing Fourier transforms. I show how to implement Fourier acceleration for Langevin updating and for conjugate gradient matrix inversion. The crucial feature of these algorithms that lends them to Fourier acceleration is that they update the lattice globally; hence the Fourier transforms are computed once per sweep rather than once per hit. (orig./HSI)

When planning is not enough: the self-regulatory effect of implementation intentions on changing snacking habits.

Science.gov (United States)

Tam, Leona; Bagozzi, Richard P; Spanjol, Jelena

2010-05-01

This study examined whether matching implementation intentions to people's regulatory orientation affects the effectiveness of changing unhealthy snacking habits. Participants' regulatory orientation was either measured (as a chronic trait) or manipulated (as a situational state), and participants were randomly assigned to implementation intention conditions to eat more healthy snacks or avoid eating unhealthy ones. A self-reported online food diary of healthy and unhealthy snacks over a 2-day period. Participants with weak unhealthy snacking habits consumed more healthy snacks when forming any type of implementation intentions (regardless of match or mismatch with their regulatory orientation), while participants with strong unhealthy snacking habits consumed more healthy snacks only when forming implementation intentions that matched their regulatory orientations. RESULTS suggest that implementation intentions that match regulatory orientation heighten motivation intensity and put snacking under intentional control for people with strong unhealthy snacking habits. (c) 2010 APA, all rights reserved.

Efficient and robust implementation of the TLISMNI method

Science.gov (United States)

Aboubakr, Ahmed K.; Shabana, Ahmed A.

2015-09-01

The dynamics of large scale and complex multibody systems (MBS) that include flexible bodies and contact/impact pairs is governed by stiff equations. Because explicit integration methods can be inefficient and often fail in the case of stiff problems, the use of implicit numerical integration methods is recommended in this case. This paper presents a new and efficient implementation of the two-loop implicit sparse matrix numerical integration (TLISMNI) method proposed for the solution of constrained rigid and flexible MBS differential and algebraic equations. The TLISMNI method has desirable features that include avoiding numerical differentiation of the forces, allowing for an efficient sparse matrix implementation, and ensuring that the kinematic constraint equations are satisfied at the position, velocity and acceleration levels. In this method, a sparse Lagrangian augmented form of the equations of motion that ensures that the constraints are satisfied at the acceleration level is used to solve for all the accelerations and Lagrange multipliers. The generalized coordinate partitioning or recursive methods can be used to satisfy the constraint equations at the position and velocity levels. In order to improve the efficiency and robustness of the TLISMNI method, the simple iteration and the Jacobian-Free Newton-Krylov approaches are used in this investigation. The new implementation is tested using several low order formulas that include Hilber-Hughes-Taylor (HHT), L-stable Park, A-stable Trapezoidal, and A-stable BDF methods. The HHT method allows for including numerical damping. Discussion on which method is more appropriate to use for a certain application is provided. The paper also discusses TLISMNI implementation issues including the step size selection, the convergence criteria, the error control, and the effect of the numerical damping. The use of the computer algorithm described in this paper is demonstrated by solving complex rigid and flexible tracked

Implementation Intention and Reminder Effects on Behavior Change in a Mobile Health System: A Predictive Cognitive Model.

Science.gov (United States)

Pirolli, Peter; Mohan, Shiwali; Venkatakrishnan, Anusha; Nelson, Les; Silva, Michael; Springer, Aaron

2017-11-30

Implementation intentions are mental representations of simple plans to translate goal intentions into behavior under specific conditions. Studies show implementation intentions can produce moderate to large improvements in behavioral goal achievement. Human associative memory mechanisms have been implicated in the processes by which implementation intentions produce effects. On the basis of the adaptive control of thought-rational (ACT-R) theory of cognition, we hypothesized that the strength of implementation intention effect could be manipulated in predictable ways using reminders delivered by a mobile health (mHealth) app. The aim of this experiment was to manipulate the effects of implementation intentions on daily behavioral goal success in ways predicted by the ACT-R theory concerning mHealth reminder scheduling. An incomplete factorial design was used in this mHealth study. All participants were asked to choose a healthy behavior goal associated with eat slowly, walking, or eating more vegetables and were asked to set implementation intentions. N=64 adult participants were in the study for 28 days. Participants were stratified by self-efficacy and assigned to one of two reminder conditions: reminders-presented versus reminders-absent. Self-efficacy and reminder conditions were crossed. Nested within the reminders-presented condition was a crossing of frequency of reminders sent (high, low) by distribution of reminders sent (distributed, massed). Participants in the low frequency condition got 7 reminders over 28 days; those in the high frequency condition were sent 14. Participants in the distributed conditions were sent reminders at uniform intervals. Participants in the massed distribution conditions were sent reminders in clusters. There was a significant overall effect of reminders on achieving a daily behavioral goal (coefficient=2.018, standard error [SE]=0.572, odds ratio [OR]=7.52, 95% CI 0.9037-3.2594, Pbehavioral goals. Computational cognitive

An exploration of how guideline developer capacity and guideline implementability influence implementation and adoption: study protocol

Directory of Open Access Journals (Sweden)

Lemieux-Charles Louise

2009-07-01

Full Text Available Abstract Background Practice guidelines can improve health care delivery and outcomes but several issues challenge guideline adoption, including their intrinsic attributes, and whether and how they are implemented. It appears that guideline format may influence accessibility and ease of use, which may overcome attitudinal barriers of guideline adoption, and appear to be important to all stakeholders. Guideline content may facilitate various forms of decision making about guideline adoption relevant to different stakeholders. Knowledge and attitudes about, and incentives and capacity for implementation on the part of guideline sponsors may influence whether and how they develop guidelines containing these features, and undertake implementation. Examination of these issues may yield opportunities to improve guideline adoption. Methods The attributes hypothesized to facilitate adoption will be expanded by thematic analysis, and quantitative and qualitative summary of the content of international guidelines for two primary care (diabetes, hypertension and institutional care (chronic ulcer, chronic heart failure topics. Factors that influence whether and how guidelines are implemented will be explored by qualitative analysis of interviews with individuals affiliated with guideline sponsoring agencies. Discussion Previous research examined guideline implementation by measuring rates of compliance with recommendations or associated outcomes, but this produced little insight on how the products themselves, or their implementation, could be improved. This research will establish a theoretical basis upon which to conduct experimental studies to compare the cost-effectiveness of interventions that enhance guideline development and implementation capacity. Such studies could first examine short-term outcomes predictive of guideline utilization, such as recall, attitude toward, confidence in, and adoption intention. If successful, then long-term objective

Effectiveness of a multifaceted implementation strategy on physicians? referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial

OpenAIRE

D?pp, Carola ME; Graff, Maud JL; Teerenstra, Steven; Nijhuis-van der Sanden, Maria WG; Olde Rikkert, Marcel GM; Vernooij-Dassen, Myrra JFJ

2013-01-01

BACKGROUND: To evaluate the effectiveness of a multifaceted implementation strategy on physicians' referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). METHODS: A cluster randomized controlled trial with 28 experimental and 17 control clusters was conducted. Cluster included a minimum of one physician, one manager, and two occupational therapists. In the control group physicians and managers received no interventions and occupational therap...

Transient Response Dynamic Module Modifications to Include Static and Kinetic Friction Effects

Science.gov (United States)

Misel, J. E.; Nenno, S. B.; Takahashi, D.

1984-01-01

A methodology that supports forced transient response dynamic solutions when both static and kinetic friction effects are included in a structural system model is described. Modifications that support this type of nonlinear transient response solution are summarized for the transient response dynamics (TRD) NASTRAN module. An overview of specific modifications for the NASTRAN processing subroutines, INITL, TRD1C, and TRD1D, are described with further details regarding inspection of nonlinear input definitions to define the type of nonlinear solution required, along with additional initialization requirements and specific calculation subroutines to successfully solve the transient response problem. The extension of the basic NASTRAN nonlinear methodology is presented through several stages of development to the point where constraint equations and residual flexibility effects are introduced into the finite difference Newmark-Beta recurrsion formulas. Particular emphasis is placed on cost effective solutions for large finite element models such as the Space Shuttle with friction degrees of freedom between the orbiter and payloads mounted in the cargo bay. An alteration to the dynamic finite difference equations of motion is discussed, which allows one to include friction effects at reasonable cost for large structural systems such as the Space Shuttle. Data are presented to indicate the possible impact of transient friction loads to the payload designer for the Space Shuttle. Transient response solution data are also included, which compare solutions without friction forces and those with friction forces for payloads mounted in the Space Shuttle cargo bay. These data indicate that payload components can be sensitive to friction induced loads.

Implementation of a Project Management Office (PMO)--experiences from year 1.

Science.gov (United States)

Isola, Miriam; Polikaitis, Audrius; Laureto, Rose Ann

2006-01-01

Recognized as an early leader in clinical information systems, the University of Illinois Medical Center was challenged to meet the ever-increasing demand for information systems. Interviews with key stakeholders revealed unfavorable attitudes toward the Information Services department. Reasons given were that projects often are not aligned with business strategy, projects are delayed, IS itself is a barrier to progress, and a lack of proactive planning precipitates crises. Under the leadership of a new CIO, IS began developing a Project Management Office, or PMO, to better meet medical center business objectives and to more effectively manage technology projects. Successes during the first year included comprehensive IT strategic planning. Collaborative relationships were established with departmental leaders for planning, prioritizing, budgeting, and executing projects. A formal Web-based process for requesting IS projects was implemented, project management training was provided, and elements of standard project management methodology were implemented. While a framework for effective project management was created, significant effort is still required to firmly root these new processes within the organizational culture. Project management office goals for the second year include implementing a project portfolio management tool, refining the benefits methodology, and continuing the advancement of the project management methodology.

Barriers and limitations during implementation of the surgical safety checklist of the World Health Organization

Directory of Open Access Journals (Sweden)

Rosa Amalia Arboleda

2014-04-01

Full Text Available Introduction: The surgical safety checklist of the World Health Organization (WHO is a tool that checks and evaluates each procedure in the operating room. Despite its demonstrated effectiveness, it has many limitations and barriers to its implementation. The aim of this article was to present the current evidence regarding limitations and barriers to achieve a successful implementation of the surgical safety WHO checklist. Methods: A narrative review was designed. We performed a systematic literature search in PubMed/MEDLINE. Articles that describe or present as primary or secondary endpoints barriers or limitations during the implementation of the checklist WHO were selected. Observational or experimental articles were included from the date of the official launch of the WHO list. To describe the data a summary table was designed. Detailed results were organized qualitatively extracting the most prevalent limitations. Results: 17 studies were included in the final review process. The main findings were: 1 a large number of constraints reported in the literature that hinder the implementation process, 2 limitations were grouped into 9 categories according to their similarities and 3 the most frequently reported category was “knowledge”. Discussion: There are several factors that limit the proper implementation of the surgical safety checklist WHO. Among these, cultural factors, knowledge, indifference and / or relevance, communication, filling completeness, among others. Effective implementation strategies would reach its successful implementation.

Implementation of Compressed Work Schedules: Participation and Job Redesign as Critical Factors for Employee Acceptance.

Science.gov (United States)

Latack, Janina C.; Foster, Lawrence W.

1985-01-01

Analyzes the effects of an implementation of a three-day/thirty-eight hour (3/38) work schedule among information systems personnel (N=84). Data showed that 18 months after implementation, 3/38 employees still strongly favor the compressed schedule. Data also suggest substantial organizational payoffs including reductions in sick time, overtime,…

Action to Support Practices Implement Research Evidence (ASPIRE): protocol for a cluster-randomised evaluation of adaptable implementation packages targeting 'high impact' clinical practice recommendations in general practice.

Science.gov (United States)

Willis, Thomas A; Hartley, Suzanne; Glidewell, Liz; Farrin, Amanda J; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Collinson, Michelle; Clamp, Susan; Hunter, Cheryl; Ward, Vicky; Hulme, Claire; Meads, David; Bregantini, Daniele; Carder, Paul; Foy, Robbie

2016-02-29

There are recognised gaps between evidence and practice in general practice, a setting which provides particular challenges for implementation. We earlier screened clinical guideline recommendations to derive a set of 'high impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. We aim to evaluate the effectiveness and cost-effectiveness of a multifaceted, adaptable intervention package to implement four targeted, high impact recommendations in general practice. The research programme Action to Support Practice Implement Research Evidence (ASPIRE) includes a pair of pragmatic cluster-randomised trials which use a balanced incomplete block design. Clusters are general practices in West Yorkshire, United Kingdom (UK), recruited using an 'opt-out' recruitment process. The intervention package adapted to each recommendation includes combinations of audit and feedback, educational outreach visits and computerised prompts with embedded behaviour change techniques selected on the basis of identified needs and barriers to change. In trial 1, practices are randomised to adapted interventions targeting either diabetes control or risky prescribing and those in trial 2 to adapted interventions targeting either blood pressure control in patients at risk of cardiovascular events or anticoagulation in atrial fibrillation. The respective primary endpoints comprise achievement of all recommended target levels of haemoglobin A1c (HbA1c), blood pressure and cholesterol in patients with type 2 diabetes, a composite indicator of risky prescribing, achievement of recommended blood pressure targets for specific patient groups and anticoagulation prescribing in patients with atrial fibrillation. We are also randomising practices to a fifth, non-intervention control group to further assess Hawthorne effects. Outcomes will be assessed using routinely collected data

Modelling heavy metals build-up on urban road surfaces for effective stormwater reuse strategy implementation

International Nuclear Information System (INIS)

Hong, Nian; Zhu, Panfeng; Liu, An

2017-01-01

Urban road stormwater is an alternative water resource to mitigate water shortage issues in the worldwide. Heavy metals deposited (build-up) on urban road surface can enter road stormwater runoff, undermining stormwater reuse safety. As heavy metal build-up loads perform high variabilities in terms of spatial distribution and is strongly influenced by surrounding land uses, it is essential to develop an approach to identify hot-spots where stormwater runoff could include high heavy metal concentrations and hence cannot be reused if it is not properly treated. This study developed a robust modelling approach to estimating heavy metal build-up loads on urban roads using land use fractions (representing percentages of land uses within a given area) by an artificial neural network (ANN) model technique. Based on the modelling results, a series of heavy metal load spatial distribution maps and a comprehensive ecological risk map were generated. These maps provided a visualization platform to identify priority areas where the stormwater can be safely reused. Additionally, these maps can be utilized as an urban land use planning tool in the context of effective stormwater reuse strategy implementation. - Highlights: • A model was developed to simulate heavy metal build-up loads on urban roads. • This model is based on artificial neural networks. • Land use fractions was used to model build-up loads on different particle sizes. • The maps of heavy metal spatial distribution and ecological risk were generated. • This model can be used for effective stormwater reuse strategy implementation. - Development of a robust modelling approach to mapping heavy metals build-up and their ecological risks for stormwater reuse safety.

DWBA (d,N) Calculations Including Dirac Phenomenological Potentials and an Exact Treatment of Finite-range Effects

Science.gov (United States)

Hawk, Eric

2005-04-01

An algorithm for the inclusion of both Dirac phenomenological potentials and an exact treatment of finite-range effects within the DWBA is presented. The numerical implementation of this algorithm is used to calculate low-energy deuteron stripping cross sections, analyzing powers, and polarizations. These calculations are compared with experimental data where available. The impact of using several commonly employed nuclear potentials (Reid soft-core, Bonn, Argonne v18) for the internal deuteron wave function is also examined.

Implementing Suicide Prevention Programs: Costs and Potential Life Years Saved in Canada.

Science.gov (United States)

Vasiliadis, Helen-Maria; Lesage, Alain; Latimer, Eric; Seguin, Monique

2015-09-01

Little is known about the costs and effects of suicide prevention programs at the population level. We aimed to determine (i) the costs associated with a suicide death and using prospective values (ii) the costs and effects of transferring, into a Canadian context, the results of the European Nuremberg Alliance against Depression (NAD) trial with the addition of 4 community-based suicide prevention strategies. These included the training of family physicians in the detection and treatment of depression, population campaigns aimed at increasing awareness about depression, the training of community leaders among first responders and follow-up of individuals who attempted suicide. This study includes a prospective value implementation study design. Using published data and information from interviews with Canadian decision makers, we assessed the costs of a suicide death in the province of Quebec and the costs of potentially implementing the NAD multi-modal suicide prevention programs, and the incremental cost-effectiveness ratio (ICER), from a health care system and societal perspective, associated with the NAD program while considering the friction cost method (FCM) and human capital approach (HCA) (discounted at 3%.) The costs considered included those incurred for the suicide prevention program and direct medical and non-medical costs as well as those related to a police investigation and funeral costs. Indirect costs associated with loss of productivity and short term disability were also considered. Sensitivity analyses were also carried out. Costs presented were in 2010 dollars. The annual total cost of implementing the suicide prevention programs in Quebec reached CAD23,982,293. The most expensive components of the program included the follow-up of individuals who had attempted suicide and psychotherapy for bereaved individuals. These accounted for 39% and 34% of total costs. The ICER associated with the implementation of the programs reached on average CAD3

Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review.

Science.gov (United States)

Casillas, Katherine L; Fauchier, Angèle; Derkash, Bridget T; Garrido, Edward F

2016-03-01

In recent years there has been an increase in the popularity of home visitation programs as a means of addressing risk factors for child maltreatment. The evidence supporting the effectiveness of these programs from several meta-analyses, however, is mixed. One potential explanation for this inconsistency explored in the current study involves the manner in which these programs were implemented. In the current study we reviewed 156 studies associated with 9 different home visitation program models targeted to caregivers of children between the ages of 0 and 5. Meta-analytic techniques were used to determine the impact of 18 implementation factors (e.g., staff selection, training, supervision, fidelity monitoring, etc.) and four study characteristics (publication type, target population, study design, comparison group) in predicting program outcomes. Results from analyses revealed that several implementation factors, including training, supervision, and fidelity monitoring, had a significant effect on program outcomes, particularly child maltreatment outcomes. Study characteristics, including the program's target population and the comparison group employed, also had a significant effect on program outcomes. Implications of the study's results for those interested in implementing home visitation programs are discussed. A careful consideration and monitoring of program implementation is advised as a means of achieving optimal study results. Copyright © 2015 Elsevier Ltd. All rights reserved.

HIV Pre-exposure Prophylaxis Program Implementation Using Intervention Mapping.

Science.gov (United States)

Flash, Charlene A; Frost, Elizabeth L T; Giordano, Thomas P; Amico, K Rivet; Cully, Jeffrey A; Markham, Christine M

2018-04-01

HIV pre-exposure prophylaxis has been proven to be an effective tool in HIV prevention. However, numerous barriers still exist in pre-exposure prophylaxis implementation. The framework of Intervention Mapping was used from August 2016 to October 2017 to describe the process of adoption, implementation, and maintenance of an HIV prevention program from 2012 through 2017 in Houston, Texas, that is nested within a county health system HIV clinic. Using the tasks outlined in the Intervention Mapping framework, potential program implementers were identified, outcomes and performance objectives established, matrices of change objectives created, and methods and practical applications formed. Results include the formation of three matrices that document program outcomes, change agents involved in the process, and the determinants needed to facilitate program adoption, implementation, and maintenance. Key features that facilitated successful program adoption and implementation were obtaining leadership buy-in, leveraging existing resources, systematic evaluation of operations, ongoing education for both clinical and nonclinical staff, and attention to emergent issues during launch. The utilization of Intervention Mapping to delineate the program planning steps can provide a model for pre-exposure prophylaxis implementation in other settings. Copyright © 2018. Published by Elsevier Inc.

The Implementation of Best Practices: Process and Performance Effects

DEFF Research Database (Denmark)

Laugen, Bjørge Timenes; Boer, Harry

2007-01-01

companies showed that a broad and incremental implementation approach initially leads to reduced performance followed by a gradual improvement as larger parts of the programmes are institutionalized. A ‘big bang' implementation approach does not seem to lead to deterioration in performance....

EXPERIMENTAL VERIFICATION OF THE EFFECTIVENESS OF IMPLEMENTATION OF PEDAGOGICAL CONDITIONS OF FORMATION OF PROFESSIONAL QUALITIES OF THE FUTURE BANKING SPECIALISTS

Directory of Open Access Journals (Sweden)

N. Benkovska

2015-05-01

Full Text Available Today there is an urgent need for reform in education. In particular those educational fields are need to reform that train specialists to build an effective economic system of the country, including the banking system. Thus, there is a need to study the effectiveness of implementation of pedagogical conditions of formation of professional qualities of future specialists of Banking and identify the priority areas of development of relevant education field. Considering on the specificity of training banking specialists, the focus of research is to determine the role of ICT both in future work and in preparing students for future professional activity. Thus, on the efficiency of formation of professional qualities of future banking specialists in the course of their professional training will have a positive impact such educational facilities as updating interdisciplinary integration of professional disciplines, activation of interactive learning tools for students and simulation of special learning situations aimed to awareness of the importance of competencies to carry out the professional activities. The implementation of pedagogical conditions of formation of professional qualities of future banking specialists will provide the stable positive dynamics of formation of professional qualities of future banking.

Epidemic spreading in scale-free networks including the effect of individual vigilance

International Nuclear Information System (INIS)

Gong Yong-Wang; Song Yu-Rong; Jiang Guo-Ping

2012-01-01

In this paper, we study the epidemic spreading in scale-free networks and propose a new susceptible-infected-recovered (SIR) model that includes the effect of individual vigilance. In our model, the effective spreading rate is dynamically adjusted with the time evolution at the vigilance period. Using the mean-field theory, an analytical result is derived. It shows that individual vigilance has no effect on the epidemic threshold. The numerical simulations agree well with the analytical result. Furthermore, we investigate the effect of individual vigilance on the epidemic spreading speed. It is shown that individual vigilance can slow the epidemic spreading speed effectively and delay the arrival of peak epidemic infection. (general)

Technology transfer in Activities Implemented Jointly (AIJ)

Energy Technology Data Exchange (ETDEWEB)

Usher, P.E.O. [United Nations Environment Programme (Cayman Islands)

1998-08-01

The agreed objective of the United Nations Framework Convention on Climate Change is to bring about early and significant reductions in greenhouse gas emissions. For many, the most attractive option for promoting this end is joint implementation. Indivisible from this is the transfer of current and innovative technology, though technology transfer is not conditional on joint implementation. The somewhat ad hoc nature of Activities Implemented Jointly (AIJ) and the failure to establish ground rules at the outset is considered. Common action can contribute to cost-effective mitigation of climate change through a sharing of the costs, benefits and risks of R and D, cross fertilisation of ideas among countries, economies of scale for new technologies, and clear signals to the international market. Potential problems include: the reluctance of national private industry to share proprietary information which might compromise competitiveness; premature convergence on technical standards that might inhibit the emergence of more developed technology; specific national circumstances which mean that solutions satisfactory to others are inappropriate in its case. This latter issue is of particular relevance to developing countries. AIJ needs to be approached in a systematic way taking into account lessons learned from evaluating the pilot phase if it is to be seen to be working effectively. (UK)

Implementation in International Business Self-Regulation

DEFF Research Database (Denmark)

Porter, Tony; Ronit, Karsten

2015-01-01

Self-regulation by business is increasingly common internationally, but the effective implementation of international rules often continues to be seen as something that only states can carry out. We argue that more exclusively private forms of effective implementation can be constructed in self......-regulation. Drawing on research in private international law, public policy implementation and self-regulation, we identify four distinct implementation sequences: monitoring, compliance, adjudication, and sanctioning. These sequences are sometimes constituted in response to deliberate integrated plans, but also come...... together in a decentralized manner. Many international business actors devise ways to carry out the sequences in order to implement rules that are important for them, reflecting a functional logic of implementation that is creative and pragmatic, and together constitute an important stage in the policy...

Multipass Steering: A Reference Implementation

Science.gov (United States)

Hennessey, Michael; Tiefenback, Michael

2015-10-01

We introduce a reference implementation of a protocol to compute corrections that bring all beams in one of the CEBAF linear accelerators (linac) to axis, including, with a larger tolerance, the lowest energy pass using measured beam trajectory data. This method relies on linear optics as representation of the system; we treat beamline perturbations as magnetic field errors localized to regions between cryomodules, providing the same transverse momentum kick to each beam. We produce a vector of measured beam position data with which we left-multiply the pseudo-inverse of a coefficient array, A, that describes the transport of the beam through the linac using parameters that include the magnetic offsets of the quadrupole magnets, the instrumental offsets of the BPMs, and the beam initial conditions. This process is repeated using a reduced array to produce values that can be applied to the available correcting magnets and beam initial conditions. We show that this method is effective in steering the beam to a straight axis along the linac by using our values in elegant, the accelerator simulation program, on a model of the linac in question. The algorithms in this reference implementation provide a tool for systematic diagnosis and cataloging of perturbations in the beam line. Supported by Jefferson Lab, Old Dominion University, NSF, DOE.

Cost-effectiveness of implementing computed tomography screening for lung cancer in Taiwan.

Science.gov (United States)

Yang, Szu-Chun; Lai, Wu-Wei; Lin, Chien-Chung; Su, Wu-Chou; Ku, Li-Jung; Hwang, Jing-Shiang; Wang, Jung-Der

2017-06-01

A screening program for lung cancer requires more empirical evidence. Based on the experience of the National Lung Screening Trial (NLST), we developed a method to adjust lead-time bias and quality-of-life changes for estimating the cost-effectiveness of implementing computed tomography (CT) screening in Taiwan. The target population was high-risk (≥30 pack-years) smokers between 55 and 75 years of age. From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Cumulative stage distributions for CT-screening and no-screening were assumed equal to those for CT-screening and radiography-screening in the NLST to estimate the savings of loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to screen-negative subjects, false-positive cases and radiation-induced lung cancer were included to obtain the incremental cost-effectiveness ratio from the public payer's perspective. The incremental costs were US$22,755 per person. After dividing this by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio was US$19,683 per QALY. This ratio would fall to US$10,947 per QALY if the stage distribution for CT-screening was the same as that of screen-detected cancers in the NELSON trial. Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Controlled ecological evaluation of an implemented exercise training programme to prevent lower limb injuries in sport: differences in implementation activity.

Science.gov (United States)

Donaldson, Alex; Gabbe, Belinda J; Lloyd, David G; Cook, Jill; Finch, Caroline F

2018-04-24

The public health benefits of injury prevention programmes are maximised when programmes are widely adopted and adhered to. Therefore, these programmes require appropriate implementation support. This study evaluated implementation activity outcomes associated with the implementation of FootyFirst, an exercise training injury prevention programme for community Australian football, both with (FootyFirst+S) and without (FootyFirst+NS) implementation support. An evaluation plan based on the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Sports Setting Matrix was applied in a controlled ecological evaluation of the implementation of FootyFirst. RE-AIM dimension-specific (range: 0-2) and total RE-AIM scores (range: 0-10) were derived by triangulating data from a number of sources (including surveys, interviews, direct observations and notes) describing FootyFirst implementation activities. The mean dimension-specific and total scores were compared for clubs in regions receiving FootyFirst+S and FootyFirst+NS, through analysis of variance. The mean total RE-AIM score forclubs in the FootyFirst+S regions was 2.4 times higher than for clubs in the FootyFirst+NS region (4.73 vs 1.94; 95% CI for the difference: 1.64 to 3.74). Similarly, all dimension-specific scores were significantly higher for clubs in the FootyFirst+S regions compared with clubs in the FootyFirst+NS region. In all regions, the dimension-specific scores were highest for reach and adoption, and lowest for implementation. Implementing exercise training injury prevention programmes in community sport is challenging. Delivering programme content supported by a context-specific and evidence-informed implementation plan leads to greater implementation activity, which is an important precursor to injury reductions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise

Implementation and effectiveness of sound mitigation measures on Texas highways (HB 790) : final report.

Science.gov (United States)

2016-10-01

The 84th Texas Legislature passed House Bill (HB) 790 directing the Texas A&M Transportation Institute (TTI) to perform a study on the implementation and effectiveness of sound mitigation measures on the state highway system and certain toll roads an...

U.S. weapons-usable plutonium disposition policy: Implementation of the MOX fuel option

Energy Technology Data Exchange (ETDEWEB)

Woods, A.L. [ed.] [Amarillo National Resource Center for Plutonium, TX (United States); Gonzalez, V.L. [Texas A and M Univ., College Station, TX (United States). Dept. of Political Science

1998-10-01

A comprehensive case study was conducted on the policy problem of disposing of US weapons-grade plutonium, which has been declared surplus to strategic defense needs. Specifically, implementation of the mixed-oxide fuel disposition option was examined in the context of national and international nonproliferation policy, and in contrast to US plutonium policy. The study reveals numerous difficulties in achieving effective implementation of the mixed-oxide fuel option including unresolved licensing and regulatory issues, technological uncertainties, public opposition, potentially conflicting federal policies, and the need for international assurances of reciprocal plutonium disposition activities. It is believed that these difficulties can be resolved in time so that the implementation of the mixed-oxide fuel option can eventually be effective in accomplishing its policy objective.

U.S. weapons-useable plutonium disposition policy: Implementation of the MOX fuel option

International Nuclear Information System (INIS)

Woods, A.L.; Gonzalez, V.L.

1998-10-01

A comprehensive case study was conducted on the policy problem of disposing of US weapons-grade plutonium, which has been declared surplus to strategic defense needs. Specifically, implementation of the mixed-oxide fuel disposition option was examined in the context of national and international nonproliferation policy, and in contrast to US plutonium policy. The study reveals numerous difficulties in achieving effective implementation of the mixed-oxide fuel option including unresolved licensing and regulatory issues, technological uncertainties, public opposition, potentially conflicting federal policies, and the need for international assurances of reciprocal plutonium disposition activities. It is believed that these difficulties can be resolved in time so that the implementation of the mixed-oxide fuel option can eventually be effective in accomplishing its policy objective

Preparing for national implementation of an evidence-based, effective HIV prevention program among bahamian sixth-grade students.

Science.gov (United States)

Knowles, Valerie; Wang, Bo; Deveaux, Lynette; Lunn, Sonja; Rolle, Glenda; Jones, Giavana; Harris, Carole; Kaljee, Linda; Li, Xiaoming; Koci, Veronica; Chen, Xinguang; Marshall, Sharon; Stanton, Bonita

2012-01-01

Using data from the preparatory phase prior to national implementation of an effective HIV prevention program (Focus on Youth in the Caribbean; FOYC) in all Bahamian government sixth-grade classes, we describe (1) actual FOYC implementation, (2) factors that influenced implementation, and (3) the relationship of implementation with intervention outcome. Six elementary schools (with 17 grade six classrooms) were selected to participate in the preparatory phase. The 17 teachers were invited to attend a training workshop, coordinate administration of questionnaires to the students, teach the 10 sessions of FOYC and complete self-assessment checklists. A total of 395 students submitted baseline and 311 students submitted year-end questionnaires. Thirteen teachers initiated FOYC; five completed all 10 sessions. Implementation of FOYC was not related to teacher FOYC workshop experience but did cluster by school. There were significant positive correlations between improved student knowledge of HIV/AIDS, protective health skills, perceived parental monitoring and reduced risk behaviours with the number of FOYC sessions delivered. Implementation was impeded by logistics issues, structural issues with the measures, and comfort-level issues, most of which can be addressed for national implementation. Degree of FOYC implementation is correlated with positive student outcomes.

Thermodynamics of strong coupling superconductors including the effect of anisotropy

Science.gov (United States)

Daams, J. M.; Carbotte, J. P.

1981-05-01

The thermodynamics of several elemental superconductors is computed from isotropic Eliashberg theory formulated on the imaginary frequency axis. A symmary of the available experimental literature is presented and a comparison with theory is given. The small disagreements that are found are all in the direction expected from anisotropy effects. We calculate the effect of a small amount of model anisotropy on the critical temperature, critical field, and high-temperature specific heat from an exact solution of the anisotropic Eliashberg equations. These are the first such results below the critical temperature; unlike previous analytical work, we include retardation, anisotropy in the mass enhancement, and the effect of the Coulomb repulsion in enhancing anisotropy, all of which are significant. We derive a new formula independent of any model anisotropy for the rate of decrease with impurity lifetime of the critical temperature. Finally we demonstrate how the commonly used formulas of Markowitz and Kadanoff and of Clem may give entirely misleading estimates of the gap anisotropy when used to interpret certain experiments.

Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men.

Science.gov (United States)

Wolff, Nancy; Huening, Jessica; Shi, Jing; Frueh, B Christopher; Hoover, Donald R; McHugo, Gregory

2015-03-01

A controlled trial of Seeking Safety (SS) and Male-Trauma Recovery Empowerment Model (M-TREM) examined implementation and effectiveness of integrated group therapy for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) on PTSD and mental health symptoms plus self-esteem and efficacy for incarcerated men. The study sample (n=230) was male inmates 18 years or older who were primarily non-white, high school graduates or equivalents, had childhood trauma histories, committed violent crimes, had serious mental illnesses, and resided in a maximum security prison. Incarcerated men, who screened positive for PTSD and SUD, were assigned randomly (n=142) or by preference (n=88) to receive SS or M-TREM, with a waitlist group of (n=93). Manualized interventions were group-administered for 14 weeks. Primary outcomes were PTSD and other mental health symptoms. Secondary outcomes were self-esteem, coping, and self-efficacy. SUD outcomes cannot be measured in a correctional setting. Implementation feasibility was exhibited by the ability to recruit, screen, assign, and retain participants. Effectiveness findings depended on sample, design, and method for analysis. Using a waitlist control group and no follow-up period, we found no aggregate effect of treatment on PTSD symptoms, although, when disaggregated, M-TREM was found to improve PTSD severity and SS improved general mental health symptoms and psychological functioning. Using intent-to-treat and completer analyses, no significant differences were found in the relative performance between SS and M-TREM on primary or secondary outcomes. When longitudinal data were maximized and modeled in ways that reflect the hierarchical nature of the data, we found that SS and M-TREM performed better than no treatment on PTSD severity and secondary outcomes, and that treatment benefits endured. Findings cautiously support implementing either Seeking Safety or M-TREM to treat incarcerated men with co-morbid PTSD

Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version.

Science.gov (United States)

Vlemmix, Floortje; Rosman, Ageeth N; Fleuren, Margot A H; Rijnders, Marlies E B; Beuckens, Antje; Haak, Monique C; Akerboom, Bettina M C; Bais, Joke M J; Kuppens, Simone M I; Papatsonis, Dimitri N; Opmeer, Brent C; van der Post, Joris A M; Mol, Ben Willem J; Kok, Marjolein

2010-05-10

Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV) is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV) and the Dutch Society for Obstetrics and Gynaecology (NVOG). Implementation of ECV does not exceed 50 to 60% and probably less.We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV.The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Dutch Trial Register (NTR): 1878.

Implementation of the external cephalic version in breech delivery. Dutch national implementation study of external cephalic version

Directory of Open Access Journals (Sweden)

Papatsonis Dimitri N

2010-05-01

Full Text Available Abstract Background Breech presentation occurs in 3 to 4% of all term pregnancies. External cephalic version (ECV is proven effective to prevent vaginal breech deliveries and therefore it is recommended by clinical guidelines of the Royal Dutch Organisation for Midwives (KNOV and the Dutch Society for Obstetrics and Gynaecology (NVOG. Implementation of ECV does not exceed 50 to 60% and probably less. We aim to improve the implementation of ECV to decrease maternal and neonatal morbidity and mortality due to breech presentations. This will be done by defining barriers and facilitators of implementation of ECV in the Netherlands. An innovative implementation strategy will be developed based on improved patient counselling and thorough instructions of health care providers for counselling. Method/design The ultimate purpose of this implementation study is to improve counselling of pregnant women and information of clinicians to realize a better implementation of ECV. The first phase of the project is to detect the barriers and facilitators of ECV. The next step is to develop an implementation strategy to inform and counsel pregnant women with a breech presentation, and to inform and educate care providers. In the third phase, the effectiveness of the developed implementation strategy will be evaluated in a randomised trial. The study population is a random selection of midwives and gynaecologists from 60 to 100 hospitals and practices. Primary endpoints are number of counselled women. Secondary endpoints are process indicators, the amount of fetes in cephalic presentation at birth, complications due to ECV, the number of caesarean sections and perinatal condition of mother and child. Cost effectiveness of the implementation strategy will be measured. Discussion This study will provide evidence for the cost effectiveness of a structural implementation of external cephalic versions to reduce the number of breech presentations at term. Trial

Optimized planning methodologies of ASON implementation

Science.gov (United States)

Zhou, Michael M.; Tamil, Lakshman S.

2005-02-01

Advanced network planning concerns effective network-resource allocation for dynamic and open business environment. Planning methodologies of ASON implementation based on qualitative analysis and mathematical modeling are presented in this paper. The methodology includes method of rationalizing technology and architecture, building network and nodal models, and developing dynamic programming for multi-period deployment. The multi-layered nodal architecture proposed here can accommodate various nodal configurations for a multi-plane optical network and the network modeling presented here computes the required network elements for optimizing resource allocation.

Pollution prevention program implementation plan

International Nuclear Information System (INIS)

Engel, J.A.

1996-09-01

The Pollution Prevention Program Implementation Plan (the Plan) describes the Pacific Northwest National Laboratory's (PNNL) Pollution Prevention (P2) Program. The Plan also shows how the P2 Program at PNNL will be in support of and in compliance with the Hanford Site Waste Minimization and Pollution Prevention (WMin/P2) Awareness Program Plan and the Hanford Site Guide for Preparing and Maintaining Generator Group Pollution Prevention Program Documentation. In addition, this plan describes how PNNL will demonstrate compliance with various legal and policy requirements for P2. This plan documents the strategy for implementing the PNNL P2 Program. The scope of the P2 Program includes implementing and helping to implement P2 activities at PNNL. These activities will be implemented according to the Environmental Protection Agency's (EPA) hierarchy of source reduction, recycling, treatment, and disposal. The PNNL P2 Program covers all wastes generated at the Laboratory. These include hazardous waste, low-level radioactive waste, radioactive mixed waste, radioactive liquid waste system waste, polychlorinated biphenyl waste, transuranic waste, and sanitary waste generated by activities at PNNL. Materials, resource, and energy conservation are also within the scope of the PNNL P2 Program

Three axis electronic flight motion simulator real time control system design and implementation.

Science.gov (United States)

Gao, Zhiyuan; Miao, Zhonghua; Wang, Xuyong; Wang, Xiaohua

2014-12-01

A three axis electronic flight motion simulator is reported in this paper including the modelling, the controller design as well as the hardware implementation. This flight motion simulator could be used for inertial navigation test and high precision inertial navigation system with good dynamic and static performances. A real time control system is designed, several control system implementation problems were solved including time unification with parallel port interrupt, high speed finding-zero method of rotary inductosyn, zero-crossing management with continuous rotary, etc. Tests were carried out to show the effectiveness of the proposed real time control system.

Three axis electronic flight motion simulator real time control system design and implementation

Energy Technology Data Exchange (ETDEWEB)

Gao, Zhiyuan; Miao, Zhonghua, E-mail: zhonghua-miao@163.com; Wang, Xiaohua [School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, 200072 (China); Wang, Xuyong [School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240 (China)

2014-12-15

A three axis electronic flight motion simulator is reported in this paper including the modelling, the controller design as well as the hardware implementation. This flight motion simulator could be used for inertial navigation test and high precision inertial navigation system with good dynamic and static performances. A real time control system is designed, several control system implementation problems were solved including time unification with parallel port interrupt, high speed finding-zero method of rotary inductosyn, zero-crossing management with continuous rotary, etc. Tests were carried out to show the effectiveness of the proposed real time control system.

Survey of Joint Implementation activities in China; Chugoku ni okeru kyodo jisshi katsudo kanren chosa

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-03-01

It is a large task for Japan to positively promote the Joint Implementation activities related to the United Nations Framework Convention on Climate Change. Rapid increase in the emission of greenhouse-effect gases, especially CO2, is predicted in China with remarkable economic growth and population of 1.2 billion. It is essential to promote the Joint Implementation activities in China. In this survey, framework, organization, problems and tasks were investigated to effectively promote the Joint Implementation activities in China. Construction of framework for the real Joint Implementation activities has been proposed. Current problems for promoting the Joint Implementation activities in China are that the distinct guideline for the Joint Implementation is not established in the government, that the receiving system including receiving, planning and arranging sections is not established, and that the burden problems for the costs of project evaluation, data acquisition, monitoring, and verification are not solved. 5 refs., 21 figs., 6 tabs.

Effects of Language of Implementation on Functional Analysis Outcomes

Science.gov (United States)

Rispoli, Mandy; O'Reilly, Mark; Lang, Russell; Sigafoos, Jeff; Mulloy, Austin; Aguilar, Jeannie; Singer, George

2011-01-01

This study evaluated the influence of language of implementation on functional analysis outcomes for a child with a severe intellectual disability from a Spanish-speaking home. Challenging behavior was assessed during 5-min sessions under 4 conditions; attention, play-verbal, play-nonverbal, and demand and across 2 phases; implementation in…

Increasing In-Service Teacher Implementation of Classroom Management Practices through Consultation, Implementation Planning, and Participant Modeling

Science.gov (United States)

Hagermoser Sanetti, Lisa M.; Williamson, Kathleen M.; Long, Anna C. J.; Kratochwill, Thomas R.

2018-01-01

Numerous evidence-based classroom management strategies to prevent and respond to problem behavior have been identified, but research consistently indicates teachers rarely implement them with sufficient implementation fidelity. The purpose of this study was to evaluate the effectiveness of implementation planning, a strategy involving logistical…

The SBIRT program matrix: a conceptual framework for program implementation and evaluation.

Science.gov (United States)

Del Boca, Frances K; McRee, Bonnie; Vendetti, Janice; Damon, Donna

2017-02-01

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. Overview and narrative description of the SBIRT Program Matrix. The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts. © 2017 Society for the Study of Addiction.

iLead-a transformational leadership intervention to train healthcare managers' implementation leadership.

Science.gov (United States)

Richter, Anne; von Thiele Schwarz, Ulrica; Lornudd, Caroline; Lundmark, Robert; Mosson, Rebecca; Hasson, Henna

2016-07-29

Leadership is a key feature in implementation efforts, which is highlighted in most implementation frameworks. However, in studying leadership and implementation, only few studies rely on established leadership theory, which makes it difficult to draw conclusions regarding what kinds of leadership managers should perform and under what circumstances. In industrial and organizational psychology, transformational leadership and contingent reward have been identified as effective leadership styles for facilitating change processes, and these styles map well onto the behaviors identified in implementation research. However, it has been questioned whether these general leadership styles are sufficient to foster specific results; it has therefore been suggested that the leadership should be specific to the domain of interest, e.g., implementation. To this end, an intervention specifically involving leadership, which we call implementation leadership, is developed and tested in this project. The aim of the intervention is to increase healthcare managers' generic implementation leadership skills, which they can use for any implementation efforts in the future. The intervention is conducted in healthcare in Stockholm County, Sweden, where first- and second-line managers were invited to participate. Two intervention groups are included, including 52 managers. Intervention group 1 consists of individual managers, and group 2 of managers from one division. A control group of 39 managers is additionally included. The intervention consists of five half-day workshops aiming at increasing the managers' implementation leadership, which is the primary outcome of this intervention. The intervention will be evaluated through a mixed-methods approach. A pre- and post-design applying questionnaires at three time points (pre-, directly after the intervention, and 6 months post-intervention) will be used, in addition to process evaluation questionnaires related to each workshop. In

Implementation of methadone therapy for opioid use disorder in Russia - a modeled cost-effectiveness analysis.

Science.gov (United States)

Idrisov, Bulat; Murphy, Sean M; Morrill, Tyler; Saadoun, Mayada; Lunze, Karsten; Shepard, Donald

2017-01-20

Opioid agonist therapy using methadone, an effective treatment of opioid use disorders (OUD) for people who inject drugs (PWID), is recommended by the World Health Organization as essential to curtail the growing HIV epidemic. Yet, despite increasing prevalence of OUD and HIV, methadone therapy has not yet been implemented in Russia. The aim of this modeling study was to estimate the cost-effectiveness of methadone therapy for Russian adults with a diagnosed OUD. We modeled the projected program implementation costs and estimated disability-adjusted life years (DALYs) averted over a 10-year period, associated with the provision of methadone therapy for a hypothetical, unreplenished cohort of Russian adults with an OUD (n = 249,000), in comparison to the current therapies at existing addiction treatment facilities. Our model compared four distinct scenarios of treatment coverage in the cohort ranging from 3.1 to 55%. Providing methadone therapy to as few as 3.1% of adults with an OUD amounted to an estimated almost 50,000 DALYs averted over 10 years at a cost of just over USD 17 million. Further expanding service coverage to 55% resulted in an estimated almost 900,000 DALYs averted, at a cost of about USD 308 million. Our study indicated that implementing opioid agonist therapy with methadone to treat OUD at existing facilities in Russia is highly cost-effective.

Effective utilization of maintenance staff in design and implementation of major project work

International Nuclear Information System (INIS)

Wyman, D.; Dingle, J.; Brown, R.

1995-01-01

The reorganization of Pickering Nuclear Division some 2 years ago resulted in the formation of the Projects and Modifications department. This department takes an integrated approach to manage all aspects of large projects at Pickering. The integration of Design, Drafting, Procurement, Construction and Operations functions into project teams represents a fundamental change to project management at Pickering. The development of integrated teams has great potential for reducing both the time and cost associated with project implementation, while at the same time improving the quality, and maintainability of the commissioned in service project. The Pickering Rehab organization 1989-1993, established to perform the rehab / retube of Units 3 and 4 had proven that a team environment will produce effective results. The outcome was astounding, critical categories such as Safety, Quality of Work, and Timeliness, had proven the team's effectiveness. The integration of operations maintenance staff into the project work activities is still evolving, and has probably required the most adaptation to change for both the former Construction and Operations organizations. Maximizing the utilization of the maintenance staff in the design and implementation of major project work will prove to be a key to a long term operating success of these projects. This paper will focus in on the effective usage of Maintenance staff in the design and implementation phases of major project work at Pickering, and on the benefits realized using this approach. It will be divided into 5 sections as indicated. 1. Past Project Shortfalls. 2. Benefits of the inclusion of Maintenance staff in the Calandria Vault Rehab Project. 3. Maintenance involvement in the Pickering 'A' Shutdown System Enhancement (SDSE) Project. 4. Challenges resulting from the inclusion of Maintenance staff project teams. 5. Summary. (author)

[A Matter of Balance: strategy for implementation in Dutch homecare organizations].

Science.gov (United States)

de Jonge, M C; van der Poel, A; van Haastregt, J C M; Du Moulin, M F T M; Zijlstra, G A R; Voordouw, I

2013-02-01

The Dutch version of A Matter of Balance (AMB-NL) is a cognitive behavioral group program to reduce fear of falling and related activity avoidance in community-living older persons. This paper presents the strategy for implementation of AMB-NL in Dutch homecare organizations and the outcomes of this implementation. The aim was to implement AMB-NL in at least 50 % of 64 homecare organizations in The Netherlands in 2009 and 2010. The implementation strategy was based on the four phases of the Replicating Effective Interventions: pre-conditions, pre-implementation, implementation, and maintenance and evolution. After preparing the implementation activities, such as identifying implementation barriers, consulting stakeholders, preparing the materials involved in the implementation, and training the facilitators of the program (n = 53), AMB-NL was implemented in 16 of the 64 homecare organizations (25 %). Another five homecare organizations indicated that they would shortly include AMB-NL in their care program. These organizations conducted the intervention 19 times to a total of 178 participants. After the implementation phase another 16 facilitators were trained, and program materials were successfully disseminated. The implementation of AMB-NL was well performed. The targeted aim is not fully reached within the two-year timeframe, but the program is well received by participants, trainers and homecare organizations. Further implementation and maintenance of AMB-NL in primary health care is recommended.

Implementing portfolio in postgraduate general practice training. Benefits and recommendations.

Science.gov (United States)

Alotaibi, Fawaz S

2012-10-01

This paper presents a review to explore the literature focusing on portfolio in postgraduate general practice (GP) training, and to examine the impact of implementation of portfolio on learning process, as well as proposing recommendations for its implementation in postgraduate GP training. An electronic search was carried out on several databases for studies addressing portfolio in postgraduate GP training. Six articles were included to address specifically the effectiveness of portfolio in postgraduate GP training. Five of them described successful experiences of portfolio-based learning implementation. Only one article addressed portfolio-based assessment in postgraduate GP training. The existing evidence provides various benefits of professional portfolio-based learning. It does appear to have advantages of stimulating reflective learning, promoting proactive learning, and bridging the hospital experiences of the learners to GP. Moreover, the challenges to implementation of portfolio-based learning are often based on orientation and training of stakeholders.

Integration of treatment innovation planning and implementation: strategic process models and organizational challenges.

Science.gov (United States)

Lehman, Wayne E K; Simpson, D Dwayne; Knight, Danica K; Flynn, Patrick M

2011-06-01

Sustained and effective use of evidence-based practices in substance abuse treatment services faces both clinical and contextual challenges. Implementation approaches are reviewed that rely on variations of plan-do-study-act (PDSA) cycles, but most emphasize conceptual identification of core components for system change strategies. A two-phase procedural approach is therefore presented based on the integration of Texas Christian University (TCU) models and related resources for improving treatment process and program change. Phase 1 focuses on the dynamics of clinical services, including stages of client recovery (cross-linked with targeted assessments and interventions), as the foundations for identifying and planning appropriate innovations to improve efficiency and effectiveness. Phase 2 shifts to the operational and organizational dynamics involved in implementing and sustaining innovations (including the stages of training, adoption, implementation, and practice). A comprehensive system of TCU assessments and interventions for client and program-level needs and functioning are summarized as well, with descriptions and guidelines for applications in practical settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Modeling of in-vessel fission product release including fuel morphology effects for severe accident analyses

International Nuclear Information System (INIS)

Suh, K.Y.

1989-10-01

A new in-vessel fission product release model has been developed and implemented to perform best-estimate calculations of realistic source terms including fuel morphology effects. The proposed bulk mass transfer correlation determines the product of fission product release and equiaxed grain size as a function of the inverse fuel temperature. The model accounts for the fuel-cladding interaction over the temperature range between 770 K and 3000 K in the steam environment. A separate driver has been developed for the in-vessel thermal hydraulic and fission product behavior models that were developed by the Department of Energy for the Modular Accident Analysis Package (MAAP). Calculational results of these models have been compared to the results of the Power Burst Facility Severe Fuel Damage tests. The code predictions utilizing the mass transfer correlation agreed with the experimentally determined fractional release rates during the course of the heatup, power hold, and cooldown phases of the high temperature transients. Compared to such conventional literature correlations as the steam oxidation model and the NUREG-0956 correlation, the mass transfer correlation resulted in lower and less rapid releases in closer agreement with the on-line and grab sample data from the Severe Fuel Damage tests. The proposed mass transfer correlation can be applied for best-estimate calculations of fission products release from the UO 2 fuel in both nominal and severe accident conditions. 15 refs., 10 figs., 2 tabs

A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice: a cluster randomised controlled trial.

Science.gov (United States)

Riis, Allan; Jensen, Cathrine Elgaard; Bro, Flemming; Maindal, Helle Terkildsen; Petersen, Karin Dam; Bendtsen, Mette Dahl; Jensen, Martin Bach

2016-10-21

Guidelines are often slowly adapted into clinical practice. However, actively supporting healthcare professionals in evidence-based treatment may speed up guideline implementation. Danish low back pain (LBP) guidelines focus on primary care treatment of LBP, to reduce referrals from primary care to secondary care. The primary aim of this project was to reduce secondary care referral within 12 weeks by a multifaceted implementation strategy (MuIS). In a cluster randomised design, 189 general practices from the North Denmark Region were invited to participate. Practices were randomised (1:1) and stratified by practice size to MuIS (28 practices) or a passive implementation strategy (PaIS; 32 practices). Included were patients with LBP aged 18 to 65 years who were able to complete questionnaires, had no serious underlying pathology, and were not pregnant. We developed a MuIS including outreach visits, quality reports, and the STarT Back Tool for subgrouping patients with LBP. Both groups were offered the usual dissemination of guidelines, guideline-concordant structuring of the medical record, and a new referral opportunity for patients with psycho-social problems. In an intention-to-treat analysis, the primary and secondary outcomes pertained to the patient, and a cost-effectiveness analysis was performed from a healthcare sector perspective. Patients and the assessment of outcomes were blinded. Practices and caregivers delivering the interventions were not blinded. Between January 2013 and July 2014, 60 practices were included, of which 54 practices (28 MuIS, 26 PaIS) included 1101 patients (539 MuIS, 562 PaIS). Follow-up data for the primary outcome were available on 100 % of these patients. Twenty-seven patients (5.0 %) in the MuIS group were referred to secondary care vs. 59 patients (10.5 %) in the PaIS group. The adjusted odds ratio (AOR) was 0.52 [95 % CI 0.30 to 0.90; p = 0.020]. The MuIS was cost-saving £-93.20 (£406.51 vs. £499.71 per patient

The Evolving Genetics of Green Infrastructure Implementation (Invited)

Science.gov (United States)

Ballestero, T. P.; Watts, A. W.; Houle, J. J.; Puls, T. A.

2013-12-01

Urbanization radically alters hydrology, with impacts from very local to regional scales. Green Infrastructure techniques use natural processes to restore hydrologic function, and provide multiple companion benefits such as energy savings, increased green space, improved ecosystems, etc. Although science can clearly demonstrate the benefits and cost saving associated with Green Infrastructure (see for example Forging The Link http://www.unh.edu/unhsc/forgingthelink ), many community decision makers continue to be reluctant to incorporate these more effective methods into standard planning practices. In spite of the wealth of evidence, communities are very slow to codify and adopt the practices, commonly waiting for regulatory or legal directives to force them down the path. Barriers to implementation include misconceptions of performance, reliability and cost, often fed by a local ';expert' who is trusted member of the community. For Green Infrastructure to be effective, implementation must become a standard practice, rather than an innovation; the methods and concepts must be integrated into planning DNA. Fundamentally, successful green infrastructure implementation comes down to changing behavior, perceptions, and priorities, and fostering trust in the science. We will present: data on the cost and effectiveness of using Green Infrastructure to restore damaged urban hydrology, incorporating methods into urban planning tools, and an ongoing science collaborative project engaging stakeholders directly in the development and optimization of Green Infrastructure tools.

WHO Parents Skills Training (PST) programme for children with developmental disorders and delays delivered by Family Volunteers in rural Pakistan: study protocol for effectiveness implementation hybrid cluster randomized controlled trial.

Science.gov (United States)

Hamdani, S U; Akhtar, P; Zill-E-Huma; Nazir, H; Minhas, F A; Sikander, S; Wang, D; Servilli, C; Rahman, A

2017-01-01

Development disorders and delays are recognised as a public health priority and included in the WHO mental health gap action programme (mhGAP). Parents Skills Training (PST) is recommended as a key intervention for such conditions under the WHO mhGAP intervention guide. However, sustainable and scalable delivery of such evidence based interventions remains a challenge. This study aims to evaluate the effectiveness and scaled-up implementation of locally adapted WHO PST programme delivered by family volunteers in rural Pakistan. The study is a two arm single-blind effectiveness implementation-hybrid cluster randomised controlled trial. WHO PST programme will be delivered by 'family volunteers' to the caregivers of children with developmental disorders and delays in community-based settings. The intervention consists of the WHO PST along with the WHO mhGAP intervention for developmental disorders adapted for delivery using the android application on a tablet device. A total of 540 parent-child dyads will be recruited from 30 clusters. The primary outcome is child's functioning, measured by WHO Disability Assessment Schedule - child version (WHODAS-Child) at 6 months post intervention. Secondary outcomes include children's social communication and joint engagement with their caregiver, social emotional well-being, parental health related quality of life, family empowerment and stigmatizing experiences. Mixed method will be used to collect data on implementation outcomes. Trial has been retrospectively registered at ClinicalTrials.gov (NCT02792894). This study addresses implementation challenges in the real world by incorporating evidence-based intervention strategies with social, technological and business innovations. If proven effective, the study will contribute to scaled-up implementation of evidence-based packages for public mental health in low resource settings. Registered with ClinicalTrials.gov as Family Networks (FaNs) for Children with Developmental

Unified theory of dislocation motion including thermal activation and inertial effects

International Nuclear Information System (INIS)

Isaac, R.D.; Granato, A.V.

1979-01-01

Transition-state rate theory has generally been used to explain the temperature dependence of the flow stress of a crystal. However, the existence of a change in the flow stress during the superconducting transition indicates the presence of inertial effects in which dislocations overcome obstacles mechanically rather than thermally. It is shown here that the thermally activated and the inertial overcoming of obstacles are not unrelated but can both be derived from principles of stochastic motion. This leads to a theory of dislocation motion that includes both thermal activation and inertial effects. It is also shown that a distribution of activation energies must be considered to account for the experimental data

An Analysis of ERP and CRM System Implementations in Poland between 2013 and 2016

Directory of Open Access Journals (Sweden)

Bartosz Wachnik

2017-02-01

Full Text Available ERP and CRM management information systems constitute one of the most popular IT system groups used by enterprises, not only in Poland. From the point of view of both theoreticians and practitioners of business informatics, it is important to understand the effectiveness of IT implementation projects in Poland in comparison to similar projects in other countries. The scope of this article is to present the results of research concerning the success and failure in ERP and CRM implementation projects in medium and large enterprises in Poland. The results answer the question regarding the level of effectiveness in selected IT projects consisting in standard implementation, roll-out, upgrade, vertical solution implementation and re-implementation in enterprises based in Poland between 2013 and 2016. The study analyzed 917 projects, including 747 projects in medium enterprises and 224 in large enterprises. The research shows the structure of fully successful, partially successful and completely failed projects following the classical evaluation of IT projects. Research results show that the level of effectiveness in IT projects consisting in implementations of management information systems is slightly higher in Poland than in analogous projects studied by the Standish Group. Importantly, despite technological progress and efforts of research centres, consulting companies and software producers, the effectiveness of IT project completion has not increased for over 20 years. The results may be interesting for researchers specializing in the subject of IT project completion, as well as for practitioners implementing such projects.

Reentry Works: The Implementation and Effectiveness of a Serious and Violent Offender Reentry Initiative

Science.gov (United States)

Bouffard, Jeffrey A.; Bergeron, Lindsey E.

2006-01-01

Spurred by large increases in prison populations and other recent sentencing and correctional trends, the federal government has supported the development and implementation of Serious and Violent Offender Reentry Initiatives (SVORI) nationwide. While existing research demonstrates the effectiveness of the separate components of these programs…

Prototype Implementation of Two Efficient Low-Complexity Digital Predistortion Algorithms

Directory of Open Access Journals (Sweden)

Timo I. Laakso

2008-01-01

Full Text Available Predistortion (PD lineariser for microwave power amplifiers (PAs is an important topic of research. With larger and larger bandwidth as it appears today in modern WiMax standards as well as in multichannel base stations for 3GPP standards, the relatively simple nonlinear effect of a PA becomes a complex memory-including function, severely distorting the output signal. In this contribution, two digital PD algorithms are investigated for the linearisation of microwave PAs in mobile communications. The first one is an efficient and low-complexity algorithm based on a memoryless model, called the simplicial canonical piecewise linear (SCPWL function that describes the static nonlinear characteristic of the PA. The second algorithm is more general, approximating the pre-inverse filter of a nonlinear PA iteratively using a Volterra model. The first simpler algorithm is suitable for compensation of amplitude compression and amplitude-to-phase conversion, for example, in mobile units with relatively small bandwidths. The second algorithm can be used to linearise PAs operating with larger bandwidths, thus exhibiting memory effects, for example, in multichannel base stations. A measurement testbed which includes a transmitter-receiver chain with a microwave PA is built for testing and prototyping of the proposed PD algorithms. In the testing phase, the PD algorithms are implemented using MATLAB (floating-point representation and tested in record-and-playback mode. The iterative PD algorithm is then implemented on a Field Programmable Gate Array (FPGA using fixed-point representation. The FPGA implementation allows the pre-inverse filter to be tested in a real-time mode. Measurement results show excellent linearisation capabilities of both the proposed algorithms in terms of adjacent channel power suppression. It is also shown that the fixed-point FPGA implementation of the iterative algorithm performs as well as the floating-point implementation.

Solar powered oxygen systems in remote health centers in Papua New Guinea: a large scale implementation effectiveness trial.

Science.gov (United States)

Duke, Trevor; Hwaihwanje, Ilomo; Kaupa, Magdalynn; Karubi, Jonah; Panauwe, Doreen; Sa'avu, Martin; Pulsan, Francis; Prasad, Peter; Maru, Freddy; Tenambo, Henry; Kwaramb, Ambrose; Neal, Eleanor; Graham, Hamish; Izadnegahdar, Rasa

2017-06-01

Pneumonia is the largest cause of child deaths in Papua New Guinea (PNG), and hypoxaemia is the major complication causing death in childhood pneumonia, and hypoxaemia is a major factor in deaths from many other common conditions, including bronchiolitis, asthma, sepsis, malaria, trauma, perinatal problems, and obstetric emergencies. A reliable source of oxygen therapy can reduce mortality from pneumonia by up to 35%. However, in low and middle income countries throughout the world, improved oxygen systems have not been implemented at large scale in remote, difficult to access health care settings, and oxygen is often unavailable at smaller rural hospitals or district health centers which serve as the first point of referral for childhood illnesses. These hospitals are hampered by lack of reliable power, staff training and other basic services. We report the methodology of a large implementation effectiveness trial involving sustainable and renewable oxygen and power systems in 36 health facilities in remote rural areas of PNG. The methodology is a before-and after evaluation involving continuous quality improvement, and a health systems approach. We describe this model of implementation as the considerations and steps involved have wider implications in health systems in other countries. The implementation steps include: defining the criteria for where such an intervention is appropriate, assessment of power supplies and power requirements, the optimal design of a solar power system, specifications for oxygen concentrators and other oxygen equipment that will function in remote environments, installation logistics in remote settings, the role of oxygen analyzers in monitoring oxygen concentrator performance, the engineering capacity required to sustain a program at scale, clinical guidelines and training on oxygen equipment and the treatment of children with severe respiratory infection and other critical illnesses, program costs, and measurement of processes and

Teamwork and Electronic Health Record Implementation: A Case Study of Preserving Effective Communication and Mutual Trust in a Changing Environment.

Science.gov (United States)

Gross, Anne H; Leib, Ryan K; Tonachel, Anne; Tonachel, Richard; Bowers, Danielle M; Burnard, Rachel A; Rhinehart, Catherine A; Valentim, Rahila; Bunnell, Craig A

2016-11-01

This article describes how trust among team members and in the technology supporting them was eroded during implementation of an electronic health record (EHR) in an adult outpatient oncology practice at a comprehensive cancer center. Delays in care of a 38-year-old woman with high-risk breast cancer occurred because of ineffective team communication and are illustrated in a case study. The case explores how the patient's trust and mutual trust between team members were disrupted because of inaccurate assumptions about the functionality of the EHR's communication tool, resultant miscommunications between team members and the patient, and the eventual recognition that care was not being effectively coordinated, as it had been previously. Despite a well-established, team-based culture and significant preparation for the EHR implementation, the challenges that occurred point to underlying human and system failures from which other organizations going through a similar process may learn. Through an analysis and evaluation of events that transpired before and during the EHR rollout, suggested interventions for preventing this experience are offered, which include: a thorough crosswalk between old and new communication mechanisms before implementation; understanding and mitigation of gaps in the communication tool's functionality; more robust training for staff, clinicians, and patients; greater consideration given to the pace of change expected of individuals; and development of models of collaboration between EHR users and vendors in developing products that support high-quality, team-based care in the oncology setting. These interventions are transferable to any organizational or system change that threatens mutual trust and effective communication.

Anticipated financial effects from the implementation of the standards from the series ISO 9000

International Nuclear Information System (INIS)

Dimitrovski, Aleksandar

1999-01-01

In the field of quality and the application of the series ISO 9000, in the last decade lot of has been done referring to the implementation, education and documentation of the system quality. In this work a significant effort is given to recognize the connection between material costs and financial effects. I consider that in our area of leaving a little significance is still given to the quality costs, or maybe clearly said, the costs that are made due to bed quality, although it is known that the one of the basic aim of the implementation of the quality system is profit raising. (Original)

The IAEA inspectorate, including new requirements

International Nuclear Information System (INIS)

Alston, W.

1998-01-01

The basic purpose of the IAEA safeguards system is 'timely detection of diversion of significant quantities of nuclear material'. Safeguards implementation is regulated by the IAEA Statute and individual safeguards agreements. The IAEA Inspectorate and its scope are described together with the technical objectives and the concept of verification. Effective implementation of safeguards requires cooperation between the IAEA and the state concerned. To this end, agreements require that the State should establish and maintain a system of accounting for and control of nuclear material subject to safeguards. The IAEA safeguards system has demonstrated a flexibility capable of responding to the verification demands of Member States. Is is capable of safeguarding nuclear materials, facilities, equipment and non-nuclear material. The IAEA is in the process of strengthening safeguards in its verification of declared activities

The IAEA inspectorate, including new requirements

Energy Technology Data Exchange (ETDEWEB)

Alston, W [International Atomic Energy Agency, Department of Safeguards, Division of Operations A, Vienna (Austria)

1999-12-31

The basic purpose of the IAEA safeguards system is `timely detection of diversion of significant quantities of nuclear material`. Safeguards implementation is regulated by the IAEA Statute and individual safeguards agreements. The IAEA Inspectorate and its scope are described together with the technical objectives and the concept of verification. Effective implementation of safeguards requires cooperation between the IAEA and the state concerned. To this end, agreements require that the State should establish and maintain a system of accounting for and control of nuclear material subject to safeguards. The IAEA safeguards system has demonstrated a flexibility capable of responding to the verification demands of Member States. Is is capable of safeguarding nuclear materials, facilities, equipment and non-nuclear material. The IAEA is in the process of strengthening safeguards in its verification of declared activities

The effects of video modeling with voiceover instruction on accurate implementation of discrete-trial instruction.

Science.gov (United States)

Vladescu, Jason C; Carroll, Regina; Paden, Amber; Kodak, Tiffany M

2012-01-01

The present study replicates and extends previous research on the use of video modeling (VM) with voiceover instruction to train staff to implement discrete-trial instruction (DTI). After staff trainees reached the mastery criterion when teaching an adult confederate with VM, they taught a child with a developmental disability using DTI. The results showed that the staff trainees' accurate implementation of DTI remained high, and both child participants acquired new skills. These findings provide additional support that VM may be an effective method to train staff members to conduct DTI.

Reporting on the Strategies Needed to Implement Proven Interventions: An Example From a "Real-World" Cross-Setting Implementation Study.

Science.gov (United States)

Gold, Rachel; Bunce, Arwen E; Cohen, Deborah J; Hollombe, Celine; Nelson, Christine A; Proctor, Enola K; Pope, Jill A; DeVoe, Jennifer E

2016-08-01

The objective of this study was to empirically demonstrate the use of a new framework for describing the strategies used to implement quality improvement interventions and provide an example that others may follow. Implementation strategies are the specific approaches, methods, structures, and resources used to introduce and encourage uptake of a given intervention's components. Such strategies have not been regularly reported in descriptions of interventions' effectiveness, or in assessments of how proven interventions are implemented in new settings. This lack of reporting may hinder efforts to successfully translate effective interventions into "real-world" practice. A recently published framework was designed to standardize reporting on implementation strategies in the implementation science literature. We applied this framework to describe the strategies used to implement a single intervention in its original commercial care setting, and when implemented in community health centers from September 2010 through May 2015. Per this framework, the target (clinic staff) and outcome (prescribing rates) remained the same across settings; the actor, action, temporality, and dose were adapted to fit local context. The framework proved helpful in articulating which of the implementation strategies were kept constant and which were tailored to fit diverse settings, and simplified our reporting of their effects. Researchers should consider consistently reporting this information, which could be crucial to the success or failure of implementing proven interventions effectively across diverse care settings. clinicaltrials.gov Identifier: NCT02299791. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Enhanced Recovery Implementation in Major Gynecologic Surgeries: Effect of Care Standardization.

Science.gov (United States)

Modesitt, Susan C; Sarosiek, Bethany M; Trowbridge, Elisa R; Redick, Dana L; Shah, Puja M; Thiele, Robert H; Tiouririne, Mohamed; Hedrick, Traci L

2016-09-01

To examine implementing an enhanced recovery after surgery (ERAS) protocol for women undergoing major gynecologic surgery at an academic institution and compare surgical outcomes before and after implementation. Two ERAS protocols were developed: a full pathway using regional anesthesia for open procedures and a light pathway without regional anesthesia for vaginal and minimally invasive procedures. Enhanced recovery after surgery pathways included extensive preoperative counseling, carbohydrate loading and oral fluids before surgery, multimodal analgesia with avoidance of intravenous opioids, intraoperative goal-directed fluid resuscitation, and immediate postoperative feeding and ambulation. A before-and-after study design was used to compare clinical outcomes, costs, and patient satisfaction. Complications and risk-adjusted length of stay were drawn from the American College of Surgeons' National Surgical Quality Improvement Program database. On the ERAS full protocol, 136 patients were compared with 211 historical controls and the median length of stay was reduced (2.0 compared with 3.0 days; P=.007) despite an increase in National Surgical Quality Improvement Program-predicted length of stay (2.5 compared with 2.0 days; P=.009). Reductions were seen in median intraoperative morphine equivalents (0.3 compared with 12.7 mg; Pcontrols and demonstrated decreased intraoperative and postoperative morphine equivalents (0.0 compared with 13.0 mg; Pcontrol, nurses keeping patients informed, and staff teamwork; 30-day total hospital costs were significantly decreased in both ERAS groups. Implementation of ERAS protocols in gynecologic surgery was associated with a substantial decrease in intravenous fluids and morphine administration coupled with reduction in length of stay for open procedures combined with improved patient satisfaction and decreased hospital costs.

Development through sustainable tourism and effective policy implementation: Practices of Puerto Princesa City, Philippines

Directory of Open Access Journals (Sweden)

Jazztin Jairum P. Manalo

2017-02-01

Full Text Available Sustainable tourism has been considered by many local governments as part of their initiatives for economic upliftment. It is one of the major sources of income through the use of their tourist attraction without compromising the natural resources situated within. The enactment and effective implementation of the local government’s policy have achieved a promising efficient outcome for sustainable tourism.. The city of Puerto Princesa had a long history considering its transformation from an environmentally degraded city into one of the major ecotourism sites around the world. Thus, this paper presents the case of Puerto Princesa and its practices as well as economic development by practicing sustainable tourism and effective policy implementation. The City Ordinance No. 163-91 and 640 has improved the lives of the communities by practicing cleanliness and effective waste management their surrounding and tourist destinations. Economic development and benefits from sustainable tourism reflects the city of Puerto Princesa as a role model for Local Government Units. The passing of City Ordinances on Cleanliness drive have played an important role in effective waste management of the city. The key role of having a strong political will in the local government has strongly maintained its best practices for two decades up to the present.

Implementation of lean construction techniques for minimizing the risks effect on project construction time

Directory of Open Access Journals (Sweden)

Usama Hamed Issa

2013-12-01

Full Text Available The construction projects involve various risk factors which have various impacts on time objective that may lead to time-overrun. This study suggests and applies a new technique for minimizing risk factors effect on time using lean construction principles. The lean construction is implemented in this study using the last planner system through execution of an industrial project in Egypt. Evaluating the effect of using the new tool is described in terms of two measurements: Percent Expected Time-overrun (PET and Percent Plan Completed (PPC. The most important risk factors are identified and assessed, while PET is quantified at the project start and during the project execution using a model for time-overrun quantification. The results showed that total project time is reduced by 15.57% due to decreasing PET values, while PPC values improved. This is due to minimizing and mitigating the effect of most of the risk factors in this project due to implementing lean construction techniques. The results proved that the quantification model is suitable for evaluating the effect of using lean construction techniques. In addition, the results showed that average value of PET due to factors affected by lean techniques represents 67% from PET values due to all minimized risk factors.

Implementing SSL/TLS using cryptography and PKI

CERN Document Server

Davies, Joshua

2011-01-01

Hands-on, practical guide to implementing SSL and TLS protocols for Internet security If you are a network professional who knows C programming, this practical book is for you.  Focused on how to implement Secure Socket Layer (SSL) and Transport Layer Security (TLS), this book guides you through all necessary steps, whether or not you have a working knowledge of cryptography. The book covers SSLv2, TLS 1.0, and TLS 1.2, including implementations of the relevant cryptographic protocols, secure hashing, certificate parsing, certificate generation, and more.  Coverage includes: Underst

Reducing Binge Drinking in Adolescents through Implementation of the Strategic Prevention Framework

Science.gov (United States)

Anderson-Carpenter, Kaston D.; Watson-Thompson, Jomella; Chaney, Lisa; Jones, Marvia

2016-01-01

The Strategic Prevention Framework (SPF) is a conceptual model that supports coalition-driven efforts to address underage drinking and related consequences. Although the SPF has been promoted by the U.S. Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention and implemented in multiple U.S. states and territories, there is limited research on the SPF’s effectiveness on improving targeted outcomes and associated influencing factors. The present quasi-experimental study examines the effects of SPF implementation on binge drinking and enforcement of existing underage drinking laws as an influencing factor. The intervention group encompassed 11 school districts that were implementing the SPF with local prevention coalitions across eight Kansas communities. The comparison group consisted of 14 school districts that were matched based on demographic variables. The intervention districts collectively facilitated 137 community-level changes, including new or modified programs, policies, and practices. SPF implementation supported significant improvements in binge drinking and enforcement outcomes over time (p .05). Overall, the findings provide a basis for guiding future research and community-based prevention practice in implementing and evaluating the SPF. PMID:27217310

We are (all) the champions: The effect of status in the implementation of innovations

NARCIS (Netherlands)

B. Szatmari (Balazs)

2016-01-01

markdownabstractThis thesis explores the effects of status in the implementation of innovations in three empirical papers which investigate both the positive and negative impact of status –status of either the project leader, the project group, or the organization. We argue that every project member

From SCIS to PELE: Approaches to Effective Dissemination Implementation and Adaptation of Instructional Programs.

Science.gov (United States)

Thier, Herbert D.

1981-01-01

Discusses in general terms the approaches necessary for effective dissemination and implementation of an educational program in a country and then relates these approaches to the cooperative relationship between the University of California at Berkeley and the Israel Science Teaching Center's MATAL and PELE Projects. (CS)

IAEA's Safeguards Implementation Practices Guides

International Nuclear Information System (INIS)

Mathews, C.; Sahar, S.; Cisar, V.

2015-01-01

Implementation of IAEA safeguards benefits greatly from effective cooperation among the IAEA, State or regional authorities (SRAs), and operators of facilities and other locations. To improve such cooperation, the IAEA has produced numerous safeguards guidance documents in its Services Series publications. The IAEA also provides assistance, training and advisory services that are based on the published guidance. The foundation of the IAEA's safeguards guidance is the Guidance for States Implementing Comprehensive Safeguards Agreements and Additional Protocols (IAEA Services Series 21) published in March of 2012. The large majority of States have concluded CSAs and therefore will benefit from this guidance. Many States with CSAs also have concluded small quantities protocols (SQPs) to their CSAs. In April of 2013, the IAEA published the Safeguards Implementation Guide for States with SQPs (IAEA Services Series 22). Other guidance focuses on specific topics such as preparing additional protocol declarations and nuclear material accounting. This paper will describe a recent effort to produce a ''Safeguards Implementation Practices'' (SIP) series of guides that will provide additional explanatory information about safeguards implementation, and share the practical experiences and lessons learned of States and the IAEA over the many decades of implementing safeguards. The topics to be addressed in four SIP guides include: 1) Facilitating IAEA Verification Activities; 2) Establishing and Maintaining State Safeguards Infrastructure; 3) Provision of Information to the IAEA; and 4) Collaborative Approaches to Safeguards Implementation. The SIP Guides build upon the content of IAEA Services Series 21. Because the SIP Guides are intended to share implementation practices and lessons learned of States, a number of experienced State experts have participated in the development of the documents, through a joint Member State Support Programme task

Spectral interferometry including the effect of transparent thin films to measure distances and displacements

International Nuclear Information System (INIS)

Hlubina, P.

2004-01-01

A spectral-domain interferometric technique is applied for measuring mirror distances and displacements in a dispersive Michelson interferometer when the effect of transparent thin films coated onto the interferometer beam splitter and compensator is known. We employ a low-resolution spectrometer in two experiments with different amounts of dispersion in a Michelson interferometer that includes fused-silica optical sample. Knowing the thickness of the optical sample and the nonlinear phase function of the thin films, the positions of the interferometer mirror are determined precisely by a least-squares fitting of the theoretical spectral interferograms to the recorded ones. We compare the results of the processing that include and do not include the effect of transparent thin films (Author)

`Discover, Understand, Implement, and Transfer': Effectiveness of an intervention programme to motivate students for science

Science.gov (United States)

Schütte, Kerstin; Köller, Olaf

2015-09-01

Considerable research has focused on how best to satisfy modern societies' needs for skilled labour in the field of science. The present study evaluated an intervention programme designed to increase secondary school students' motivation to pursue a science career. Students from 3 schools of the highest educational track participated for up to 2 years in the intervention programme, which was implemented as an elective in the school curriculum. Our longitudinal study design for evaluating the effectiveness of the intervention programme included all students at the grade levels involved in the programme with students who did not participate serving as a control group. Mixed-model analyses of variance showed none of the intended effects of the intervention programme on science motivation; latent growth models corroborated these results. When the programme began, students who enrolled in the science elective (n = 92) were already substantially more motivated than their classmates (n = 228). Offering such an intervention programme as an elective did not further increase the participating students' science motivation. It seems worthwhile to carry out intervention programmes with talented students who show (comparatively) little interest in science at the outset rather than with highly motivated students who self-select into the programme.

EXPLORING TAX HOLIDAY POLICY IMPLEMENTATION FOR INDONESIAN INVESTMENT CLIMATE: HAS IT BEEN EFFECTIVE?

Directory of Open Access Journals (Sweden)

Mulyono R.D.P.

2017-07-01

Full Text Available This study aims to explore the reasons for the ineffectiveness of tax holiday policy implementation in Indonesia as well as the government’s strategies to improve the investment climate. This research uses exploratory study type which does not test theory or hypothesis by using preliminary survey method, conducting direct or indirect interview via e-mail to certain informant by giving questionnaire and direct observation passively observing the field and related websites supporting statistical data in this study in depth. In testing the validity of research data used source triangulation and method triangulation. The progress that has been achieved to date in the implementation of tax holiday policy is to provide ease of bureaucracy administration and simplicity of licensing services in investing by improving coordination among government to improve foreign investors' confidence when investing in Indonesia. So technically, the implementation of tax holiday policy is quite effective in attracting foreign direct investment because it can perform the right obligations according to the regulations. In the investment point of view, tax holiday policy is not effective in attracting foreign direct investment or not becoming the main factor of investor's goal in investment. The cause of the ineffectiveness of the tax holiday policy in attracting foreign direct investment in Indonesia is another indicator that becomes an assessment among others the ease of investment licensing, infrastructure, electricity supply, investor protection, minority and tax administration. Indonesian government's strategy to improve the investment climate is through deregulation, debureaucracy, law enforcement and business certainty for investors.

Translating Research to Practice: Overcoming Barriers to Implementing Effective Off-Campus Party Intervention. Issues in Prevention

Science.gov (United States)

Higher Education Center for Alcohol, Drug Abuse, and Violence Prevention, 2012

2012-01-01

This issue of "Issues in Prevention" focuses on overcoming barriers in implementing effective off-campus party intervention. This issue contains the following articles: (1) Confronting the Problems Associated With Off-Campus Parties With Evidence-Based Strategies (John D. Clapp); (2) Overview of Research on Effective Off-Campus Party…

PCI compliance understand and implement effective PCI data security standard compliance

CERN Document Server

Williams, Branden R

2012-01-01

The credit card industry established the PCI Data Security Standards to provide a minimum standard for how vendors should protect data to ensure it is not stolen by fraudsters. PCI Compliance, 3e, provides the information readers need to understand the current PCI Data Security standards, which have recently been updated to version 2.0, and how to effectively implement security within your company to be compliant with the credit card industry guidelines and protect sensitive and personally identifiable information. Security breaches continue to occur on a regular basis, affecting millions of

Implementing New Ways of Working

DEFF Research Database (Denmark)

Granlien, Maren Sander; Hertzum, Morten

2009-01-01

Successful deployment of information technology (IT) involves implementation of new ways of working. Under-recognition of this organizational element of implementation entails considerable risk of not attaining the benefits that motivated deployment, yet knowledge of how to work systematically...... were devised and performed as part of the study, significantly lowered the number of records that violated the procedure. This positive effect was, however, not achieved until multiple interventions had been employed, and there is some indication that the effect may be wearing off after...... the interventions have ended. We discuss the implications of these results for efforts to work systematically with the organizational implementation of IT systems....

Task-selective memory effects for successfully implemented encoding strategies.

Science.gov (United States)

Leshikar, Eric D; Duarte, Audrey; Hertzog, Christopher

2012-01-01

Previous behavioral evidence suggests that instructed strategy use benefits associative memory formation in paired associate tasks. Two such effective encoding strategies--visual imagery and sentence generation--facilitate memory through the production of different types of mediators (e.g., mental images and sentences). Neuroimaging evidence suggests that regions of the brain support memory reflecting the mental operations engaged at the time of study. That work, however, has not taken into account self-reported encoding task success (i.e., whether participants successfully generated a mediator). It is unknown, therefore, whether task-selective memory effects specific to each strategy might be found when encoding strategies are successfully implemented. In this experiment, participants studied pairs of abstract nouns under either visual imagery or sentence generation encoding instructions. At the time of study, participants reported their success at generating a mediator. Outside of the scanner, participants further reported the quality of the generated mediator (e.g., images, sentences) for each word pair. We observed task-selective memory effects for visual imagery in the left middle occipital gyrus, the left precuneus, and the lingual gyrus. No such task-selective effects were observed for sentence generation. Intriguingly, activity at the time of study in the left precuneus was modulated by the self-reported quality (vividness) of the generated mental images with greater activity for trials given higher ratings of quality. These data suggest that regions of the brain support memory in accord with the encoding operations engaged at the time of study.

Evaluation of the implementation of entrepreneurial potential (on the example of the Republic of Tatarstan)

Science.gov (United States)

Guzelbaeva, G. T.; Rakhmatullina, D. K.; Akhmetshina, E. R.

2017-12-01

Increase in the number of small businesses and the lack of effectiveness of existing support at local and regional level have led to curb the development of entrepreneurial activity. The article presents the methodological tools for assessing the effectiveness, which allows to identify existing municipalities in the advantages and disadvantages for the implementation of entrepreneurial potential, including the effectiveness of state and municipal support measures, as well as calculate the degree of progress in the implementation of entrepreneurial potential. In order to evaluate the implementation of the business potential of the Republic of Tatarstan and the impact of their public support at the regional level was calculated indexes of business activity in the municipal districts (MD) of the republic. It should be noted that a major breakthrough in share of small and medium-sized businesses is important to the whole ecosystem. The method of evaluation of the implementation of entrepreneurial potential which is presented in this paper can be used by every competent organization to analyze and form the effective programs of the economic and finance development.

Implementing a 6-day physiotherapy service in rehabilitation: exploring staff perceptions.

Science.gov (United States)

Caruana, Erin L; Kuys, Suzanne S; Clarke, Jane; Brauer, Sandra G

2017-11-20

Objective Australian weekend rehabilitation therapy provision is increasing. Staff engagement optimises service delivery. The present mixed-methods process evaluation explored staff perceptions regarding implementation of a 6-day physiotherapy service in a private rehabilitation unit. Methods All multidisciplinary staff working in the rehabilitation unit were surveyed regarding barriers, facilitators and perceptions of the effect of a 6-day physiotherapy service on length of stay (LOS) and patient goal attainment at three time points: before and after implementation, as well as after modification of a 6-day physiotherapy service. Descriptive statistics and thematic analysis was used to analyse the data. Results Fifty-one staff (50%) responded. Before implementation, all staff identified barriers, the most common being staffing (62%) and patient selection (29%). After implementation, only 30% of staff identified barriers, which differed to those identified before implementation, and included staff rostering and experience (20%), timing of therapy (10%) and increasing the allocation of patients (5%). Over time, staff perceptions changed from being unsure to being positive about the effect of the 6-day service on LOS and patient goal attainment. Conclusion Staff perceived a large number of barriers before implementation of a 6-day rehabilitation service, but these did not eventuate following implementation. Staff perceived improved LOS and patient goal attainment after implementation of a 6-day rehabilitation service incorporating staff feedback. What is known about this topic? Rehabilitation weekend services improve patient quality of life and functional independence while reducing LOS. What does this study add? Staff feedback during implementation and modification of new services is important to address potential barriers and ensure staff satisfaction and support. What are the implications for practitioners? Staff engagement and open communication are important to

Cost-effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for nonspecific low back pain: design of a stepped-wedge cluster randomised controlled trial.

Science.gov (United States)

Suman, Arnela; Schaafsma, Frederieke G; Elders, Petra J M; van Tulder, Maurits W; Anema, Johannes R

2015-05-31

Low back pain (LBP) is one of the most prevalent and expensive health care problems in industrialised countries. LBP leads to high health care utility and productivity losses; leaving the individual, the employer, and society with substantial costs. To improve the care for LBP patients and reduce the high societal and financial burden of LBP, in 2010 the 'Multidisciplinary care guideline for nonspecific low back pain' was developed in the Netherlands. The current paper describes the design of a study aiming to evaluate the (cost-) effectiveness of a multifaceted strategy to implement this guideline. In a cluster-randomised controlled trial, the (cost-) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination. Using a stepped-wedge approach, participating general practitioners, physiotherapists, and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training session. The timing these clusters receive the training is the unit of randomisation. LBP patients visiting the participating health care providers are invited to participate in the trial and will receive access to a multimedia intervention aimed at improving beliefs, cognitions, and self-management. The primary outcome measure of this study is patient back beliefs. Secondary outcome measures on patient level include pain, functional status, quality of life, health care utility, and productivity losses. Outcome measures on professional level include knowledge and attitude towards the guideline, and guideline adherence. A process evaluation for the implementation strategy will be performed among the health care providers and the patients. Furthermore, a qualitative subgroup analysis among patients with various ethnic backgrounds will be performed. This study will give insight into the (cost-) effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for non

Towards the implementation of malaria elimination policy in South Africa: the stakeholders' perspectives.

Science.gov (United States)

Hlongwana, Khumbulani Welcome; Tsoka-Gwegweni, Joyce

2017-01-01

The past decade has seen substantial global reduction in malaria morbidity and mortality due to increased international funding and decisive steps by the international malaria community to fight malaria. South Africa has been declared ready to institute malaria elimination. However, research on the factors that would affect this policy implementation is inadequate. To investigate the stakeholders' understanding of the malaria elimination policy in South Africa, including their perceived barriers and facilitators to effective policy implementation. The study followed a constructivist epistemological approach which manifests in phenomenological study design. Twelve purposively selected key informants from malaria researchers, provincial and national malaria programmes were interviewed using semi-structured interviews. Interview questions elicited interviewees' knowledge of the policy and its achievability, including any perceived barriers and facilitating factors to effective implementation. The hybrid approach was used to perform thematic data analysis. The dominant view was that malaria remains a problem in South Africa, exacerbated by staff attitudes and poor capacity, lack of resources, lack of new effective intervention tools, lack of intra- and inter-departmental collaboration, poor cross-border collaboration and weak stakeholder collaboration. Informants were concerned about the target year (2018) for elimination, and about the process followed in developing the policy, including the perceived malaria epidemiology shortfalls, regulatory issues and political context of the policy. Achievability of malaria elimination remains a subject of intense debate for a variety of reasons. These include the sporadic nature of malaria resurgence, raising questions about the contributions of malaria control interventions and climate to the transmission trends in South Africa. The shortage of resources, inadequate staff capacity, lack of any new effective intervention tools

Operational research as implementation science: definitions, challenges and research priorities.

Science.gov (United States)

Monks, Thomas

2016-06-06

as implementation science include limited evidence and evaluation of impact, limited service user involvement, a lack of managerial awareness, effective communication between research users and OR modellers, and availability of healthcare data. To progress the science, a focus is needed in three key areas: evaluation of OR interventions, embedding the knowledge of OR in health services, and educating OR modellers about the aims and benefits of service user involvement.

Impact and Implementation of Higher-Order Ionospheric Effects on Precise GNSS Applications

Science.gov (United States)

Hadas, T.; Krypiak-Gregorczyk, A.; Hernández-Pajares, M.; Kaplon, J.; Paziewski, J.; Wielgosz, P.; Garcia-Rigo, A.; Kazmierski, K.; Sosnica, K.; Kwasniak, D.; Sierny, J.; Bosy, J.; Pucilowski, M.; Szyszko, R.; Portasiak, K.; Olivares-Pulido, G.; Gulyaeva, T.; Orus-Perez, R.

2017-11-01

High precision Global Navigation Satellite Systems (GNSS) positioning and time transfer require correcting signal delays, in particular higher-order ionospheric (I2+) terms. We present a consolidated model to correct second- and third-order terms, geometric bending and differential STEC bending effects in GNSS data. The model has been implemented in an online service correcting observations from submitted RINEX files for I2+ effects. We performed GNSS data processing with and without including I2+ corrections, in order to investigate the impact of I2+ corrections on GNSS products. We selected three time periods representing different ionospheric conditions. We used GPS and GLONASS observations from a global network and two regional networks in Poland and Brazil. We estimated satellite orbits, satellite clock corrections, Earth rotation parameters, troposphere delays, horizontal gradients, and receiver positions using global GNSS solution, Real-Time Kinematic (RTK), and Precise Point Positioning (PPP) techniques. The satellite-related products captured most of the impact of I2+ corrections, with the magnitude up to 2 cm for clock corrections, 1 cm for the along- and cross-track orbit components, and below 5 mm for the radial component. The impact of I2+ on troposphere products turned out to be insignificant in general. I2+ corrections had limited influence on the performance of ambiguity resolution and the reliability of RTK positioning. Finally, we found that I2+ corrections caused a systematic shift in the coordinate domain that was time- and region-dependent and reached up to -11 mm for the north component of the Brazilian stations during the most active ionospheric conditions.

Effectiveness of an implementation strategy for a breastfeeding guideline in Primary Care: cluster randomised trial

Directory of Open Access Journals (Sweden)

Martín-Iglesias Susana

2011-12-01

Full Text Available Abstract Background The protection and promotion of breastfeeding is considered a priority in Europe where only 22% of infants less than 6 months old are exclusively breastfed. In Spain this percentage reaches 24.8% but in our city it falls to 18.26%. Various studies emphasise that the improvement of these results should be based upon the training of health professionals. Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age. Method/Design This study involves a community based cluster randomized trial in primary healthcare centres in Leganés (Madrid, Spain. The project aims to determine whether the use of an implementation strategy (including training session, information distribution, opinion leader of a breastfeeding guideline in primary care is more effective than usual diffusion. The number of patients required will be 240 (120 in each arm. It will be included all the mothers of infants born during the study period (6 months who come to the health centre on the first visit of the child care programme and who give their consent to participate. The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age.. Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. Discussion Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period. By applying the guide

High impact of implementation on school-based smoking prevention

DEFF Research Database (Denmark)

Bast, Lotus Sofie; Due, Pernille; Bendtsen, Pernille

2016-01-01

prevention trial-the X:IT study. METHODS: A cluster-randomized trial testing is a multi-component intervention to prevent smoking among adolescents in 94 Danish elementary schools (51 intervention, 43 control schools). Participants were grade 7 pupils (mean age 12.5 years). Data was collected by electronic...... into account the complexity of the concept nor the intervention. The objective of the present study was to develop an overall quantitative measure of implementation fidelity, to examine the degree of implementation fidelity and the association of implementation and effect of a randomized school-based smoking...... questionnaires among pupils at baseline (n = 4161), the first follow-up (n = 3764), and the second follow-up (n = 3269) and among school coordinators at intervention schools at the first and second follow-up (50 and 39 coordinators). INTERVENTION: The intervention included three components: (1) smoke-free school...

The meaning and measurement of implementation climate

Science.gov (United States)

2011-01-01

Background Climate has a long history in organizational studies, but few theoretical models integrate the complex effects of climate during innovation implementation. In 1996, a theoretical model was proposed that organizations could develop a positive climate for implementation by making use of various policies and practices that promote organizational members' means, motives, and opportunities for innovation use. The model proposes that implementation climate--or the extent to which organizational members perceive that innovation use is expected, supported, and rewarded--is positively associated with implementation effectiveness. The implementation climate construct holds significant promise for advancing scientific knowledge about the organizational determinants of innovation implementation. However, the construct has not received sufficient scholarly attention, despite numerous citations in the scientific literature. In this article, we clarify the meaning of implementation climate, discuss several measurement issues, and propose guidelines for empirical study. Discussion Implementation climate differs from constructs such as organizational climate, culture, or context in two important respects: first, it has a strategic focus (implementation), and second, it is innovation-specific. Measuring implementation climate is challenging because the construct operates at the organizational level, but requires the collection of multi-dimensional perceptual data from many expected innovation users within an organization. In order to avoid problems with construct validity, assessments of within-group agreement of implementation climate measures must be carefully considered. Implementation climate implies a high degree of within-group agreement in climate perceptions. However, researchers might find it useful to distinguish implementation climate level (the average of implementation climate perceptions) from implementation climate strength (the variability of

The meaning and measurement of implementation climate

Directory of Open Access Journals (Sweden)

Bergmire Dawn M

2011-07-01

Full Text Available Abstract Background Climate has a long history in organizational studies, but few theoretical models integrate the complex effects of climate during innovation implementation. In 1996, a theoretical model was proposed that organizations could develop a positive climate for implementation by making use of various policies and practices that promote organizational members' means, motives, and opportunities for innovation use. The model proposes that implementation climate--or the extent to which organizational members perceive that innovation use is expected, supported, and rewarded--is positively associated with implementation effectiveness. The implementation climate construct holds significant promise for advancing scientific knowledge about the organizational determinants of innovation implementation. However, the construct has not received sufficient scholarly attention, despite numerous citations in the scientific literature. In this article, we clarify the meaning of implementation climate, discuss several measurement issues, and propose guidelines for empirical study. Discussion Implementation climate differs from constructs such as organizational climate, culture, or context in two important respects: first, it has a strategic focus (implementation, and second, it is innovation-specific. Measuring implementation climate is challenging because the construct operates at the organizational level, but requires the collection of multi-dimensional perceptual data from many expected innovation users within an organization. In order to avoid problems with construct validity, assessments of within-group agreement of implementation climate measures must be carefully considered. Implementation climate implies a high degree of within-group agreement in climate perceptions. However, researchers might find it useful to distinguish implementation climate level (the average of implementation climate perceptions from implementation climate strength (the

Fluid mechanics moderate the effect of implementation intentions on a health prospective memory task in older adults.

Science.gov (United States)

Brom, Sarah Susanne; Schnitzspahn, Katharina Marlene; Melzer, Marlen; Hagner, Franziska; Bernhard, Anka; Kliegel, Matthias

2014-03-01

The aim of the present study was to test if a cognitive strategy improves older adults' prospective memory performance in a naturalistic health task. Moreover, it was tested if a possible strategy effect is moderated by individual differences. Therefore, a group of older adults was asked to perform a task taken from the medication adherence literature (i.e., blood pressure monitoring). Half of them were asked to form implementation intentions. Additionally, crystallized pragmatics and fluid mechanics, conscientiousness, self-efficacy, and lifestyle factors were assessed as possible moderators. Results showed a strong positive strategy effect on prospective memory. Moreover, the effect was qualified by a significant interaction and only emerged for participants with low levels in fluid mechanics. No other moderator showed an effect. In conclusion, an enhancing effect of implementation intentions on prospective memory seems to be dependent on individual differences in cognitive capacity and less related to key motivational or personality variables.

A strategic approach for Water Safety Plans implementation in Portugal.

Science.gov (United States)

Vieira, Jose M P

2011-03-01

Effective risk assessment and risk management approaches in public drinking water systems can benefit from a systematic process for hazards identification and effective management control based on the Water Safety Plan (WSP) concept. Good results from WSP development and implementation in a small number of Portuguese water utilities have shown that a more ambitious nationwide strategic approach to disseminate this methodology is needed. However, the establishment of strategic frameworks for systematic and organic scaling-up of WSP implementation at a national level requires major constraints to be overcome: lack of legislation and policies and the need for appropriate monitoring tools. This study presents a framework to inform future policy making by understanding the key constraints and needs related to institutional, organizational and research issues for WSP development and implementation in Portugal. This methodological contribution for WSP implementation can be replicated at a global scale. National health authorities and the Regulator may promote changes in legislation and policies. Independent global monitoring and benchmarking are adequate tools for measuring the progress over time and for comparing the performance of water utilities. Water utilities self-assessment must include performance improvement, operational monitoring and verification. Research and education and resources dissemination ensure knowledge acquisition and transfer.

The Effects of Behavioral Skills Training on Implementation of the Picture Exchange Communication System

Science.gov (United States)

Rosales, Rocio; Stone, Karen; Rehfeldt, Ruth Anne

2009-01-01

The effectiveness of a behavioral skills training (BST) package to teach the implementation of the first three phases of the picture exchange communication system (PECS) was evaluated with 3 adults who had no history teaching any functional communication system. A multiple baseline design across participants was used to evaluate the effectiveness…

Waste generator services implementation plan

Energy Technology Data Exchange (ETDEWEB)

Mousseau, J.; Magleby, M.; Litus, M.

1998-04-01

Recurring waste management noncompliance problems have spurred a fundamental site-wide process revision to characterize and disposition wastes at the Idaho National Engineering and Environmental Laboratory. The reengineered method, termed Waste Generator Services, will streamline the waste acceptance process and provide waste generators comprehensive waste management services through a single, accountable organization to manage and disposition wastes in a timely, cost-effective, and compliant manner. This report outlines the strategy for implementing Waste Generator Services across the INEEL. It documents the culmination of efforts worked by the LMITCO Environmental Management Compliance Reengineering project team since October 1997. These efforts have included defining problems associated with the INEEL waste management process; identifying commercial best management practices; completing a review of DOE Complex-wide waste management training requirements; and involving others through an Integrated Process Team approach to provide recommendations on process flow, funding/charging mechanisms, and WGS organization. The report defines the work that will be performed by Waste Generator Services, the organization and resources, the waste acceptance process flow, the funding approach, methods for measuring performance, and the implementation schedule and approach. Field deployment will occur first at the Idaho Chemical Processing Plant in June 1998. Beginning in Fiscal Year 1999, Waste Generator Services will be deployed at the other major INEEL facilities in a phased approach, with implementation completed by March 1999.

Waste generator services implementation plan

International Nuclear Information System (INIS)

Mousseau, J.; Magleby, M.; Litus, M.

1998-04-01

Recurring waste management noncompliance problems have spurred a fundamental site-wide process revision to characterize and disposition wastes at the Idaho National Engineering and Environmental Laboratory. The reengineered method, termed Waste Generator Services, will streamline the waste acceptance process and provide waste generators comprehensive waste management services through a single, accountable organization to manage and disposition wastes in a timely, cost-effective, and compliant manner. This report outlines the strategy for implementing Waste Generator Services across the INEEL. It documents the culmination of efforts worked by the LMITCO Environmental Management Compliance Reengineering project team since October 1997. These efforts have included defining problems associated with the INEEL waste management process; identifying commercial best management practices; completing a review of DOE Complex-wide waste management training requirements; and involving others through an Integrated Process Team approach to provide recommendations on process flow, funding/charging mechanisms, and WGS organization. The report defines the work that will be performed by Waste Generator Services, the organization and resources, the waste acceptance process flow, the funding approach, methods for measuring performance, and the implementation schedule and approach. Field deployment will occur first at the Idaho Chemical Processing Plant in June 1998. Beginning in Fiscal Year 1999, Waste Generator Services will be deployed at the other major INEEL facilities in a phased approach, with implementation completed by March 1999

Cost-effectiveness and resource use of implementing MRI-guided NACT in ER-positive/HER2-negative breast cancers in The Netherlands

International Nuclear Information System (INIS)

Miquel-Cases, Anna; Steuten, Lotte M. G.; Rigter, Lisanne S.; Harten, Wim H. van

2016-01-01

Response-guided neoadjuvant chemotherapy (RG-NACT) with magnetic resonance imaging (MRI) is effective in treating oestrogen receptor positive/human epidermal growth factor receptor-2 negative (ER-positive/HER2-negative) breast cancer. We estimated the expected cost-effectiveness and resources required for its implementation compared to conventional-NACT. A Markov model compared costs, quality-adjusted-life-years (QALYs) and costs/QALY of RG-NACT vs. conventional-NACT, from a hospital perspective over a 5-year time horizon. Health services required for and health outcomes of implementation were estimated via resource modelling analysis, considering a current (4 %) and a full (100 %) implementation scenario. RG-NACT was expected to be more effective and less costly than conventional NACT in both implementation scenarios, with 94 % (current) and 95 % (full) certainty, at a willingness to pay threshold of €20.000/QALY. Fully implementing RG-NACT in the Dutch target population of 6306 patients requires additional 5335 MRI examinations and an (absolute) increase in the number of MRI technologists, by 3.6 fte (full-time equivalent), and of breast radiologists, by 0.4 fte. On the other hand, it prevents 9 additional relapses, 143 cancer deaths, 23 congestive heart failure events and 2 myelodysplastic syndrome/acute myeloid leukaemia events. Considering cost-effectiveness, RG-NACT is expected to dominate conventional-NACT. While personnel capacity is likely to be sufficient for a full implementation scenario, MRI utilization needs to be intensified

Five years of lesson modification to implement non-traditional learning sessions in a traditional-delivery curriculum: A retrospective assessment using applied implementation variables.

Science.gov (United States)

Gleason, Shaun E; McNair, Bryan; Kiser, Tyree H; Franson, Kari L

Non-traditional learning (NTL), including aspects of self-directed learning (SDL), may address self-awareness development needs. Many factors can impact successful implementation of NTL. To share our multi-year experience with modifications that aim to improve NTL sessions in a traditional curriculum. To improve understanding of applied implementation variables (some of which were based on successful SDL implementation components) that impact NTL. We delivered a single lesson in a traditional-delivery curriculum once annually for five years, varying delivery annually in response to student learning and reaction-to-learning results. At year 5, we compared student learning and reaction-to-learning to applied implementation factors using logistic regression. Higher instructor involvement and overall NTL levels predicted correct exam responses (p=0.0007 and ptraditional and highest overall NTL deliveries. Students rated instructor presentation skills and teaching methods higher when greater instructor involvement (pmethods were most effective when lower student involvement and higher technology levels (ptraditional-delivery curriculum, instructor involvement appears essential, while the impact of student involvement and educational technology levels varies. Copyright © 2017 Elsevier Inc. All rights reserved.

Nutritional screening, assessment and implementation strategies for adults in an Australian acute tertiary hospital: a best practice implementation report.

Science.gov (United States)

Smith, Louise; Chapman, Amanda; Flowers, Kelli; Wright, Kylie; Chen, Tanghua; O'Connor, Charmaine; Astorga, Cecilia; Francis, Nevenka; Vigh, Gia; Wainwright, Craig

2018-01-01

The project aimed to improve the effectiveness of nutritional screening and assessment practices through clinical audits and the implementation of evidence-based practice recommendations. In the absence of optimal nutrition, health may decline and potentially manifest as adverse health outcomes. In a hospitalized person, poor nutrition may adversely impact on the person's outcome. If the nutritional status can be ascertained, nutritional needs can be addressed and potential risks minimized.The overall purpose of this project was to review and monitor staff compliance with nutritional screening and assessment best practice recommendations ensuring there is timely, relevant and structured nutritional therapeutic practices that support safe, compassionate and person-centered care in adults in a tertiary hospital in South Western Sydney, Australia, in the acute care setting. A baseline retrospective chart audit was conducted and measured against 10 best practice criteria in relation to nutritional screening and assessment practices. This was followed by a facilitated multidisciplinary focus group to identify targeted strategies, implementation of targeted strategies, and a post strategy implementation chart audit.The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRIP) tool, including evidence from other available supporting literature, for promoting change in healthcare practice. The baseline audit revealed deficits between current practice and best practice across the 10 criteria. Barriers for implementation of nutritional screening and assessment best practice criteria were identified by the focus group and an education strategy was implemented. There were improved outcomes across all best practice criteria in the follow-up audit. The baseline audit revealed gaps between current practice and best practice. Through the implementation of a targeted education program and

Critical success factors in implementing clinical pathways/case management.

Science.gov (United States)

Choo, J

2001-07-01

With the advent of casemix reimbursement implementation, rapid technological changes, an ageing population and changing consumer behaviour, the Singapore health care industry is faced with the impetus to provide a cost-effective and efficient care delivery system. One ubiquitous tool used is the establishment of a clinical pathway/case management programme within the hospital. As the concept of clinical pathway for patient care is a relatively new concept in Singapore, several critical factors must be considered to ensure successful implementation of clinical pathway/case management programme. One key success factor lies in continued clinician support and acceptance. Other factors include top management leadership and support and a dedicated team of case managers, nurses and paramedical professionals.

Barriers to and facilitators of implementing complex workplace dietary interventions: process evaluation results of a cluster controlled trial.

Science.gov (United States)

Fitzgerald, Sarah; Geaney, Fiona; Kelly, Clare; McHugh, Sheena; Perry, Ivan J

2016-04-21

Ambiguity exists regarding the effectiveness of workplace dietary interventions. Rigorous process evaluation is vital to understand this uncertainty. This study was conducted as part of the Food Choice at Work trial which assessed the comparative effectiveness of a workplace environmental dietary modification intervention and an educational intervention both alone and in combination versus a control workplace. Effectiveness was assessed in terms of employees' dietary intakes, nutrition knowledge and health status in four large manufacturing workplaces. The study aimed to examine barriers to and facilitators of implementing complex workplace interventions, from the perspectives of key workplace stakeholders and researchers involved in implementation. A detailed process evaluation monitored and evaluated intervention implementation. Interviews were conducted at baseline (27 interviews) and at 7-9 month follow-up (27 interviews) with a purposive sample of workplace stakeholders (managers and participating employees). Topic guides explored factors which facilitated or impeded implementation. Researchers involved in recruitment and data collection participated in focus groups at baseline and at 7-9 month follow-up to explore their perceptions of intervention implementation. Data were imported into NVivo software and analysed using a thematic framework approach. Four major themes emerged; perceived benefits of participation, negotiation and flexibility of the implementation team, viability and intensity of interventions and workplace structures and cultures. The latter three themes either positively or negatively affected implementation, depending on context. The implementation team included managers involved in coordinating and delivering the interventions and the researchers who collected data and delivered intervention elements. Stakeholders' perceptions of the benefits of participating, which facilitated implementation, included managers' desire to improve company

The impact of minimum pay implementation on small businesses operating cost and sustainability: A case of service business

OpenAIRE

Hanim Rusly Fariza; Yakimin Abdul Talib Yurita; Salleh Danilah

2017-01-01

The implementation of minimum wage requirement in Malaysia beginning mid 2016 seems to impact both employees and employers in different ways. While this implementation could increase household income and claimed to boost employees’ productivity, employers or business operators, on the other hand are experiencing stringent effect on their business operating cost. The effect is more significant for small business operators, including the childcare centers. Childcare industry operates in the ser...

Implementation of Patient-Centered Education for Chronic-Disease Management in Uganda: An Effectiveness Study.

Science.gov (United States)

Siddharthan, Trishul; Rabin, Tracy; Canavan, Maureen E; Nassali, Faith; Kirchhoff, Phillip; Kalyesubula, Robert; Coca, Steven; Rastegar, Asghar; Knauf, Felix

2016-01-01

The majority of non-communicable disease related deaths occur in low- and middle-income countries. Patient-centered care is an essential component of chronic disease management in high income settings. To examine feasibility of implementation of a validated patient-centered education tool among patients with heart failure in Uganda. Mixed-methods, prospective cohort. A private and public cardiology clinic in Mulago National Referral and Teaching Hospital, Kampala, Uganda. Adults with a primary diagnosis of heart failure. PocketDoktor Educational Booklets with patient-centered health education. The primary outcomes were the change in Patient Activation Measure (PAM-13), as well as the acceptability of the PocketDoktor intervention, and feasibility of implementing patient-centered education in outpatient clinical settings. Secondary outcomes included the change in satisfaction with overall clinical care and doctor-patient communication. A total of 105 participants were enrolled at two different clinics: the Mulago Outpatient Department (public) and the Uganda Heart Institute (private). 93 participants completed follow up at 3 months and were included in analysis. The primary analysis showed improved patient activation measure scores regarding disease-specific knowledge, treatment options and prevention of exacerbations among both groups (mean change 0.94 [SD = 1.01], 1.02 [SD = 1.15], and 0.92 [SD = 0.89] among private paying patients and 1.98 [SD = 0.98], 1.93 [SD = 1.02], and 1.45 [SD = 1.02] among public paying patients, pmanagement as well as satisfaction with doctor-patient communication and overall care in Uganda. Our results show that printed booklets are locally appropriate, highly acceptable and feasible to implement in an LMIC outpatient setting across socioeconomic groups.

The becoming of methadone in Kenya: How an intervention's implementation constitutes recovery potential.

Science.gov (United States)

Rhodes, Tim

2018-03-01

This analysis treats the recent introduction of methadone treatment in Kenya as a case of 'evidence-making intervention'. Using 30 qualitative interviews with people in receipt of methadone treatment in Nairobi, Kenya, methadone's becoming is treated as an effect of its narrative and material implementations. The interviews are shown to enact a narrative of methadone recovery potential towards normalcy beyond addiction. Such recovery potential is materialised in practice through social interactions wherein methadone's embodied effects are seen to be believed. Here, the recovering body affects others' recovery potential. In a context of competing claims about methadone's effects, including the circulation of doubt about experimenting with methadone treatment, embodied methadone effect helps moderate the multiverse of methadone knowledge. The material dynamics of methadone treatment delivery also affect its recovery potential, with the methadone queue enacting a rationing of recovery hope. Here, the experience of methadone's implementation loops back to a life with drugs. I conclude that there is a coexistence of potentiality and actuality, a 'methadone multiple', produced through its narrative and material implementations. Copyright © 2018 Elsevier Ltd. All rights reserved.

Seismic response and fragility evaluation for an Eastern US NPP including soil-structure interaction effects

International Nuclear Information System (INIS)

Ghiocel, Dan M.; Wilson, Paul R.; Thomas, Gary G.; Stevenson, John D.

1998-01-01

The paper discusses methodological aspects involved in a probabilistic seismic soil-structure interaction (SSI) analysis for a Seismic Probabilistic Risk Assessment (SPRA) review. An example of an Eastern US nuclear power plant (NPP) is presented. The approach presented herein follows the current practice of the Individual Plant Examination for External Events (IPEEE) program in the US. The NPP is founded on a relatively soft soil deposit, and thus the SSI effects on seismic responses are significant. Probabilistic models used for the idealization of the seismic excitation and the surrounding soil deposit are described. Using a lognormal format, computed random variability effects were combined with those proposed in the SPRA methodology guidelines. Probabilistic floor response spectra and structural fragilities for different NPP buildings were computed. Structural capacities were determined following the current practice which assumes independent median safety factors for strength and inelastic absorption. Limitations of the IPEEE practice for performing SPRA are discussed and alternate procedures, more rigorous and simple to implement, are suggested

76 FR 30557 - Office of Thrift Supervision Integration; Dodd-Frank Act Implementation

Science.gov (United States)

2011-05-26

..., Manager, Disclosure Services and Administrative Operations, Communications Division, (202) 874-5378... Supervision to other banking agencies, including the OCC, on the ``transfer date.'' The transfer date is one... necessary to implement certain revisions to the banking laws that took effect on the enactment of the Dodd...

A Literature Review: The Effect of Implementing Technology in a High School Mathematics Classroom

Science.gov (United States)

Murphy, Daniel

2016-01-01

This study is a literature review to investigate the effects of implementing technology into a high school mathematics classroom. Mathematics has a hierarchical structure in learning and it is essential that students get a firm understanding of mathematics early in education. Some students that miss beginning concepts may continue to struggle with…

EVALUATING THE EFFECTS OF THE IMPLEMENTATION OF IRAN NATIONAL QUALITY AWARD NEW MODEL (INQA IN IRANIAN ORGANIZATIONS

Directory of Open Access Journals (Sweden)

Mahmoud Zamani

2014-09-01

Full Text Available The aim of this study is to examine the effectiveness of the Iran National Quality Award new model (INQA in corporations that have implemented this model in Iran. This research aims to reveal the effects of implementation of Iran National Quality Award (INQA New Model on seven dimensions of the Iranian companies which indeed are seven core factors of this model, i.e. Management & leadership, People, Processes, Resources, Customer & consumer results, Environment & community results, and Performance results. A mail survey was conducted on a simple random sample of 210 organizations that have achieved certification or appreciation during the implementation of INQA model in four rounds. 400 questionnaires were randomly distributed and 392 complete and correct questionnaires were returned. Descriptive and inferential statistics were employed to analyze the data.Results indicated that the highest positive impact of INQA New Model on the improvement of organizational performance of the surveyed organizations was on customers' area. Performance results, leadership and management, processes improvement, environment and society results, and finally better utilization of organizational resources were respectively other areas which are affected mostly. Also, this study found no significant relationship between the implementation of this model and the improvement of employees' conditions in the surveyed organizations.

Effective implementation of research into practice: an overview of systematic reviews of the health literature.

Science.gov (United States)

Boaz, Annette; Baeza, Juan; Fraser, Alec

2011-06-22

The gap between research findings and clinical practice is well documented and a range of interventions has been developed to increase the implementation of research into clinical practice. A review of systematic reviews of the effectiveness of interventions designed to increase the use of research in clinical practice. A search for relevant systematic reviews was conducted of Medline and the Cochrane Database of Reviews 1998-2009. 13 systematic reviews containing 313 primary studies were included. Four strategy types are identified: audit and feedback; computerised decision support; opinion leaders; and multifaceted interventions. Nine of the reviews reported on multifaceted interventions. This review highlights the small effects of single interventions such as audit and feedback, computerised decision support and opinion leaders. Systematic reviews of multifaceted interventions claim an improvement in effectiveness over single interventions, with effect sizes ranging from small to moderate. This review found that a number of published systematic reviews fail to state whether the recommended practice change is based on the best available research evidence. This overview of systematic reviews updates the body of knowledge relating to the effectiveness of key mechanisms for improving clinical practice and service development. Multifaceted interventions are more likely to improve practice than single interventions such as audit and feedback. This review identified a small literature focusing explicitly on getting research evidence into clinical practice. It emphasizes the importance of ensuring that primary studies and systematic reviews are precise about the extent to which the reported interventions focus on changing practice based on research evidence (as opposed to other information codified in guidelines and education materials).

A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up.

Science.gov (United States)

Kerrigan, Deanna; Kennedy, Caitlin E; Morgan-Thomas, Ruth; Reza-Paul, Sushena; Mwangi, Peninah; Win, Kay Thi; McFall, Allison; Fonner, Virginia A; Butler, Jennifer

2015-01-10

A community empowerment-based response to HIV is a process by which sex workers take collective ownership of programmes to achieve the most effective HIV outcomes and address social and structural barriers to their overall health and human rights. Community empowerment has increasingly gained recognition as a key approach for addressing HIV in sex workers, with its focus on addressing the broad context within which the heightened risk for infection takes places in these individuals. However, large-scale implementation of community empowerment-based approaches has been scarce. We undertook a comprehensive review of community empowerment approaches for addressing HIV in sex workers. Within this effort, we did a systematic review and meta-analysis of the effectiveness of community empowerment in sex workers in low-income and middle-income countries. We found that community empowerment-based approaches to addressing HIV among sex workers were significantly associated with reductions in HIV and other sexually transmitted infections, and with increases in consistent condom use with all clients. Despite the promise of a community-empowerment approach, we identified formidable structural barriers to implementation and scale-up at various levels. These barriers include regressive international discourses and funding constraints; national laws criminalising sex work; and intersecting social stigmas, discrimination, and violence. The evidence base for community empowerment in sex workers needs to be strengthened and diversified, including its role in aiding access to, and uptake of, combination interventions for HIV prevention. Furthermore, social and political change are needed regarding the recognition of sex work as work, both globally and locally, to encourage increased support for community empowerment responses to HIV. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Effect of Implementing Workplace Organization Technigue on Nurses’ Job Satisfaction

Directory of Open Access Journals (Sweden)

Mohammad Ali Hoseini

2016-06-01

Full Text Available Background and Objective: Physical characteristics of the workplace are among the factors affecting nurses’ job satisfaction. Nurses are employed in crowded environments. The purpose of this study was to examine the effect of implementing 5S workplace organization technique on nurses’ job satisfaction. Materials and Method: In this semi-experimental study, 70 nurses from medical and surgical wards of two therapeutic-education centers in Gorgan in 2015 were studied. Nurses were selected through census and then were assigned into intervention and control groups (each group 35 persons. The intervention group took advantage from organized working environment for 6 weeks. Visual workplace audit checklist was used in order to assess the need for organizing the workplace before and one month after the intervention. Nurses’ job satisfaction was measured through the questionnaire by Kohli and Jaworski before and after the intervention in both groups. Data were analyzed by Fisher's exact test, chi-square test, independent t-test and paired t-test in SPSS 20. Results: The mean score of job satisfaction of nurses was changed after the intervention from 14.94 ± 2.66 to 18.48 ± 2.03 in intervention group (p > 0.001 and from 15.31 ± 1.54 to 14.80 ± 1.47 in control group. This difference was significant between the groups after the intervention (p > 0.001. Conclusion: Results showed that the implementing of workplace organization technique could improve nurses’ Job satisfaction. According to simplicity of this technique, nursing managers can use it as an effective way to improve nurses’ job satisfaction.

The American College of Surgeons/Association of Program Directors in Surgery National Skills Curriculum: adoption rate, challenges and strategies for effective implementation into surgical residency programs.

Science.gov (United States)

Korndorffer, James R; Arora, Sonal; Sevdalis, Nick; Paige, John; McClusky, David A; Stefanidis, Dimitris

2013-07-01

The American College of Surgeons/Association of Program Directors in Surgery (ACS/APDS) National Skills Curriculum is a 3-phase program targeting technical and nontechnical skills development. Few data exist regarding the adoption of this curriculum by surgical residencies. This study attempted to determine the rate of uptake and identify implementation enablers/barriers. A web-based survey was developed by an international expert panel of surgical educators (5 surgeons and 1 psychologist). After piloting, the survey was sent to all general surgery program directors via email link. Descriptive statistics were used to determine the residency program characteristics and perceptions of the curriculum. Implementation rates for each phase and module were calculated. Adoption barriers were identified quantitatively and qualitatively using free text responses. Standardized qualitative methodology of emergent theme analysis was used to identify strategies for success and details of support required for implementation. Of the 238 program directors approached, 117 (49%) responded to the survey. Twenty-one percent (25/117) were unaware of the ACS/APDS curriculum. Implementation rates for were 36% for phase I, 19% for phase II, and 16% for phase III. The most common modules adopted were the suturing, knot-tying, and chest tube modules of phase I. Over 50% of respondents identified lack of faculty protected time, limited personnel, significant costs, and resident work-hour restrictions as major obstacles to implementation. Strategies for effective uptake included faculty incentives, adequate funding, administrative support, and dedicated time and resources. Despite the availability of a comprehensive curriculum, its diffusion into general surgery residency programs remains low. Obstacles related to successful implementation include personnel, learner, and administrative issues. Addressing these issues may improve the adoption rate of the curriculum. Copyright © 2013 Mosby, Inc

Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services.

Science.gov (United States)

Wolfenden, Luke; Jones, Jannah; Williams, Christopher M; Finch, Meghan; Wyse, Rebecca J; Kingsland, Melanie; Tzelepis, Flora; Wiggers, John; Williams, Amanda J; Seward, Kirsty; Small, Tameka; Welch, Vivian; Booth, Debbie; Yoong, Sze Lin

2016-10-04

Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care.

Science.gov (United States)

Philips, Hilde; Remmen, Roy; Van Royen, Paul; Teblick, Marc; Geudens, Leo; Bronckaers, Marc; Meeuwis, Herman

2010-07-30

Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice. We used a prospective before/after interventional study design. The intervention was the implementation of a GPC. One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836). One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.

Review of critical factors for SEA implementation

Energy Technology Data Exchange (ETDEWEB)

Zhang Jie, E-mail: jasmine@plan.aau.dk; Christensen, Per; Kornov, Lone

2013-01-15

The implementation process involved in translating Strategic Environmental Assessment (SEA) intention into action is vital to an effective SEA. Many factors influence implementation and thus the effectiveness of an SEA. Empirical studies have identified and documented some factors influencing the implementation of an SEA. This research is fragmented, however, and it is still not clear what are the most critical factors of effective SEA performance, and how these relate to different stages of the implementation process or other contextual circumstances. The paper takes its point of departure in implementation theory. Firstly, we introduce implementation theory, and then use it in practice to establish a more comprehensive model related to the stages in the implementation process. Secondly, we identify the critical factors in order to see how they are related to the different stages of SEA or are more general in character. Finally we map the different critical factors and how they influence the overall results of an SEA. Based on a literature review, we present a comprehensive picture of the critical factors and where they are found in the process. We conclude that most of the critical factors identified are of a more general character influencing the SEA process as such, while only one out of four of these factors relates to the specific stages of the SEA. Based on this mapping we can sketch a picture of the totality of critical factors. In this study 266 notions of critical factors were identified. Seen at the level of notions of critical factors, only 24% of these relate to specific stages while for 76% the critical factors are of a more general nature. These critical factors interact in complex ways and appear in different combinations in different stages of the implementation process so tracing the cause and effect is difficult. The pervasiveness of contextual and general factors also clearly suggests that there is no single way to put SEA into practice. The

Review of critical factors for SEA implementation

International Nuclear Information System (INIS)

Zhang Jie; Christensen, Per; Kørnøv, Lone

2013-01-01

The implementation process involved in translating Strategic Environmental Assessment (SEA) intention into action is vital to an effective SEA. Many factors influence implementation and thus the effectiveness of an SEA. Empirical studies have identified and documented some factors influencing the implementation of an SEA. This research is fragmented, however, and it is still not clear what are the most critical factors of effective SEA performance, and how these relate to different stages of the implementation process or other contextual circumstances. The paper takes its point of departure in implementation theory. Firstly, we introduce implementation theory, and then use it in practice to establish a more comprehensive model related to the stages in the implementation process. Secondly, we identify the critical factors in order to see how they are related to the different stages of SEA or are more general in character. Finally we map the different critical factors and how they influence the overall results of an SEA. Based on a literature review, we present a comprehensive picture of the critical factors and where they are found in the process. We conclude that most of the critical factors identified are of a more general character influencing the SEA process as such, while only one out of four of these factors relates to the specific stages of the SEA. Based on this mapping we can sketch a picture of the totality of critical factors. In this study 266 notions of critical factors were identified. Seen at the level of notions of critical factors, only 24% of these relate to specific stages while for 76% the critical factors are of a more general nature. These critical factors interact in complex ways and appear in different combinations in different stages of the implementation process so tracing the cause and effect is difficult. The pervasiveness of contextual and general factors also clearly suggests that there is no single way to put SEA into practice. The

Consensus implementation of a groundwater remediation project at the Idaho National Engineering Laboratory

International Nuclear Information System (INIS)

Hastings, K.R.; Carlson, D.S.

1996-01-01

Because of significant characterization uncertainties existing when the Record of Decision was signed and the unfavorable national reputation of groundwater pump and treat remediation projects, the Test Area North (TAN) groundwater ROD includes the evaluation of five emerging technologies that show potential for treating the organic contamination in situ or reducing the toxicity of contaminants above ground. Treatability studies will be conducted to ascertain whether any may be suitable for implementation at TAN to yield more timely or cost effective restoration of the aquifer. The implementation approach established for the TAN groundwater project is a consensus approach, maximizing a partnership relation with stakeholders in constant, iterative implementation decision making

Factors Supporting Implementation among CDSMP Organizations.

Science.gov (United States)

Paone, Deborah

2014-01-01

Reaching individuals who can benefit from evidence-based health promotion and disability prevention programs is a goal of federal, state, and local agencies as well as researchers, providers, community agencies, and other stakeholders. Implementation effectiveness at the organizational level must be achieved in order to reach these individuals and sustain the program. This mixed methods study examined eight organizations within two states that successfully implemented the Chronic Disease Self-Management Program (CDSMP) and sustained it from 4 to 10 years. There were two types of organizations: aging services and health care. Internal and external implementation factors and influences were explored. Additional examination of state activities (as a key external agent supporting CDSMP implementation) was conducted. The examination found agreement among the eight organizations regarding why they had adopted the CDSMP - citing the alignment between the program and their organizations' mission and purpose to improve health status and promote better self-care, and the demonstrated value (benefits) of the program. Organizations were also alike in that they described the importance of an internal champion and supportive senior leader. Organizations differed in how they experienced and valued peer support and collaborative networks. Organizations also differed in how they filled their CDSMP workshops. Internal drivers and capability were more often discussed as facilitating successful implementation than external factors. However, state activities and external support enabled successful adoption - particularly funding and training. The primary challenges identified by this set of organizations included difficulty in recruiting participants (filling workshops) and irregular or insufficient funding sources. These challenges were identified as significant and represented barriers to sustaining the program.

Factors Supporting Implementation among CDSMP Organizations

Science.gov (United States)

Paone, Deborah

2015-01-01

Reaching individuals who can benefit from evidence-based health promotion and disability prevention programs is a goal of federal, state, and local agencies as well as researchers, providers, community agencies, and other stakeholders. Implementation effectiveness at the organizational level must be achieved in order to reach these individuals and sustain the program. This mixed methods study examined eight organizations within two states that successfully implemented the Chronic Disease Self-Management Program (CDSMP) and sustained it from 4 to 10 years. There were two types of organizations: aging services and health care. Internal and external implementation factors and influences were explored. Additional examination of state activities (as a key external agent supporting CDSMP implementation) was conducted. The examination found agreement among the eight organizations regarding why they had adopted the CDSMP – citing the alignment between the program and their organizations’ mission and purpose to improve health status and promote better self-care, and the demonstrated value (benefits) of the program. Organizations were also alike in that they described the importance of an internal champion and supportive senior leader. Organizations differed in how they experienced and valued peer support and collaborative networks. Organizations also differed in how they filled their CDSMP workshops. Internal drivers and capability were more often discussed as facilitating successful implementation than external factors. However, state activities and external support enabled successful adoption – particularly funding and training. The primary challenges identified by this set of organizations included difficulty in recruiting participants (filling workshops) and irregular or insufficient funding sources. These challenges were identified as significant and represented barriers to sustaining the program. PMID:25964928

Designing theoretically-informed implementation interventions: Fine in theory, but evidence of effectiveness in practice is needed

Directory of Open Access Journals (Sweden)

Reeves Scott

2006-02-01

Full Text Available Abstract The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG authors assert that a key weakness in implementation research is the unknown applicability of a given intervention outside its original site and problem, and suggest that use of explicit theory offers an effective solution. This assertion is problematic for three primary reasons. First, the presence of an underlying theory does not necessarily ease the task of judging the applicability of a piece of empirical evidence. Second, it is not clear how to translate theory reliably into intervention design, which undoubtedly involves the diluting effect of "common sense." Thirdly, there are many theories, formal and informal, and it is not clear why any one should be given primacy. To determine whether explicitly theory-based interventions are, on average, more effective than those based on implicit theories, pragmatic trials are needed. Until empirical evidence is available showing the superiority of theory-based interventions, the use of theory should not be used as a basis for assessing the value of implementation studies by research funders, ethics committees, editors or policy decision makers.

The implementation of national and European environmental legislation in Germany: three case studies

Energy Technology Data Exchange (ETDEWEB)

Bueltmann, A.; Waetzold, F. [UFZ - Umweltforschungszentrum Leipzig-Halle GmbH, Leipzig (Germany). Sektion Oekonomie, Soziologie und Recht

2000-07-01

This report traces the implementation of the EMAS Regulation in Germany, i.e. it describes what kind of an institutional setting was chosen, in what way it was established and how it is working in practice. Moreover, the outcome of the implementation process is analysed in terms of efficiency and environmental effectiveness. To gain the relevant data and information we conducted expert interviews, reviewed the relevant literature and carried out a questionnaire survey. Chapter 2 provides some background information about EMAS, including the main contents of the EMAS Regulation and the political process that preceded the adoption of the EMAS Regulation and the implementation requirements imposed on the Member States. Chapter 3 describes the implementation of the EMAS Regulation and companies' motives to participate in the scheme. In chapter 4 the outcome of the implementation process is assessed in terms of the attainment of the Regulation's environmental goals and efficiency. To this end the criteria of efficiency (allocative, productive and administrative efficiency) and environmental effectiveness are adapted to the case of EMAS and indicators are developed for their assessment. Finally, data for the indicators are provided for Germany. Chapter 5 develops some hypotheses on how goal attainment and efficiency have been influenced by specific features of the implementation process. (orig.)

Designing, testing, and implementing a sustainable nurse home visiting program: right@home.

Science.gov (United States)

Goldfeld, Sharon; Price, Anna; Kemp, Lynn

2018-05-01

Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of The New York Academy of Sciences.

Implementation of early intensive behavioural intervention for children with autism in Switzerland.

Science.gov (United States)

Studer, Nadja; Gundelfinger, Ronnie; Schenker, Tanja; Steinhausen, Hans-Christoph

2017-01-21

There is a major gap between the US and most European countries regarding the implementation of early intensive behavioural intervention (EIBI) for children with autism. The present paper reports on the current status of EIBI in Switzerland and on the effectiveness of EIBI under clinical conditions in a Swiss pilot project. The paper combines a narrative report of the care system for children with autism in Switzerland and an initial evaluation of EIBI as implemented in the Department of Child and Adolescent Psychiatry, University of Zurich. The current situation of the implementation of EIBI for children with autism in Switzerland is characterized by marked deficits in its acceptance. Major reasons include insufficient governmental approval and lacking legal and financial support. In addition, ignorance among health care providers and educational professionals has contributed to this situation precluding that children with autism receive the most beneficial assistance. The authors have initiated and been working in an intervention centre offering EIBI for a decade and report on their experience with the implementation of EIBI. Based on their clinical practice, they document that EIBI also works efficiently under ordinary mental health service conditions. EIBI needs to be implemented more intensively in Switzerland. Although the effects of EIBI as implemented in Zurich are promising, the results are not as pronounced as under controlled research conditions.

Westinghouse Hanford Company Pollution Prevention Program Implementation Plan

International Nuclear Information System (INIS)

Floyd, B.C.

1994-10-01

This plan documents Westinghouse Hanford Company's (WHC) Pollution Prevention (P2) (formerly Waste Minimization) program. The program includes WHC; BCS Richland, Inc. (BCSR); and ICF Kaiser Hanford Company (ICF KH). The plan specifies P2 program activities and schedules for implementing the Hanford Site Waste Minimization and Pollution Prevention Awareness (WMin/P2) Program Plan requirements (DOE 1994a). It is intended to satisfy the U.S. Department of Energy (DOE) and other legal requirements that are discussed in both the Hanford Site WMin/P2 plan and paragraph C of this plan. As such, the Pollution Prevention Awareness Program required by DOE Order 5400.1 (DOE 1988) is included in the WHC P2 program. WHC, BCSR, and ICF KH are committed to implementing an effective P2 program as identified in the Hanford Site WMin/P2 Plan. This plan provides specific information on how the WHC P2 program will develop and implement the goals, activities, and budget needed to accomplish this. The emphasis has been to provide detailed planning of the WHC P2 program activities over the next 3 years. The plan will guide the development and implementation of the program. The plan also provides background information on past program activities. Because the plan contains greater detail than in the past, activity scope and implementation schedules may change as new priorities are identified and new approaches are developed and realized. Some activities will be accelerated, others may be delayed; however, all of the general program elements identified in this plan and contractor requirements identified in the Site WMin/P2 plan will be developed and implemented during the next 3 years. This plan applies to all WHC, BCSR, and ICF KH organizations and subcontractors. It will be distributed to those with defined responsibilities in this plan; and the policy, goals, objectives, and strategy of the program will be communicated to all WHC, BCSR, and ICF KH employees

The route to best science in implementation of the Endangered Species Act's consultation mandate: the benefits of structured effects analysis.

Science.gov (United States)

Murphy, Dennis D; Weiland, Paul S

2011-02-01

The Endangered Species Act is intended to conserve at-risk species and the ecosystems upon which they depend, and it is premised on the notion that if the wildlife agencies that are charged with implementing the statute use the best available scientific information, they can successfully carry out this intention. We assess effects analysis as a tool for using best science to guide agency decisions under the Act. After introducing effects analysis, we propose a framework that facilitates identification and use of the best available information in the development of agency determinations. The framework includes three essential steps--the collection of reliable scientific information, the critical assessment and synthesis of available data and analyses derived from those data, and the analysis of the effects of actions on listed species and their habitats. We warn of likely obstacles to rigorous, structured effect analyses and describe the extent to which independent scientific review may assist in overcoming these obstacles. We conclude by describing eight essential elements that are required for a successful effects analysis.

Jet-calculus approach including coherence effects

International Nuclear Information System (INIS)

Jones, L.M.; Migneron, R.; Narayanan, K.S.S.

1987-01-01

We show how integrodifferential equations typical of jet calculus can be combined with an averaging procedure to obtain jet-calculus-based results including the Mueller interference graphs. Results in longitudinal-momentum fraction x for physical quantities are higher at intermediate x and lower at large x than with the conventional ''incoherent'' jet calculus. These results resemble those of Marchesini and Webber, who used a Monte Carlo approach based on the same dynamics

Change Management Model for Implementing an Effective First-Year Experience Program in the Community College Setting

Science.gov (United States)

Tucker, Joy C.

2015-01-01

This study provides evidence that systematic management of change can facilitate the implementation of first-year experience programming that leads to improved results in retention and student success for community college students. The study includes four major themes: (a) first-year experience, (b) change management, (c) change leadership, and…

Task-selective memory effects for successfully implemented encoding strategies.

Directory of Open Access Journals (Sweden)

Eric D Leshikar

Full Text Available Previous behavioral evidence suggests that instructed strategy use benefits associative memory formation in paired associate tasks. Two such effective encoding strategies--visual imagery and sentence generation--facilitate memory through the production of different types of mediators (e.g., mental images and sentences. Neuroimaging evidence suggests that regions of the brain support memory reflecting the mental operations engaged at the time of study. That work, however, has not taken into account self-reported encoding task success (i.e., whether participants successfully generated a mediator. It is unknown, therefore, whether task-selective memory effects specific to each strategy might be found when encoding strategies are successfully implemented. In this experiment, participants studied pairs of abstract nouns under either visual imagery or sentence generation encoding instructions. At the time of study, participants reported their success at generating a mediator. Outside of the scanner, participants further reported the quality of the generated mediator (e.g., images, sentences for each word pair. We observed task-selective memory effects for visual imagery in the left middle occipital gyrus, the left precuneus, and the lingual gyrus. No such task-selective effects were observed for sentence generation. Intriguingly, activity at the time of study in the left precuneus was modulated by the self-reported quality (vividness of the generated mental images with greater activity for trials given higher ratings of quality. These data suggest that regions of the brain support memory in accord with the encoding operations engaged at the time of study.

Effect of Implementing a Birth Plan on Womens' Childbirth Experiences and Maternal & Neonatal Outcomes

Science.gov (United States)

Farahat, Amal Hussain; Mohamed, Hanan El Sayed; Elkader, Shadia Abd; El-Nemer, Amina

2015-01-01

Childbirth satisfaction represents a sense of feeling good about one's birth. It is thought to result from having a sense of control, having expectations met, feeling empowered, confident and supported. The aim of this study was to implement a birth plan and evaluate its effect on women's childbirth experiences and maternal, neonatal outcomes. A…

Development, implementation, and effects of an integrated web-based teaching model in a nursing ethics course.

Science.gov (United States)

Chao, S-Y; Chang, Y-C; Yang, S C; Clark, M J

2017-08-01

Ethical competence, which is reflected in the ability to detect ethical challenges in clinical situations and engage in deliberate thinking on ethical actions, is one of the core competencies of nursing practice. The purpose of this study was to develop and implement an interactive situational e-learning system, integrating nursing ethical decisions into a nursing ethics course, and to evaluate the effects of this course on student nurses' ethical decision-making competence. The project was designed to be carried out in two phases. In the first phase, an interactive situated e-learning system was developed and integrated into the nursing ethics course. The second phase involved implementing the course and evaluating its effects in a quasi-experimental study. The course intervention was designed for 2h per week over one semester (18weeks). A total of 100 two-year technical college nursing students in their second year of the program participated in the study, with 51 in the experimental group and 49 in the control group. After completing the course, the students in the experimental group showed significant improvement in nursing ethical decision-making competence, including skills in "raising questions," "recognizing differences," "comparing differences," "self-dialogue," "taking action," and "identifying the implications of decisions made," compared to their performance prior to the class. After controlling for factors influencing learning effects, students in the experimental group showed superiority to those in the control group in the competency of "recognizing differences." The students in the experimental group reported that the course pushed them to search for and collect information needed to resolve the ethical dilemma. The interactive situational e-learning system developed by our project was helpful in developing the students' competence in ethical reasoning. The e-learning system and the situational teaching materials used in this study may be applicable

A multifaceted implementation strategy versus passive implementation of low back pain guidelines in general practice: a cluster randomised controlled trial

Directory of Open Access Journals (Sweden)

Allan Riis

2016-10-01

Full Text Available Abstract Background Guidelines are often slowly adapted into clinical practice. However, actively supporting healthcare professionals in evidence-based treatment may speed up guideline implementation. Danish low back pain (LBP guidelines focus on primary care treatment of LBP, to reduce referrals from primary care to secondary care. The primary aim of this project was to reduce secondary care referral within 12 weeks by a multifaceted implementation strategy (MuIS. Methods In a cluster randomised design, 189 general practices from the North Denmark Region were invited to participate. Practices were randomised (1:1 and stratified by practice size to MuIS (28 practices or a passive implementation strategy (PaIS; 32 practices. Included were patients with LBP aged 18 to 65 years who were able to complete questionnaires, had no serious underlying pathology, and were not pregnant. We developed a MuIS including outreach visits, quality reports, and the STarT Back Tool for subgrouping patients with LBP. Both groups were offered the usual dissemination of guidelines, guideline-concordant structuring of the medical record, and a new referral opportunity for patients with psycho-social problems. In an intention-to-treat analysis, the primary and secondary outcomes pertained to the patient, and a cost-effectiveness analysis was performed from a healthcare sector perspective. Patients and the assessment of outcomes were blinded. Practices and caregivers delivering the interventions were not blinded. Results Between January 2013 and July 2014, 60 practices were included, of which 54 practices (28 MuIS, 26 PaIS included 1101 patients (539 MuIS, 562 PaIS. Follow-up data for the primary outcome were available on 100 % of these patients. Twenty-seven patients (5.0 % in the MuIS group were referred to secondary care vs. 59 patients (10.5 % in the PaIS group. The adjusted odds ratio (AOR was 0.52 [95 % CI 0.30 to 0.90; p = 0.020]. The MuIS was cost

A treatment of the Zeeman effect using Stokes formalism and its implementation in the Atmospheric Radiative Transfer Simulator (ARTS)

International Nuclear Information System (INIS)

Larsson, Richard; Buehler, Stefan A.; Eriksson, Patrick; Mendrok, Jana

2014-01-01

This paper presents the practical theory that was used to implement the Zeeman effect using Stokes formalism in the Atmospheric Radiative Transfer Simulator (ARTS). ARTS now treats the Zeeman effect in a general manner for several gas species for all polarizations and takes into account variations in both magnetic and atmospheric fields along a full 3D geometry. We present how Zeeman splitting affects polarization in radiative transfer simulations and find that the effect may be large in Earth settings for polarized receivers in limb observing geometry. We find that not taking a spatially varying magnetic field into account can result in absolute errors in the measurement vector of at least 10 K in Earth magnetic field settings. The paper also presents qualitative tests for O 2 lines against previous models (61.15 GHz line) and satellite data from Odin-SMR (487.25 GHz line), and the overall consistency between previous models, satellite data, and the new ARTS Zeeman module seems encouraging. -- Highlights: • We implement the Zeeman effect with Stokes formalism in ARTS. • We give a practical theory for the implementation. • Examples of how the Zeeman effect change RT are presented. • Qualitative Odin-SMR O 2 limb sounding model indicates the Zeeman effect is necessary

A required course in the development, implementation, and evaluation of clinical pharmacy services.

Science.gov (United States)

Skomo, Monica L; Kamal, Khalid M; Berdine, Hildegarde J

2008-10-15

To develop, implement, and assess a required pharmacy practice course to prepare pharmacy students to develop, implement, and evaluate clinical pharmacy services using a business plan model. Course content centered around the process of business planning and pharmacoeconomic evaluations. Selected business planning topics included literature evaluation, mission statement development, market evaluation, policy and procedure development, and marketing strategy. Selected pharmacoeconomic topics included cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and health-related quality of life (HRQoL). Assessment methods included objective examinations, student participation, performance on a group project, and peer evaluation. One hundred fifty-three students were enrolled in the course. The mean scores on the objective examinations (100 points per examination) ranged from 82 to 85 points, with 25%-35% of students in the class scoring over 90, and 40%-50% of students scoring from 80 to 89. The mean scores on the group project (200 points) and classroom participation (50 points) were 183.5 and 46.1, respectively. The mean score on the peer evaluation was 30.8, with scores ranging from 27.5 to 31.7. The course provided pharmacy students with the framework necessary to develop and implement evidence-based disease management programs and to assure efficient, cost-effective utilization of pertinent resources in the provision of patient care.

10 CFR 905.11 - What must an IRP include?

Science.gov (United States)

2010-01-01

..., energy conservation and efficiency, cogeneration and district heating and cooling applications, and..., consumer preferences, environmental impacts, demand or energy impacts, implementation issues, revenue... 10 Energy 4 2010-01-01 2010-01-01 false What must an IRP include? 905.11 Section 905.11 Energy...

PrEP implementation: moving from trials to policy and practice.

Science.gov (United States)

Cáceres, Carlos F; O'Reilly, Kevin R; Mayer, Kenneth H; Baggaley, Rachel

2015-01-01

It is increasingly clear that the HIV response will not be sustainable if the number of infections is not significantly reduced. For two decades, research has been ongoing to identify new behavioural and biomedical strategies to prevent HIV infection. In the past few years, the efficacy of several new strategies has been demonstrated, including oral pre-exposure prophylaxis (PrEP; i.e. daily use of tenofovir/emtricitabine). Because several social, political and logistic barriers remain, however, optimal PrEP implementation will require a better dissemination of new evidence in a number of areas and additional implementation research from various disciplinary perspectives (i.e. social science, policy and ethics; health systems; and economics, including cost-effectiveness studies). Discussion of new evidence on those topics, as well as case studies of potential PrEP implementation in diverse environments, can improve the understanding of the role that PrEP may play in addressing the global HIV/AIDS epidemic.In light of these needs, the Network for Multidisciplinary Studies in ARV-based HIV Prevention (NEMUS) and the World Health Organization (WHO) were honoured to co-organize a special issue of JIAS aimed at contributing to a scholarly discussion of current conditions surrounding PrEP implementation, potential impact and efficiency, social science concerns and the study of PrEP implementation in specific country cases. The papers included in this monograph identify and cover many of the main aspects of the complex yet promising discussions around PrEP implementation today. This is a collection of timely contributions from global leaders in HIV research and policy that addresses geographic diversity, uses a trans-disciplinary approach and covers a variety of the complex issues raised by PrEP. As this publication will become accessible to all, we hope that it will remain a valuable resource for policy makers, programme managers, researchers and activists around the

An effective, robust and parallel implementation of an interior point algorithm for limit state optimization

DEFF Research Database (Denmark)

Dollerup, Niels; Jepsen, Michael S.; Frier, Christian

2014-01-01

A robust and effective finite element based implementation of lower bound limit state analysis applying an interior point formulation is presented in this paper. The lower bound formulation results in a convex optimization problem consisting of a number of linear constraints from the equilibrium...

APhA 2011 REMS white paper: Summary of the REMS stakeholder meeting on improving program design and implementation.

Science.gov (United States)

American Pharmacists Association; Bough, Marcie

2011-01-01

To develop an improved risk evaluation and mitigation strategies (REMS) system for maximizing effective and safe patient medication use while minimizing burden on the health care delivery system. 34 stakeholders gathered October 6-7, 2010, in Arlington, VA, for the REMS Stakeholder Meeting, convened by the American Pharmacists Association (APhA). Participants included national health care provider associations, including representatives for physicians, physician assistants, nurses, nurse practitioners, and pharmacists, as well as representatives for patient advocates, drug distributors, community pharmacists (chain and independent), drug manufacturer associations (brand, generic, and biologic organizations), and health information technology, standards, and safety organizations. Staff from the Food and Drug Administration (FDA) Center for Drug Evaluation and Research participated as observers. The meeting built on themes from the APhA's 2009 REMS white paper. The current REMS environment presents many challenges for health care providers due to the growing number of REMS programs and the lack of standardization or similarities among various REMS programs. A standardized REMS process that focuses on maximizing patient safety and minimizing impacts on patient access and provider implementation could offset these challenges. A new process that includes effective provider interventions and standardized tools and systems for implementing REMS programs may improve patient care and overcome some of the communication issues providers and patients currently face. Metrics could be put in place to evaluate the effectiveness of REMS elements. By incorporating REMS program components into existing technologies and data infrastructures, achieving REMS implementation that is workflow neutral and minimizes administrative burden may be possible. An appropriate compensation model could ensure providers have adequate resources for patient care and REMS implementation. Overall

Vibration of Piezoelectric Nanowires Including Surface Effects

Directory of Open Access Journals (Sweden)

R. Ansari

2014-04-01

Full Text Available In this paper, surface and piezoelectric effects on the vibration behavior of nanowires (NWs are investigated by using a Timoshenko beam model. The electric field equations and the governing equations of motion for the piezoelectric NWs are derived with the consideration of surface effects. By the exact solution of the governing equations, an expression for the natural frequencies of NWs with simply-supported boundary conditions is obtained. The effects of piezoelectricity and surface effects on the vibrational behavior of Timoshenko NWs are graphically illustrated. A comparison is also made between the predictions of Timoshenko beam model and those of its Euler-Bernoulli counterpart. Additionally, the present results are validated through comparison with the available data in the literature.

Physician practice responses to financial incentive programs: exploring the concept of implementation mechanisms.

Science.gov (United States)

Cohen, Genna R; Erb, Natalie; Lemak, Christy Harris

2012-01-01

To develop a framework for studying financial incentive program implementation mechanisms, the means by which physician practices and physicians translate incentive program goals into their specific office setting. Understanding how new financial incentives fit with the structure of physician practices and individual providers' work may shed some insight on the variable effects of physician incentives documented in numerous reviews and meta-analyses. Reviewing select articles on pay-for-performance evaluations to identify and characterize the presence of implementation mechanisms for designing, communicating, implementing, and maintaining financial incentive programs as well as recognizing participants' success and effects on patient care. Although uncommonly included in evaluations, evidence from 26 articles reveals financial incentive program sponsors and participants utilized a variety of strategies to facilitate communication about program goals and intentions, to provide feedback about participants' progress, and to assist-practices in providing recommended services. Despite diversity in programs' geographic locations, clinical targets, scope, and market context, sponsors and participants deployed common strategies. While these methods largely pertained to communication between program sponsors and participants and the provision of information about performance through reports and registries, they also included other activities such as efforts to engage patients and ways to change staff roles. This review covers a limited body of research to develop a conceptual framework for future research; it did not exhaustively search for new articles and cannot definitively link particular implementation mechanisms to outcomes. Our results underscore the effects implementation mechanisms may have on how practices incorporate new programs into existing systems of care which implicates both the potential rewards from small changes as well as the resources which may be

Paradoxical cardiovascular effects of implementing adaptive emotion regulation strategies in generalized anxiety disorder.

Science.gov (United States)

Aldao, Amelia; Mennin, Douglas S

2012-02-01

Recent models of generalized anxiety disorder (GAD) have expanded on Borkovec's avoidance theory by delineating emotion regulation deficits associated with the excessive worry characteristic of this disorder (see Behar, DiMarco, Hekler, Mohlman, & Staples, 2009). However, it has been difficult to determine whether emotion regulation is simply a useful heuristic for the avoidant properties of worry or an important extension to conceptualizations of GAD. Some of this difficulty may arise from a focus on purported maladaptive regulation strategies, which may be confounded with symptomatic distress components of the disorder (such as worry). We examined the implementation of adaptive regulation strategies by participants with and without a diagnosis of GAD while watching emotion-eliciting film clips. In a between-subjects design, participants were randomly assigned to accept, reappraise, or were not given specific regulation instructions. Implementation of adaptive regulation strategies produced differential effects in the physiological (but not subjective) domain across diagnostic groups. Whereas participants with GAD demonstrated lower cardiac flexibility when implementing adaptive regulation strategies than when not given specific instructions on how to regulate, healthy controls showed the opposite pattern, suggesting they benefited from the use of adaptive regulation strategies. We discuss the implications of these findings for the delineation of emotion regulation deficits in psychopathology. Copyright © 2011 Elsevier Ltd. All rights reserved.

A Statewide Partnership for Implementing Inquiry Science

Science.gov (United States)

Lytle, Charles

The North Carolina Infrastructure for Science Education (NC-ISE) is a statewide partnership for implementing standards-based inquiry science using exemplary curriculum materials in the public schools of North Carolina. North Carolina is the 11th most populous state in the USA with 8,000,000 residents, 117 school districts and a geographic area of 48,718 miles. NC-ISE partners include the state education agency, local school systems, three branches of the University of North Carolina, the state mathematics and science education network, businesses, and business groups. The partnership, based upon the Science for All Children model developed by the National Science Resources Centre, was initiated in 1997 for improvement in teaching and learning of science and mathematics. This research-based model has been successfully implemented in several American states during the past decade. Where effectively implemented, the model has led to significant improvements in student interest and student learning. It has also helped reduce the achievement gap between minority and non-minority students and among students from different economic levels. A key program element of the program is an annual Leadership Institute that helps teams of administrators and teachers develop a five-year strategic plan for their local systems. Currently 33 of the117 local school systems have joined the NC-ISE Program and are in various stages of implementation of inquiry science in grades K-8.

Effect of care management program structure on implementation: a normalization process theory analysis.

Science.gov (United States)

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

2016-08-15

Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice. Data collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework. Seventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship

The INEL approach: Environmental Restoration Program management and implementation methodology