WorldWideScience

Sample records for pretreatment implementation review

  1. Processes for pretreating lignocellulosic biomass: A review

    Energy Technology Data Exchange (ETDEWEB)

    McMillan, J.D.

    1992-11-01

    This paper reviews existing and proposed pretreatment processes for biomass. The focus is on the mechanisms by which the various pretreatments act and the influence of biomass structure and composition on the efficacy of particular pretreatment techniques. This analysis is used to identify pretreatment technologies and issues that warrant further research.

  2. Extrusion Pretreatment of Lignocellulosic Biomass: A Review

    Directory of Open Access Journals (Sweden)

    Jun Zheng

    2014-10-01

    Full Text Available Bioconversion of lignocellulosic biomass to bioethanol has shown environmental, economic and energetic advantages in comparison to bioethanol produced from sugar or starch. However, the pretreatment process for increasing the enzymatic accessibility and improving the digestibility of cellulose is hindered by many physical-chemical, structural and compositional factors, which make these materials difficult to be used as feedstocks for ethanol production. A wide range of pretreatment methods has been developed to alter or remove structural and compositional impediments to (enzymatic hydrolysis over the last few decades; however, only a few of them can be used at commercial scale due to economic feasibility. This paper will give an overview of extrusion pretreatment for bioethanol production with a special focus on twin-screw extruders. An economic assessment of this pretreatment is also discussed to determine its feasibility for future industrial cellulosic ethanol plant designs.

  3. Organic solvent pretreatment of lignocellulosic biomass for biofuels and biochemicals: A review.

    Science.gov (United States)

    Zhang, Ke; Pei, Zhijian; Wang, Donghai

    2016-01-01

    Lignocellulosic biomass represents the largest potential volume and lowest cost for biofuel and biochemical production. Pretreatment is an essential component of biomass conversion process, affecting a majority of downstream processes, including enzymatic hydrolysis, fermentation, and final product separation. Organic solvent pretreatment is recognized as an emerging way ahead because of its inherent advantages, such as the ability to fractionate lignocellulosic biomass into cellulose, lignin, and hemicellulose components with high purity, as well as easy solvent recovery and solvent reuse. Objectives of this review were to update and extend previous works on pretreatment of lignocellulosic biomass for biofuels and biochemicals using organic solvents, especially on ethanol, methanol, ethylene glycol, glycerol, acetic acid, and formic acid. Perspectives and recommendations were given to fully describe implementation of proper organic solvent pretreatment for future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Chemical and Physicochemical Pretreatment of Lignocellulosic Biomass: A Review

    Directory of Open Access Journals (Sweden)

    Gary Brodeur

    2011-01-01

    Full Text Available Overcoming the recalcitrance (resistance of plant cell walls to deconstruction of lignocellulosic biomass is a key step in the production of fuels and chemicals. The recalcitrance is due to the highly crystalline structure of cellulose which is embedded in a matrix of polymers-lignin and hemicellulose. The main goal of pretreatment is to overcome this recalcitrance, to separate the cellulose from the matrix polymers, and to make it more accessible for enzymatic hydrolysis. Reports have shown that pretreatment can improve sugar yields to higher than 90% theoretical yield for biomass such as wood, grasses, and corn. This paper reviews different leading pretreatment technologies along with their latest developments and highlights their advantages and disadvantages with respect to subsequent hydrolysis and fermentation. The effects of different technologies on the components of biomass (cellulose, hemicellulose, and lignin are also reviewed with a focus on how the treatment greatly enhances enzymatic cellulose digestibility.

  5. Chemical and physicochemical pretreatment of lignocellulosic biomass: a review.

    Science.gov (United States)

    Brodeur, Gary; Yau, Elizabeth; Badal, Kimberly; Collier, John; Ramachandran, K B; Ramakrishnan, Subramanian

    2011-01-01

    Overcoming the recalcitrance (resistance of plant cell walls to deconstruction) of lignocellulosic biomass is a key step in the production of fuels and chemicals. The recalcitrance is due to the highly crystalline structure of cellulose which is embedded in a matrix of polymers-lignin and hemicellulose. The main goal of pretreatment is to overcome this recalcitrance, to separate the cellulose from the matrix polymers, and to make it more accessible for enzymatic hydrolysis. Reports have shown that pretreatment can improve sugar yields to higher than 90% theoretical yield for biomass such as wood, grasses, and corn. This paper reviews different leading pretreatment technologies along with their latest developments and highlights their advantages and disadvantages with respect to subsequent hydrolysis and fermentation. The effects of different technologies on the components of biomass (cellulose, hemicellulose, and lignin) are also reviewed with a focus on how the treatment greatly enhances enzymatic cellulose digestibility.

  6. Pretreatment technologies for industrial effluents: Critical review on bioenergy production and environmental concerns.

    Science.gov (United States)

    Prabakar, Desika; Suvetha K, Subha; Manimudi, Varshini T; Mathimani, Thangavel; Kumar, Gopalakrishnan; Rene, Eldon R; Pugazhendhi, Arivalagan

    2018-07-15

    The implementation of different pretreatment techniques and technologies prior to effluent discharge is a direct result of the inefficiency of several existing wastewater treatment methods. A majority of the industrial sectors have known to cause severe negative effects on the environment. The five major polluting industries are the paper and pulp mills, coal manufacturing facilities, petrochemical, textile and the pharmaceutical sectors. Pretreatment methods have been widely used in order to lower the toxicity levels of effluents and comply with environmental standards. In this review, the possible environmental benefits and concerns of adopting different pretreatment technologies for renewable energy production and product/resource recovery has been reviewed and discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. Microalgal biomass pretreatment for bioethanol production: a review

    Directory of Open Access Journals (Sweden)

    Jesús Velazquez-Lucio

    2018-03-01

    Full Text Available Biofuels derived from microalgae biomass have received a great deal of attention owing to their high potentials as sustainable alternatives to fossil fuels. Microalgae have a high capacity of CO2 fixation and depending on their growth conditions, they can accumulate different quantities of lipids, proteins, and carbohydrates. Microalgal biomass can, therefore, represent a rich source of fermentable sugars for third generation bioethanol production. The utilization of microalgal carbohydrates for bioethanol production follows three main stages: i pretreatment, ii saccharification, and iii fermentation. One of the most important stages is the pretreatment, which is carried out to increase the accessibility to intracellular sugars, and thus plays an important role in improving the overall efficiency of the bioethanol production process. Diverse types of pretreatments are currently used including chemical, thermal, mechanical, biological, and their combinations, which can promote cell disruption, facilitate extraction, and result in the modification the structure of carbohydrates as well as the production of fermentable sugars. In this review, the different pretreatments used on microalgae biomass for bioethanol production are presented and discussed. Moreover, the methods used for starch and total carbohydrates quantification in microalgae biomass are also briefly presented and compared.

  8. Literature Review of Physical and Chemical Pretreatment Processes for Lignocellulosic Biomass

    Energy Technology Data Exchange (ETDEWEB)

    Harmsen, P.; Bakker, R. [Wageningen University and Research centre WUR, Food and Biobased Research WUR-FBR, Wageningen (Netherlands); Huijgen, W.J.J. [ECN Biomass, Coal and Environment, Petten (Netherlands); Bermudez Lopez, L. [Abengoa Bioenergia Nuevas Tecnologias ABNT (Spain)

    2010-09-15

    This literature review was performed within the BioSynergy project (2007-2010). BioSynergy is a European Integrated Project supported through the Sixth Framework Programme for Research and Technological Development (038994-SES6). BioSynergy stands for 'BIOmass for the market competitive and environmentally friendly SYNthesis of bio-products together with the production of secondary enERGY carriers through the biorefinery approach'. Within the BioSynergy project the overall goal of the pretreatment routes being developed is to convert raw lignocellulosic biomass into its composing sugars and lignin in a market competitive and environmentally sustainable way. This report reviews lignocellulose pretreatment in general as well as specific pretreatment technologies that are developed within the BioSynergy project including steam explosion (ABNT), mechanical/alkaline fractionation (WUR) and organosolv fractionation (ECN). In addition to these pretreatment technologies, other pretreatment technologies are studied within the BioSynergy project such as acetic/formic acid pretreatment and mild- and strong acid pretreatment.

  9. Chemical and Physicochemical Pretreatment of Lignocellulosic Biomass: A Review

    OpenAIRE

    Brodeur, Gary; Yau, Elizabeth; Badal, Kimberly; Collier, John; Ramachandran, K. B.; Ramakrishnan, Subramanian

    2011-01-01

    Overcoming the recalcitrance (resistance of plant cell walls to deconstruction) of lignocellulosic biomass is a key step in the production of fuels and chemicals. The recalcitrance is due to the highly crystalline structure of cellulose which is embedded in a matrix of polymers-lignin and hemicellulose. The main goal of pretreatment is to overcome this recalcitrance, to separate the cellulose from the matrix polymers, and to make it more accessible for enzymatic hydrolysis. Reports have sh...

  10. The effectiveness of pretreatment physics plan review for detecting errors in radiation therapy

    International Nuclear Information System (INIS)

    Gopan, Olga; Zeng, Jing; Novak, Avrey; Nyflot, Matthew; Ford, Eric

    2016-01-01

    Purpose: The pretreatment physics plan review is a standard tool for ensuring treatment quality. Studies have shown that the majority of errors in radiation oncology originate in treatment planning, which underscores the importance of the pretreatment physics plan review. This quality assurance measure is fundamentally important and central to the safety of patients and the quality of care that they receive. However, little is known about its effectiveness. The purpose of this study was to analyze reported incidents to quantify the effectiveness of the pretreatment physics plan review with the goal of improving it. Methods: This study analyzed 522 potentially severe or critical near-miss events within an institutional incident learning system collected over a three-year period. Of these 522 events, 356 originated at a workflow point that was prior to the pretreatment physics plan review. The remaining 166 events originated after the pretreatment physics plan review and were not considered in the study. The applicable 356 events were classified into one of the three categories: (1) events detected by the pretreatment physics plan review, (2) events not detected but “potentially detectable” by the physics review, and (3) events “not detectable” by the physics review. Potentially detectable events were further classified by which specific checks performed during the pretreatment physics plan review detected or could have detected the event. For these events, the associated specific check was also evaluated as to the possibility of automating that check given current data structures. For comparison, a similar analysis was carried out on 81 events from the international SAFRON radiation oncology incident learning system. Results: Of the 356 applicable events from the institutional database, 180/356 (51%) were detected or could have been detected by the pretreatment physics plan review. Of these events, 125 actually passed through the physics review; however

  11. The effectiveness of pretreatment physics plan review for detecting errors in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Gopan, Olga; Zeng, Jing; Novak, Avrey; Nyflot, Matthew; Ford, Eric, E-mail: eford@uw.edu [Department of Radiation Oncology, University of Washington Medical Center, 1959 NE Pacific Street, Box 356043, Seattle, Washington 98195 (United States)

    2016-09-15

    Purpose: The pretreatment physics plan review is a standard tool for ensuring treatment quality. Studies have shown that the majority of errors in radiation oncology originate in treatment planning, which underscores the importance of the pretreatment physics plan review. This quality assurance measure is fundamentally important and central to the safety of patients and the quality of care that they receive. However, little is known about its effectiveness. The purpose of this study was to analyze reported incidents to quantify the effectiveness of the pretreatment physics plan review with the goal of improving it. Methods: This study analyzed 522 potentially severe or critical near-miss events within an institutional incident learning system collected over a three-year period. Of these 522 events, 356 originated at a workflow point that was prior to the pretreatment physics plan review. The remaining 166 events originated after the pretreatment physics plan review and were not considered in the study. The applicable 356 events were classified into one of the three categories: (1) events detected by the pretreatment physics plan review, (2) events not detected but “potentially detectable” by the physics review, and (3) events “not detectable” by the physics review. Potentially detectable events were further classified by which specific checks performed during the pretreatment physics plan review detected or could have detected the event. For these events, the associated specific check was also evaluated as to the possibility of automating that check given current data structures. For comparison, a similar analysis was carried out on 81 events from the international SAFRON radiation oncology incident learning system. Results: Of the 356 applicable events from the institutional database, 180/356 (51%) were detected or could have been detected by the pretreatment physics plan review. Of these events, 125 actually passed through the physics review; however

  12. Review of pretreatment processes for lignocellulosic ethanol production, and development of an innovative method

    International Nuclear Information System (INIS)

    Chiaramonti, David; Prussi, Matteo; Ferrero, Simone; Oriani, Luis; Ottonello, Piero; Torre, Paolo; Cherchi, Francesco

    2012-01-01

    Biomass pretreatment aims at separating and providing easier access to the main biomass components (cellulose, hemicellulose and lignin), eventually removing lignin, preserving the hemicellulose, reducing the cellulose crystallinity and increasing the porosity of the material. Pretreatment is an essential step towards the development and industrialization of efficient 2nd generation lignocellulosic ethanol processes. The present work reviewed the main options available in pretreatment. Autohydrolysis and steam explosion were then selected for further investigation. Experimental work was carried out on batch scale reactors, using Miscanthus as biomass feedstock: the effects on sugar solubilization and degradation products generation have been examined for each of these two pretreatment systems. A new process using only water and steam as reacting media was then developed, experimentally tested, and results compared to those achieved by the autohydrolysis and steam explosion processes. Products obtained with the new pretreatment contained a lower amount of usual fermentation inhibitor compounds compared to that typically obtained in steam explosion. This result was achieved under operating conditions that at the same time allowed a good xylan yield, preventing degradation of hemicelluloses. The new pretreatment process was also able to act as an equalization step, as the solid material from the pretreatment phase had a similar composition even under different operating conditions. As regards the effect of pretreatment on enzymatic hydrolysis, the new process achieved yields similar to steam explosion on glucans: however, this was obtained reducing the formation of degradation products from sugars, mainly from C5 sugars. These results made the proposed pretreatment system suitable for further development and industrialization on pilot and industrial scale.

  13. Pretreatment of Lignocellulosic Wastes to Improve Ethanol and Biogas Production: A Review

    Directory of Open Access Journals (Sweden)

    Keikhosro Karimi

    2008-09-01

    Full Text Available Lignocelluloses are often a major or sometimes the sole components of different waste streams from various industries, forestry, agriculture and municipalities. Hydrolysis of these materials is the first step for either digestion to biogas (methane or fermentation to ethanol. However, enzymatic hydrolysis of lignocelluloses with no pretreatment is usually not so effective because of high stability of the materials to enzymatic or bacterial attacks. The present work is dedicated to reviewing the methods that have been studied for pretreatment of lignocellulosic wastes for conversion to ethanol or biogas. Effective parameters in pretreatment of lignocelluloses, such as crystallinity, accessible surface area, and protection by lignin and hemicellulose are described first. Then, several pretreatment methods are discussed and their effects on improvement in ethanol and/or biogas production are described. They include milling, irradiation, microwave, steam explosion, ammonia fiber explosion (AFEX, supercritical CO2 and its explosion, alkaline hydrolysis, liquid hot-water pretreatment, organosolv processes, wet oxidation, ozonolysis, dilute- and concentrated-acid hydrolyses, and biological pretreatments.

  14. Influence of pretreatment techniques on anaerobic digestion of pulp and paper mill sludge: A review.

    Science.gov (United States)

    Veluchamy, C; Kalamdhad, Ajay S

    2017-12-01

    Pulp and paper industry is one of the most polluting, energy and water intensive industries in the world. Produced pulp and paper mill sludge (PPMS) faces a major problem for handling and its management. An anaerobic digestion has become an alternative source. This review provides a detailed summary of anaerobic digestion of PPMS - An overview of the developments and improvement opportunities. This paper explores the different pretreatment methods to enhance biogas production from the PPMS. First, the paper gives an overview of PPMS production, and then it reviews PPMS as a substrate for anaerobic digestion with or without pretreatment. Finally, it discuss the optimal condition and concentration of organic and inorganic compounds required for the anaerobic metabolic activity. Future research should focus on the combination of different pretreatment technologies, relationship between sludge composition, reactor design and its operation, and microbial community dynamics. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Post Implementation Review Framework and Procedures

    Data.gov (United States)

    Social Security Administration — This template outlines the Social Security Administration's (SSA) approach to initiating, conducting, and completing Post Implementation Reviews (PIRs). The template...

  16. 40 CFR 403.8 - Pretreatment Program Requirements: Development and Implementation by POTW.

    Science.gov (United States)

    2010-07-01

    ... AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GENERAL PRE-TREAT-MENT REGULATIONS FOR EXIST-ING AND... applicable civil and criminal penalties for violation of Pretreatment Standards and requirements, and any... authority to seek or assess civil or criminal penalties in at least the amount of $1,000 a day for each...

  17. SU-E-T-148: Benchmarks and Pre-Treatment Reviews: A Study of Quality Assurance Effectiveness

    International Nuclear Information System (INIS)

    Lowenstein, J; Nguyen, H; Roll, J; Walsh, A; Tailor, A; Followill, D

    2015-01-01

    Purpose: To determine the impact benchmarks and pre-treatment reviews have on improving the quality of submitted clinical trial data. Methods: Benchmarks are used to evaluate a site’s ability to develop a treatment that meets a specific protocol’s treatment guidelines prior to placing their first patient on the protocol. A pre-treatment review is an actual patient placed on the protocol in which the dosimetry and contour volumes are evaluated to be per protocol guidelines prior to allowing the beginning of the treatment. A key component of these QA mechanisms is that sites are provided timely feedback to educate them on how to plan per the protocol and prevent protocol deviations on patients accrued to a protocol. For both benchmarks and pre-treatment reviews a dose volume analysis (DVA) was performed using MIM softwareTM. For pre-treatment reviews a volume contour evaluation was also performed. Results: IROC Houston performed a QA effectiveness analysis of a protocol which required both benchmarks and pre-treatment reviews. In 70 percent of the patient cases submitted, the benchmark played an effective role in assuring that the pre-treatment review of the cases met protocol requirements. The 35 percent of sites failing the benchmark subsequently modified there planning technique to pass the benchmark before being allowed to submit a patient for pre-treatment review. However, in 30 percent of the submitted cases the pre-treatment review failed where the majority (71 percent) failed the DVA. 20 percent of sites submitting patients failed to correct their dose volume discrepancies indicated by the benchmark case. Conclusion: Benchmark cases and pre-treatment reviews can be an effective QA tool to educate sites on protocol guidelines and to minimize deviations. Without the benchmark cases it is possible that 65 percent of the cases undergoing a pre-treatment review would have failed to meet the protocols requirements.Support: U24-CA-180803

  18. Review: Waste-Pretreatment Technologies for Remediation of Legacy Defense Nuclear Wastes

    Energy Technology Data Exchange (ETDEWEB)

    Wilmarth, William R.; Lumetta, Gregg J.; Johnson, Michael E.; Poirier, Micheal R.; Thompson, Major C.; Suggs, Patricia C.; Machara, N.

    2011-01-13

    The U.S. Department of Energy (DOE) is responsible for retrieving, immobilizing, and disposing of radioactive waste that has been generated during the production of nuclear weapons in the United States. The vast bulk of this waste material is stored in underground tanks at the Savannah River Site in South Carolina and the Hanford Site in Washington State. The general strategy for treating the radioactive tank waste consists of first separating the waste into high-level and low-activity fractions. This initial partitioning of the waste is referred to as pretreatment. Following pretreatment, the high-level fraction will be immobilized in a glass form suitable for disposal in a geologic repository. The low-activity waste will be immobilized in a waste form suitable for disposal at the respective site. This paper provides a review of recent developments in the application of pretreatment technologies to the processing of the Hanford and Savannah River radioactive tank wastes. Included in the review are discussions of 1) solid/liquid separations methods, 2) cesium separation technologies, and 3) other separations critical to the success of the DOE tank waste remediation effort. Also included is a brief discussion of the different requirements and circumstances at the two DOE sites that have in some cases led to different choices in pretreatment technologies.

  19. A critical review of ionic liquids for the pretreatment of lignocellulosic biomass

    Directory of Open Access Journals (Sweden)

    Prashant Reddy

    2015-11-01

    Full Text Available Ionic liquids have been the subject of active research over the course of the last decade and have in the past been touted as one of the most promising technologies for revolutionising the chemical and petro-chemical industries. The sheer abundance of potential ionic liquid structures coupled with their tuneable physico-chemical properties has endeared ionic liquids to the scientific community across a broad range of disciplines with potential applications that include pharmaceuticals, electrolytes, thermal energy storage media and liquid mirror telescopes. Within the context of a biorefinery for the production of biofuels and other bio-based products from renewable resources, the unique abilities of some ionic liquids to selectively dissolve biomass components or whole native biomass have been demonstrated. This ability has sparked extensive investigations of ionic liquids for the pretreatment of different biomass types, particularly for the production of cellulosic biofuels. However, the esoteric nature of ionic liquids persists and constructing a fundamental framework for correlating ionic liquid structures with useful applications remains a significant challenge. In addition to the above, the more practical challenges of toxicity, high costs, high viscosities, low solids loading and complex recycling are key factors hindering the wide-scale uptake of ionic liquids as pretreatment solvents in a commercial biorefinery. This critical review provides insights from academic studies and the implications thereof for elevating ionic liquids from the status of �promising� to �commercialisable� in the pretreatment of biomass. It is vital that key hurdles for the commercialisation of ionic liquids in the form of high costs, high viscosities, poor water tolerance, toxicity, low solids loading and recovery/recycling be addressed.

  20. 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

  1. 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

  2. Review of pre-treated peat applied in treating domestic wastewaters and oily waters

    International Nuclear Information System (INIS)

    Jiang, X.; Coles, C.A.; Asapo, E.S.

    2008-01-01

    This paper discussed recent research related to the use of peat in removing contaminants from domestic wastewater, oil-contaminated water, and soil. The review also discussed methods of pretreating peat before its application to polluted area. Pretreatment processes are needed to remove components in peat that interfere with treatment mechanisms. Polymers are added to peat in order to encourage the aggregation of the peat particles into larger colloidal particles that are easy to dewater. Phosphoric acid treatments are also applied to increase the swelling capacity of peat. Hydrogen peroxide is used to break down oil-contaminated peat in order to facilitate its subsequent decomposition. Experiments have demonstrated that peat is an effective adsorbent for many different types of oil. Studies have demonstrated that the removal rate for standard mineral and crude oils from wastewater using peat was 83 and 70 per cent. Applications of commercial peat to the surface of oily contaminated waters resulted in oil removal efficiencies of 99.998 per cent. It was concluded that peat is an effective, low-cost material for removing contaminants from domestic waste water and oil-contaminated water. The peat can also be used as a secondary energy source after the sorption process. While peat is an abundant resource in Canada, the resource is found mainly in wetlands. Effective harvesting strategies should be used to ensure the environmental sustainability of peat filtration systems. 38 refs., 1 tab

  3. SU-F-T-351: Establishing a Workflow for IMRT Pre-Treatment Reviews for NRG-GY006 Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Giaddui, T [Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States); Li, N; Moore, K; Mell, L [University of California, San Diego, San Diego, CA (United States); Curry, K [MIM Software, Inc., Clevealand, OH (United States); Leath, C [University of Alabama at Birmingham, Birmingham, AL (United States); Kunos, C [Northeastern Ohio University College, Clevealand, OH (United States); Xiao, Y [University of Pennsylvania, Philadelphia, PA (United States)

    2016-06-15

    Purpose: To establish a workflow for NRG-GY006 IMRT pre-treatment reviews, incorporating advanced radiotherapy technologies being evaluated as part of the clinical trial. Methods: Pre-Treatment reviews are required for every IMRT case as part of NRG-GY006 (a randomized phase II trial of radiation therapy and cisplatin alone or in combination with intravenous triapine in women with newly diagnosed bulky stage I B2, stage II, IIIB, or IVA cancer of the uterine cervix or stage II-IVA vaginal cancer. The pretreatment review process includes structures review and generating an active bone marrow(ABM)- to be used as an avoidance structure during IMRT optimization- and evaluating initial IMRT plan quality using knowledgeengineering based planning (KBP). Institutions will initially submit their simulation CT scan, structures file and PET/CT to IROC QA center for generating ABM. The ABM will be returned to the institution for use in planning. Institutions will then submit an initial IMRT plan for review and will receive information back following implementation of a KBP algorithm, for use in re-optimization, before submitting the final IMRT used for treatment. Results: ABM structure is generated using MIM vista software (Version 6.5, MIM corporation, Inc.). Here, the planning CT and the diagnostic PET/CT are fused and a sub threshold structure is auto segmented above the mean value of the SUV of the bone marrow. The generated ABM were compared with those generated with other software system (e.g. Velocity, Varian) and Dice coefficient (reflects the overlap of structures) ranged between 80 – 90% was achieved. A KBP model was built in Varian Eclipse TPS using the RapidPlan KBP software to perform plan quality assurance. Conclusion: The workflow for IMRT pretreatment reviews has been established. It represents a major improvement of NRG Oncology clinical trial quality assurance and incorporates the latest radiotherapy technologies as part of NCI clinical trials. This project

  4. SU-F-T-351: Establishing a Workflow for IMRT Pre-Treatment Reviews for NRG-GY006 Clinical Trial

    International Nuclear Information System (INIS)

    Giaddui, T; Li, N; Moore, K; Mell, L; Curry, K; Leath, C; Kunos, C; Xiao, Y

    2016-01-01

    Purpose: To establish a workflow for NRG-GY006 IMRT pre-treatment reviews, incorporating advanced radiotherapy technologies being evaluated as part of the clinical trial. Methods: Pre-Treatment reviews are required for every IMRT case as part of NRG-GY006 (a randomized phase II trial of radiation therapy and cisplatin alone or in combination with intravenous triapine in women with newly diagnosed bulky stage I B2, stage II, IIIB, or IVA cancer of the uterine cervix or stage II-IVA vaginal cancer. The pretreatment review process includes structures review and generating an active bone marrow(ABM)- to be used as an avoidance structure during IMRT optimization- and evaluating initial IMRT plan quality using knowledgeengineering based planning (KBP). Institutions will initially submit their simulation CT scan, structures file and PET/CT to IROC QA center for generating ABM. The ABM will be returned to the institution for use in planning. Institutions will then submit an initial IMRT plan for review and will receive information back following implementation of a KBP algorithm, for use in re-optimization, before submitting the final IMRT used for treatment. Results: ABM structure is generated using MIM vista software (Version 6.5, MIM corporation, Inc.). Here, the planning CT and the diagnostic PET/CT are fused and a sub threshold structure is auto segmented above the mean value of the SUV of the bone marrow. The generated ABM were compared with those generated with other software system (e.g. Velocity, Varian) and Dice coefficient (reflects the overlap of structures) ranged between 80 – 90% was achieved. A KBP model was built in Varian Eclipse TPS using the RapidPlan KBP software to perform plan quality assurance. Conclusion: The workflow for IMRT pretreatment reviews has been established. It represents a major improvement of NRG Oncology clinical trial quality assurance and incorporates the latest radiotherapy technologies as part of NCI clinical trials. This project

  5. Pre-treatment risk stratification of prostate cancer patients: A critical review.

    Science.gov (United States)

    Rodrigues, George; Warde, Padraig; Pickles, Tom; Crook, Juanita; Brundage, Michael; Souhami, Luis; Lukka, Himu

    2012-04-01

    The use of accepted prostate cancer risk stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated risk stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer risk stratification schema to assess the feasibility and need for changes to existing risk stratification systems. A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and risk stratification in prostate cancer. Search terms included risk stratification, risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing risk stratification schema. The critical review identified three specific clinically relevant potential changes to the most commonly used three-group risk stratification system: (1) the creation of a very-low risk category; (2) the splitting of intermediate-risk into a low- and high-intermediate risk groups; and (3) the clarification of the interface between intermediate- and high-risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important risk-stratification factors. Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer risk stratification systems. We propose potential changes to existing systems.

  6. Impact of the environmental conditions and substrate pre-treatment on whey protein hydrolysis: A review.

    Science.gov (United States)

    Cheison, Seronei Chelulei; Kulozik, Ulrich

    2017-01-22

    Proteins in solution are subject to myriad forces stemming from interactions with each other as well as with the solvent media. The role of the environmental conditions, namely pH, temperature, ionic strength remains under-estimated yet it impacts protein conformations and consequently its interaction with, and susceptibility to, the enzyme. Enzymes, being proteins are also amenable to the environmental conditions because they are either activated or denatured depending on the choice of the conditions. Furthermore, enzyme specificity is restricted to a narrow regime of optimal conditions while opportunities outside the optimum conditions remain untapped. In addition, the composition of protein substrate (whether mixed or single purified) have been underestimated in previous studies. In addition, protein pre-treatment methods like heat denaturation prior to hydrolysis is a complex phenomenon whose progression is influenced by the environmental conditions including the presence or absence of sugars like lactose, ionic strength, purity of the protein, and the molecular structure of the mixed proteins particularly presence of free thiol groups. In this review, we revisit protein hydrolysis with a focus on the impact of the hydrolysis environment and show that preference of peptide bonds and/or one protein over another during hydrolysis is driven by the environmental conditions. Likewise, heat-denaturing is a process which is dependent on not only the environment but the presence or absence of other proteins.

  7. TU-G-BRD-01: Quantifying the Effectiveness of the Physics Pre-Treatment Plan Review for Detecting Errors in Radiation Therapy

    International Nuclear Information System (INIS)

    Gopan, O; Novak, A; Zeng, J; Ford, E

    2015-01-01

    Purpose: Physics pre-treatment plan review is crucial to safe radiation oncology treatments. Studies show that most errors originate in treatment planning, which underscores the importance of physics plan review. As a QA measure the physics review is of fundamental importance and is central to the profession of medical physics. However, little is known about its effectiveness. More hard data are needed. The purpose of this study was to quantify the effectiveness of physics review with the goal of improving it. Methods: This study analyzed 315 “potentially serious” near-miss incidents within an institutional incident learning system collected over a two-year period. 139 of these originated prior to physics review and were found at the review or after. Incidents were classified as events that: 1)were detected by physics review, 2)could have been detected (but were not), and 3)could not have been detected. Category 1 and 2 events were classified by which specific check (within physics review) detected or could have detected the event. Results: Of the 139 analyzed events, 73/139 (53%) were detected or could have been detected by the physics review; although, 42/73 (58%) were not actually detected. 45/73 (62%) errors originated in treatment planning, making physics review the first step in the workflow that could detect the error. Two specific physics checks were particularly effective (combined effectiveness of >20%): verifying DRRs (8/73) and verifying isocenter (7/73). Software-based plan checking systems were evaluated and found to have potential effectiveness of 40%. Given current data structures, software implementations of some tests such as isocenter verification check would be challenging. Conclusion: Physics plan review is a key safety measure and can detect majority of reported events. However, a majority of events that potentially could have been detected were NOT detected in this study, indicating the need to improve the performance of physics review

  8. Pre-treatments, characteristics, and biogeochemical dynamics of dissolved organic matter in sediments: A review.

    Science.gov (United States)

    Chen, Meilian; Hur, Jin

    2015-08-01

    Dissolved organic matter (DOM) in sediments, termed here sediment DOM, plays a variety of important roles in global biogeochemical cycling of carbon and nutrients as well as in the fate and transport of xenobiotics. Here we reviewed sediment DOM, including pore waters and water extractable organic matter from inland and coastal sediments, based on recent literature (from 1996 to 2014). Sampling, pre-treatment, and characterization methods for sediment DOM were summarized. The characteristics of sediment DOM have been compared along an inland to coastal ecosystems gradient and also with the overlying DOM in water column to distinguish the unique nature of it. Dissolved organic carbon (DOC) from inland sediment DOM was generally higher than coastal areas, while no notable differences were found for their aromaticity and apparent molecular weight. Fluorescence index (FI) revealed that mixed sources are dominant for inland sediment DOM, but marine end-member prevails for coastal sediment DOM. Many reports showed that sediments operate as a net source of DOC and chromophoric DOM (CDOM) to the water column. Sediment DOM has shown more enrichment of nitrogen- and sulfur-containing compounds in the elemental signature than the overlying DOM. Fluorescent fingerprint investigated by excitation-emission matrix coupled with parallel factor analysis (EEM-PARAFAC) further demonstrated the characteristics of sediment DOM lacking in the photo-oxidized and the intermediate components, which are typically present in the overlying surface water. In addition, the biogeochemical changes in sediment DOM and the subsequent environmental implications were discussed with the focus on the binding and the complexation properties with pollutants. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Implementation of Balanced Scorecard and the Successful of Implementation Strategy: a Review

    OpenAIRE

    Ellitan, Lena; Anatan, Lina

    2008-01-01

    The balanced scorecard is a formal management technique for development, implementation and management of business strategy. It is difficult to ascertain the success of the technique as most of the literature on its implementation is put out by those with a vested interest in its success as a commercial product. Much has been written about barriers to strategy implementation but not specifically to the implementation of balanced scorecard. This paper presents a review of the factors that cont...

  10. A Review of Telehealth Service Implementation Frameworks

    Directory of Open Access Journals (Sweden)

    Liezl Van Dyk

    2014-01-01

    Full Text Available Despite the potential of telehealth services to increase the quality and accessibility of healthcare, the success rate of such services has been disappointing. The purpose of this paper is to find and compare existing frameworks for the implementation of telehealth services that can contribute to the success rate of future endeavors. After a thorough discussion of these frameworks, this paper outlines the development methodologies in terms of theoretical background, methodology and validation. Finally, the common themes and formats are identified for consideration in future implementation. It was confirmed that a holistic implementation approach is needed, which includes technology, organizational structures, change management, economic feasibility, societal impacts, perceptions, user-friendliness, evaluation and evidence, legislation, policy and governance. Furthermore, there is some scope for scientifically rigorous framework development and validation approaches.

  11. Balanced Scorecard implementation in small companies: a literature review

    Directory of Open Access Journals (Sweden)

    Estefanie Argüello-Solano

    2015-12-01

    Full Text Available The Balanced Scorecard (BSC has been used for performance measurement and strategy management for many years. This literature review analyzed studies about the implementation of the BSC in small companies, identifying implementation cases of BSC reported in small enterprises, factors of influence of small enterprises to implement the BSC model, main stages of implementation of the BSC in small enterprises, and future research lines. As a result 23 papers, 12 academic theses and 8 industry reports were identified. Our results shown that small enterprises can take advantage of its specific characteristics to implement the BSC and the implementation process in small companies may differ from the original BSC implementation process. There is little literature on the implementation of the BSC in small businesses, thus it is necessary additional empirical evidence on the effectiveness of CMI implementations in small businesses.

  12. Review of technologies for the pretreatment of retrieved single-shell tank waste at Hanford

    International Nuclear Information System (INIS)

    Gerber, M.A.

    1992-08-01

    The purpose of the study reported here was to identify and evaluate innovative processes that could be used to pretreat mixed waste retrieved from the 149 single-shell tanks (SSTs) on the US Department of Energy's (DOE) Hanford site. The information was collected as part of the Single Shell Tank Waste Treatment project at Pacific Northwest Laboratory (PNL). The project is being conducted for Westinghouse Hanford Company under their SST Disposal Program

  13. A comprehensive review on pre-treatment strategy for lignocellulosic food industry waste: Challenges and opportunities.

    Science.gov (United States)

    Ravindran, Rajeev; Jaiswal, Amit Kumar

    2016-01-01

    Lignocellulose is a generic term used to describe plant biomass. It is the most abundant renewable carbon resource in the world and is mainly composed of lignin, cellulose and hemicelluloses. Most of the food and food processing industry waste are lignocellulosic in nature with a global estimate of up to 1.3 billion tons/year. Lignocellulose, on hydrolysis, releases reducing sugars which is used for the production of bioethanol, biogas, organic acids, enzymes and biosorbents. However, structural conformation, high lignin content and crystalline cellulose hinder its use for value addition. Pre-treatment strategies facilitate the exposure of more cellulose and hemicelluloses for enzymatic hydrolysis. The present article confers about the structure of lignocellulose and how it influences enzymatic degradation emphasising the need for pre-treatments along with a comprehensive analysis and categorisation of the same. Finally, this article concludes with a detailed discussion on microbial/enzymatic inhibitors that arise post pre-treatment and strategies to eliminate them. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Review of automated vehicle technology : policy and implementation implications.

    Science.gov (United States)

    2016-03-14

    The goals of this project were to undergo a systematic review of automated vehicle technologies with a focus on policy : implications, methods of implementation, regulation by states, and developments occurring on legal fronts, ultimately creating a ...

  15. Sustainable multifunctional landscapes: a review to implementation

    CSIR Research Space (South Africa)

    O'Farrell, PJ

    2010-05-01

    Full Text Available 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429..., 36:522-527. 11. Antrop M: Landscape change: plan or chaos? Landscape Urban Plan 1998, 41:155-161. 12. Knight AT, Cowling RM, Campbell BM: An operational model for implementing conservation action. Conserv Biol 2006, 20:408- 419. 13. � Fischer...

  16. Biomass pretreatment

    Science.gov (United States)

    Hennessey, Susan Marie; Friend, Julie; Elander, Richard T; Tucker, III, Melvin P

    2013-05-21

    A method is provided for producing an improved pretreated biomass product for use in saccharification followed by fermentation to produce a target chemical that includes removal of saccharification and or fermentation inhibitors from the pretreated biomass product. Specifically, the pretreated biomass product derived from using the present method has fewer inhibitors of saccharification and/or fermentation without a loss in sugar content.

  17. A review on biomass classification and composition, cofiring issues and pretreatment methods

    Energy Technology Data Exchange (ETDEWEB)

    Jaya Shankar Tumuluru; Shahab Sokhansanj; Christopher T. Wright; Richard D. Boardman

    2011-08-01

    Presently around the globe there is a significant interest in using biomass for power generation as power generation from coal continues to raise environmental concerns. Biomass alone can be used for generation of power which can bring lot of environmental benefits. However the constraints of using biomass alone can include high investments costs for biomass feed systems and also uncertainty in the security of the feedstock supply due to seasonal variations and in most of the countries biomass is dispersed and the infrastructure for biomass supply is not well established. Alternatively cofiring biomass along with coal offer advantages like (a) reducing the issues related to biomass quality and buffers the system when there is insufficient feedstock quantity and (b) costs of adapting the existing coal power plants will be lower than building new systems dedicated only to biomass. However with the above said advantages there exists some technical constrains including low heating and energy density values, low bulk density, lower grindability index, higher moisture and ash content to successfully cofire biomass with coal. In order to successfully cofire biomass with coal, biomass feedstock specifications need to be established to direct pretreatment options that may include increasing the energy density, bulk density, stability during storage and grindability. Impacts on particle transport systems, flame stability, pollutant formation and boiler tube fouling/corrosion must also be minimized by setting feedstock specifications including composition and blend ratios if necessary. Some of these limitations can be overcome by using pretreatment methods. This paper discusses the impact of feedstock pretreatment methods like sizing, baling, pelletizing, briquetting, washing/leaching, torrefaction, torrefaction and pelletization and steam explosion in attainment of optimum feedstock characteristics to successfully cofire biomass with coal.

  18. 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.

  19. 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.

  20. Management implementation plan for a safety analysis and review system

    International Nuclear Information System (INIS)

    Hulburt, D.A.; Berkey, B.D.

    1981-04-01

    The US Department of Energy has issued an Order, DOE 5481.1, which establishes uniform requirements for the preparation and review of Safety Analysis for DOE Operations. The Management Implementation Plan specified herein establishes the administrative procedures and technical requirements for implementing DOE 5481.1 to Operations under the cognizance of the Pittsburgh Energy Technology Center. This Implementation Plan is applicable to all present and future Operations under the cognizance of PETC. The Plan identifies those Operations for which DOE 5481.1 is applicable and those Operations for which no further analysis is required because the initial determination and review has concluded that DOE 5481.1 does not apply

  1. Implementing Prehospital Evidence-Based Guidelines: A Systematic Literature Review.

    Science.gov (United States)

    Fishe, Jennifer N; Crowe, Remle P; Cash, Rebecca E; Nudell, Nikiah G; Martin-Gill, Christian; Richards, Christopher T

    2018-01-19

    As prehospital research advances, more evidence-based guidelines (EBGs) are implemented into emergency medical services (EMS) practice. However, incomplete or suboptimal prehospital EBG implementation may hinder improvement in patient outcomes. To inform future efforts, this study's objective was to review existing evidence pertaining to prehospital EBG implementation methods. This study was a systematic literature review and evaluation following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. PubMed, EMBASE, Scopus, and Google Advanced Search were searched without language or publication date filters for articles addressing prehospital EBG implementation. Conference proceedings, textbooks, and non-English articles were excluded. GRADE was applied to the remaining articles independently by three of five study investigators. Study characteristics and salient findings from the included articles are reported. The systematic literature review identified 1,367 articles, with 41 meeting inclusion criteria. Most articles described prehospital EBG implementation (n = 24, 59%), or implementation barriers (n = 13, 32%). Common study designs were statement documents (n = 12, 29%), retrospective cohort studies (n = 12, 29%), and cross-sectional studies (n = 9, 22%). Using GRADE, evidence quality was rated low (n = 18, 44%), or very low (n = 23, 56%). Salient findings from the articles included: (i) EBG adherence and patient outcomes depend upon successful implementation, (ii) published studies generally lack detailed implementation methods, (iii) EBG implementation takes longer than planned (mostly for EMS education), (iv) EMS systems' heterogeneity affects EBG implementation, and (v) multiple barriers limit successful implementation (e.g., financial constraints, equipment purchasing, coordination with hospitals, and regulatory agencies). This review found no direct evidence for best prehospital EBG implementation practices. There

  2. Automated packing systems: review of industrial implementations

    Science.gov (United States)

    Whelan, Paul F.; Batchelor, Bruce G.

    1993-08-01

    A rich theoretical background to the problems that occur in the automation of material handling can be found in operations research, production engineering, systems engineering and automation, more specifically machine vision, literature. This work has contributed towards the design of intelligent handling systems. This paper will review the application of these automated material handling and packing techniques to industrial problems. The discussion will also highlight the systems integration issues involved in these applications. An outline of one such industrial application, the automated placement of shape templates on to leather hides, is also discussed. The purpose of this system is to arrange shape templates on a leather hide in an efficient manner, so as to minimize the leather waste, before they are automatically cut from the hide. These pieces are used in the furniture and car manufacturing industries for the upholstery of high quality leather chairs and car seats. Currently this type of operation is semi-automated. The paper will outline the problems involved in the full automation of such a procedure.

  3. A review on hydrothermal pre-treatment technologies and environmental profiles of algal biomass processing.

    Science.gov (United States)

    Patel, Bhavish; Guo, Miao; Izadpanah, Arash; Shah, Nilay; Hellgardt, Klaus

    2016-01-01

    The need for efficient and clean biomass conversion technologies has propelled Hydrothermal (HT) processing as a promising treatment option for biofuel production. This manuscript discussed its application for pre-treatment of microalgae biomass to solid (biochar), liquid (biocrude and biodiesel) and gaseous (hydrogen and methane) products via Hydrothermal Carbonisation (HTC), Hydrothermal Liquefaction (HTL) and Supercritical Water Gasification (SCWG) as well as the utility of HT water as an extraction medium and HT Hydrotreatment (HDT) of algal biocrude. In addition, the Solar Energy Retained in Fuel (SERF) using HT technologies is calculated and compared with benchmark biofuel. Lastly, the Life Cycle Assessment (LCA) discusses the limitation of the current state of art as well as introduction to new potential input categories to obtain a detailed environmental profile. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Targeted pre-treatment of hemp bast fibres for optimal performance in biocomposite materials: A review

    DEFF Research Database (Denmark)

    Liu, Ming; Thygesen, Anders; Summerscales, John

    2017-01-01

    . In order to achieve strong NFCs, well separated and cellulose-rich fibres are required. Hemp is taking a center stage in this regard as a source of suitable natural plant cellulose fibres because natural hemp bast fibres are long and inherently possess high strength. Classical field and water retting...... methods have been used for centuries for removal of non-cellulosic components from fibrous plant stems including from hemp, but carries a risk of reducing the mechanical properties of the fibres via damaging the cellulose. For NFCs new targeted fibre pre-treatment methods are needed to selectively...... and effectively remove non-cellulosic components from the plant fibres to produce cellulose rich fibres without introducing any damage to the fibres. A key feature for successful use of natural fibres such as hemp fibres in composite materials is optimal interfacial contact between the fibres and the hydrophobic...

  5. Implementing Montessori Methods for Dementia: A Scoping Review.

    Science.gov (United States)

    Hitzig, Sander L; Sheppard, Christine L

    2017-10-01

    A scoping review was conducted to develop an understanding of Montessori-based programing (MBP) approaches used in dementia care and to identify optimal ways to implement these programs across various settings. Six peer-reviewed databases were searched for relevant abstracts by 2 independent reviewers. Included articles and book chapters were those available in English and published by the end of January 2016. Twenty-three articles and 2 book chapters met the inclusion criteria. Four approaches to implementing MBP were identified: (a) staff assisted (n = 14); (b) intergenerational (n = 5); (c) resident assisted (n = 4); and (d) volunteer or family assisted (n = 2). There is a high degree of variability with how MBP was delivered and no clearly established "best practices" or standardized protocol emerged across approaches except for resident-assisted MBP. The findings from this scoping review provide an initial road map on suggestions for implementing MBP across dementia care settings. Irrespective of implementation approach, there are several pragmatic and logistical issues that need to be taken into account for optimal implementation. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Process and implementation of participatory ergonomic interventions: a systematic review.

    Science.gov (United States)

    van Eerd, Dwayne; Cole, Donald; Irvin, Emma; Mahood, Quenby; Keown, Kiera; Theberge, Nancy; Village, Judy; St Vincent, Marie; Cullen, Kim

    2010-10-01

    Participatory ergonomic (PE) interventions may vary in implementation. A systematic review was done to determine the evidence regarding context, barriers and facilitators to the implementation of participatory ergonomic interventions in workplaces. In total, 17 electronic databases were searched. Data on PE process and implementation were extracted from documents meeting content and quality criteria and synthesised. The search yielded 2151 references. Of these, 190 documents were relevant and 52 met content and quality criteria. Different ergonomic teams were described in the documents as were the type, duration and content of ergonomic training. PE interventions tended to focus on physical and work process changes and report positive impacts. Resources, programme support, ergonomic training, organisational training and communication were the most often noted facilitators or barriers. Successful PE interventions require the right people to be involved, appropriate ergonomic training and clear responsibilities. Addressing key facilitators and barriers such as programme support, resources, and communication is paramount. STATEMENT OF RELEVANCE: A recent systematic review has suggested that PE has some effect on reducing symptoms, lost days of work and claims. Systematic reviews of effectiveness provide practitioners with the desire to implement but do not provide clear information about how. This article reviews the literature on process and implementation of PE.

  7. Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review.

    Science.gov (United States)

    Yoo, Byong Chul; Yeo, Seung-Gu

    2017-03-01

    Approximately 20% of all patients with locally advanced rectal cancer experience pathologically complete responses following neoadjuvant chemoradiotherapy (CRT) and standard surgery. The utility of radical surgery for patients exhibiting good CRT responses has been challenged. Organ-sparing strategies for selected patients exhibiting complete clinical responses include local excision or no immediate surgery. The subjects of this tailored management are patients whose presenting disease corresponds to current indications of neoadjuvant CRT, and their post-CRT tumor response is assessed by clinical and radiological examinations. However, a model predictive of the CRT response, applied before any treatment commenced, would be valuable to facilitate such a personalized approach. This would increase organ preservation, particularly in patients for whom upfront CRT is not generally prescribed. Molecular biomarkers hold the greatest promise for development of a pretreatment predictive model of CRT response. A combination of clinicopathological, radiological, and molecular markers will be necessary to render the model robust. Molecular research will also contribute to the development of drugs that can overcome the radioresistance of rectal tumors. Current treatments for rectal cancer are based on the expected prognosis given the presenting disease extent. In the future, treatment schemes may be modified by including the predicted CRT response evaluated at presentation.

  8. The implementation and discussion on review of periodic safety reviews (PSRs) for research reactors in China

    International Nuclear Information System (INIS)

    Gao Quanyuan

    2011-01-01

    The overview of regulations with which the review of PSRs for research reactors shall comply, the implementation of the review of PSRs for research reactors in China and its effects, the discussion on several issues about PSRs for research reactors and its review, and suggestions on reinforcing the PSRs for research reactors in China are concerned. (author)

  9. LEAN THINKING IN HEALTHCARE: REVIEW OF IMPLEMENTATION RESULTS

    Directory of Open Access Journals (Sweden)

    Marija Kovacevic

    2016-03-01

    Full Text Available For over decade, automotive industry originated lean concept has been successfully implemented in healthcare systems as a management method and philosophy with main focus on elimination of all types of wastes and looses in all tasks and processes so that time, materials, resources and medical procedures could be realized as effectively as it is possible. As main result lean concept implementation ensured to healthcare organizations to focus on their main core function and dedicate more time and efforts to patients without additional costs for them or healthcare system. However, lean implementation in healthcare could be much more difficult than in standard industrial environment and there are significant number of examples of lean in healthcare projects that failed to gain any measurable results and sustainable benefits from it. This paper presents review of some of the most successful implementations of lean tools and principles in healthcare organizations.

  10. Standard Review Plan Update and Development Program. Implementing Procedures Document

    Energy Technology Data Exchange (ETDEWEB)

    1992-05-01

    This implementing procedures document (IPD) was prepared for use in implementing tasks under the standard review plan update and development program (SRP-UDP). The IPD provides comprehensive guidance and detailed procedures for SRP-UDP tasks. The IPD is mandatory for contractors performing work for the SRP-UDP. It is guidance for the staff. At the completion of the SRP-UDP, the IPD will be revised (to remove the UDP aspects) and will replace NRR Office Letter No. 800 as long-term maintenance procedures.

  11. Implementing Statewide Severe Maternal Morbidity Review: The Illinois Experience.

    Science.gov (United States)

    Koch, Abigail R; Roesch, Pamela T; Garland, Caitlin E; Geller, Stacie E

    2018-03-07

    Severe maternal morbidity (SMM) rates in the United States more than doubled between 1998 and 2010. Advanced maternal age and chronic comorbidities do not completely explain the increase in SMM or how to effectively address it. The Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists have called for facility-level multidisciplinary review of SMM for potential preventability and have issued implementation guidelines. Within Illinois, SMM was identified as any intensive or critical care unit admission and/or 4 or more units of packed red blood cells transfused at any time from conception through 42 days postpartum. All cases meeting this definition were counted during statewide surveillance. Cases were selected for review on the basis of their potential to yield insights into factors contributing to preventable SMM or best practices preventing further morbidity or death. If the SMM review committee deemed a case potentially preventable, it identified specific factors associated with missed opportunities and made actionable recommendations for quality improvement. Approximately 1100 cases of SMM were identified from July 1, 2016, to June 30, 2017, yielding a rate of 76 SMM cases per 10 000 pregnancies. Reviews were conducted on 142 SMM cases. Most SMM cases occurred during delivery hospitalization and more than half were delivered by cesarean section. Hemorrhage was the primary cause of SMM (>50% of the cases). Facility-level SMM review was feasible and acceptable in statewide implementation. States that are planning SMM reviews across obstetric facilities should permit ample time for translation of recommendations to practice. Although continued maternal mortality reviews are valuable, they are not sufficient to address the increasing rates of SMM and maternal death. In-depth multidisciplinary review offers the potential to identify factors associated with SMM and interventions to prevent women from moving along the

  12. Standard Review Plan Maintenance Program implementing procedures document

    International Nuclear Information System (INIS)

    1996-11-01

    The implementing Procedures Document (IPD) was developed by the Inspection Program Projects Branch, Office of Nuclear Reactor Regulation, with assistance from Pacific Northwest National Laboratory, for the Standard Review Plan Maintenance Program (SRP-MP). The SRP-MP was established to maintain the Standard Review Plan (SRP) on an on-going basis. The IPD provides guidance, including an overall approach and procedures, for SRP-MP tasks. The objective of the IPD is to ensure that modifications to SRP need to reflect current NRC requirements and guidance are identified and that a consistent methodology is used to develop and revise SRP sections

  13. Real-Time Pretreatment Review Limits Unacceptable Deviations on a Cooperative Group Radiation Therapy Technique Trial: Quality Assurance Results of RTOG 0933

    International Nuclear Information System (INIS)

    Gondi, Vinai; Cui, Yunfeng; Mehta, Minesh P.; Manfredi, Denise; Xiao, Ying; Galvin, James M.; Rowley, Howard; Tome, Wolfgang A.

    2015-01-01

    Purpose: RTOG 0933 was a phase II trial of hippocampal avoidance during whole brain radiation therapy for patients with brain metastases. The results demonstrated improvement in short-term memory decline, as compared with historical control individuals, and preservation of quality of life. Integral to the conduct of this trial were quality assurance processes inclusive of pre-enrollment credentialing and pretreatment centralized review of enrolled patients. Methods and Materials: Before enrolling patients, all treating physicians and sites were required to successfully complete a “dry-run” credentialing test. The treating physicians were credentialed based on accuracy of magnetic resonance imaging–computed tomography image fusion and hippocampal and normal tissue contouring, and the sites were credentialed based on protocol-specified dosimetric criteria. Using the same criteria, pretreatment centralized review of enrolled patients was conducted. Physicians enrolling 3 consecutive patients without unacceptable deviations were permitted to enroll further patients without pretreatment review, although their cases were reviewed after treatment. Results: In all, 113 physicians and 84 sites were credentialed. Eight physicians (6.8%) failed hippocampal contouring on the first attempt; 3 were approved on the second attempt. Eight sites (9.5%) failed intensity modulated radiation therapy planning on the first attempt; all were approved on the second attempt. One hundred thirteen patients were enrolled in RTOG 0933; 100 were analyzable. Eighty-seven cases were reviewed before treatment; 5 (5.7%) violated the eligibility criteria, and 21 (24%) had unacceptable deviations. With feedback, 18 cases were approved on the second attempt and 2 cases on the third attempt. One patient was treated off protocol. Twenty-two cases were reviewed after treatment; 1 (4.5%) violated the eligibility criteria, and 5 (23%) had unacceptable deviations. Conclusions: Although >95% of the

  14. Real-Time Pretreatment Review Limits Unacceptable Deviations on a Cooperative Group Radiation Therapy Technique Trial: Quality Assurance Results of RTOG 0933

    Energy Technology Data Exchange (ETDEWEB)

    Gondi, Vinai, E-mail: vgondi@chicagocancer.org [Cadence Brain Tumor Center and CDH Proton Center, Warrenville, Illinois (United States); University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin (United States); Cui, Yunfeng [Duke University School of Medicine, Durham, North Carolina (United States); Mehta, Minesh P. [University of Maryland School of Medicine, Baltimore, Maryland (United States); Manfredi, Denise [Radiation Therapy Oncology Group—RTQA, Philadelphia, Pennsylvania (United States); Xiao, Ying; Galvin, James M. [Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Rowley, Howard [University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin (United States); Tome, Wolfgang A. [Montefiore Medical Center and Institute for Onco-Physics, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States)

    2015-03-01

    Purpose: RTOG 0933 was a phase II trial of hippocampal avoidance during whole brain radiation therapy for patients with brain metastases. The results demonstrated improvement in short-term memory decline, as compared with historical control individuals, and preservation of quality of life. Integral to the conduct of this trial were quality assurance processes inclusive of pre-enrollment credentialing and pretreatment centralized review of enrolled patients. Methods and Materials: Before enrolling patients, all treating physicians and sites were required to successfully complete a “dry-run” credentialing test. The treating physicians were credentialed based on accuracy of magnetic resonance imaging–computed tomography image fusion and hippocampal and normal tissue contouring, and the sites were credentialed based on protocol-specified dosimetric criteria. Using the same criteria, pretreatment centralized review of enrolled patients was conducted. Physicians enrolling 3 consecutive patients without unacceptable deviations were permitted to enroll further patients without pretreatment review, although their cases were reviewed after treatment. Results: In all, 113 physicians and 84 sites were credentialed. Eight physicians (6.8%) failed hippocampal contouring on the first attempt; 3 were approved on the second attempt. Eight sites (9.5%) failed intensity modulated radiation therapy planning on the first attempt; all were approved on the second attempt. One hundred thirteen patients were enrolled in RTOG 0933; 100 were analyzable. Eighty-seven cases were reviewed before treatment; 5 (5.7%) violated the eligibility criteria, and 21 (24%) had unacceptable deviations. With feedback, 18 cases were approved on the second attempt and 2 cases on the third attempt. One patient was treated off protocol. Twenty-two cases were reviewed after treatment; 1 (4.5%) violated the eligibility criteria, and 5 (23%) had unacceptable deviations. Conclusions: Although >95% of the

  15. Tailoring the Systems Engineering Technical Review Implementation Within Naval Acquisition

    Science.gov (United States)

    2017-09-01

    Chapter 1 is the introductory and background information. Chapter II is an overview of the SETR implementation which includes potential ways in...addition, fewer SETR events should indicate less time and resources spent preparing for unneeded reviews. Additional statistical analysis should be...time as shown in Table 9. Future research should include statistical analysis in this area. Table 8. Categorization of “Other” Survey Responses for

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

    Science.gov (United States)

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

    2017-04-07

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

  17. 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

  18. Critical factors for EIA implementation: literature review and research options.

    Science.gov (United States)

    Zhang, Jie; Kørnøv, Lone; Christensen, Per

    2013-01-15

    After decades of development, the gap between expectations of Environment Impact Assessments (EIA) and their practical performance remains significant. Research has been done to identify the critical factors for an effective implementation of EIA. However, this research, to a large extent, has not been cumulated and analysed comprehensively according to the stages of the EIA process. This paper contributes to the critical review of the literature on EIA implementation and effectiveness by cumulating mainly empirical findings in an implementation theoretical perspective. It focuses on the links between different critical factors and how they relate to different stages in the EIA and thus influence the decision making process. After reviewing 33 refereed journal articles published between 1999 and 2011, we identified 203 notions of critical factors. Of these, 102 related to different stages defined in our comprehensive EIA implementation model, and 101 were identified as general factors related to the whole EIA system. The number of notions of stage factors and general factors is thus about equal. An overlap between stage factors and general factors was found, which demonstrates that critical factors function differently in different cases. The function of the critical factors is complex and it is difficult to determine contingencies and causations. In the sources we examined, there is evidently an imbalance between in-depth empirical research and general knowledge, and the paper offers some suggestions for future research. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. IMPLEMENTATION OF EMPOWERMENT PROGRAM FOR FISHERMAN SOCIETY: A THEORETICAL REVIEW

    Directory of Open Access Journals (Sweden)

    Mh I.

    2018-01-01

    Full Text Available This article aimed at describing and explaining a set of theoretical review on the implementation of human empowerment program for fisherman society. This article was composed using review of related literature method. The result of the review points out some interesting findings: policy is a set of actions that contain some agreements agreed by a person or a group of people to solve certain problem or to achieve certain goal; implementation of a policy involves a long process in implementing the program which should be oriented to achieve the predetermined goals as stated in the policy; fisherman society can be classified into several categories, such as traditional fisherman, subsystem fisherman, pure fisherman, recreational and commercial fisherman; traditional fisherman refers to those who seize resources from the nature using traditional tools, small capital, and relatively simple organization; empowerment is an effort to develop certain capability or potential by driving, motivating and raising society’s awareness upon their own capability to be explored; society empowerment is an attempt to strengthen the dignity of certain society, to get themselves free from poverty or poor quality of life. In another word, empowerment is a program that helps a society to grow their ability and independence.

  20. 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.

  1. What implementation interventions increase cancer screening rates? a systematic review

    Directory of Open Access Journals (Sweden)

    Lent Barbara

    2011-09-01

    Full Text Available Abstract Background Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP change in completed screening tests. Methods Our first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo. Results The update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions. Conclusion The new evidence generally aligns with the evidence and conclusions from the original systematic

  2. Issues and Opportunities on Implementing an Online Faculty Review System.

    Science.gov (United States)

    Erstad, Brian L; Oxnam, Maliaca G; Miller, Tom P; Draugalis, JoLaine R

    2018-04-01

    Intensifying accountability pressures have led to an increased attention to assessments of teaching, but teaching generally represents only a portion of faculty duties. Less attention has been paid to how evaluations of faculty members can be used to gather data on teaching, research, clinical work, and outreach to integrate clinical and academic contributions and fill in information gaps in strategic areas such as technology transfer and commercialization where universities are being pressed to do more. Online reporting systems can enable departments to gather comprehensive data on faculty activities that can be aggregated for accreditation assessments, program reviews, and strategic planning. As detailed in our case study of implementing such a system at a research university, online annual reviews can also be used to publicize faculty achievements, to document departmental achievements, foster interdisciplinary and community collaborations, recognize service contributions (and disparities), and provide a comprehensive baseline for salary and budgetary investments.

  3. Optimization of infobutton design and Implementation: A systematic review.

    Science.gov (United States)

    Teixeira, Miguel; Cook, David A; Heale, Bret S E; Del Fiol, Guilherme

    2017-10-01

    Infobuttons are clinical decision tools embedded in the electronic health record that attempt to link clinical data with context sensitive knowledge resources. We systematically reviewed technical approaches that contribute to improved infobutton design, implementation and functionality. We searched databases including MEDLINE, EMBASE, and the Cochrane Library database from inception to March 1, 2016 for studies describing the use of infobuttons. We selected full review comparative studies, usability studies, and qualitative studies examining infobutton design and implementation. We abstracted usability measures such as user satisfaction, impact, and efficiency, as well as prediction accuracy of infobutton content retrieval algorithms and infobutton adoption/interoperability. We found 82 original research studies on infobuttons. Twelve studies met criteria for detailed abstraction. These studies investigated infobutton interoperability (1 study); tools to help tailor infobutton functionality (1 study); interventions to improve user experience (7 studies); and interventions to improve content retrieval by improving prediction of relevant knowledge resources and information needs (3 studies). In-depth interviews with implementers showed the Health Level Seven (HL7) Infobutton standard to be simple and easy to implement. A usability study demonstrated the feasibility of a tool to help medical librarians tailor infobutton functionality. User experience studies showed that access to resources with which users are familiar increased user satisfaction ratings; and that links to specific subsections of drug monographs increased information seeking efficiency. However, none of the user experience improvements led to increased usage uptake. Recommender systems based on machine learning algorithms outperformed hand-crafted rules in the prediction of relevant resources and clinicians' information needs in a laboratory setting, but no studies were found using these techniques

  4. Prognostic value of the pretreatment neutrophil-to-lymphocyte ratio in cervical cancer: a meta-analysis and systematic review.

    Science.gov (United States)

    Wu, Jiayuan; Chen, Manyu; Liang, Caixia; Su, Wenmei

    2017-02-21

    The prognostic value of pretreatment neutrophil-to-lymphocyte ratio (NLR) in cervical cancer remains controversial. We conducted a meta-analysis based on the data from 13 studies with 3729 patients to evaluate the association between the pretreatment NLR and the clinical outcomes of overall survival and progression-free survival in patients with cervical cancer. The relationship between NLR and clinicopathological parameters was also assessed. Hazard ratio (HR) or odds ratio (OR) with its 95% confidence interval (CI) was used as the effect size estimate. Our analysis indicated that elevated pretreatment NLR was a poor prognostic marker for patients with cervical cancer because it predicted unfavorable overall survival (HR = 1.375, 95% CI: 1.200-1.576) and progression-free survival (HR = 1.646, 95% CI: 1.313-2.065). Increased NLR is also significantly associated with the larger tumor size (OR = 1.780, 95% CI: 1.090-2.908), advanced clinical stage (OR = 2.443, 95% CI: 1.730-3.451), and positive lymph node metastasis (OR = 2.380, 95% CI: 1.775-3.190). By these results, high pretreatment NLR predicted a shorter survival period for patients with cervical cancer, and it could be served as a novel index of prognostic evaluation in patients with cervical cancer.

  5. Steam explosion and its combinatorial pretreatment refining technology of plant biomass to bio-based products.

    Science.gov (United States)

    Chen, Hong-Zhang; Liu, Zhi-Hua

    2015-06-01

    Pretreatment is a key unit operation affecting the refinery efficiency of plant biomass. However, the poor efficiency of pretreatment and the lack of basic theory are the main challenges to the industrial implementation of the plant biomass refinery. The purpose of this work is to review steam explosion and its combinatorial pretreatment as a means of overcoming the intrinsic characteristics of plant biomass, including recalcitrance, heterogeneity, multi-composition, and diversity. The main advantages of the selective use of steam explosion and other combinatorial pretreatments across the diversity of raw materials are introduced. Combinatorial pretreatment integrated with other unit operations is proposed as a means to exploit the high-efficiency production of bio-based products from plant biomass. Finally, several pilot- and demonstration-scale operations of the plant biomass refinery are described. Based on the principle of selective function and structure fractionation, and multi-level and directional composition conversion, an integrated process with the combinatorial pretreatments of steam explosion and other pretreatments as the core should be feasible and conform to the plant biomass refinery concept. Combinatorial pretreatments of steam explosion and other pretreatments should be further exploited based on the type and intrinsic characteristics of the plant biomass used, the bio-based products to be made, and the complementarity of the processes. Copyright © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  6. Chemical and physical pretreatments of fruits and vegetables: Effects on drying characteristics and quality attributes - a comprehensive review.

    Science.gov (United States)

    Deng, Li-Zhen; Mujumdar, Arun S; Zhang, Qian; Yang, Xu-Hai; Wang, Jun; Zheng, Zhi-An; Gao, Zhen-Jiang; Xiao, Hong-Wei

    2017-12-20

    Pretreatment is widely used before drying of agro-products to inactivate enzymes, enhance drying process and improve quality of dried products. In current work, the influence of various pretreatments on drying characteristics and quality attributes of fruits and vegetables is summarized. They include chemical solution (hyperosmotic, alkali, sulfite and acid, etc.) and gas (sulfur dioxide, carbon dioxide and ozone) treatments, thermal blanching (hot water, steam, super heated steam impingement, ohmic and microwave heating, etc), and non-thermal process (ultrasound, freezing, pulsed electric field, and high hydrostatic pressure, etc). Chemical pretreatments effectively enhance drying kinetics, meanwhile, it causes soluble nutrients losing, trigger food safety issues by chemical residual. Conventional hot water blanching has significant effect on inactivating various undesirable enzymatic reactions, destroying microorganisms, and softening the texture, as well as facilitating drying rate. However, it induces undesirable quality of products, e.g., loss of texture, soluble nutrients, pigment and aroma. Novel blanching treatments, such as high-humidity hot air impingement blanching, microwave and ohmic heat blanching can reduce the nutrition loss and are more efficient. Non-thermal technologies can be a better alternative to thermal blanching to overcome these drawbacks, and more fundamental researches are needed for better design and scale up.

  7. Implementation of psychological clinical trials in epilepsy: Review and guide.

    Science.gov (United States)

    Modi, Avani C; Wagner, Janelle; Smith, Aimee W; Kellermann, Tanja S; Michaelis, Rosa

    2017-09-01

    The International League Against Epilepsy (ILAE) Neuropsychiatry commission and United States Institute of Medicine report both identified cognitive and psychological comorbidities as a significant issue for individuals with epilepsy, with rates as high as 60%. However, there is a paucity of evidence-based treatments for many psychological conditions (e.g., learning disorders, cognitive disorders, behavioral disorders). Because of inherent challenges in the implementation of psychological therapy trials and specific considerations for the population with epilepsy, the focus of the current review was to provide guidance and recommendations to conduct psychological trials for individuals with epilepsy. Several key areas will be discussed, including selection of patients, trial design, psychological intervention considerations, outcomes and evaluation of results, publication of trial results, and special issues related to pediatric clinical trials. Rigorously designed psychological therapy trials will set the stage for evidence-based practice in the care of individuals with epilepsy, with the goal of improving seizures, side effects, and HRQOL. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Implementation plan for WRAP Module 1 operational readiness review

    International Nuclear Information System (INIS)

    Irons, L.G.

    1994-01-01

    The Waste Receiving and Processing Module 1 (WRAP 1) will be used to receive, sample, treat, and ship contact-handled (CH) transuranic (TRU), low-level waste (LLW), and low-level mixed waste (LLMW) to storage and disposal sites both on the Hanford site and off-site. The primary mission of WRAP 1 is to characterize and certify CH waste in 55-gallon and 85-gallon drums; and its secondary function is to certify CH waste standard waste boxes (SWB) and boxes of similar size for disposal. The WRAP 1 will provide the capability for examination (including x-ray, visual, and contents sampling), limited treatment, repackaging, and certification of CH suspect-TRU waste in 55-gallon drums retrieved from storage, as well as newly generated CH LLW and CH TRU waste drums. The WRAP 1 will also provide examination (X-ray and visual only) and certification of CH LLW and CH TRU waste in small boxes. The decision to perform an Operational Readiness Review (ORR) was made in accordance with WHC-CM-5-34, Solid Waste Disposal Operations Administration, Section 1.4, Operational Readiness Activities. The ORR will ensure plant and equipment readiness, management and personnel readiness, and management programs readiness for the initial startup of the facility. This implementation plan is provided for defining the conduct of the WHC ORR

  9. Implementing electronic health records in hospitals : a systematic literature review

    NARCIS (Netherlands)

    Boonstra, A.; Versluis, Arie; Vos, J.F.J.

    2014-01-01

    Background: The literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and to identify generally applicable findings and lessons for implementers.

  10. Radiotherapy options for localized prostate cancer based upon pretreatment serum prostate-specific antigen levels and biochemical control: A comprehensive review of the literature

    International Nuclear Information System (INIS)

    Vicini, Frank A.; Horwitz, Eric M.; Kini, Vijay R.; Stromberg, Jannifer S.; Martinez, Alvaro A.

    1998-01-01

    Purpose: To review all the available radiotherapy (RT) literature on localized prostate cancer treatment where serum prostate-specific antigen (PSA) levels were used to both stratify patients and evaluate outcome and determine if any conclusions can be reached regarding an optimal radiotherapeutic management for this disease. Methods and Materials: A MEDLINE search was conducted to obtain all articles in English on prostate cancer treatment employing RT from 1986-1997. Studies were considered eligible for review only if they met all the following criteria: 1) pretreatment PSA values were recorded and grouped for subsequent evaluation, 2) posttreatment PSA values were continuously monitored, 3) definitions of biochemical control were stated, and 4) the median follow-up was given. Results: Of the 246 articles identified, only 20 met the inclusion criteria; 4 using conformal external beam RT, 8 using conventional external beam RT, and 8 using interstitial brachytherapy (4 using a permanent implant alone, 3 combining external beam RT with a permanent implant, and 1 combining a conformal temporary interstitial implant boost with external beam RT). No studies using neutrons (with or without external beam RT) or androgen deprivation (combined with external beam RT) were identified where patients were stratified by pretreatment PSA levels. Results for all therapies were extremely variable with the 3-5-year rates of biochemical control for patients with pretreatment PSA levels ≤4 ng/ml ranging from 48 to 100%, for PSA levels >4 and ≤10 ng/ml ranging from 44 to 90%, for PSA levels >10 and ≤20 ng/ml ranging from 27 to 89%, and for PSA levels >20 ranging from 14 to 89%. The median Gleason score, T-stage, definition of biochemical control, and follow-up were substantially different from series to series. No RT option consistently produced superior results. Conclusions: When data are reviewed from studies using serum PSA levels to stratify patients and to evaluate

  11. Implementation and Validation of PACS Integrated Peer Review for Discrepancy Recording of Radiology Reporting

    NARCIS (Netherlands)

    Olthof, A. W.; van Ooijen, P. M. A.

    The purpose of this work is to demonstrate the possibility of implementation of a PACS-integrated peer review system based on RADPEER T classification providing a step-wise implementation plan utilizing features already present in the standard PACS implementation and without the requirement of

  12. Effective implementation of research into practice: an overview of systematic reviews of the health literature

    OpenAIRE

    Boaz, Annette; Baeza, Juan; Fraser, Alec

    2011-01-01

    Abstract Background 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. Findings 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...

  13. Review on Implementation of 5S in Various Organization

    OpenAIRE

    Vipulkumar C. Patel; Dr. Hemant Thakkar

    2014-01-01

    This paper explains the methods and techniques of 5 S uses to increase the efficiency of all processes in the company. Special emphasis will be given to the implementation of 5S system and elimination of losses in the company. It can be observed that introducing the 5S rules bring the great changes in the company, for example: process improvement by costs‟ reduction, increasing of effectiveness and efficiency in the processes, maintenance and improvement of the machines‟ effic...

  14. Review and Implementation Status of Prior Defense Business Board Recommendations

    Science.gov (United States)

    2007-04-01

    key recommendation to appoint a single Fund Manager – Improved training programs, including eLearning , underway – Capabilities-Based Budgeting allowed...framework focused on et. al. enterprise enhancements, support for the Global War on Terror, progress on implementation of the Quadrennial Defense...Improve Global Mail Operations – MPSA in receipt of all industry responses by Aug 2006 – On December 12th MPSA will brief the Postal Oversight Board on

  15. IMPLEMENTING NDN USING SDN: A REVIEW ON METHODS AND APPLICATIONS

    Directory of Open Access Journals (Sweden)

    Shiva Rowshanrad

    2016-11-01

    Full Text Available In recent years many claims about the limitations of todays’ network architecture, its lack of flexibility and ability to response to ongoing changes and increasing users demands. In this regard, new network architectures are proposed. Software Defined Networking (SDN is one of these new architectures which centralizes the control of network by separating control plane from data plane. This separation leads to intelligence, flexibility and easier control in computer networks. One of the advantages of this framework is the ability to implement and test new protocols and architectures in actual networks without any concern of interruption.Named Data Networking (NDN is another paradigm for future network architecture. With NDN the network becomes aware of the content that is providing, rather than just transferring it among end-points. NDN attracts researchers’ attention and known as the potential future of networking and internet. Providing NDN functionalities over SDN is an important requirement to enable the innovation and optimization of network resources. In this paper first we describe about SDN and NDN, and then we introduce methods for implementing NDN using SDN. We also point out the advantages and applications of implementing NDN over SDN.

  16. 77 FR 7041 - Changes to Implement Inter Partes Review Proceedings

    Science.gov (United States)

    2012-02-10

    ... amended, will provide for estoppel against an inter partes review petitioner, or the real party in... under 35 U.S.C. 317, no estoppel under 35 U.S.C. 315(e), as amended, will attach to the petitioner, or... rule is consistent with 35 U.S.C. 315(e)(1), as amended, which will provide for estoppel arising from a...

  17. 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.

  18. Preparation, review, and approval of implementation plans for nuclear safety requirements

    International Nuclear Information System (INIS)

    1994-10-01

    This standard describes an acceptable method to prepare, review, and approve implementation plans for DOE Nuclear Safety requirements. DOE requirements are identified in DOE Rules, Orders, Notices, Immediate Action Directives, and Manuals

  19. Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update

    Directory of Open Access Journals (Sweden)

    Jamie Ross

    2016-10-01

    Full Text Available Abstract Background There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation. This review provides an update and re-analysis of a systematic review of the e-health implementation literature culminating in a set of accessible and usable recommendations for anyone involved or interested in the implementation of e-health. Methods MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library were searched for studies published between 2009 and 2014. Studies were included if they were systematic reviews of the implementation of e-health. Data from included studies were synthesised using the principles of meta-ethnography, and categorisation of the data was informed by the Consolidated Framework for Implementation Research (CFIR. Results Forty-four reviews mainly from North America and Europe were included. A range of e-health technologies including electronic medical records and clinical decision support systems were represented. Healthcare settings included primary care, secondary care and home care. Factors important for implementation were identified at the levels of the following: the individual e-health technology, the outer setting, the inner setting and the individual health professionals as well as the process of implementation. Conclusion This systematic review of reviews provides a synthesis of the literature that both acknowledges the multi-level complexity of e-health implementation and provides an accessible and useful guide for those

  20. A Review of Implementing ADC in RFID Sensor

    Directory of Open Access Journals (Sweden)

    M. Zurita

    2016-01-01

    Full Text Available The general considerations to design a sensor interface for passive RFID tags are discussed. This way, power and timing constraints imposed by ISO/IEC 15693 and ISO/IEC 14443 standards to HF RFID tags are explored. A generic multisensor interface is proposed and a survey analysis on the most suitable analog-to-digital converters for passive RFID sensing applications is reported. The most appropriate converter type and architecture are suggested. At the end, a specific sensor interface for carbon nanotube gas sensors is proposed and a brief discussion about its implemented circuits and preliminary results is made.

  1. Benefits and implementation of home hemodialysis: A narrative review

    Directory of Open Access Journals (Sweden)

    Ayman Karkar

    2015-01-01

    Full Text Available Home hemodialysis (HD is a modality of renal replacement therapy that can be safely and independently performed at home by end-stage renal disease (ESRD patients. Home HD can be performed at the convenience of the patients on a daily basis, every other day and overnight (nocturnal. Despite the great and many perceived benefits of home HD, including the significant improvements in health outcomes and resource utilization, the adoption of home HD has been limited; lack or inadequate pre-dialysis education and training constitute a major barrier. The lack of self-confidence and/or self-efficacy to manage own therapy, lack of family and/or social support, fear of machine and cannulation of blood access and worries of possible catastrophic events represent other barriers for the implementation of home HD besides inadequate competence and/or expertise in caring for home HD patients among renal care providers (nephrologists, dialysis nurses, educators. A well-studied, planned and prepared and carefully implemented central country program supported by adequate budget can play a positive role in overcoming the challenges to home HD. Healthcare authorities, with the increasingly financial and logistic demands and the relatively higher mortality and morbidity rates of the conventional in-center HD, should tackle home HD as an attractive and cost-effective modality with more freedom, quality of life and improvement of clinical outcomes for the ESRD patients.

  2. A systematic review of instruments that assess the implementation of hospital quality management systems.

    NARCIS (Netherlands)

    Groene, O.; Botje, D.; Suñol, R.; Lopez, M.A.; Wagner, C.

    2013-01-01

    Purpose: Health-care providers invest substantial resources to establish and implement hospital quality management systems. Nevertheless, few tools are available to assess implementation efforts and their effect on quality and safety outcomes. This review aims to (i) identify instruments to assess

  3. 77 FR 24148 - Revision to the Hawaii State Implementation Plan, Minor New Source Review Program

    Science.gov (United States)

    2012-04-23

    ... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA-R09-OAR-2012-0213; FRL-9661-6] Revision to the Hawaii State Implementation Plan, Minor New Source Review Program AGENCY: Environmental Protection Agency... final action to approve revisions to the Hawaii State Implementation Plan (SIP). These revisions would...

  4. Education Policy Implementation: A Literature Review and Proposed Framework. OECD Education Working Papers, No. 162

    Science.gov (United States)

    Viennet, Romane; Pont, Beatriz

    2017-01-01

    This literature review focuses on education policy implementation, its definition, processes and determinants. It aims to clarify what implementing policies involve in complex education systems to support policy work, building on the literature and country examples. An introduction delves into the reasons behind the need to update the concept of…

  5. Pressure ulcer prevention and its implementation in practise : a literature review

    OpenAIRE

    Loikkanen, Rosa; Tammi, Mariam

    2016-01-01

    This thesis is a literature review on pressure ulcer guidelines implementation. The aim is to produce information about the implementation of evidence-based pressure ulcer prevention guidelines, describe the challenges met, and identify measures which healthcare organizations can take in order to ease the implementation process. The subject is timely as the revision of Finnish pressure ulcer prevention guidelines took place on October 2015 by the nursing research foundation HOTUS, based on th...

  6. Book Review: Mentoring and coaching: Tools and techniques for implementation

    Directory of Open Access Journals (Sweden)

    Fiona Donald

    2007-10-01

    Full Text Available Mentoring and coaching: Tools and techniques for implementation. Meyer, M., & Fourie, L. (2004. Randburg: Knowres Publishing. This book is aimed at providing practical guidelines for people involved in mentoring and coaching. Given the need for skills development, employee involvement and change management in South Africa, mentoring and coaching offer a method of transforming the way in which organisations train their employees, manage performance and accelerate employee career development. Further, it can be used to transfer knowledge from people with the most experience to those with less knowledge. As a result it can be a useful tool in achieving employment equity. Written by South African authors, the book is tailored to organisations in this environment where issues such as diversity place additional challenges for mentoring and coaching processes. The book is easy to read and includes a number of issues to consider as well as check lists in each of its ten chapters.

  7. An Evaluative Review of School Accreditation Implementation Program in Indonesian Contexts

    Science.gov (United States)

    Haryati, Sri

    2014-01-01

    This paper critically reviews and evaluates the implementation of School Accreditation Program for the period of 2013 with a particular reference to Central Java Schools, consisting of Kindergarten (TK) Elementary School (SD), Junior High School (SMP) and Senior High School (SMA) (Note 1). The aim of the review is to see to what extent they can…

  8. Implementing digital skills training in care homes: a literature review.

    Science.gov (United States)

    Wild, Deidre; Kydd, Angela; Szczepura, Ala

    2016-05-01

    This article is the first of a two-part series that informs and describes digital skills training using a dedicated console computer provided for staff and residents in a care home setting. This was part of a programme of culture change in a large care home with nursing in Glasgow, Scotland. The literature review shows that over the past decade there has been a gradual increase in the use of digital technology by staff and older people in community settings including care homes. Policy from the European Commission presents a persuasive argument for the advancement of technology-enabled care to counter the future impact of an increased number of people of advanced age on finite health and social care resources. The psychosocial and environmental issues that inhibit or enhance the acquisition of digital skills in care homes are considered and include the identification of exemplar schemes and the support involved.

  9. Pretreatment Engineering Platform Phase 1 Final Test Report

    International Nuclear Information System (INIS)

    Kurath, Dean E.; Hanson, Brady D.; Minette, Michael J.; Baldwin, David L.; Rapko, Brian M.; Mahoney, Lenna A.; Schonewill, Philip P.; Daniel, Richard C.; Eslinger, Paul W.; Huckaby, James L.; Billing, Justin M.; Sundar, Parameshwaran S.; Josephson, Gary B.; Toth, James J.; Yokuda, Satoru T.; Baer, Ellen B.K.; Barnes, Steven M.; Golovich, Elizabeth C.; Rassat, Scot D.; Brown, Christopher F.; Geeting, John G.H.; Sevigny, Gary J.; Casella, Amanda J.; Bontha, Jagannadha R.; Aaberg, Rosanne L.; Aker, Pamela M.; Guzman-Leong, Consuelo E.; Kimura, Marcia L.; Sundaram, S.K.; Pires, Richard P.; Wells, Beric E.; Bredt, Ofelia P.

    2009-01-01

    Pacific Northwest National Laboratory (PNNL) was tasked by Bechtel National Inc. (BNI) on the River Protection Project, Hanford Tank Waste Treatment and Immobilization Plant (RPP-WTP) project to conduct testing to demonstrate the performance of the WTP Pretreatment Facility (PTF) leaching and ultrafiltration processes at an engineering-scale. In addition to the demonstration, the testing was to address specific technical issues identified in Issue Response Plan for Implementation of External Flowsheet Review Team (EFRT) Recommendations - M12, Undemonstrated Leaching Processes. Testing was conducted in a 1/4.5-scale mock-up of the PTF ultrafiltration system, the Pretreatment Engineering Platform (PEP). Parallel laboratory testing was conducted in various PNNL laboratories to allow direct comparison of process performance at an engineering-scale and a laboratory-scale. This report presents and discusses the results of those tests.

  10. Pretreatment Engineering Platform Phase 1 Final Test Report

    Energy Technology Data Exchange (ETDEWEB)

    Kurath, Dean E.; Hanson, Brady D.; Minette, Michael J.; Baldwin, David L.; Rapko, Brian M.; Mahoney, Lenna A.; Schonewill, Philip P.; Daniel, Richard C.; Eslinger, Paul W.; Huckaby, James L.; Billing, Justin M.; Sundar, Parameshwaran S.; Josephson, Gary B.; Toth, James J.; Yokuda, Satoru T.; Baer, Ellen BK; Barnes, Steven M.; Golovich, Elizabeth C.; Rassat, Scot D.; Brown, Christopher F.; Geeting, John GH; Sevigny, Gary J.; Casella, Amanda J.; Bontha, Jagannadha R.; Aaberg, Rosanne L.; Aker, Pamela M.; Guzman-Leong, Consuelo E.; Kimura, Marcia L.; Sundaram, S. K.; Pires, Richard P.; Wells, Beric E.; Bredt, Ofelia P.

    2009-12-23

    Pacific Northwest National Laboratory (PNNL) was tasked by Bechtel National Inc. (BNI) on the River Protection Project, Hanford Tank Waste Treatment and Immobilization Plant (RPP-WTP) project to conduct testing to demonstrate the performance of the WTP Pretreatment Facility (PTF) leaching and ultrafiltration processes at an engineering-scale. In addition to the demonstration, the testing was to address specific technical issues identified in Issue Response Plan for Implementation of External Flowsheet Review Team (EFRT) Recommendations - M12, Undemonstrated Leaching Processes.( ) Testing was conducted in a 1/4.5-scale mock-up of the PTF ultrafiltration system, the Pretreatment Engineering Platform (PEP). Parallel laboratory testing was conducted in various PNNL laboratories to allow direct comparison of process performance at an engineering-scale and a laboratory-scale. This report presents and discusses the results of those tests.

  11. A review of the National pharmacovigilance system in Malta - implementing and operating a pharmacovigilance management system.

    Science.gov (United States)

    Tanti, Amy; Micallef, Benjamin; Serracino-Inglott, Anthony; Borg, John-Joseph

    2017-01-01

    Regulatory authorities have a legal mandate to implement and maintain a Pharmacovigilance System designed to monitor the safety of authorised medicinal products and detect any change to their risk-benefit balance. Areas covered: This review maps the implementation of pharmacovigilance activities in Malta since accession in the EU in mid 2004 and discusses the challenges the Maltese Regulator encountered while setting up adequate and effective systems to fulfil its legal mandate. Areas reviewed are those around ADR reporting, promotion and safety communications including rapid alerts and recalls, direct healthcare professional communications, risk minimisation measures and safety circulars and quality systems. Expert opinion: Within a ten year period, 3 EU directives on pharmacovigilance were implemented by our agency. Despite limitations to resources, based on a prioritised implementation, the legislation provisions are now fully operational with a good level of sustainability. Lessons learnt from this process are discussed in this review. The coming years will involve strengthening and consolidation of existing processes.

  12. Biofuel implementation agendas. A review of Task 39 Member Countries

    International Nuclear Information System (INIS)

    Van Neeft, J.; Van Thuijl, E.; Wismeijer, R.; Mabee, W.

    2007-01-01

    Biofuels for use in the transportation sector have been produced on a significant scale since the 1970's, using a variety of technologies. The biofuels widely available today are predominantly sugar- and starch-based bioethanol, and oilseed- and waste oil-based biodiesel, although new technologies under development may allow the use of lignocellulosic feedstocks. Measures to promote the use of biofuels include renewable fuel mandates, tax incentives, and direct funding for capital projects or fleet upgrades. This paper provides a review of the policies behind the successful establishment of the biofuel industry in countries around the world. The impact of direct funding programs and excise tax exemptions are examined using the United States as a case study. It is found that the success of five major bioethanol producing states (Illinois, Iowa, Nebraska, South Dakota, and Minnesota) is closely related to the presence of funding designed to support the industry in its start-up phase. The study concludes that successful policy interventions can take many forms, but that success is equally dependent upon external factors which include biomass availability, an active industry, and competitive energy prices

  13. The Role and Impact of Critical Review as Perceived by an Implementer

    International Nuclear Information System (INIS)

    Thegerstroem, Claes; Laarouchi Engstroem, Saida; Olsson, Olle

    2006-01-01

    The quality and success of a nuclear waste management programme is based on the amalgamation of the interests of a wide number of stakeholders, integration of many different scientific disciplines, and merging of scientific, technical, ethical and social issues. In this process, a broad and structured review of all aspects of the program is necessary and we find the process with submission and review by stakeholders, regulators and government every third year very useful. High-quality critical review of is always a real benefit to the implementer - as it gives the implementer the possibility to see where improvements can be made. However, a close dialogue and a dynamic reviewing process, where questions are raised throughout the process, are essential in order to optimize the quality of the final applications. Naturally, critical review should not be used for pushing specific general research interests or issues that belong to the political arena rather than nuclear waste management itself. Moreover, critical review provides additional insight and promotes confidence by the general public. However, sometimes the public might be confused and have difficulties in judging the importance and relevance of critical comments. The implementer and regulatory authorities have a special duty to provide an overall perspective of safety-related issues. Even if critical review is valuable, the implementer can not only rely on this. The implementers' own internal quality assurance practise, internal review process as well as its overall safety culture is all crucial. Indeed, a successful management of radio-active waste, including operational aspects as well as siting process, starts with the implementers' own wish to perform state-of-the art-work both in terms of technology and overall approach

  14. The Role and Impact of Critical Review as Perceived by an Implementer

    Energy Technology Data Exchange (ETDEWEB)

    Thegerstroem, Claes; Laarouchi Engstroem, Saida; Olsson, Olle [Swedish Nuclear Fuel and Waste Management Co, Stockholm (Sweden)

    2006-09-15

    The quality and success of a nuclear waste management programme is based on the amalgamation of the interests of a wide number of stakeholders, integration of many different scientific disciplines, and merging of scientific, technical, ethical and social issues. In this process, a broad and structured review of all aspects of the program is necessary and we find the process with submission and review by stakeholders, regulators and government every third year very useful. High-quality critical review of is always a real benefit to the implementer - as it gives the implementer the possibility to see where improvements can be made. However, a close dialogue and a dynamic reviewing process, where questions are raised throughout the process, are essential in order to optimize the quality of the final applications. Naturally, critical review should not be used for pushing specific general research interests or issues that belong to the political arena rather than nuclear waste management itself. Moreover, critical review provides additional insight and promotes confidence by the general public. However, sometimes the public might be confused and have difficulties in judging the importance and relevance of critical comments. The implementer and regulatory authorities have a special duty to provide an overall perspective of safety-related issues. Even if critical review is valuable, the implementer can not only rely on this. The implementers' own internal quality assurance practise, internal review process as well as its overall safety culture is all crucial. Indeed, a successful management of radio-active waste, including operational aspects as well as siting process, starts with the implementers' own wish to perform state-of-the art-work both in terms of technology and overall approach.

  15. Innovative pretreatment strategies for biogas production.

    Science.gov (United States)

    Patinvoh, Regina J; Osadolor, Osagie A; Chandolias, Konstantinos; Sárvári Horváth, Ilona; Taherzadeh, Mohammad J

    2017-01-01

    Biogas or biomethane is traditionally produced via anaerobic digestion, or recently by thermochemical or a combination of thermochemical and biological processes via syngas (CO and H 2 ) fermentation. However, many of the feedstocks have recalcitrant structure and are difficult to digest (e.g., lignocelluloses or keratins), or they have toxic compounds (such as fruit flavors or high ammonia content), or not digestible at all (e.g., plastics). To overcome these challenges, innovative strategies for enhanced and economically favorable biogas production were proposed in this review. The strategies considered are commonly known physical pretreatment, rapid decompression, autohydrolysis, acid- or alkali pretreatments, solvents (e.g. for lignin or cellulose) pretreatments or leaching, supercritical, oxidative or biological pretreatments, as well as combined gasification and fermentation, integrated biogas production and pretreatment, innovative biogas digester design, co-digestion, and bio-augmentation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Harnessing implementation science to improve care quality and patient safety: a systematic review of targeted literature.

    Science.gov (United States)

    Braithwaite, Jeffrey; Marks, Danielle; Taylor, Natalie

    2014-06-01

    Getting greater levels of evidence into practice is a key problem for health systems, compounded by the volume of research produced. Implementation science aims to improve the adoption and spread of research evidence. A linked problem is how to enhance quality of care and patient safety based on evidence when care settings are complex adaptive systems. Our research question was: according to the implementation science literature, which common implementation factors are associated with improving the quality and safety of care for patients? We conducted a targeted search of key journals to examine implementation science in the quality and safety domain applying PRISMA procedures. Fifty-seven out of 466 references retrieved were considered relevant following the application of exclusion criteria. Included articles were subjected to content analysis. Three reviewers extracted and documented key characteristics of the papers. Grounded theory was used to distil key features of the literature to derive emergent success factors. Eight success factors of implementation emerged: preparing for change, capacity for implementation-people, capacity for implementation-setting, types of implementation, resources, leverage, desirable implementation enabling features, and sustainability. Obstacles in implementation are the mirror image of these: for example, when people fail to prepare, have insufficient capacity for implementation or when the setting is resistant to change, then care quality is at risk, and patient safety can be compromised. This review of key studies in the quality and safety literature discusses the current state-of-play of implementation science applied to these domains. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  17. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.

    Science.gov (United States)

    Francke, Anneke L; Smit, Marieke C; de Veer, Anke J E; Mistiaen, Patriek

    2008-09-12

    Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1) screening on the basis of references and abstracts and (2) screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all) of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals - e.g., awareness of the existence of the guideline and familiarity with its content - likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for instance, co-morbidity reduces the chance that guidelines

  18. Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review

    Directory of Open Access Journals (Sweden)

    de Veer Anke JE

    2008-09-01

    Full Text Available Abstract Background Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. Methods A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1 screening on the basis of references and abstracts and (2 screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Results Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals – e.g., awareness of the existence of the guideline and familiarity with its content – likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for

  19. Implementation in nursing and midwifery. A scoping review / Implementationsprojekte in der Pflege und Hebammenarbeit. Scoping review

    Directory of Open Access Journals (Sweden)

    Loytved Christine Anna Lieselotte

    2017-09-01

    Full Text Available Evidence-based expertise in nursing and midwifery is growing but is not automatically turned into practice. The importance of implementation research is therefore increasing. International research results on factors facilitating implementation have not yet been sufficiently presented.

  20. Facilitators and barriers of implementing and delivering social prescribing services: a systematic review.

    Science.gov (United States)

    Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch

    2018-02-07

    Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers

  1. A review of simple multiple criteria decision making analytic procedures which are implementable on spreadsheet packages

    Directory of Open Access Journals (Sweden)

    T.J. Stewart

    2003-12-01

    Full Text Available A number of modern multi-criteria decision making aids for the discrete choice problem, are reviewed, with particular emphasis on those which can be implemented on standard commercial spreadsheet packages. Three broad classes of procedures are discussed, namely the analytic hierarchy process, reference point methods, and outranking methods. The broad principles are summarised in a consistent framework, and on a spreadsheet. LOTUS spreadsheets implementing these are available from the author.

  2. Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions.

    Science.gov (United States)

    Gagnon, Marie-Pierre; Nsangou, Édith-Romy; Payne-Gagnon, Julie; Grenier, Sonya; Sicotte, Claude

    2014-01-01

    We conducted a systematic review identifying users groups' perceptions of barriers and facilitators to implementing electronic prescription (e-prescribing) in primary care. We included studies following these criteria: presence of an empirical design, focus on the users' experience of e-prescribing implementation, conducted in primary care, and providing data on barriers and facilitators to e-prescribing implementation. We used the Donabedian logical model of healthcare quality (adapted by Barber et al) to analyze our findings. We found 34 publications (related to 28 individual studies) eligible to be included in this review. These studies identified a total of 594 elements as barriers or facilitators to e-prescribing implementation. Most user groups perceived that e-prescribing was facilitated by design and technical concerns, interoperability, content appropriate for the users, attitude towards e-prescribing, productivity, and available resources. This review highlights the importance of technical and organizational support for the successful implementation of e-prescribing systems. It also shows that the same factor can be seen as a barrier or a facilitator depending on the project's own circumstances. Moreover, a factor can change in nature, from a barrier to a facilitator and vice versa, in the process of e-prescribing implementation. This review summarizes current knowledge on factors related to e-prescribing implementation in primary care that could support decision makers in their design of effective implementation strategies. Finally, future studies should emphasize on the perceptions of other user groups, such as pharmacists, managers, vendors, and patients, who remain neglected in the literature.

  3. Methods for pretreating biomass

    Science.gov (United States)

    Balan, Venkatesh; Dale, Bruce E; Chundawat, Shishir; Sousa, Leonardo

    2017-05-09

    A method for pretreating biomass is provided, which includes, in a reactor, allowing gaseous ammonia to condense on the biomass and react with water present in the biomass to produce pretreated biomass, wherein reactivity of polysaccharides in the biomass is increased during subsequent biological conversion as compared to the reactivity of polysaccharides in biomass which has not been pretreated. A method for pretreating biomass with a liquid ammonia and recovering the liquid ammonia is also provided. Related systems which include a biochemical or biofuel production facility are also disclosed.

  4. [Lessons learned in the implementation of interoperable National Health Information Systems: a systematic review].

    Science.gov (United States)

    Ovies-Bernal, Diana Paola; Agudelo-Londoño, Sandra M

    2014-01-01

    Identify shared criteria used throughout the world in the implementation of interoperable National Health Information Systems (NHIS) and provide validated scientific information on the dimensions affecting interoperability. This systematic review sought to identify primary articles on the implementation of interoperable NHIS published in scientific journals in English, Portuguese, or Spanish between 1990 and 2011 through a search of eight databases of electronic journals in the health sciences and informatics: MEDLINE (PubMed), Proquest, Ovid, EBSCO, MD Consult, Virtual Health Library, Metapress, and SciELO. The full texts of the articles were reviewed, and those that focused on technical computer aspects or on normative issues were excluded, as well as those that did not meet the quality criteria for systematic reviews of interventions. Of 291 studies found and reviewed, only five met the inclusion criteria. These articles reported on the process of implementing an interoperable NHIS in Brazil, China, the United States, Turkey, and the Semiautonomous Region of Zanzíbar, respectively. Five common basic criteria affecting implementation of the NHIS were identified: standards in place to govern the process, availability of trained human talent, financial and structural constraints, definition of standards, and assurance that the information is secure. Four dimensions affecting interoperability were defined: technical, semantic, legal, and organizational. The criteria identified have to be adapted to the actual situation in each country and a proactive approach should be used to ensure that implementation of the interoperable NHIS is strategic, simple, and reliable.

  5. A systematic review of instruments that assess the implementation of hospital quality management systems.

    Science.gov (United States)

    Groene, Oliver; Botje, Daan; Suñol, Rosa; Lopez, Maria Andrée; Wagner, Cordula

    2013-10-01

    Health-care providers invest substantial resources to establish and implement hospital quality management systems. Nevertheless, few tools are available to assess implementation efforts and their effect on quality and safety outcomes. This review aims to (i) identify instruments to assess the implementation of hospital quality management systems, (ii) describe their measurement properties and (iii) assess the effects of quality management on quality improvement and quality of care outcomes. We performed a systematic literature search from 1990 to 2011 in PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science. In addition, we used snowball strategies, screened the reference lists of eligible papers, reviewed grey literature and contacted experts in the field. and data extraction Two reviewers screened eligible papers based on pre-defined inclusion and exclusion criteria and all authors extracted data. Eligible papers are described in terms of general characteristics (settings, type and level of respondents, mode of data collection), methodological properties (sampling strategy, item derivation, conceptualization of quality management, assessment of reliability and validity, scoring) and application/implementation (accounting for context, organizational adaptations, sensitivity to change, deployment and effect size). Eighteen papers were deemed eligible for inclusion. While some common domains emerged in measurement conceptualization, substantial differences in scope persist. The instruments' measurement properties were insufficiently described and only few instruments assessed links between the implementation of quality management systems (QMS) and improvement strategies or outcomes. There is currently no well-established measure to assess the implementation and effectiveness of quality management systems. Future research should address this gap.

  6. 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.

  7. Facilitators and barriers of implementing the chronic care model in primary care: a systematic review.

    Science.gov (United States)

    Kadu, Mudathira K; Stolee, Paul

    2015-02-06

    The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation. This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation. This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs. These findings highlight the importance of assessing organizational capacity and needs prior

  8. The Use of Systematic Reviews and Reporting Guidelines to Advance the Implementation of the 3Rs

    Science.gov (United States)

    Avey, Marc T; Fenwick, Nicole; Griffin, Gilly

    2015-01-01

    In 1959, Russell and Burch published The Principles of Humane Experimental Technique, which included concrete advice on factors that they considered would govern progress in the implementation of these principles (enunciated as the 3Rs [Replacement, Reduction, and Refinement in animal-based studies]). One challenge to the implementation of the 3Rs was identified as information retrieval. Here, we further explore this challenge—the need for ‘research on research’—and the role that systematic reviews and reporting guidelines can play in implementation of the 3Rs. First, we examine the 2-fold nature of the challenge of information retrieval: 1) the identification of relevant publications spread throughout a large population of nonrelevant publications and 2) the incomplete reporting of relevant details within those publications. Second, we evaluate how systematic reviews and reporting guidelines can be used generally to address this challenge. Third, we assess the explicit reporting of the 3Rs in a cohort of preclinical animal systematic reviews. Our results show that Reduction methods are the most commonly reported by authors of systematic reviews but that, in general, reporting on how findings relate to the 3Rs is limited at best. Although systematic reviews are excellent tools for resolving the challenge of information retrieval, their utility for making progress in implementation of the 3Rs may be limited unless authors improve their reporting of these principles. PMID:25836961

  9. Techniques and practices for pretreatment of low and intermediate level solid and liquid radioactive wastes

    International Nuclear Information System (INIS)

    1987-01-01

    An overall waste management strategy generally includes several components: pretreatment, treatment, conditioning, transport and disposal. Benefits of pretreatment are improved safety, lower radiation exposures and significantly lower costs in subsequent waste management operations. This publication reviews current practices in the pretreatment of wastes in different countries and may assist the specialist in selection of appropriate pretreatment techniques

  10. A literature review for large-scale health information system project planning, implementation and evaluation.

    Science.gov (United States)

    Sligo, Judith; Gauld, Robin; Roberts, Vaughan; Villa, Luis

    2017-01-01

    Information technology is perceived as a potential panacea for healthcare organisations to manage pressure to improve services in the face of increased demand. However, the implementation and evaluation of health information systems (HIS) is plagued with problems and implementation shortcomings and failures are rife. HIS implementation is complex and relies on organisational, structural, technological, and human factors to be successful. It also requires reflective, nuanced, multidimensional evaluation to provide ongoing feedback to ensure success. This article provides a comprehensive review of the literature about evaluating and implementing HIS, detailing the challenges and recommendations for both evaluators and healthcare organisations. The factors that inhibit or promote successful HIS implementation are identified and effective evaluation strategies are described with the goal of informing teams evaluating complex HIS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. 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.

  12. Implementation of an electronic laboratory notebook to accelerate data review in bioanalysis.

    Science.gov (United States)

    Shoup, Ronald E; Beato, Brian D; Pisek, April; White, Jessica; Branstrator, Laurel; Bousum, Abby; Roach, Jasmine; Grever, Tim

    2013-07-01

    Electronic laboratory notebooks increase opportunities for collaboration and information exchange when compared with paper records. Depending on the degree of implementation, a laboratory- or enterprise-wide system can unify the collection, review and dissemination of data to improve laboratory efficiency and productivity. The advantages of an electronic laboratory notebook for speeding data review in bioanalysis are discussed, through the use of validated templates and organizational constructs to block errors in real-time and reduce manual audit tasks.

  13. Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators.

    Science.gov (United States)

    Vlaeyen, Ellen; Stas, Joke; Leysens, Greet; Van der Elst, Elisa; Janssens, Elise; Dejaeger, Eddy; Dobbels, Fabienne; Milisen, Koen

    2017-05-01

    To identify the barriers and facilitators for fall prevention implementation in residential care facilities. Systematic review. Review registration number on PROSPERO: CRD42013004655. Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles. This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified. We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers. Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills

  14. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review.

    Science.gov (United States)

    Semenic, Sonia; Childerhose, Janet E; Lauzière, Julie; Groleau, Danielle

    2012-08-01

    Despite growing evidence for the positive impact of the Baby-Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby-Friendly practices that can be used to improve uptake of the BFI at the local or country levels. This integrative review aimed to identify and synthesize information on the barriers, facilitators, and recommendations related to the BFI from the international, peer-reviewed literature. Thirteen databases were searched using the keywords Baby Friendly, Baby-Friendly Hospital Initiative, BFI, BFHI, Ten Steps, implementation, adoption, barriers, facilitators, and their combinations. A total of 45 English-language articles from 16 different countries met the inclusion criteria for the review. Data analysis was guided by Cooper's five stages of integrative research review. Using a multiple intervention program framework, findings were categorized into sociopolitical, organizational-level, and individual-level barriers and facilitators to implementing the BFI, as well as intra-, inter-, and extraorganizational recommendations for strengthening BFI implementation. A wide variety of obstacles and potential solutions to BFI implementation were identified. Findings suggest some priority issues to address when pursuing Baby-Friendly designation, including the endorsements of both local administrators and governmental policy makers, effective leadership of the practice change process, health care worker training, the marketing influence of formula companies, and integrating hospital and community health services. Framing the BFI as a complex, multilevel, evidence-based change process and using context-focused research implementation models to guide BFI implementation efforts may help identify effective strategies for promoting wider adoption of the BFI in health services.

  15. Do implementation strategies increase adherence to pain assessment in hospitals? A systematic review

    NARCIS (Netherlands)

    Ista, E.; Dijk, M. van; Achterberg, T. van

    2013-01-01

    OBJECTIVES: Pain assessment and reassessment is an essential part of the treatment of hospitalised patients and must be integrated in pain management protocols. Yet nurses' adherence to pain assessment recommendations is problematic. We sought to review the comparative evidence for implementation

  16. Results of Review of the Implementation of Public Law 98-94 for Air Force Retirees

    National Research Council Canada - National Science Library

    1993-01-01

    ... of P.L. 98-94 was not fully implemented in a timely manner. We also believe there was no intentional disregard of the law by management at the Defense Finance and Accounting Service-Denver Center. Scope of Review...

  17. 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…

  18. Implementation of Blended Learning in Higher Learning Institutions: A Review of the Literature

    Science.gov (United States)

    Ma'arop, Amrien Hamila; Embi, Mohamed Amin

    2016-01-01

    While many educational premises including higher learning institutions favor blended learning over traditional approach and merely online learning, some academicians are still apprehensive about teaching in blended learning. The aim of this review is to synthesize the available evidence in the literature on challenges faced in implementing blended…

  19. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.

    NARCIS (Netherlands)

    Francke, A.L.; Smit, M.C.; Veer, A.J.E. de; Mistiaen, P.

    2008-01-01

    BACKGROUND: Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect

  20. A bibliographic review of public health dissemination and implementation research output and citation rates.

    Science.gov (United States)

    Wolfenden, Luke; Milat, Andrew J; Lecathelinais, Christophe; Skelton, Eliza; Clinton-McHarg, Tara; Williams, Christopher; Wiggers, John; Chai, Li Kheng; Yoong, Sze Lin

    2016-12-01

    The aim of this study was to describe the research output and citation rates (academic impact) of public health dissemination and implementation research according to research design and study type. A cross sectional bibliographic study was undertaken in 2013. All original data-based studies and review articles focusing on dissemination and implementation research that had been published in 10 randomly selected public health journals in 2008 were audited. The electronic database 'Scopus' was used to calculate 5-year citation rates for all included publications. Of the 1648 publications examined, 216 were original data-based research or literature reviews focusing on dissemination and implementation research. Of these 72% were classified as descriptive/epidemiological, 26% were intervention and just 1.9% were measurement research. Cross-sectional studies were the most common study design (47%). Reviews, randomized trials, non-randomized trials and decision/cost-effectiveness studies each represented between 6 and 10% of all output. Systematic reviews, randomized controlled trials and cohort studies were the most frequently cited study designs. The study suggests that publications that had the greatest academic impact (highest citation rates) made up only a small proportion of overall public health dissemination and implementation research output.

  1. Identifying Barriers in Implementing Outcomes-Based Assessment Program Review: A Grounded Theory Analysis

    Science.gov (United States)

    Bresciani, Marilee J.

    2011-01-01

    The purpose of this grounded theory study was to identify the typical barriers encountered by faculty and administrators when implementing outcomes-based assessment program review. An analysis of interviews with faculty and administrators at nine institutions revealed a theory that faculty and administrators' promotion, tenure (if applicable),…

  2. Implementation of Web 2.0 services in academic, medical and research libraries: a scoping review.

    Science.gov (United States)

    Gardois, Paolo; Colombi, Nicoletta; Grillo, Gaetano; Villanacci, Maria C

    2012-06-01

    Academic, medical and research libraries frequently implement Web 2.0 services for users. Several reports notwithstanding, characteristics and effectiveness of services are unclear. To find out: the Web 2.0 services implemented by medical, academic and research libraries; study designs, measures and types of data used in included articles to evaluate effectiveness; whether the identified body of literature is amenable to a systematic review of results. Scoping review mapping the literature on the topic. Searches were performed in 19 databases. research articles in English, Italian, German, French and Spanish (publication date ≥ 2006) about Web 2.0 services for final users implemented by academic, medical and research libraries. Reviewers' agreement was measured by Cohen's kappa. From a data set of 6461 articles, 255 (4%) were coded and analysed. Conferencing/chat/instant messaging, blogging, podcasts, social networking, wikis and aggregators were frequently examined. Services were mainly targeted at general academic users of English-speaking countries. Data prohibit a reliable estimate of the relative frequency of implemented Web 2.0 services. Case studies were the prevalent design. Most articles evaluated different outcomes using diverse assessment methodologies. A systematic review is recommended to assess the effectiveness of such services. © 2012 The authors. Health Information and Libraries Journal © 2012 Health Libraries Group.

  3. A Systematic Review of Fidelity of Implementation in Parent-Mediated Early Communication Intervention

    Science.gov (United States)

    Lieberman-Betz, Rebecca G.

    2015-01-01

    This article examined the reporting of four elements of fidelity of implementation (FOI) in parent-mediated early communication treatment studies. Thirty-five studies were reviewed to extract information regarding reporting of dosage, adherence, quality, and participant responsiveness for both practitioners and parents involved in parent-delivered…

  4. A bibliographic review of public health dissemination and implementation research output and citation rates

    Directory of Open Access Journals (Sweden)

    Luke Wolfenden

    2016-12-01

    Systematic reviews, randomized controlled trials and cohort studies were the most frequently cited study designs. The study suggests that publications that had the greatest academic impact (highest citation rates made up only a small proportion of overall public health dissemination and implementation research output.

  5. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems

    OpenAIRE

    Phansalkar, Shobha; Edworthy, Judy; Hellier, Elizabeth; Seger, Diane L; Schedlbauer, Angela; Avery, Anthony J; Bates, David W

    2010-01-01

    The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decisio...

  6. Implementing the Health Promoting University approach in culturally different contexts: a systematic review.

    Science.gov (United States)

    Suárez-Reyes, Mónica; Van den Broucke, Stephan

    2016-03-01

    Universities represent a valuable opportunity to promote health and well-being. Based on the setting approach, the Health Promoting Universities concept has been developed in different countries and contexts. However, the implementation process remains poorly documented. This systematic review aims to describe how universities have implemented the Health Promoting University concept in different cultural contexts. Pubmed, Medline, Lilacs and Scielo were searched for articles on Health Promoting Universities, published between 1995 and 2015. Studies detailing the implementation of a Health Promoting University approach were included. Selected articles were content analysed paying attention to: (a) the definition of a Health Promoting University; (b) priority areas of action; (c) items of work; (d) coordination of the project; (e) evaluation; and (f) adaptation to the cultural context. Twelve studies were identified for in-depth analysis. Of those, three were theoretical papers, and nine were intervention studies. The programmes described in the selected studies are mostly based on the guidelines of the Edmonton Charter. They incorporated the main areas of action and items of works proposed by the Health Promoting University framework. The implementation of healthy policies and incorporation of health promotion in the curriculum are remaining challenges. Strategies to facilitate adaptation to context include: stakeholder participation in planning and implementation, adaptation of educational material and analysis of needs. The review suggests that most of the universities work towards similar goals, relying on the Health Promoting University framework, yet that the way in which initiatives are implemented depends on the context. © The Author(s) 2015.

  7. The Society for Implementation Research Collaboration Instrument Review Project: a methodology to promote rigorous evaluation.

    Science.gov (United States)

    Lewis, Cara C; Stanick, Cameo F; Martinez, Ruben G; Weiner, Bryan J; Kim, Mimi; Barwick, Melanie; Comtois, Katherine A

    2015-01-08

    Identification of psychometrically strong instruments for the field of implementation science is a high priority underscored in a recent National Institutes of Health working meeting (October 2013). Existing instrument reviews are limited in scope, methods, and findings. The Society for Implementation Research Collaboration Instrument Review Project's objectives address these limitations by identifying and applying a unique methodology to conduct a systematic and comprehensive review of quantitative instruments assessing constructs delineated in two of the field's most widely used frameworks, adopt a systematic search process (using standard search strings), and engage an international team of experts to assess the full range of psychometric criteria (reliability, construct and criterion validity). Although this work focuses on implementation of psychosocial interventions in mental health and health-care settings, the methodology and results will likely be useful across a broad spectrum of settings. This effort has culminated in a centralized online open-access repository of instruments depicting graphical head-to-head comparisons of their psychometric properties. This article describes the methodology and preliminary outcomes. The seven stages of the review, synthesis, and evaluation methodology include (1) setting the scope for the review, (2) identifying frameworks to organize and complete the review, (3) generating a search protocol for the literature review of constructs, (4) literature review of specific instruments, (5) development of an evidence-based assessment rating criteria, (6) data extraction and rating instrument quality by a task force of implementation experts to inform knowledge synthesis, and (7) the creation of a website repository. To date, this multi-faceted and collaborative search and synthesis methodology has identified over 420 instruments related to 34 constructs (total 48 including subconstructs) that are relevant to implementation

  8. 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

  9. Effective implementation of research into practice: an overview of systematic reviews of the health literature

    Directory of Open Access Journals (Sweden)

    Fraser Alec

    2011-06-01

    Full Text Available Abstract Background 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. Findings 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. Conclusions 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.

  10. 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).

  11. The Economic Cost of Implementing Maternal and Neonatal Death Review in a District of Bangladesh.

    Science.gov (United States)

    Biswas, Animesh; Halim, Abdul; Rahman, Fazlur; Eriksson, Charli; Dalal, Koustuv

    2016-12-09

    Maternal and neonatal death review (MNDR) introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals). This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012. MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31 st Dec 2012. Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT) in the first year (2010). In the following years cost reduced to 8,208,995 BDT (335,609 $INT, during 2011) and 6,622,166 BDT (270,735 $INT, during 2012). The average cost per activity required was 3070 BDT in 2010, 1887 BDT and 2207 BDT required in 2011 and 2012 respectively. Each death notification cost 4.09 $INT, verbal autopsy cost 8.18 $INT, and social autopsy cost 16.35 $INT. Facility death notification cost 2.04 $INT and facility death review meetings cost 20.44 $INT. One death saved by MNDR costs 53,654 BDT (2193 $INT). Programmatic implementation cost of conducting MPDR give an idea on how much cost will be required to run a death review system for a low income country settings using government health system.

  12. The economic cost of implementing maternal and neonatal death review in a district of Bangladesh

    Directory of Open Access Journals (Sweden)

    Animesh Biswas

    2016-12-01

    Full Text Available Introduction: Maternal and neonatal death review (MNDR introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals. This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012. Materials and methods: MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31st Dec 2012. Results: Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT in the first year (2010. In the following years cost reduced to 8,208,995 BDT (335,609 $INT, during 2011 and 6,622,166 BDT (270,735 $INT, during 2012. The average cost per activity required was 3070 BDT in 2010, 1887 BDT and 2207 BDT required in 2011 and 2012 respectively. Each death notification cost 4.09 $INT, verbal autopsy cost 8.18 $INT, and social autopsy cost 16.35 $INT. Facility death notification cost 2.04 $INT and facility death review meetings cost 20.44 $INT. One death saved by MNDR costs 53,654 BDT (2193 $INT.Conclusions: Programmatic implementation cost of conducting MPDR give an idea on how much cost will be required to run a death review system for a low income country settings using government health system.

  13. Implementing Dementia Care Mapping as a practice development tool in dementia care services: a systematic review

    Directory of Open Access Journals (Sweden)

    Surr CA

    2018-01-01

    Full Text Available Claire A Surr, Alys W Griffiths, Rachael Kelley Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK Abstract: Dementia Care Mapping (DCM is an observational tool set within a practice development process. Following training in the method, DCM is implemented via a cyclic process of briefing staff, conducting mapping observations, data analysis and report preparation, feedback to staff and action planning. Recent controlled studies of DCM’s efficacy have found heterogeneous results, and variability in DCM implementation has been indicated as a potential contributing factor. This review aimed to examine the primary research evidence on the processes and the barriers and facilitators to implementing DCM as a practice development method within formal dementia care settings. PUBMED, PsycINFO, CINAHL, The Cochrane Library-Cochrane reviews, HMIC (Ovid, Web of Science and Social Care Online were searched using the term “Dementia Care Mapping”. Inclusion criterion was primary research studies in any formal dementia care settings where DCM was used as a practice development tool and which included discussion/critique of the implementation processes. Assessment of study quality was conducted using the Mixed Methods Appraisal Tool. Twelve papers were included in the review, representing nine research studies. The papers included discussion of various components of the DCM process, including mapper selection and preparation; mapping observations; data analysis, report writing and feedback; and action planning. However, robust evidence on requirements for successful implementation of these components was limited. Barriers and facilitators to mapping were also discussed. The review found some consensus that DCM is more likely to be successfully implemented if the right people are selected to be trained as mappers, with appropriate mapper preparation and ongoing support and with effective leadership for

  14. Implementation strategies for health systems in low-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Pantoja, Tomas; Opiyo, Newton; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustín; Wiysonge, Charles S; Herrera, Cristian A; Rada, Gabriel; Peñaloza, Blanca; Dudley, Lilian; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Oxman, Andrew D

    2017-09-12

    A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview. We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. We identified 7272 systematic reviews and included 39 of them in this overview. An additional four

  15. Inside help: An integrative review of champions in healthcare-related implementation.

    Science.gov (United States)

    Miech, Edward J; Rattray, Nicholas A; Flanagan, Mindy E; Damschroder, Laura; Schmid, Arlene A; Damush, Teresa M

    2018-01-01

    The idea that champions are crucial to effective healthcare-related implementation has gained broad acceptance; yet the champion construct has been hampered by inconsistent use across the published literature. This integrative review sought to establish the current state of the literature on champions in healthcare settings and bring greater clarity to this important construct. This integrative review was limited to research articles in peer-reviewed, English-language journals published from 1980 to 2016. Searches were conducted on the online MEDLINE database via OVID and PubMed using the keyword "champion." Several additional terms often describe champions and were also included as keywords: implementation leader, opinion leader, facilitator, and change agent. Bibliographies of full-text articles that met inclusion criteria were reviewed for additional references not yet identified via the main strategy of conducting keyword searches in MEDLINE. A five-member team abstracted all full-text articles meeting inclusion criteria. The final dataset for the integrative review consisted of 199 unique articles. Use of the term champion varied widely across the articles with respect to topic, specific job positions, or broader organizational roles. The most common method for operationalizing champion for purposes of analysis was the use of a dichotomous variable designating champion presence or absence. Four studies randomly allocated of the presence or absence of champions. The number of published champion-related articles has markedly increased: more articles were published during the last two years of this review (i.e. 2015-2016) than during its first 30 years (i.e. 1980-2009).The number of champion-related articles has continued to increase sharply since the year 2000. Individual studies consistently found that champions were important positive influences on implementation effectiveness. Although few in number, the randomized trials of champions that have been

  16. Interventions to Support System-level Implementation of Health Promoting Schools: A Scoping Review

    Directory of Open Access Journals (Sweden)

    Jessie-Lee D. McIsaac

    2016-02-01

    Full Text Available Health promoting schools (HPS is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students.

  17. Interventions to Support System-level Implementation of Health Promoting Schools: A Scoping Review

    Science.gov (United States)

    McIsaac, Jessie-Lee D.; Hernandez, Kimberley J.; Kirk, Sara F.L.; Curran, Janet A.

    2016-01-01

    Health promoting schools (HPS) is recognized globally as a multifaceted approach that can support health behaviours. There is increasing clarity around factors that influence HPS at a school level but limited synthesized knowledge on the broader system-level elements that may impact local implementation barriers and support uptake of a HPS approach. This study comprised a scoping review to identify, summarise and disseminate the range of research to support the uptake of a HPS approach across school systems. Two reviewers screened and extracted data according to inclusion/exclusion criteria. Relevant studies were identified using a multi-phased approach including searching electronic bibliographic databases of peer reviewed literature, hand-searching reference lists and article recommendations from experts. In total, 41 articles met the inclusion criteria for the review, representing studies across nine international school systems. Overall, studies described policies that provided high-level direction and resources within school jurisdictions to support implementation of a HPS approach. Various multifaceted organizational and professional interventions were identified, including strategies to enable and restructure school environments through education, training, modelling and incentives. A systematic realist review of the literature may be warranted to identify the types of intervention that work best for whom, in what circumstance to create healthier schools and students. PMID:26861376

  18. A review on energy efficiency standards and labels: present status and implementation possibilities in malaysia

    Directory of Open Access Journals (Sweden)

    T.M.I. Mahlia,

    2017-11-01

    Full Text Available This article is a review on energy efficiency standards  and labels for household electrical appliances around the world. Through the review of other country experiences on energy efficiency standards and labels, we attempt to identify savings possibilities in Malaysian households. The implementation possibilities of standards and labels for various household electrical appliances in Malaysia are also examined. It is found that various household appliances in Malaysia offer some potential in reducing electricity consumption. Finally, it is concluded that there are many advantages for Malaysia to implement the standards and labels for household electrical appliances as soon as possible in order to reduce electricity  bills  and energy  consumption  in Malaysian  households.

  19. What are the barriers and facilitators to implementing Collaborative Care for depression? A systematic review.

    Science.gov (United States)

    Wood, Emily; Ohlsen, Sally; Ricketts, Thomas

    2017-05-01

    Collaborative Care is an evidence-based approach to the management of depression within primary care services recommended within NICE Guidance. However, uptake within the UK has been limited. This review aims to investigate the barriers and facilitators to implementing Collaborative Care. A systematic review of the literature was undertaken to uncover what barriers and facilitators have been reported by previous research into Collaborative Care for depression in primary care. The review identified barriers and facilitators to successful implementation of Collaborative Care for depression in 18 studies across a range of settings. A framework analysis was applied using the Collaborative Care definition. The most commonly reported barriers related to the multi-professional approach, such as staff and organisational attitudes to integration, and poor inter-professional communication. Facilitators to successful implementation particularly focussed on improving inter-professional communication through standardised care pathways and case managers with clear role boundaries and key underpinning personal qualities. Not all papers were independent title and abstract screened by multiple reviewers thus limiting the reliability of the selected studies. There are many different frameworks for assessing the quality of qualitative research and little consensus as to which is most appropriate in what circumstances. The use of a quality threshold led to the exclusion of six papers that could have included further information on barriers and facilitators. Although the evidence base for Collaborative Care is strong, and the population within primary care with depression is large, the preferred way to implement the approach has not been identified. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  20. Towards ICF implementation in menopause healthcare: a systematic review of ICF application in Switzerland.

    OpenAIRE

    Zangger, Martina; Poethig, Dagmar; Meissner, Florian; von Wolff, Michael; Stute, Petra

    2017-01-01

    AIMS OF THE STUDY To present a systematic literature review on the application and degree of implementation of the International Classification of Functioning, Disability and Health (ICF) across different health conditions and regions in Switzerland in order to develop an ICF classification of the climacteric syndrome in the medium term. METHODS A systematic literature search was conducted through Embase and Medline covering the period between 2011 and August 2016. Inclusion crite...

  1. Systematic review of the implementation of simulation training in surgical residency curriculum.

    Science.gov (United States)

    Kurashima, Yo; Hirano, Satoshi

    2017-07-01

    We reviewed the literature regarding the specific methods and strategies for implementing simulation-based training into the modern surgical residency curriculum. Residency programs are still struggling with how best to implement it into their curricula from a practical viewpoint. A systematic review was performed using Ovid MEDLINE, EMBASE, PubMed, PsycINFO, Web of Science, and other resources for studies involving the use of simulation for technical skills training in the surgical residency curriculum. Studies were selected based on the integration of simulation into the curriculum and/or a description of the details of implementation and the resources required. In total, 2533 unique citations were retrieved based on this search, and 31 articles met the inclusion criteria. Most simulators were focused on laparoscopic procedures, and training occurred most often in a skills lab. The assessment of skills consisted mostly of speed of task completion. Only 4 studies addressed issues of cost, and 6 programs mentioned human resources without any mention of skills center personnel or administrative support. All of the studies described the nature of the simulation training, but very few commented on how it was actually implemented and what was needed from organizational, administrative and logistical perspectives.

  2. Barriers to Implementing the ACGME Outcome Project: A Systematic Review of Program Director Surveys.

    Science.gov (United States)

    Malik, Mohammad U; Diaz Voss Varela, David A; Stewart, Charles M; Laeeq, Kulsoom; Yenokyan, Gayane; Francis, Howard W; Bhatti, Nasir I

    2012-12-01

    The Accreditation Council for Graduate Medical Education (ACGME) introduced the Outcome Project in July 2001 to improve the quality of resident education through competency-based learning. The purpose of this systematic review is to determine and explore the perceptions of program directors regarding challenges to implementing the ACGME Outcome Project. We used the PubMed and Web of Science databases and bibliographies for English-language articles published between January 1, 2001, and February 17, 2012. Studies were included if they described program directors' opinions on (1) barriers encountered when attempting to implement ACGME competency-based education, and (2) assessment methods that each residency program was using to implement competency-based education. Articles meeting the inclusion criteria were screened by 2 researchers. The grading criterion was created by the authors and used to assess the quality of each study. The survey-based data reported the opinions of 1076 program directors. Barriers that were encountered include: (1) lack of time; (2) lack of faculty support; (3) resistance of residents to the Outcome Project; (4) insufficient funding; (5) perceived low priority for the Outcome Project; (6) inadequate salary incentive; and (7) inadequate knowledge of the competencies. Of the 6 competencies, those pertaining to patient care and medical knowledge received the most responses from program directors and were given highest priority. The reviewed literature revealed that time and financial constraints were the most important barriers encountered when implementing the ACGME Outcome Project.

  3. Implementing system-wide risk stratification approaches: A review of critical success and failure factors.

    Science.gov (United States)

    Huckel Schneider, Carmen; Gillespie, James A; Wilson, Andrew

    2017-05-01

    Risk stratification has become a widely used tool for linking people identified at risk of health deterioration to the most appropriate evidence-based care. This article systematically reviews recent literature to determine key factors that have been identified as critical enablers and/or barriers to successful implementation of risk stratification tools at a system level. A systematic search found 23 articles and four promising protocols for inclusion in the review, covering the use to 20 different risk stratification tools. These articles reported on only a small fraction of the risk stratification tools used in health systems; suggesting that while the development and statistical validation of risk stratification algorithms is widely reported, there has been little published evaluation of how they are implemented in real-world settings. Controlled studies provided some evidence that the use of risk stratification tools in combination with a care management plan offer patient benefits and that the use of a risk stratification tool to determine components of a care management plan may contribute to reductions in hospital readmissions, patient satisfaction and improved patient outcomes. Studies with the strongest focus on implementation used qualitative and case study methods. Among these, the literature converged on four key areas of implementation that were found to be critical for overcoming barriers to success: the engagement of clinicians and safeguarding equity, both of which address barriers of acceptance; the health system context to address administrative, political and system design barriers; and data management and integration to address logistical barriers.

  4. Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues

    Science.gov (United States)

    Bonneville, Luc; Bouchard, Louise

    2018-01-01

    Organizational health literacy is described as an organization-wide effort to transform organization and delivery of care and services to make it easier for people to navigate, understand, and use information and services to take care of their health. Several health literacy guides have been developed to assist healthcare organizations with this effort, but their content has not been systematically reviewed to understand the scope and practical implications of this transformation. The objective of this study was to review (1) theories and frameworks that inform the concept of organizational health literacy, (2) the attributes of organizational health literacy as described in the guides, (3) the evidence for the effectiveness of the guides, and (4) the barriers and facilitators to implementing organizational health literacy. Drawing on a metanarrative review method, 48 publications were reviewed, of which 15 dealt with the theories and operational frameworks, 20 presented health literacy guides, and 13 addressed guided implementation of organizational health literacy. Seven theories and 9 operational frameworks have been identified. Six health literacy dimensions and 9 quality-improvement characteristics were reviewed for each health literacy guide. Evidence about the effectiveness of health literacy guides is limited at this time, but experiences with the guides were positive. Thirteen key barriers (conceived also as facilitators) were identified. Further development of organizational health literacy requires a strong and a clear connection between its vision and operationalization as an implementation strategy to patient-centered care. For many organizations, becoming health literate will require multiple, simultaneous, and radical changes. Organizational health literacy has to make sense from clinical and financial perspectives in order for organizations to embark on such transformative journey. PMID:29569968

  5. Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues.

    Science.gov (United States)

    Farmanova, Elina; Bonneville, Luc; Bouchard, Louise

    2018-01-01

    Organizational health literacy is described as an organization-wide effort to transform organization and delivery of care and services to make it easier for people to navigate, understand, and use information and services to take care of their health. Several health literacy guides have been developed to assist healthcare organizations with this effort, but their content has not been systematically reviewed to understand the scope and practical implications of this transformation. The objective of this study was to review (1) theories and frameworks that inform the concept of organizational health literacy, (2) the attributes of organizational health literacy as described in the guides, (3) the evidence for the effectiveness of the guides, and (4) the barriers and facilitators to implementing organizational health literacy. Drawing on a metanarrative review method, 48 publications were reviewed, of which 15 dealt with the theories and operational frameworks, 20 presented health literacy guides, and 13 addressed guided implementation of organizational health literacy. Seven theories and 9 operational frameworks have been identified. Six health literacy dimensions and 9 quality-improvement characteristics were reviewed for each health literacy guide. Evidence about the effectiveness of health literacy guides is limited at this time, but experiences with the guides were positive. Thirteen key barriers (conceived also as facilitators) were identified. Further development of organizational health literacy requires a strong and a clear connection between its vision and operationalization as an implementation strategy to patient-centered care. For many organizations, becoming health literate will require multiple, simultaneous, and radical changes. Organizational health literacy has to make sense from clinical and financial perspectives in order for organizations to embark on such transformative journey.

  6. Barriers and facilitators to the implementation of orthodontic mini implants in clinical practice: a systematic review.

    Science.gov (United States)

    Meursinge Reynders, Reint; Ronchi, Laura; Ladu, Luisa; Di Girolamo, Nicola; de Lange, Jan; Roberts, Nia; Mickan, Sharon

    2016-09-23

    Numerous surveys have shown that orthodontic mini implants (OMIs) are underused in clinical practice. To investigate this implementation issue, we conducted a systematic review to (1) identify barriers and facilitators to the implementation of OMIs for all potential stakeholders and (2) quantify these implementation constructs, i.e., record their prevalence. We also recorded the prevalence of clinicians in the eligible studies that do not use OMIs. Methods were based on our published protocol. Broad-spectrum eligibility criteria were defined. A barrier was defined as any variable that impedes or obstructs the use of OMIs and a facilitator as any variable that eases and promotes their use. Over 30 databases including gray literature were searched until 15 January 2016. The Joanna Briggs Institute tool for studies reporting prevalence and incidence data was used to critically appraise the included studies. Outcomes were qualitatively synthesized, and meta-analyses were only conducted when pre-set criteria were fulfilled. Three reviewers conducted all research procedures independently. We also contacted authors of eligible studies to obtain additional information. Three surveys fulfilled the eligibility criteria. Seventeen implementation constructs were identified in these studies and were extracted from a total of 165 patients and 1391 clinicians. Eight of the 17 constructs were scored by more than 50 % of the pertinent stakeholders. Three of these constructs overlapped between studies. Contacting of authors clarified various uncertainties but was not always successful. Limitations of the eligible studies included (1) the small number of studies; (2) not defining the research questions, i.e., the primary outcomes; (3) the research design (surveys) of the studies and the exclusive use of closed-ended questions; (4) not consulting standards for identifying implementation constructs; (5) the lack of pilot testing; (6) high heterogeneity; (7) the risk of reporting bias

  7. Pretreatment techniques for biofuels and biorefineries

    Energy Technology Data Exchange (ETDEWEB)

    Fang, Zhen (ed.) [Chinese Academy of Sciences, Kunming, YN (China). Xishuangbanna Tropical Botonical Garden

    2013-02-01

    The first book focused on pretreatment techniques for biofuels contributed by the world's leading experts. Extensively covers the different types of biomass, various pretreatment approaches and methods that show the subsequent production of biofuels and chemicals. In addition to traditional pretreatment methods, novel techniques are also introduced and discussed. An accessible reference work for students, researchers, academicians and industrialists in biorefineries. This book includes 19 chapters contributed by the world's leading experts on pretreatment methods for biomass. It extensively covers the different types of biomass (e.g. molasses, sugar beet pulp, cheese whey, sugarcane residues, palm waste, vegetable oil, straws, stalks and wood), various pretreatment approaches (e.g. physical, thermal, chemical, physicochemical and biological) and methods that show the subsequent production of biofuels and chemicals such as sugars, ethanol, extracellular polysaccharides, biodiesel, gas and oil. In addition to traditional methods such as steam, hot-water, hydrothermal, diluted-acid, organosolv, ozonolysis, sulfite, milling, fungal and bacterial, microwave, ultrasonic, plasma, torrefaction, pelletization, gasification (including biogas) and liquefaction pretreatments, it also introduces and discusses novel techniques such as nano and solid catalysts, organic electrolyte solutions and ionic liquids. This book offers a review of state-of-the-art research and provides guidance for the future paths of developing pretreatment techniques of biomass for biofuels, especially in the fields of biotechnology, microbiology, chemistry, materials science and engineering. It intends to provide a systematic introduction of pretreatment techniques. It is an accessible reference work for students, researchers, academicians and industrialists in biorefineries.

  8. Improving the implementation of health workforce policies through governance: a review of case studies.

    Science.gov (United States)

    Dieleman, Marjolein; Shaw, Daniel Mp; Zwanikken, Prisca

    2011-04-12

    Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC). We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'. In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy development and implementation were lacking. This review shows that the term

  9. A qualitative systematic review of studies using the normalization process theory to research implementation processes.

    Science.gov (United States)

    McEvoy, Rachel; Ballini, Luciana; Maltoni, Susanna; O'Donnell, Catherine A; Mair, Frances S; Macfarlane, Anne

    2014-01-02

    There is a well-recognized need for greater use of theory to address research translational gaps. Normalization Process Theory (NPT) provides a set of sociological tools to understand and explain the social processes through which new or modified practices of thinking, enacting, and organizing work are implemented, embedded, and integrated in healthcare and other organizational settings. This review of NPT offers readers the opportunity to observe how, and in what areas, a particular theoretical approach to implementation is being used. In this article we review the literature on NPT in order to understand what interventions NPT is being used to analyze, how NPT is being operationalized, and the reported benefits, if any, of using NPT. Using a framework analysis approach, we conducted a qualitative systematic review of peer-reviewed literature using NPT. We searched 12 electronic databases and all citations linked to six key NPT development papers. Grey literature/unpublished studies were not sought. Limitations of English language, healthcare setting and year of publication 2006 to June 2012 were set. Twenty-nine articles met the inclusion criteria; in the main, NPT is being applied to qualitatively analyze a diverse range of complex interventions, many beyond its original field of e-health and telehealth. The NPT constructs have high stability across settings and, notwithstanding challenges in applying NPT in terms of managing overlaps between constructs, there is evidence that it is a beneficial heuristic device to explain and guide implementation processes. NPT offers a generalizable framework that can be applied across contexts with opportunities for incremental knowledge gain over time and an explicit framework for analysis, which can explain and potentially shape implementation processes. This is the first review of NPT in use and it generates an impetus for further and extended use of NPT. We recommend that in future NPT research, authors should explicate

  10. Lessons learnt from implementation of the International Health Regulations: a systematic review

    Science.gov (United States)

    Allen, Lisa G; Cifuentes, Sara; Dye, Christopher; Nagata, Jason M

    2018-01-01

    Abstract Objective To respond to the World Health Assembly call for dissemination of lessons learnt from countries that have begun implementing the International Health Regulations, 2005 revision; IHR (2005). Methods In November 2015, we conducted a systematic search of the following online databases and sources: PubMed®, Embase®, Global Health, Scopus, World Health Organization (WHO) Global Index Medicus, WHO Bulletin on IHR Implementation and the International Society for Disease Surveillance. We included identified studies and reports summarizing national experience in implementing any of the IHR (2005) core capacities or their components. We excluded studies that were theoretical or referred to IHR (1969). Qualitative systematic review methodology, including meta-ethnography, was used for qualitative synthesis. Findings We analysed 51 articles from 77 countries representing all WHO Regions. The meta-syntheses identified a total of 44 lessons learnt across the eight core capacities of IHR (2005). Major themes included the need to mobilize and sustain political commitment; to adapt global requirements based on local sociocultural, epidemiological, health system and economic contexts; and to conduct baseline and follow-up assessments to monitor the status of IHR (2005) implementation. Conclusion Although experiences of IHR (2005) implementation covered a wide global range, more documentation from Africa and Eastern Europe is needed. We did not find specific areas of weakness in monitoring IHR (2005); sustained monitoring of all core capacities is required to ensure effective systems. These lessons learnt could be adapted by countries in the process of meeting IHR (2005) requirements. PMID:29403114

  11. A review of BIM (Building Information Modeling) implementation in Indonesia construction industry

    Science.gov (United States)

    Suryadinata Telaga, Abdi

    2018-05-01

    Construction projects in Indonesia have been growing rapidly in the last three years. Therefore, construction management is very important to ensure completion of construction projects are within schedule and budget. Utilization of building information modeling (BIM) can increase the efficiency of a construction project. However, the implementation of BIM in Indonesia is still not known. This paper is intended to review the implementation of BIM in Indonesia through literature analysis. To find BIM articles in Indonesia, Firstly, searching was limited to English articles published in reputed journals or conferences. However the results were limited, then the search was expanded to the article using Indonesian languages that published in journal and conference. Based on the number of articles, the results showed that BIM research in Indonesia is still in a dearth. Furthermore, BIM study cases were conducted in a limited location and within a small population. Nevertheless, the literature shared the conclusion that BIM can increase project efficiency, but the implementation was hindered by high initial investment cost, inadequate human resources, small demand, and technology resistant. The research contributes to providing a current reported level of BIM implementation in Indonesia. In the future research to study of BIM implementation comprehensively in Indonesia is eminent.

  12. Implementation strategies for health systems in low-income countries: an overview of systematic reviews

    Science.gov (United States)

    Pantoja, Tomas; Opiyo, Newton; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustín; Wiysonge, Charles S; Herrera, Cristian A; Rada, Gabriel; Peñaloza, Blanca; Dudley, Lilian; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Oxman, Andrew D

    2017-01-01

    Background A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging, particularly if it entails complex changes in clinical routines; in collaborative patterns among different healthcare providers and disciplines; in the behaviour of providers, patients or other stakeholders; or in the organisation of care. Decision-makers may use a range of strategies to implement health interventions, and these choices should be based on evidence of the strategies' effectiveness. Objectives To provide an overview of the available evidence from up-to-date systematic reviews about the effects of implementation strategies for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on alternative implementation strategies and informing refinements of the framework for implementation strategies presented in the overview. Methods We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of implementation strategies on professional practice and patient outcomes and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the review findings. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries. Main results We identified 7272 systematic reviews and included 39 of

  13. Operational Readiness Review Implementation Plan for the K Basin Fuel Transfer System

    International Nuclear Information System (INIS)

    DAVIES, T.H.

    2002-01-01

    This implementation plan has been prepared to comply with the requirements of U.S. Department of Energy (DOE) Order 425.1A, Startup and Restart of Nuclear Facilities, and DOE-STD-3006-2000, Planning and Conduct of Operational Readiness Reviews (ORR) (DOE 2002). The scope of the ORR is described in the contractor K Basin Fuel Transfer System (FTS) Plan of Action (POA), which was prepared by Spent Nuclear Fuel (SNF) Project line management and approved by the DOE Richland Operations Office (RL) Manager on April 4, 2002 (FH 2002a). While the Project Hanford Management Contractor has been revised to include DOE Order 425.1B, the contractor implementing procedure, ''F-PRO-055, Startup Readiness (Revision 9) has not yet been approved by RL for contractor use. Appendix A provides a crosswalk between the requirements of DOE Order 425.1A and DOE Order 425.1B to show that all requirements of DOE 425.1B are covered by this implementation plan. DOE Order 425.1B indicates that the Secretarial Officer is the Authorization Authority when substantial modifications are made to a Hazard Category 2 nuclear facility. This Authorization Authority has been delegated to the RL Manager by memorandum from Jessie Hill Roberson, dated November 20, 2001 (Roberson 2001). The scope of the ORR is described in the RL Plan of Action, K Basin Fuel Transfer System, prepared by DOE project line management and approved by the RL Manager, the designated approval authority, on September 12, 2002 (Schlender 2002). This implementation plan provides the overall approach and guidelines for performance of the DOE ORR. Appendix B contains the Criteria and Review Approach Documents (CRAD), which define the review objectives and criteria as well as the approach for assessing each objective. ORR results will be published in a final report, as discussed in Section 9.4

  14. Implementing Head and Neck Contouring Peer Review without Pathway Delay: The On-demand Approach.

    Science.gov (United States)

    Fong, C; Sanghera, P; Good, J; Nightingale, P; Hartley, A

    2017-12-01

    Peer review of contour volume is a priority in the radiotherapy treatment quality assurance process for head and neck cancer. It is essential that incorporation of peer review activity does not introduce additional delays. An on-demand peer review process was piloted to assess the feasibility and efficiency of this approach, as compared with a historic scheduled weekly approach. Between November 2016 and April 2017 four head and neck clinicians in one centre took part in an on-demand peer review process. Cases were of radical or adjuvant intent of any histology and submitted on a voluntary basis. The outcome of contour peer review would be one of unchanged (UC), unchanged with variation or discretion noted (UV), minor change (M) or significant change (S). The time difference between the completion of the on-demand peer review was compared with the time difference to a hypothetical next Monday or Tuesday weekly peer review meeting. The time taken to review each case was also documented in the latter period of the pilot project. In total, 62 cases underwent peer review. Peer review on-demand provided dosimetrists with an average of an extra two working days available per case to meet treatment start dates. The proportion of cases with outcomes UC, UV, M and S were 45%, 16%, 26% and 13%, respectively. The mean peer review time spent per case was 17 min (12 cases). The main reason for S was discrepancy in imaging interpretation (4/8 cases). A lower proportion of oropharyngeal cases were submitted and had S outcomes. A higher proportion of complex cases, e.g. sinonasal/nasopharynx location or previous downstaging chemotherapy had S outcomes. The distribution of S outcomes appears to be similar regardless of clinician experience. The level of peer review activity among individuals differed by workload and job timetable. On-demand peer review of the head and neck contour volume is feasible, reduces delay to the start of dosimetry planning and bypasses the logistical

  15. Implementation of a reimbursed medication review program: Corporate and pharmacy level strategies.

    Science.gov (United States)

    MacKeigan, Linda D; Ijaz, Nadine; Bojarski, Elizabeth A; Dolovich, Lisa

    In 2006, the Ontario drug plan greatly reduced community pharmacy reimbursement for generic drugs. In exchange, a fee-for-service medication review program was introduced to help patients better understand their medication therapy and ensure that medications were taken as prescribed. A qualitative study of community pharmacy implementation strategies was undertaken to inform a mixed methods evaluation of the program. To describe strategies used by community pharmacies to implement a government-funded medication review service. Key informant interviews were conducted with pharmacy corporate executives and managers, as well as independent pharmacy owners. All pharmacy corporations in the province were approached; owners were purposively sampled from the registry of the pharmacist licensing body to obtain diversity in pharmacy attributes; and pharmacy managers were identified through a mix of snowball and registry sampling. Thematic qualitative coding and analysis were applied to interview transcripts. 42 key informants, including 14 executives, 15 managers/franchisees, and 11 owners, participated. The most common implementation strategy was software adaptation to flag eligible patients and to document the service. Human resource management (task shifting to technicians and increasing the technician complement), staff training, and patient identification and recruitment processes were widely mentioned. Motivational strategies including service targets and financial incentives were less frequent but controversial. Strategies typically unfolded over time, and became multifaceted. Apart from the use of targets in chain pharmacies only, strategies were similar across pharmacy ownership types. Ontario community pharmacies appeared to have done little preplanning of implementation strategies. Strategies focused on service efficiency and quantity, rather than quality. Unlike other jurisdictions, many managers supported the use of targets as motivators, and very few reported

  16. Implementing maternal death surveillance and response: a review of lessons from country case studies.

    Science.gov (United States)

    Smith, Helen; Ameh, Charles; Roos, Natalie; Mathai, Matthews; Broek, Nynke van den

    2017-07-17

    Maternal Death Surveillance and Response (MDSR) implementation is monitored globally, but not much is known about what works well, where and why in scaling up. We reviewed a series of country case studies in order to determine whether and to what extent these countries have implemented the four essential components of MDSR and identify lessons for improving implementation. A secondary analysis of ten case studies from countries at different stages of MDSR implementation, using a policy analysis framework to draw out lessons learnt and opportunities for improvement. We identify the consistent drivers of success in countries with well-established systems for MDSR, and common barriers in countries were Maternal Death Review (MDR) systems have been less successful. MDR is accepted and ongoing at subnational level in many countries, but it is not adequately institutionalised and the shift from facility based MDR to continuous MDSR that informs the wider health system still needs to be made. Our secondary analysis of country experiences highlights the need for a) social and team processes at facility level, for example the existence of a 'no shame, no blame' culture, and the ability to reflect on practice and manage change as a team for recommendations to be acted upon, b) health system inputs including adequate funding and reliable health information systems to enable identification and analysis of cases c) national level coordination of dissemination, and monitoring implementation of recommendations at all levels and d) mandatory notification of maternal deaths (and enforcement of this) and a professional requirement to participate in MDRs. Case studies from countries with established MDSR systems can provide valuable guidance on ways to set up the processes and overcome some of the barriers; but the challenge, as with many health system interventions, is to find a way to provide catalytic assistance and strengthen capacity for MDSR such that this becomes embedded in

  17. 42 CFR 435.136 - State agency implementation requirements for one-time notice and annual review system.

    Science.gov (United States)

    2010-10-01

    ...-time notice and annual review system. 435.136 Section 435.136 Public Health CENTERS FOR MEDICARE... agency implementation requirements for one-time notice and annual review system. An agency must— (a...) Establish an annual review system to identify individuals who meet the requirements of § 435.135 (a) or (c...

  18. Implementing the 4D cycle of appreciative inquiry in health care: a methodological review.

    Science.gov (United States)

    Trajkovski, Suza; Schmied, Virginia; Vickers, Margaret; Jackson, Debra

    2013-06-01

    To examine and critique how the phases of the 4D cycle (Discovery, Dream, Design, and Destiny) of appreciative inquiry are implemented in a healthcare context. Appreciative inquiry is a theoretical research perspective, an emerging research methodology and a world view that builds on action research, organizational learning, and organizational change. Increasing numbers of articles published provide insights and learning into its theoretical and philosophical underpinnings. Many articles describe appreciative inquiry and the outcomes of their studies; however, there is a gap in the literature examining the approaches commonly used to implement the 4D cycle in a healthcare context. A methodological review following systematic principles. A methodological review was conducted including articles from the inception of appreciative inquiry in 1986 to the time of writing this review in November, 2011. Key database searches included CINAHL, Emerald, MEDLINE, PubMed, PsycINFO, and Scopus. A methodological review following systematic principles was undertaken. Studies were included if they described in detail the methods used to implement the 4D cycle of appreciative inquiry in a healthcare context. Nine qualitative studies met the inclusion criteria. Results highlighted that appreciative inquiry application is unique and varied between studies. The 4D phases were not rigid steps and were adapted to the setting and participants. Overall, participant enthusiasm and commitment were highlighted suggesting appreciative inquiry was mostly positively perceived by participants. Appreciative inquiry provides a positive way forward shifting from problems to solutions offering a new way of practicing in health care and health research. © 2012 Blackwell Publishing Ltd.

  19. GREET Pretreatment Module

    Energy Technology Data Exchange (ETDEWEB)

    Adom, Felix K. [Argonne National Lab. (ANL), Argonne, IL (United States). Energy Systems Division; Dunn, Jennifer B. [Argonne National Lab. (ANL), Argonne, IL (United States). Energy Systems Division; Han, Jeongwoo [Argonne National Lab. (ANL), Argonne, IL (United States). Energy Systems Division

    2014-09-01

    A wide range of biofuels and biochemicals can be produced from cellulosic biomass via different pretreatment technologies that yield sugars. Process simulations of dilute acid and ammonia fiber expansion pretreatment processes and subsequent hydrolysis were developed in Aspen Plus for four lignocellulosic feedstocks (corn stover, miscanthus, switchgrass, and poplar). This processing yields sugars that can be subsequently converted to biofuels or biochemical. Material and energy consumption data from Aspen Plus were then compiled in a new Greenhouses Gases, Regulated Emissions, and Energy Use in Transportation (GREETTM) pretreatment module. The module estimates the cradle-to-gate fossil energy consumption (FEC) and greenhouse gas (GHG) emissions associated with producing fermentable sugars. This report documents the data and methodology used to develop this module and the cradle-to-gate FEC and GHG emissions that result from producing fermentable sugars.

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

    Directory of Open Access Journals (Sweden)

    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

  1. Barriers in the Implementation of Health Information Systems: A Scoping Review

    Directory of Open Access Journals (Sweden)

    Florin STAMATIAN

    2013-12-01

    Full Text Available Context. A well-developed health information system which is implemented according to present standards allows a healthcare quality increase. Our study aims at providing an overview of the barriers which were encountered in the process of implementing the health information systems by reviewing the literature connected to Europe and the United States of America. Methodology. We searched within five databases (Cochrane Library, Google Scholar, PubMed, ScienceDirect and Scopus for the exact phrase ‘implementation health information system’ along with the name of each European country/USA state. Relevance was then tested by scanning titles and abstracts. The third and final step involved assessing all the articles in order to set their relevance and a data extraction tool was created, containing the name of the state/country that the article reports data on, the article citation and the challenges identified. Results. The barriers identified were classified in four major categories: technical, organizational, behavioral/human and financial. Seemingly, Europe (41 articles and USA (20 articles are facing the same issues in the implementation of a health information system. No major difference between EU and non-EU countries was found after our analysis with regards to the identified barriers. Discussion. Even if recommendations and solutions are continuously being developed in order to solve these barriers, the implementation of a new health information system must be very detailed in order to face all these problems. Additionally, further research is required in order to evaluate their impact on the successful implementation of a health information system.

  2. PRETREATING THORIUM FOR ELECTROPLATING

    Science.gov (United States)

    Beach, J.G.; Schaer, G.R.

    1959-07-28

    A method is presented for pretreating a thorium surface prior to electroplating the surface. The pretreatment steps of the invention comprise cleaning by vapor blasting the surface, anodically pickling in a 5 to 15% by volume aqueous hydrochloric acid bath with a current of 125 to 250 amp/sq ft for 3 to 5 min at room temperature, chemically pickling the surface in a 5 to 15% by volume of aqueous sulfuric acid for 3 to 5 min at room temperature, and rinsing the surface with water.

  3. Hospital implementation of resuscitation guidelines and review of CPR training programmes: a nationwide study.

    Science.gov (United States)

    Schmidt, Anders S; Lauridsen, Kasper G; Adelborg, Kasper; Løfgren, Bo

    2016-06-01

    This study aimed to investigate cardiopulmonary resuscitation (CPR) guideline implementation and CPR training in hospitals. This nationwide study included mandatory resuscitation protocols from each Danish hospital. Protocols were systematically reviewed for adherence to the European Resuscitation Council (ERC) 2010 guidelines and CPR training in each hospital. Data were included from 45 of 47 hospitals. Adherence to the ERC basic life support (BLS) algorithm was 49%, whereas 63 and 58% of hospitals adhered to the recommended chest compression depth and rate. Adherence to the ERC advanced life support (ALS) algorithm was 81%. Hospital BLS course duration was [median (interquartile range)] 2.3 (1.5-2.5) h, whereas ALS course duration was 4.0 (2.5-8.0) h. Implementation of ERC 2010 guidelines on BLS is limited in Danish hospitals 2 years after guideline publication, whereas the majority of hospitals adhere to the ALS algorithm. CPR training differs among hospitals.

  4. Implementing technology to improve medication safety in healthcare facilities: a literature review.

    Science.gov (United States)

    Hidle, Unn

    Medication errors remain one of the most common causes of patient injuries in the United States, with detrimental outcomes including adverse reactions and even death. By developing a better understanding of why and how medication errors occur, preventative measures may be implemented including technological advances. In this literature review, potential methods of reducing medication errors were explored. Furthermore, technology tools available for medication orders and administration are described, including advantages and disadvantages of each system. It was found that technology can be an excellent aid in improving safety of medication administration. However, computer technology cannot replace human intellect and intuition. Nurses should be involved when implementing any new computerized system in order to obtain the most appropriate and user-friendly structure.

  5. Implementing graduate entry registration for nursing in England: a scope review.

    Science.gov (United States)

    DeBell, Diane; Branson, Kathy

    2009-07-01

    A graduate entry workforce for nurse registration has been approved for England by 2010/11. The aim of this research was to discover the immediate tasks facing nurse managers in implementing that change. Previous research has focused on making the case for change rather than on implementation. Similar to the implementation of Project 2000, this change in nurse education and employment will raise questions for employers and for higher education institutions. It will also raise questions about nurse recruitment numbers, workforce development, and the profiles of entrants to a changing workforce. In preparation for these changes, we conducted a scope review of published and grey literature in the English language. We also reviewed the earlier experiences of transfer to graduate status amongst other workforces such as teaching and social work and we investigated reported practice in other industrialised countries. The education provider changes necessary for such a large professional workforce will need considerable leadership skills from within nursing and nurse management. At present, there are too many employers and education providers in England who appear to be relatively unaware of the changes facing nurse education and professional practice and the urgency needed to lead that change. Education, training and development as well as employer/commissioner practice will rely on leadership from within the nurse profession itself. For nurse managers, this requires a rapid planning process in order to ensure smooth implementation. The danger is that either education providers or commissioners of nursing services will react rather than proactively plan for the changes that are already in progress.

  6. 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

  7. 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

  8. Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review.

    Science.gov (United States)

    Overbeck, Gritt; Davidsen, Annette Sofie; Kousgaard, Marius Brostrøm

    2016-12-28

    Collaborative care is an increasingly popular approach for improving quality of care for people with mental health problems through an intensified and structured collaboration between primary care providers and health professionals with specialized psychiatric expertise. Trials have shown significant positive effects for patients suffering from depression, but since collaborative care is a complex intervention, it is important to understand the factors which affect its implementation. We present a qualitative systematic review of the enablers and barriers to implementing collaborative care for patients with anxiety and depression. We developed a comprehensive search strategy in cooperation with a research librarian and performed a search in five databases (EMBASE, PubMed, PsycINFO, ProQuest, and CINAHL). All authors independently screened titles and abstracts and reviewed full-text articles. Studies were included if they were published in English and based on the original qualitative data on the implementation of a collaborative care intervention targeted at depression or anxiety in an adult patient population in a high-income country. Our subsequent analysis employed the normalization process theory (NPT). We included 17 studies in our review of which 11 were conducted in the USA, five in the UK, and one in Canada. We identified several barriers and enablers within the four major analytical dimensions of NPT. Securing buy-in among primary care providers was found to be critical but sometimes difficult. Enablers included physician champions, reimbursement for extra work, and feedback on the effectiveness of collaborative care. The social and professional skills of the care managers seemed critical for integrating collaborative care in the primary health care clinic. Day-to-day implementation was also found to be facilitated by the care managers being located in the clinic since this supports regular face-to-face interactions between physicians and care managers

  9. 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

  10. Shared care in mental illness: A rapid review to inform implementation

    Directory of Open Access Journals (Sweden)

    Kelly Brian J

    2011-11-01

    Full Text Available Abstract Background While integrated primary healthcare for the management of depression has been well researched, appropriate models of primary care for people with severe and persistent psychotic disorders are poorly understood. In 2010 the NSW (Australia Health Department commissioned a review of the evidence on "shared care" models of ambulatory mental health services. This focussed on critical factors in the implementation of these models in clinical practice, with a view to providing policy direction. The review excluded evidence about dementia, substance use and personality disorders. Methods A rapid review involving a search for systematic reviews on The Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects (DARE. This was followed by a search for papers published since these systematic reviews on Medline and supplemented by limited iterative searching from reference lists. Results Shared care trials report improved mental and physical health outcomes in some clinical settings with improved social function, self management skills, service acceptability and reduced hospitalisation. Other benefits include improved access to specialist care, better engagement with and acceptability of mental health services. Limited economic evaluation shows significant set up costs, reduced patient costs and service savings often realised by other providers. Nevertheless these findings are not evident across all clinical groups. Gains require substantial cross-organisational commitment, carefully designed and consistently delivered interventions, with attention to staff selection, training and supervision. Effective models incorporated linkages across various service levels, clinical monitoring within agreed treatment protocols, improved continuity and comprehensiveness of services. Conclusions "Shared Care" models of mental health service delivery require attention to multiple levels (from organisational to individual

  11. Regulatory mechanisms for absenteeism in the health sector: a systematic review of strategies and their implementation.

    Science.gov (United States)

    Kisakye, Angela N; Tweheyo, Raymond; Ssengooba, Freddie; Pariyo, George W; Rutebemberwa, Elizeus; Kiwanuka, Suzanne N

    2016-01-01

    A systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middle-income countries. Mechanisms described in this review are at the local workplace and broader national policy level. A comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review. Twenty six of the 4,975 published articles retrieved were included. All were from high-income countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1) organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs); 2) prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3) contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4) multifaceted work interventions being implemented in most settings; 5) the possibility of using financial and incentive regulatory mechanisms in LMICs; 6) health intervention mechanisms reducing absenteeism when integrated with exercise programs; and 7) attendance by legislation during emergencies being criticized for violating human rights in the United States and not being effective in curbing absenteeism. Most countries have applied multiple strategies to mitigate health care worker absenteeism. The success of these

  12. Regulatory mechanisms for absenteeism in the health sector: a systematic review of strategies and their implementation

    Science.gov (United States)

    Kisakye, Angela N; Tweheyo, Raymond; Ssengooba, Freddie; Pariyo, George W; Rutebemberwa, Elizeus; Kiwanuka, Suzanne N

    2016-01-01

    Background A systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middle-income countries. Mechanisms described in this review are at the local workplace and broader national policy level. Methods A comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review. Results Twenty six of the 4,975 published articles retrieved were included. All were from high-income countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1) organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs); 2) prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3) contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4) multifaceted work interventions being implemented in most settings; 5) the possibility of using financial and incentive regulatory mechanisms in LMICs; 6) health intervention mechanisms reducing absenteeism when integrated with exercise programs; and 7) attendance by legislation during emergencies being criticized for violating human rights in the United States and not being effective in curbing absenteeism. Conclusion Most countries have applied multiple strategies to mitigate health care

  13. Operational readiness review implementation plan for K Basin sludge water system

    International Nuclear Information System (INIS)

    IRWIN, R.M.

    2003-01-01

    This Implementation Plan (IP) has been prepared consistent with the requirements of U.S. Department of Energy (DOE) Order 425.1B, ''Startup and Restart of Nuclear Facilities'', and DOE-STD-3006-2000, ''Planning and Conduct of Operational Readiness Reviews'' (ORR) (DOE 2002). The scope of the DOE ORR is described in the RL ''Plan of Action, K Basin Sludge Water System'' (Veitenheimer 2003), prepared by DOE project line management and approved by the RL Manager, the designated Approval Authority, on March 20, 2003. The scope of the contractor ORR is described in the contractor ''Plan of Action for the K Basins Sludge Water System Operational Readiness Review'' (FH 2002a) which was prepared by Spent Nuclear Fuel (SNF) Project line management and approved by the DOE Richland Operations Office (RL) Manager on December 19, 2002. DOE Order 425.1B indicates that the Secretarial Officer is the Authorization Authority when substantial modifications are made to a Hazard Category 2 nuclear facility. This Authorization Authority has been delegated to the RL Manager by memorandum from Jessie Hill Roberson, dated February 5, 2003 (Roberson 2003). This IP provides the overall approach and guidelines for performance of the DOE ORR. Appendix A contains the Criteria and Review Approach Documents (CRAD), which define the review objectives and criteria as well as the approach for assessing each objective. ORR results will be published in a final report, as discussed in Section 9.4

  14. A systematic review of the implementation of recommended psychological interventions for schizophrenia: Rates, barriers, and improvement strategies.

    Science.gov (United States)

    Ince, Paul; Haddock, Gillian; Tai, Sara

    2016-09-01

    A systematic review of the literature exploring if the UK recommendations for psychological interventions for schizophrenia were being met was carried out. Rates of implementation for cognitive behavioural therapy (CBT) and family intervention (FI) were compared. The barriers against implementation and described strategies aimed at improving implementation were reviewed. A literature search of electronic bibliography databases (Psychinfo, Medline, Pubmed, AMED, CINHAL, and EMBASE), reference and citation lists, the Evaluation and Review of NICE Implementation (ERNIE) database, a manual search of Clinical Psychology Forum, governmental reports, charity, and service user group reports was conducted. Twenty-six articles met the inclusion criteria, 11 provided data on implementation rates, 13 explored the barriers to implementation, and 10 gave information about improvement strategies. Rates of implementation varied from 4% to 100% for CBT and 0% to 53% for FI, and studies varied in the methodology used and quality of the articles. Previously reported barriers to implementation were found, with organisational barriers being most commonly followed by barriers met by staff members and service users. Implementation strategies discovered included training packages for CBT, FI, and psychosocial interventions as well as empirical evidence suggesting methods for engagement with service users. Rates of implementation for CBT and FI are still below recommended levels with wide variation of rates found. This suggests inequalities in the provision of psychological interventions for schizophrenia are still present. Previously identified barriers to implementation were confirmed. Attempted implementation strategies have been met with modest success. Inequalities in the provision of psychological therapies for schizophrenia persist. Good quality cognitive behavioural therapy and FI training do not ensure implementation. Collaboration at all levels of healthcare is needed for

  15. Advanced musculoskeletal physiotherapists in post arthroplasty review clinics: a state wide implementation program evaluation.

    Science.gov (United States)

    Harding, Paula; Burge, Angela; Walter, Kerrie; Shaw, Bridget; Page, Carolyn; Phan, Uyen; Terrill, Desiree; Liew, Susan

    2018-03-01

    To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists. A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015. The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding). 2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding. The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  16. Effect of Pretreatments on Seed Viability During Fruit Development ...

    African Journals Online (AJOL)

    Fiifi Baidoo

    and petri dishes on moist filter paper, gave 80% germination in variety gabonensis, 20 weeks after fruiting. .... Effect of pretreatments on seed germination of fruits of Irvingia gabonensis plucked from forest ...... A review of the tariff structure and.

  17. 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.

  18. Evaluation of lean manufacturing implementation: review of the proceedings of the NMPE

    Directory of Open Access Journals (Sweden)

    Olga Maria Formigoni Carvalho Walter

    2012-08-01

    Full Text Available Through a review of the proceedings of the National Meeting of Production Engineering (NMPE over the past 10 years, this article aims to identify the profile of Brazilian research regarding methods that assess the implementation of Lean Manufacturing (LM, proposing a classification for the methods analyzed. We identified 28 articles that specifically address the assessment of the implementation of LM, which accounts for 16 evaluation methods because some methods have been found in more than one article. The results show that the type of research most widely used is the case study. Lean practices more addressed are: Quality Tools, Multifunctional Teams, Quick-Changeover Techniques, Continuous Improvement and Visual Control. The presence of the researcher was found more than half of the studies analyzed. Less than half showed the full data collection instrument. Moreover most of the papers evaluate the LM industry, specifically on the shop floor. This article will be useful both to researchers and to professionals in Production Engineering interested in evaluating the progress of LM implementation, because it shows the profile of all the methods presented in NMIE, which reflects the progress in the Brazilian research on the subject.

  19. Success criteria for electronic medical record implementations in low-resource settings: a systematic review.

    Science.gov (United States)

    Fritz, Fleur; Tilahun, Binyam; Dugas, Martin

    2015-03-01

    Electronic medical record (EMR) systems have the potential of supporting clinical work by providing the right information at the right time to the right people and thus make efficient use of resources. This is especially important in low-resource settings where reliable data are also needed to support public health and local supporting organizations. In this systematic literature review, our objectives are to identify and collect literature about success criteria of EMR implementations in low-resource settings and to summarize them into recommendations. Our search strategy relied on PubMed queries and manual bibliography reviews. Studies were included if EMR implementations in low-resource settings were described. The extracted success criteria and measurements were summarized into 7 categories: ethical, financial, functionality, organizational, political, technical, and training. We collected 381 success criteria with 229 measurements from 47 articles out of 223 articles. Most papers were evaluations or lessons learned from African countries, published from 1999 to 2013. Almost half of the EMR systems served a specific disease area like human immunodeficiency virus (HIV). The majority of criteria that were reported dealt with the functionality, followed by organizational issues, and technical infrastructures. Sufficient training and skilled personnel were mentioned in roughly 10%. Political, ethical, and financial considerations did not play a predominant role. More evaluations based on reliable frameworks are needed. Highly reliable data handling methods, human resources and effective project management, as well as technical architecture and infrastructure are all key factors for successful EMR implementation. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes.

    Science.gov (United States)

    Geach, Nicole; Moghaddam, Nima G; De Boos, Danielle

    2017-10-03

    Team formulation is promoted by professional practice guidelines for clinical psychologists. However, it is unclear whether team formulation is understood/implemented in consistent ways - or whether there is outcome evidence to support the promotion of this practice. This systematic review aimed to (1) synthesize how team formulation practice is defined and implemented by practitioner psychologists and (2) analyse the range of team formulation outcomes in the peer-reviewed literature. Seven electronic bibliographic databases were searched in June 2016. Eleven articles met inclusion criteria and were quality assessed. Extracted data were synthesized using content analysis. Descriptions of team formulation revealed three main forms of instantiation: (1) a structured, consultation approach; (2) semi-structured, reflective practice meetings; and (3) unstructured/informal sharing of ideas through routine interactions. Outcome evidence linked team formulation to a range of outcomes for staff teams and service users, including some negative outcomes. Quality appraisal identified significant issues with evaluation methods; such that, overall, outcomes were not well-supported. There is weak evidence to support the claimed beneficial outcomes of team formulation in practice. There is a need for greater specification and standardization of 'team formulation' practices, to enable a clearer understanding of any relationships with outcomes and implications for best-practice implementations. Under the umbrella term of 'team formulation', three types of practice are reported: (1) highly structured consultation; (2) reflective practice meetings; and (3) informal sharing of ideas. Outcomes linked to team formulation, including some negative outcomes, were not well evidenced. Research using robust study designs is required to investigate the process and outcomes of team formulation practice. © 2017 The British Psychological Society.

  1. Implementing managed alcohol programs in hospital settings: A review of academic and grey literature.

    Science.gov (United States)

    Brooks, Hannah L; Kassam, Shehzad; Salvalaggio, Ginetta; Hyshka, Elaine

    2018-04-01

    People with severe alcohol use disorders are at increased risk of poor acute-care outcomes, in part due to difficulties maintaining abstinence from alcohol while hospitalised. Managed alcohol programs (MAP), which administer controlled doses of beverage alcohol to prevent withdrawal and stabilise drinking patterns, are one strategy for increasing adherence to treatment, and improving health outcomes for hospital inpatients with severe alcohol use disorders. Minimal research has examined the implementation of MAPs in hospital settings. We conducted a scoping review to describe extant literature on MAPs in community settings, as well as the therapeutic provision of alcohol to hospital inpatients, to assess the feasibility of implementing formal MAPs in hospital settings and identify knowledge gaps requiring further study. Four academic and 10 grey literature databases were searched. Evidence was synthesised using quantitative and qualitative approaches. Forty-two studies met review inclusion criteria. Twenty-eight examined the administration of alcohol to hospital inpatients, with most reporting positive outcomes related to prevention or treatment of alcohol withdrawal. Fourteen studies examined MAPs in the community and reported that they help stabilise drinking patterns, reduce alcohol-related harms and facilitate non-judgemental health and social care. MAPs in the community have been well described and research has documented effective provision of alcohol in hospital settings for addressing withdrawal. Implementing MAPs as a harm reduction approach in hospital settings is potentially feasible. However, there remains a need to build off extant literature and develop and evaluate standardised MAP protocols tailored to acute-care settings. © 2018 Australasian Professional Society on Alcohol and other Drugs.

  2. 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

  3. Implementation of a consent for chart review and contact and its impact in one clinical centre.

    Science.gov (United States)

    Druce, Irena; Ooi, T C; McGuire, Debbie; Sorisky, Alexander; Malcolm, Janine

    2015-05-01

    Informed consent and protection of patient confidentiality are central to the conduction of clinical research. Consent for chart review and contact (CCRC) allows a patient chart to be screened for research by persons outside the direct circle-of-care and for the patient to be contacted regarding potential studies. This study describes the process of implementation and benefits of such a consent. We present a descriptive report of a CCRC document that was created and presented to patients over a 3.5-year period at a tertiary care Endocrinology and Metabolism centre. To assess the potential impact of such a document on patient recruitment, the basic demographics of patients who did and did not consent were compared. In addition, we compared the recruitment rate at our centre, using our novel approach, with that at other centres for an ongoing study of patients with type 1 diabetes. A large proportion (6501/8025, or 81%) of patients gave their consent for chart review. Patients who denied consent were more likely to be women and older. Compared with other centres, our centre recruited at the highest rate for a known study of patients with type 1 diabetes. The majority (46/60, or 76.7%) of patients were recruited via the novel approach. Consent for chart review and contact addresses several important ethical issues regarding the use of patient clinical information for research purposes. Our study demonstrated how such a process can be implemented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Implementation outcome assessment instruments used in physical healthcare settings and their measurement properties: a systematic review protocol

    Science.gov (United States)

    Vitoratou, Silia; Sevdalis, Nick; Hull, Louise

    2017-01-01

    Introduction Over the past 10 years, research into methods that promote the uptake, implementation and sustainability of evidence-based interventions has gathered pace. However, implementation outcomes are defined in different ways and assessed by different measures; the extent to which these measures are valid and reliable is unknown. The aim of this systematic review is to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings, to advance the use of precise and accurate measures. Methods and analysis The following databases will be searched from inception to March 2017: MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. Grey literature will be sought via HMIC, OpenGrey, ProQuest for theses and Web of Science Conference Proceedings Citation Index-Science. Reference lists of included studies and relevant reviews will be hand searched. Three search strings will be combined to identify eligible studies: (1) implementation literature, (2) implementation outcomes and (3) measurement properties. Screening of titles, abstracts and full papers will be assessed for eligibility by two reviewers independently and any discrepancies resolved via consensus with the wider team. The methodological quality of the studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. A set of bespoke criteria to determine the quality of the instruments will be used, and the relationship between instrument usability and quality will be explored. Ethics and dissemination Ethical approval is not necessary for systematic review protocols. Researchers and healthcare professionals can use the findings of this systematic review to guide the selection of implementation outcomes instruments, based on their psychometric quality, to assess the impact of their implementation efforts. The findings will also provide a useful guide for

  5. Chemical leasing--a review of implementation in the past decade.

    Science.gov (United States)

    Moser, Frank; Jakl, Thomas

    2015-04-01

    In the past decade, research on innovative business models to manage the risk of chemical substances has sought to provide solutions to achieve the goals of the World Summit on Sustainable Development of 2002, which called for a renewal of the commitment to the sound management of chemicals and of hazardous wastes throughout their life cycle and set the ambitious goal, by 2020, to use and produce chemicals in ways that do not lead to significant adverse effects on human health and the environment. Chemical Leasing is an innovative business model that shows a great potential to become a global model for sustainable development within chemical management. This paper provides a review of the current standings of literature regarding the implementation of Chemical Leasing in the past decade. In doing so, the paper highlights the potential of this business model to serve as an approach for dematerializing production processes and managing the risks of chemicals at all levels. More in detail, it provides an outline of how Chemical Leasing has supported the alignment and implementation of the objectives of chemicals policy-makers and industry regarding the production and use of chemicals and analyses to what extent Chemical Leasing contributes to the implementation of a number of voluntary global initiatives, such as Cleaner Production, Sustainable Chemistry and Corporate Social Responsibility. This paper provides a systematic analysis of the gaps identified in literature regarding the implementation of Chemical Leasing business models. Based on this analysis, specific aspects in the field of Chemical Leasing are recommended to be further elaborated in order to increase the understanding and applicability of the business model.

  6. Regulatory mechanisms for absenteeism in the health sector: a systematic review of strategies and their implementation

    Directory of Open Access Journals (Sweden)

    Kisakye AN

    2016-11-01

    Full Text Available Angela N Kisakye,1 Raymond Tweheyo,1 Freddie Ssengooba,1 George W Pariyo,2 Elizeus Rutebemberwa,1 Suzanne N Kiwanuka1 1Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda; 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Background: A systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middle-income countries. Mechanisms described in this review are at the local workplace and broader national policy level. Methods: A comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review. Results: Twenty six of the 4,975 published articles retrieved were included. All were from high-income countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1 organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs; 2 prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3 contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4 multifaceted work interventions being implemented in most settings; 5 the possibility of using financial and incentive regulatory mechanisms

  7. The implementation of the Plan Esperanza and response to the imPACT Review.

    Science.gov (United States)

    Vidaurre, Tatiana; Santos, Carlos; Gómez, Henry; Sarria, Gustavo; Amorin, Edgar; López, Marga; Regalado, Roxana; Manrique, Javier; Tarco, Duniska; Ayestas, Carlos; Calderón, Mónica; Mas, Luis; Neciosup, Silvia; Salazar, Miriam; Chávez, Juan Carlos; Ubillus, Milward; Limache, Abel; Ubillus, José Carlos; Navarro, Jeannie; Sarwal, Kavita; Sutcliffe, Simon; Gutiérrez-Aguado, Alfonso; Silva, Marianela; Mena, Amalia; Guillén, María Eugenia; Castañeda, Carlos; Abugattas, Julio

    2017-10-01

    Following the implementation of the National Cancer Prevention and Control Results-based Budget Programme (PpR Cancer-024) in 2011, the Peruvian Government approved the Plan Esperanza-a population-based national cancer control plan-in 2012. Legislation that ensured full government-supported funding for people who were otherwise unable to access or afford care and treatment accompanied the Plan. In 2013, the Ministry of Health requested an integrated mission of the Programme of Action for Cancer Therapy (imPACT) report to strengthen cancer control in Peru. The imPACT Review, which was executed in 2014, assessed Peru's achievements in cancer control, and areas for improvement, including cancer control planning, further development of population-based cancer registration, increased prevention, early diagnosis, treatment and palliative care, and the engagement and participation of civil society in the health-care system. This Series paper gives a brief history of the development of the Plan Esperanza, describes the innovative funding model that supports it, and summarises how funds are disseminated on the basis of disease, geography, and demographics. An overview of the imPACT Review, and the government's response in the context of the Plan Esperanza, is provided. The development and execution of the Plan Esperanza and the execution of and response to the imPACT Review demonstrates the Peruvian Government's commitment to fighting cancer across the country, including in remote and urban areas. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Readiness factors for lean implementation in healthcare settings--a literature review.

    Science.gov (United States)

    Al-Balushi, S; Sohal, A S; Singh, P J; Al Hajri, A; Al Farsi, Y M; Al Abri, R

    2014-01-01

    The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature. A comprehensive review of literature focussing on lean and lean healthcare was conducted. Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings. The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study. The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed. To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

  9. Curricular Review and Renewal at Massey University: A Process to Implement Improved Learning Practices.

    Science.gov (United States)

    Parkinson, Tim J; Weston, Jenny F; Williamson, Norman B

    Curriculum managers of the Bachelor of Veterinary Science program at Massey University have undertaken major curricular review every 5-10 years and also made adjustments to the program as a result of student and other stakeholder feedback. New curricula introduced in 2003 and 2013 aimed to address specific stakeholder requirements in the veterinary, agricultural, and allied industries. The new curricula initially sought to strengthen clinical skills but more recently focused on the core professional skill of client communication, the integration of knowledge and clinical skills, and a better understanding of the effects of herd health interventions on farm economics. The need for greater emphasis on the veterinarian's role in One Health at the intersection of humans, animals, and the environment was also recognized. The most recent curricular review was preceded by faculty enlightenment and discussion about innovative models of medical education with a focus on student-centered and integrated learning. A new curriculum was introduced from 2013 that presented more material in its clinical context, attempted to manage curriculum overload through a focus on Day One Competences, implemented vertical and horizontal integration of subjects, and introduced more problem-based and student-centered learning. Regular reviews of student workload were needed to ensure that the objectives were achieved, but student feedback has generally been positive.

  10. 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.

  11. The evidence-practice gap in specialist mental healthcare: systematic review and meta-analysis of guideline implementation studies.

    Science.gov (United States)

    Girlanda, Francesca; Fiedler, Ines; Becker, Thomas; Barbui, Corrado; Koesters, Markus

    2017-01-01

    Clinical practice guidelines are not easily implemented, leading to a gap between research synthesis and their use in routine care. To summarise the evidence relating to the impact of guideline implementation on provider performance and patient outcomes in mental healthcare settings, and to explore the performance of different strategies for guideline implementation. A systematic review of randomised controlled trials, controlled clinical trials and before-and-after studies comparing guideline implementation strategies v. usual care, and different guideline implementation strategies, in patients with severe mental illness. In total, 19 studies met our inclusion criteria. The studies did not show a consistent positive effect of guideline implementation on provider performance, but a more consistent small to modest positive effect on patient outcomes. Guideline implementation does not seem to have an impact on provider performance, nonetheless it may influence patient outcomes positively. © The Royal College of Psychiatrists 2017.

  12. Biomass shock pretreatment

    Science.gov (United States)

    Holtzapple, Mark T.; Madison, Maxine Jones; Ramirez, Rocio Sierra; Deimund, Mark A.; Falls, Matthew; Dunkelman, John J.

    2014-07-01

    Methods and apparatus for treating biomass that may include introducing a biomass to a chamber; exposing the biomass in the chamber to a shock event to produce a shocked biomass; and transferring the shocked biomass from the chamber. In some aspects, the method may include pretreating the biomass with a chemical before introducing the biomass to the chamber and/or after transferring shocked biomass from the chamber.

  13. Alcolocks : factors influencing implementation, participation and compliance : literature review contributed to the EU project Alcolock Implementation in the European Union.

    NARCIS (Netherlands)

    Mathijssen, M.P.M.

    2007-01-01

    In 2004-2005, a series of alcolock field trials were conducted in four European countries, in the framework of the EU research project Alcolock Implementation in the European Union. This project was granted by the European Commission, Directorate-General for Energy and Transport (DG-TREN). As part

  14. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa.

    Science.gov (United States)

    Silumbwe, Adam; Zulu, Joseph Mumba; Halwindi, Hikabasa; Jacobs, Choolwe; Zgambo, Jessy; Dambe, Rosalia; Chola, Mumbi; Chongwe, Gershom; Michelo, Charles

    2017-05-22

    Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to

  15. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Adam Silumbwe

    2017-05-01

    Full Text Available Abstract Background Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. Methods A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. Results The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Conclusion Mass drug administration for lymphatic filariasis elimination programmes should design their implementation

  16. Microwave pretreatment of switchgrass for bioethanol production

    Science.gov (United States)

    Keshwani, Deepak Radhakrishin

    Lignocellulosic materials are promising alternative feedstocks for bioethanol production. These materials include agricultural residues, cellulosic waste such as newsprint and office paper, logging residues, and herbaceous and woody crops. However, the recalcitrant nature of lignocellulosic biomass necessitates a pretreatment step to improve the yield of fermentable sugars. The overall goal of this dissertation is to expand the current state of knowledge on microwave-based pretreatment of lignocellulosic biomass. Existing research on bioenergy and value-added applications of switchgrass is reviewed in Chapter 2. Switchgrass is an herbaceous energy crop native to North America and has high biomass productivity, potentially low requirements for agricultural inputs and positive environmental impacts. Based on results from test plots, yields in excess of 20 Mg/ha have been reported. Environmental benefits associated with switchgrass include the potential for carbon sequestration, nutrient recovery from run-off, soil remediation and provision of habitats for grassland birds. Published research on pretreatment of switchgrass reported glucose yields ranging from 70-90% and xylose yields ranging from 70-100% after hydrolysis and ethanol yields ranging from 72-92% after fermentation. Other potential value-added uses of switchgrass include gasification, bio-oil production, newsprint production and fiber reinforcement in thermoplastic composites. Research on microwave-based pretreatment of switchgrass and coastal bermudagrass is presented in Chapter 3. Pretreatments were carried out by immersing the biomass in dilute chemical reagents and exposing the slurry to microwave radiation at 250 watts for residence times ranging from 5 to 20 minutes. Preliminary experiments identified alkalis as suitable chemical reagents for microwave-based pretreatment. An evaluation of different alkalis identified sodium hydroxide as the most effective alkali reagent. Under optimum pretreatment

  17. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems.

    Science.gov (United States)

    Phansalkar, Shobha; Edworthy, Judy; Hellier, Elizabeth; Seger, Diane L; Schedlbauer, Angela; Avery, Anthony J; Bates, David W

    2010-01-01

    The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many basic human factors principles are not followed, possibly contributing to the lack of acceptance of alerts in clinical information systems. We evaluate the limitations of current alerting philosophies and provide recommendations for improving acceptance of alerts by incorporating human factors principles in their design.

  18. Review and Implementation of the Emerging CCSDS Recommended Standard for Multispectral and Hyperspectral Lossless Image Coding

    Science.gov (United States)

    Sanchez, Jose Enrique; Auge, Estanislau; Santalo, Josep; Blanes, Ian; Serra-Sagrista, Joan; Kiely, Aaron

    2011-01-01

    A new standard for image coding is being developed by the MHDC working group of the CCSDS, targeting onboard compression of multi- and hyper-spectral imagery captured by aircraft and satellites. The proposed standard is based on the "Fast Lossless" adaptive linear predictive compressor, and is adapted to better overcome issues of onboard scenarios. In this paper, we present a review of the state of the art in this field, and provide an experimental comparison of the coding performance of the emerging standard in relation to other state-of-the-art coding techniques. Our own independent implementation of the MHDC Recommended Standard, as well as of some of the other techniques, has been used to provide extensive results over the vast corpus of test images from the CCSDS-MHDC.

  19. International Review of the Development and Implementation of Energy Efficiency Standards and Labeling Programs

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Nan; Zheng, Nina; Fridley, David

    2012-02-28

    Appliance energy efficiency standards and labeling (S&L) programs have been important policy tools for regulating the efficiency of energy-using products for over 40 years and continue to expand in terms of geographic and product coverage. The most common S&L programs include mandatory minimum energy performance standards (MEPS) that seek to push the market for efficient products, and energy information and endorsement labels that seek to pull the market. This study seeks to review and compare some of the earliest and most well-developed S&L programs in three countries and one region: the U.S. MEPS and ENERGY STAR, Australia MEPS and Energy Label, European Union MEPS and Ecodesign requirements and Energy Label and Japanese Top Runner programs. For each program, key elements of S&L programs are evaluated and comparative analyses across the programs undertaken to identify best practice examples of individual elements as well as cross-cutting factors for success and lessons learned in international S&L program development and implementation. The international review and comparative analysis identified several overarching themes and highlighted some common factors behind successful program elements. First, standard-setting and programmatic implementation can benefit significantly from a legal framework that stipulates a specific timeline or schedule for standard-setting and revision, product coverage and legal sanctions for non-compliance. Second, the different MEPS programs revealed similarities in targeting efficiency gains that are technically feasible and economically justified as the principle for choosing a standard level, in many cases at a level that no product on the current market could reach. Third, detailed survey data such as the U.S. Residential Energy Consumption Survey (RECS) and rigorous analyses provide a strong foundation for standard-setting while incorporating the participation of different groups of stakeholders further strengthen the process

  20. Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis.

    Science.gov (United States)

    Breland, Jessica Y; Asch, Steven M; Slightam, Cindie; Wong, Ava; Zulman, Donna M

    2016-03-01

    Intensive outpatient programs aim to transform care while conserving resources for high-need, high-cost patients, but little is known about factors that influence their implementation within patient-centered medical homes (PCMHs). In this mixed-methods study, we reviewed the literature to identify factors affecting intensive outpatient program implementation, then used semi-structured interviews to determine how these factors influenced the implementation of an intensive outpatient program within the Veterans Affairs' (VA) PCMH. Interviewees included facility leadership and clinical staff who were involved in a pilot Intensive Management Patient Aligned Care Team (ImPACT) intervention for high-need, high-cost VA PCMH patents. We classified implementation factors in the literature review and qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). The literature review (n=9 studies) and analyses of interviews (n=15) revealed key implementation factors in three CFIR domains. First, the Inner Setting (i.e., the organizational and PCMH environment), mostly enabled implementation through a culture of innovation, good networks and communication, and positive tension for change. Second, Characteristics of Individuals, including creativity, flexibility, and interpersonal skills, allowed program staff to augment existing PCMH services. Finally, certain Intervention Characteristics (e.g., adaptability) enabled implementation, while others (e.g., complexity) generated implementation barriers. Resources and structural features common to PCMHs can facilitate implementation of intensive outpatient programs, but program success is also dependent on staff creativity and flexibility, and intervention adaptations to meet patient and organizational needs. Established PCMHs likely provide resources and environments that permit accelerated implementation of intensive outpatient programs. V. Published by Elsevier Inc.

  1. Early Child Development and Nutrition: A Review of the Benefits and Challenges of Implementing Integrated Interventions.

    Science.gov (United States)

    Hurley, Kristen M; Yousafzai, Aisha K; Lopez-Boo, Florencia

    2016-03-01

    Poor nutrition (substandard diet quantity and/or quality resulting in under- or overnutrition) and the lack of early learning opportunities contribute to the loss of developmental potential and life-long health and economic disparities among millions of children aged early child development (ECD) or nutrition have been linked to positive child development and/or nutritional status, and recommendations currently advocate for the development and testing of integrated interventions. We reviewed the theoretical and practical benefits and challenges of implementing integrated nutrition and ECD interventions along with the evidence for best practice and benefit-cost and concluded that the strong theoretical rationale for integration is more nuanced than the questions that the published empirical evidence have addressed. For example, further research is needed to 1) answer questions related to how integrated messaging influences caregiver characteristics such as well-being, knowledge, and behavior and how these influence early child nutrition and development outcomes; 2) understand population and nutritional contexts in which integrated interventions are beneficial; and 3) explore how varying implementation processes influence the efficacy, uptake, and cost-benefit of integrated nutrition and ECD interventions. © 2016 American Society for Nutrition.

  2. The effects of implementing synoptic pathology reporting in cancer diagnosis: a systematic review.

    Science.gov (United States)

    Sluijter, Caro E; van Lonkhuijzen, Luc R C W; van Slooten, Henk-Jan; Nagtegaal, Iris D; Overbeek, Lucy I H

    2016-06-01

    Pathology reporting is evolving from a traditional narrative report to a more structured synoptic report. Narrative reporting can cause misinterpretation due to lack of information and structure. In this systematic review, we evaluate the impact of synoptic reporting on completeness of pathology reports and quality of pathology evaluation for solid tumours. Pubmed, Embase and Cochrane databases were systematically searched to identify studies describing the effect of synoptic reporting implementation on completeness of reporting and quality of pathology evaluation of solid malignant tumours. Thirty-three studies met the inclusion criteria. All studies, except one, reported an increased overall completeness of pathology reports after introduction of synoptic reporting (SR). Most frequently studied cancers were breast (n = 9) and colorectal cancer (n = 16). For breast cancer, narrative reports adequately described 'tumour type' and 'nodal status'. Synoptic reporting resulted in improved description of 'resection margins', 'DCIS size', 'location' and 'presence of calcifications'. For colorectal cancer, narrative reports adequately reported 'tumour type', 'invasion depth', 'lymph node counts' and 'nodal status'. Synoptic reporting resulted in increased reporting of 'circumferential margin', 'resection margin', 'perineural invasion' and 'lymphovascular invasion'. In addition, increased numbers of reported lymph nodes were found in synoptic reports. Narrative reports of other cancer types described the traditional parameters adequately, whereas for 'resection margins' and '(lympho)vascular/perineural invasion', implementation of synoptic reporting was necessary. Synoptic reporting results in improved reporting of clinical relevant data. Demonstration of clinical impact of this improved method of pathology reporting is required for successful introduction and implementation in daily pathology practice.

  3. Cost analysis for the implementation of a medication review with follow-up service in Spain.

    Science.gov (United States)

    Noain, Aranzazu; Garcia-Cardenas, Victoria; Gastelurrutia, Miguel Angel; Malet-Larrea, Amaia; Martinez-Martinez, Fernando; Sabater-Hernandez, Daniel; Benrimoj, Shalom I

    2017-08-01

    Background Medication review with follow-up (MRF) is a professional pharmacy service proven to be cost-effective. Its broader implementation is limited, mainly due to the lack of evidence-based implementation programs that include economic and financial analysis. Objective To analyse the costs and estimate the price of providing and implementing MRF. Setting Community pharmacy in Spain. Method Elderly patients using poly-pharmacy received a community pharmacist-led MRF for 6 months. The cost analysis was based on the time-driven activity based costing model and included the provider costs, initial investment costs and maintenance expenses. The service price was estimated using the labour costs, costs associated with service provision, potential number of patients receiving the service and mark-up. Main outcome measures Costs and potential price of MRF. Results A mean time of 404.4 (SD 232.2) was spent on service provision and was extrapolated to annual costs. Service provider cost per patient ranged from €196 (SD 90.5) to €310 (SD 164.4). The mean initial investment per pharmacy was €4594 and the mean annual maintenance costs €3,068. Largest items contributing to cost were initial staff training, continuing education and renting of the patient counselling area. The potential service price ranged from €237 to €628 per patient a year. Conclusion Time spent by the service provider accounted for 75-95% of the final cost, followed by initial investment costs and maintenance costs. Remuneration for professional pharmacy services provision must cover service costs and appropriate profit, allowing for their long-term sustainability.

  4. Cochrane Qualitative and Implementation Methods Group guidance series-paper 5: methods for integrating qualitative and implementation evidence within intervention effectiveness reviews.

    Science.gov (United States)

    Harden, Angela; Thomas, James; Cargo, Margaret; Harris, Janet; Pantoja, Tomas; Flemming, Kate; Booth, Andrew; Garside, Ruth; Hannes, Karin; Noyes, Jane

    2018-05-01

    The Cochrane Qualitative and Implementation Methods Group develops and publishes guidance on the synthesis of qualitative and mixed-method evidence from process evaluations. Despite a proliferation of methods for the synthesis of qualitative research, less attention has focused on how to integrate these syntheses within intervention effectiveness reviews. In this article, we report updated guidance from the group on approaches, methods, and tools, which can be used to integrate the findings from quantitative studies evaluating intervention effectiveness with those from qualitative studies and process evaluations. We draw on conceptual analyses of mixed methods systematic review designs and the range of methods and tools that have been used in published reviews that have successfully integrated different types of evidence. We outline five key methods and tools as devices for integration which vary in terms of the levels at which integration takes place; the specialist skills and expertise required within the review team; and their appropriateness in the context of limited evidence. In situations where the requirement is the integration of qualitative and process evidence within intervention effectiveness reviews, we recommend the use of a sequential approach. Here, evidence from each tradition is synthesized separately using methods consistent with each tradition before integration takes place using a common framework. Reviews which integrate qualitative and process evaluation evidence alongside quantitative evidence on intervention effectiveness in a systematic way are rare. This guidance aims to support review teams to achieve integration and we encourage further development through reflection and formal testing. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Bevacizumab Demonstrates Prolonged Disease Stabilization in Patients with Heavily Pretreated Metastatic Renal Cell Carcinoma: A Case Series and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Nicole M. Agostino

    2010-01-01

    Full Text Available There are now a variety of therapies approved for the treatment of metastatic renal cell carcinoma (RCC. These include the immunotherapeutics, alfa-interferon, and interleukin-2, and agents that target the vascular endothelial growth factor receptor (VEGFR via its tyrosine kinase, such as sorafenib, sunitinib, and pazopanib, or the mammalian target of rapamycin (mTOR, such as temsirolimus and everolimus. Bevacizumab, a monoclonal antibody directed against the ligand, VEGF, has shown activity against RCC as a single agent in patients who had failed prior cytokine therapy and as first line therapy in combination with interferon. The activity of bevacizumab in patients who had received and failed prior therapy has not been described. We report our experience in 4 patients with metastatic RCC who had failed prior cytokine, TKI, and mTOR inhibitors who were treated with bevacizumab as single agent therapy. These heavily pretreated patients sustained very prolonged periods of stable disease (median of 12 months with very little toxicity and excellent quality of life. The activity of this agent in patients who had failed prior therapies directed against the VEGFR and mTOR suggests that therapy targeting the ligand, VEGF, is still a viable approach in these patients and deserves further study.

  6. 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

  7. Design and implementation of Metta, a metasearch engine for biomedical literature retrieval intended for systematic reviewers.

    Science.gov (United States)

    Smalheiser, Neil R; Lin, Can; Jia, Lifeng; Jiang, Yu; Cohen, Aaron M; Yu, Clement; Davis, John M; Adams, Clive E; McDonagh, Marian S; Meng, Weiyi

    2014-01-01

    Individuals and groups who write systematic reviews and meta-analyses in evidence-based medicine regularly carry out literature searches across multiple search engines linked to different bibliographic databases, and thus have an urgent need for a suitable metasearch engine to save time spent on repeated searches and to remove duplicate publications from initial consideration. Unlike general users who generally carry out searches to find a few highly relevant (or highly recent) articles, systematic reviewers seek to obtain a comprehensive set of articles on a given topic, satisfying specific criteria. This creates special requirements and challenges for metasearch engine design and implementation. We created a federated search tool that is connected to five databases: PubMed, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials. Retrieved bibliographic records were shown online; optionally, results could be de-duplicated and exported in both BibTex and XML format. The query interface was extensively modified in response to feedback from users within our team. Besides a general search track and one focused on human-related articles, we also added search tracks optimized to identify case reports and systematic reviews. Although users could modify preset search options, they were rarely if ever altered in practice. Up to several thousand retrieved records could be exported within a few minutes. De-duplication of records returned from multiple databases was carried out in a prioritized fashion that favored retaining citations returned from PubMed. Systematic reviewers are used to formulating complex queries using strategies and search tags that are specific for individual databases. Metta offers a different approach that may save substantial time but which requires modification of current search strategies and better indexing of randomized controlled trial articles. We envision Metta as one piece of a multi-tool pipeline that will assist

  8. Strategies for implementing school-located influenza vaccination of children: a systematic literature review.

    Science.gov (United States)

    Cawley, John; Hull, Harry F; Rousculp, Matthew D

    2010-04-01

    The Advisory Committee on Immunization Practices (ACIP) recommends influenza vaccinations for all children 6 months to 18 years of age, which includes school-aged children. Influenza immunization programs may benefit schools by reducing absenteeism. A systematic literature review of PubMed, PsychLit, and Dissertation Abstracts available as of January 7, 2008, was conducted for school-located vaccinations, using search words "School Health Services" and "Immunization Programs"; limited to "Child" (6-12 years) and "Adolescent" (13-18 years) for PubMed and "mass or universal" and (immuniz(*) or immunis(*) or vaccin(*)) and (school or Child or Adolescen(*)) for PsychLit and Dissertation Abstracts. Fifty-nine studies met the criteria for review. Strategies such as incentives, education, the design of the consent form, and follow-up can increase parental consent and number of returned forms. Minimizing out-of-pocket cost, offering both the intramuscular (shot) and intranasal (nasal spray) vaccination, and using reminders can increase vaccination coverage among those whose parents consented. Finally, organization, communication, and planning can minimize the logistical challenges. Schools-based vaccination programs are a promising option for achieving the expanded ACIP recommendation; school-located vaccination programs are feasible and effective. Adhering to lessons from the peer-reviewed scientific literature may help public health officials and schools implement the expanded recommendation to provide the greatest benefit for the lowest cost. Given the potential benefits of the expanded recommendation, both directly to the vaccinated children and indirectly to the community, prospective, well-controlled trials to establish the cost-effectiveness of specific vaccination strategies should be high priorities for future research.

  9. A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia.

    Science.gov (United States)

    Janamian, Tina; Jackson, Claire L; Glasson, Nicola; Nicholson, Caroline

    2014-08-04

    To review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. Systematic review of peer-reviewed literature. PubMed and Embase databases were searched in December 2012 for studies published in English between January 2007 and December 2012. Studies of any type were included if they defined PCMH using the Patient-Centered Primary Care Collaborative Joint Principles, and reported data on challenges and barriers to implementation and adoption of the PCMH model. One researcher with content knowledge in the area abstracted data relating to the review objective and study design from eligible articles. A second researcher reviewed the abstracted data alongside the original article to check for accuracy and completeness. Thematic synthesis was used to in three stages: free line-by-line coding of data; organisation of "free codes" into related areas to construct "descriptive" themes and develop "analytical" themes. The main barriers identified related to: challenges with the transformation process; difficulties associated with change management; challenges in implementing and using an electronic health record that administers principles of PCMH; challenges with funding and appropriate payment models; insufficient resources and infrastructure within practices; and inadequate measures of performance. This systematic review documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable evidence for Australian clinicians, policymakers, and organisations approaching adoption of PCMH elements within reform initiatives in this country.

  10. Factors associated with the implementation of community-based peer-led health promotion programs: A scoping review.

    Science.gov (United States)

    Lorthios-Guilledroit, Agathe; Richard, Lucie; Filiatrault, Johanne

    2018-06-01

    Peer education is growing in popularity as a useful health promotion strategy. However, optimal conditions for implementing peer-led health promotion programs (HPPs) remain unclear. This scoping review aimed to describe factors that can influence implementation of peer-led HPPs targeting adult populations. Five databases were searched using the keywords "health promotion/prevention", "implementation", "peers", and related terms. Studies were included if they reported at least one factor associated with the implementation of community-based peer-led HPPs. Fifty-five studies were selected for the analysis. The method known as "best fit framework synthesis" was used to analyze the factors identified in the selected papers. Many factors included in existing implementation conceptual frameworks were deemed applicable to peer-led HPPs. However, other factors related to individuals, programs, and implementation context also emerged from the analysis. Based on this synthesis, an adapted theoretical framework was elaborated, grounded in a complex adaptive system perspective and specifying potential mechanisms through which factors may influence implementation of community-based peer-led HPPs. Further research is needed to test the theoretical framework against empirical data. Findings from this scoping review increase our knowledge of the optimal conditions for implementing peer-led HPPs and thereby maximizing the benefits of such programs. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Implementing communication and decision-making interventions directed at goals of care: a theory-led scoping review.

    Science.gov (United States)

    Cummings, Amanda; Lund, Susi; Campling, Natasha; May, Carl R; Richardson, Alison; Myall, Michelle

    2017-10-06

    To identify the factors that promote and inhibit the implementation of interventions that improve communication and decision-making directed at goals of care in the event of acute clinical deterioration. A scoping review was undertaken based on the methodological framework of Arksey and O'Malley for conducting this type of review. Searches were carried out in Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to identify peer-reviewed papers and in Google to identify grey literature. Searches were limited to those published in the English language from 2000 onwards. Inclusion and exclusion criteria were applied, and only papers that had a specific focus on implementation in practice were selected. Data extracted were treated as qualitative and subjected to directed content analysis. A theory-informed coding framework using Normalisation Process Theory (NPT) was applied to characterise and explain implementation processes. Searches identified 2619 citations, 43 of which met the inclusion criteria. Analysis generated six themes fundamental to successful implementation of goals of care interventions: (1) input into development; (2) key clinical proponents; (3) training and education; (4) intervention workability and functionality; (5) setting and context; and (6) perceived value and appraisal. A broad and diverse literature focusing on implementation of goals of care interventions was identified. Our review recognised these interventions as both complex and contentious in nature, making their incorporation into routine clinical practice dependent on a number of factors. Implementing such interventions presents challenges at individual, organisational and systems levels, which make them difficult to introduce and embed. We have identified a series of factors that influence successful implementation and our analysis has distilled key learning points, conceptualised as a set of propositions, we consider relevant to implementing other complex

  12. Electrolytic pretreatment of urine

    Science.gov (United States)

    1977-01-01

    Electrolysis has been under evaluation for several years as a process to pretreat urine for ultimate recovery of potable water in manned spacecraft applications. The conclusions that were drawn from this investigation are the following: (1) A platinum alloy containing 10 percent rhodium has been shown to be an effective, corrosion-resistant anode material for the electrolytic pretreatment of urine. Black platinum has been found to be suitable as a cathode material. (2) The mechanism of the reactions occurring during the electrolysis of urine is two-stage: (a) a total Kjeldahl nitrogen and total organic carbon (TOC) removal in the first stage is the result of electrochemical oxidation of urea to CO2, H2O, and ammonia followed by chloride interaction to produce N2 from ammonia, (b) after the urea has been essentially removed and the chloride ions have no more ammonia to interact with, the chloride ions start to oxidize to higher valence states, thus producing perchlorates. (3) Formation of perchlorates can be suppressed by high/low current operation, elevated temperature, and pH adjustment. (4) UV-radiation showed promise in assisting electrolytic TOC removal in beaker tests, but was not substantiated in limited single cell testing. This may have been due to non-optimum configurations of the single cell test rig and the light source.

  13. 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.

  14. Results From the Audit of DOD’s American Recovery and Reinvestment Act of 2009 Initial Data Quality Review Implementation

    Science.gov (United States)

    2009-11-03

    Results From the Audit of DoD’s American Recovery and Reinvestment Act of 2009 Initial Data Quality Review Implementation Memorandum No. D-2010-RAM...number. 1. REPORT DATE 03 NOV 2009 2. REPORT TYPE 3. DATES COVERED 00-00-2009 to 00-00-2009 4. TITLE AND SUBTITLE Results From the Audit of...SUBJECT: Results From the Audit of DOD’ s American Recovery and Reinvestment Act of2009 Initial Data Quality Review Implementation (Report No. D

  15. An evaluation of dilute acid and ammonia fiber explosion pretreatment for cellulosic ethanol production.

    Science.gov (United States)

    Mathew, Anil Kuruvilla; Parameshwaran, Binod; Sukumaran, Rajeev Kumar; Pandey, Ashok

    2016-01-01

    The challenge associated with cellulosic ethanol production is maximizing sugar yield at low cost. Current research is being focused to develop a pretreatment method to overcome biomass recalcitrance in an efficient way. This review is focused on two major pretreatments: dilute acid (DA) and ammonia fiber explosion (AFEX) pretreatment of corn stover and how these pretreatment cause morphological and chemical changes to corn stover in order to overcome the biomass recalcitrance. This review highlights the key differences of these two pretreatments based on compositional analysis, cellulose and its crystallinity, morphological changes, structural changes to lignin, enzymatic reactivity and enzyme adsorption onto pretreated solids and finally cellulosic ethanol production from the hydrolysate of DA and AFEX treated corn stover. Each stage of the process, AFEX pretreated corn stover was superior to DA treated corn stover. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review.

    Science.gov (United States)

    Li, Shelly-Anne; Jeffs, Lianne; Barwick, Melanie; Stevens, Bonnie

    2018-05-05

    Organizational contextual features have been recognized as important determinants for implementing evidence-based practices across healthcare settings for over a decade. However, implementation scientists have not reached consensus on which features are most important for implementing evidence-based practices. The aims of this review were to identify the most commonly reported organizational contextual features that influence the implementation of evidence-based practices across healthcare settings, and to describe how these features affect implementation. An integrative review was undertaken following literature searches in CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Cochrane databases from January 2005 to June 2017. English language, peer-reviewed empirical studies exploring organizational context in at least one implementation initiative within a healthcare setting were included. Quality appraisal of the included studies was performed using the Mixed Methods Appraisal Tool. Inductive content analysis informed data extraction and reduction. The search generated 5152 citations. After removing duplicates and applying eligibility criteria, 36 journal articles were included. The majority (n = 20) of the study designs were qualitative, 11 were quantitative, and 5 used a mixed methods approach. Six main organizational contextual features (organizational culture; leadership; networks and communication; resources; evaluation, monitoring and feedback; and champions) were most commonly reported to influence implementation outcomes in the selected studies across a wide range of healthcare settings. We identified six organizational contextual features that appear to be interrelated and work synergistically to influence the implementation of evidence-based practices within an organization. Organizational contextual features did not influence implementation efforts independently from other features. Rather, features were interrelated and often influenced each

  17. Lignocellulosic Biomass Pretreatment Using AFEX

    Science.gov (United States)

    Balan, Venkatesh; Bals, Bryan; Chundawat, Shishir P. S.; Marshall, Derek; Dale, Bruce E.

    Although cellulose is the most abundant organic molecule, its susceptibility to hydrolysis is restricted due to the rigid lignin and hemicellulose protection surrounding the cellulose micro fibrils. Therefore, an effective pretreatment is necessary to liberate the cellulose from the lignin-hemicellulose seal and also reduce cellulosic crystallinity. Some of the available pretreatment techniques include acid hydrolysis, steam explosion, ammonia fiber expansion (AFEX), alkaline wet oxidation, and hot water pretreatment. Besides reducing lignocellulosic recalcitrance, an ideal pretreatment must also minimize formation of degradation products that inhibit subsequent hydrolysis and fermentation. AFEX is an important pretreatment technology that utilizes both physical (high temperature and pressure) and chemical (ammonia) processes to achieve effective pretreatment. Besides increasing the surface accessibility for hydrolysis, AFEX promotes cellulose decrystallization and partial hemicellulose depolymerization and reduces the lignin recalcitrance in the treated biomass. Theoretical glucose yield upon optimal enzymatic hydrolysis on AFEX-treated corn stover is approximately 98%. Furthermore, AFEX offers several unique advantages over other pretreatments, which include near complete recovery of the pretreatment chemical (ammonia), nutrient addition for microbial growth through the remaining ammonia on pretreated biomass, and not requiring a washing step during the process which facilitates high solid loading hydrolysis. This chapter provides a detailed practical procedure to perform AFEX, design the reactor, determine the mass balances, and conduct the process safely.

  18. Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review

    OpenAIRE

    Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

    2017-01-01

    Background Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Methods Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: “Healthcar...

  19. Implementation outcome assessment instruments used in physical healthcare settings and their measurement properties: a systematic review protocol.

    Science.gov (United States)

    Khadjesari, Zarnie; Vitoratou, Silia; Sevdalis, Nick; Hull, Louise

    2017-10-08

    Over the past 10 years, research into methods that promote the uptake, implementation and sustainability of evidence-based interventions has gathered pace. However, implementation outcomes are defined in different ways and assessed by different measures; the extent to which these measures are valid and reliable is unknown. The aim of this systematic review is to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings, to advance the use of precise and accurate measures. The following databases will be searched from inception to March 2017: MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. Grey literature will be sought via HMIC, OpenGrey, ProQuest for theses and Web of Science Conference Proceedings Citation Index-Science. Reference lists of included studies and relevant reviews will be hand searched. Three search strings will be combined to identify eligible studies: (1) implementation literature, (2) implementation outcomes and (3) measurement properties. Screening of titles, abstracts and full papers will be assessed for eligibility by two reviewers independently and any discrepancies resolved via consensus with the wider team. The methodological quality of the studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. A set of bespoke criteria to determine the quality of the instruments will be used, and the relationship between instrument usability and quality will be explored. Ethical approval is not necessary for systematic review protocols. Researchers and healthcare professionals can use the findings of this systematic review to guide the selection of implementation outcomes instruments, based on their psychometric quality, to assess the impact of their implementation efforts. The findings will also provide a useful guide for reviewers of papers and grants to determine the

  20. National Medicines Policy in retrospective: a review of (almost) 20 years of implementation.

    Science.gov (United States)

    Vasconcelos, Daniela Moulin Maciel de; Chaves, Gabriela Costa; Azeredo, Thiago Botelho; Silva, Rondineli Mendes da

    2017-08-01

    Pharmaceutical services and the formulation of a medicines policy are SUS areas ensured by the organic health care law 8,080/90. Thus, after a widely participative process, involving stakeholders, the National Medicines Policy (NMP) was approved in 1998 by Ordinance 3,916.The NMP presents directives and priorities, aligned with organic health care law, which should guide the federal, states and municipals entities actions to achieve the policy goals. Considering almost 20 years of the NMP, this paper took stock discussed some of the directives in light of the SUS principles. It was not the objective to provide an exhaustive review of all the activities performed during this period. The authors tried to get close to those that have brought advances and dilemmas, with potential risk of regression. Efforts to implement an ambitious agenda applied to pharmaceutical services were identified. This agenda tried to deal with different challenges like the dynamics of the pharmaceutical market and the operation of pharmaceutical services to guarantee the supply of medicines aligned with principles and directives of SUS.

  1. Evaluation and review of the safety management system implementation in the Royal Thai Air Force

    Science.gov (United States)

    Chaiwan, Sakkarin

    This study was designed to determine situation and effectiveness of the safety management system currently implemented in the Royal Thai Air Force. Reviewing the ICAO's SMS and the RTAF's SMS was conducted to identify similarities and differences between the two safety management systems. Later, the researcher acquired safety statistics from the RTAF Safety Center to investigate effectiveness of its safety system. The researcher also collected data to identify other factors affecting effectiveness of the safety system during conducting in-depth interviews. Findings and Conclusions: The study shows that the Royal Thai Air Force has never applied the International Civil Aviation Organization's Safety management System to its safety system. However, the RTAF's SMS and the ICAO's SMS have been developed based on the same concepts. These concepts are from Richard H. Woods's book, Aviation safety programs: A management handbook. However, the effectiveness of the Royal Thai Air Force's safety system is in good stance. An accident rate has been decreasing regularly but there are no known factors to describe the increasing rate, according to the participants' opinion. The participants have informed that there are many issues to be resolved to improve the RTAF's safety system. Those issues are cooperation among safety center's staffs, attitude toward safety of the RTAF senior commanders, and safety standards.

  2. PCA safety data review after clinical decision support and smart pump technology implementation.

    Science.gov (United States)

    Prewitt, Judy; Schneider, Susan; Horvath, Monica; Hammond, Julia; Jackson, Jason; Ginsberg, Brian

    2013-06-01

    Medication errors account for 20% of medical errors in the United States with the largest risk at prescribing and administration. Analgesics or opioids are frequently used medications that can be associated with patient harm when prescribed or administered improperly. In an effort to decrease medication errors, Duke University Hospital implemented clinical decision support via computer provider order entry (CPOE) and "smart pump" technology, 2/2008, with the goal to decrease patient-controlled analgesia (PCA) adverse events. This project evaluated PCA safety events, reviewing voluntary report system and adverse drug events via surveillance (ADE-S), on intermediate and step-down units preimplementation and postimplementation of clinical decision support via CPOE and PCA smart pumps for the prescribing and administration of opioids therapy in the adult patient requiring analgesia for acute pain. Voluntary report system and ADE-S PCA events decreased based upon 1000 PCA days; ADE-S PCA events per 1000 PCA days decreased 22%, from 5.3 (pre) to 4.2 (post) (P = 0.09). Voluntary report system events decreased 72%, from 2.4/1000 PCA days (pre) to 0.66/1000 PCA days (post) and was statistically significant (P PCA events between time periods in both the ADE-S and voluntary report system data, thus supporting the recommendation of clinical decision support via CPOE and PCA smart pump technology.

  3. Towards ICF implementation in menopause healthcare: a systematic review of ICF application in Switzerland.

    Science.gov (United States)

    Zangger, Martina; Poethig, Dagmar; Meissner, Florian; von Wolff, Michael; Stute, Petra

    2017-12-28

    To present a systematic literature review on the application and degree of implementation of the International Classification of Functioning, Disability and Health (ICF) across different health conditions and regions in Switzerland in order to develop an ICF classification of the climacteric syndrome in the medium term. A systematic literature search was conducted through Embase and Medline covering the period between 2011 and August 2016. Inclusion criteria were the term ICF in title or abstract and Switzerland as the workplace of the first author. Identified publications were analysed as descriptive statistics. A total of 83 articles were included in the analysis. Forty-seven different first authors from 24 different institutions were identified. The majority of publications were from Swiss Paraplegic Research (68.7%) and focused on neurology (31.3%). Forty-six cohort studies were identified. In most of them, the ICF was used to set up a general language for comparing patients' information (82.9%). Only one paper from the medical specialty gynaecology was identified; this was on breast cancer. No paper on the menopause was found. In Switzerland, the ICF is actively used in various areas of healthcare, especially in the field of neurology and rehabilitation. There is a need for ICF core sets in other medical fields, such as menopause healthcare, in order to accomplish the goal of the European Menopause and Andropause Society, which is a healthcare model for healthy menopause and aging.

  4. Education, implementation, and policy barriers to greater integration of palliative care: A literature review.

    Science.gov (United States)

    Aldridge, Melissa D; Hasselaar, Jeroen; Garralda, Eduardo; van der Eerden, Marlieke; Stevenson, David; McKendrick, Karen; Centeno, Carlos; Meier, Diane E

    2016-03-01

    Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. To provide an overview of the barriers to more widespread palliative care integration in the United States. A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness. © The Author(s) 2015.

  5. Development and implementation of technologies for physical telerehabilitation in Latin America: a systematic review of literature, programs and projects

    OpenAIRE

    Narváez, Fabián; Marín-Castrillón, Diana M; Cuenca, Ma. Cisne; Latta, Ma. Augusta

    2017-01-01

    Abstract Telerehabilitation has arised by the inclusion of emerging technologies for capturing, transmitting, analyzing and visualizing movement patterns associated to musculoskeletal disorders. This therapeutic strategy enables to carry out diagnosis processes and provide rehabilitation treatments. This paper presents a systematic review of the current development and implementation of telerehabilitation technologies in Latin America. The main goal is to explore the scientific literature and...

  6. Large scale implementation of clinical medication reviews in Dutch community pharmacies: Drug-related problems and interventions

    NARCIS (Netherlands)

    Kempen, Thomas G. H.; Van De Steeg-Van Gompel, Caroline H. P. A.; Hoogland, Petra; Liu, Yuqian; Bouvy, Marcel L.

    2014-01-01

    Background: Research on the benefits of clinical medication reviews (CMRs) performed by pharmacists has been conducted mostly in controlled settings and has been widely published. Less is known of the effects after large scale implementation in community pharmacies. An online CMR tool enabled the

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

    NARCIS (Netherlands)

    Hage, M.L.; Roo, J.P.; van Offenbeek, M.A.G.; Boonstra, A.

    2013-01-01

    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

  8. A peer review process as part of the implementation of clinical pathways in radiation oncology: Does it improve compliance?

    Science.gov (United States)

    Gebhardt, Brian J; Heron, Dwight E; Beriwal, Sushil

    Clinical pathways are patient management plans that standardize evidence-based practices to ensure high-quality and cost-effective medical care. Implementation of a pathway is a collaborative process in our network, requiring the active involvement of physicians. This approach promotes acceptance of pathway recommendations, although a peer review process is necessary to ensure compliance and to capture and approve off-pathway selections. We investigated the peer review process and factors associated with time to completion of peer review. Our cancer center implemented radiation oncology pathways for every disease site throughout a large, integrated network. Recommendations are written based upon national guidelines, published literature, and institutional experience with evidence evaluated hierarchically in order of efficacy, toxicity, and then cost. Physicians enter decisions into an online, menu-driven decision support tool that integrates with medical records. Data were collected from the support tool and included the rate of on- and off-pathway selections, peer review decisions performed by disease site directors, and time to complete peer review. A total of 6965 treatment decisions were entered in 2015, and 605 (8.7%) were made off-pathway and were subject to peer review. The median time to peer review decision was 2 days (interquartile range, 0.2-6.8). Factors associated with time to peer review decision >48 hours on univariate analysis include disease site (P peer review (P 48 hours. Clinical pathways are an integral tool for standardizing evidence-based care throughout our large, integrated network, with 91.3% of all treatment decisions being made as per pathway. The peer review process was feasible, with peer review of treatment decisions encourages compliance with clinical pathway recommendations. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  9. Exploring the factors affecting the implementation of tobacco and substance use interventions within a secondary school setting: a systematic review.

    Science.gov (United States)

    Waller, Gillian; Finch, Tracy; Giles, Emma L; Newbury-Birch, Dorothy

    2017-11-14

    The aim of this mixed-methods, systematic literature review was to develop an understanding of the factors affecting the implementation of tobacco and substance use intervention programmes in the secondary school setting using NPT as an analytical framework. A search strategy was developed that combined implementation, school and intervention search terms. Literature searches were conducted in MEDLINE, Embase, PsycHINFO, Scopus, ERIC, CINAHL, Web of Science and the Cochrane Library. PROSPERO was also searched for similar systematic reviews and a grey literature search of policy documents and relevant material was also conducted. Papers were eligible for inclusion if they were based in a secondary school and focused on the implementation of a tobacco or substance use programme. Both quantitative and qualitative methodologies were considered for inclusion. Normalisation Process Theory (NPT) was used as a conceptual framework to identify facilitators and barriers of implementation and to structure the synthesis. Inclusion criteria were met by 15 papers. The included papers were both quantitative and qualitative and focused on a range of tobacco and substance use interventions, delivered by differing providers. Key facilitating factors for implementation were positive organisational climate, adequate training and teacher's and pupil's motivation. Barriers to implementation included heavy workloads, budget cuts and lack of resources or support. Quality appraisal identified papers to be of moderate to weak quality, as papers generally lacked detail. NPT highlighted the need for studies to extend their focus to include reflexive monitoring around appraisal and the evaluation processes of implementing new tobacco or substance use programs. Future research should also focus on employing implementation theory as a tool to facilitate bridging the gap between school health research and practice.

  10. Exploring the factors affecting the implementation of tobacco and substance use interventions within a secondary school setting: a systematic review

    Directory of Open Access Journals (Sweden)

    Gillian Waller

    2017-11-01

    Full Text Available Abstract Background The aim of this mixed-methods, systematic literature review was to develop an understanding of the factors affecting the implementation of tobacco and substance use intervention programmes in the secondary school setting using NPT as an analytical framework. Methods A search strategy was developed that combined implementation, school and intervention search terms. Literature searches were conducted in MEDLINE, Embase, PsycHINFO, Scopus, ERIC, CINAHL, Web of Science and the Cochrane Library. PROSPERO was also searched for similar systematic reviews and a grey literature search of policy documents and relevant material was also conducted. Papers were eligible for inclusion if they were based in a secondary school and focused on the implementation of a tobacco or substance use programme. Both quantitative and qualitative methodologies were considered for inclusion. Normalisation Process Theory (NPT was used as a conceptual framework to identify facilitators and barriers of implementation and to structure the synthesis. Results Inclusion criteria were met by 15 papers. The included papers were both quantitative and qualitative and focused on a range of tobacco and substance use interventions, delivered by differing providers. Key facilitating factors for implementation were positive organisational climate, adequate training and teacher's and pupil’s motivation. Barriers to implementation included heavy workloads, budget cuts and lack of resources or support. Quality appraisal identified papers to be of moderate to weak quality, as papers generally lacked detail. Conclusion NPT highlighted the need for studies to extend their focus to include reflexive monitoring around appraisal and the evaluation processes of implementing new tobacco or substance use programs. Future research should also focus on employing implementation theory as a tool to facilitate bridging the gap between school health research and practice.

  11. Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers.

    Science.gov (United States)

    Antunes, Bárbara; Harding, Richard; Higginson, Irene J

    2014-02-01

    Many patient-reported outcome measures have been developed in the past two decades, playing an increasingly important role in palliative care. However, their routine use in practice has been slow and difficult to implement. To systematically identify facilitators and barriers to the implementation of patient-reported outcome measures in different palliative care settings for routine practice, and to generate evidence-based recommendations, to inform the implementation process in clinical practice. Systematic literature review and narrative synthesis. Medline, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Embase and British Nursing Index were systematically searched from 1985. Hand searching of reference lists for all included articles and relevant review articles was performed. A total of 3863 articles were screened. Of these, 31 articles met the inclusion criteria. First, data were integrated in the main themes: facilitators, barriers and lessons learned. Second, each main theme was grouped into either five or six categories. Finally, recommendations for implementation on outcome measures at management, health-care professional and patient levels were generated for three different points in time: preparation, implementation and assessment/improvement. Successful implementation of patient-reported outcome measures should be tailored by identifying and addressing potential barriers according to setting. Having a coordinator throughout the implementation process seems to be key. Ongoing cognitive and emotional processes of each individual should be taken into consideration during changes. The educational component prior to the implementation is crucial. This could promote ownership and correct use of the measure by clinicians, potentially improving practice and the quality of care provided through patient-reported outcome measure data use in clinical decision-making.

  12. Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation.

    Science.gov (United States)

    Ratwani, Raj; Fairbanks, Terry; Savage, Erica; Adams, Katie; Wittie, Michael; Boone, Edna; Hayden, Andrew; Barnes, Janey; Hettinger, Zach; Gettinger, Andrew

    2016-11-16

    Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation.

  13. Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies.

    Directory of Open Access Journals (Sweden)

    Susi Lund

    Full Text Available Advance Care Plans (ACPs enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges.To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice.An explanatory systematic review of qualitative implementation studies.Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched.Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes.13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations.This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows.

  14. 42 CFR 476.73 - Notification of QIO designation and implementation of review.

    Science.gov (United States)

    2010-10-01

    ... OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION AND QUALITY CONTROL REVIEW Review Responsibilities of Utilization and Quality Control Quality Improvement... dates of the QIO contract and specifies the area and types of health care facilities to be reviewed by...

  15. Implementation and evaluation of a peer review process for advanced practice nurses in a university hospital setting.

    Science.gov (United States)

    Bergum, Shelly K; Canaan, Talitha; Delemos, Christi; Gall, Elizabeth Funke; McCracken, Bonnie; Rowen, Dave; Salvemini, Steve; Wiens, Kimberly

    2017-07-01

    Over the past decade, implementation of the peer review process for the development of the advanced practice nurse (APN) has been emphasized. However, little exists in the literature regarding APN peer review. The peer review process is intended to help demonstrate competency of care, enhance quality improvement measures, and foster the professional growth of the APN. APNs serving on a professional governance council within a university teaching hospital developed a model of peer review for APNs. Nine months after the tool was implemented, an anonymous follow-up survey was conducted. A follow-up request was sent 4 weeks later to increase the number of respondents. Likert scales were used to elicit subjective data regarding the process. Of 81 APNs who participated in the survey, more than half (52%) felt that the process would directly improve their professional practice. Survey results show that the peer review process affected APN professional practice positively. Additional research might include pathways for remediation and education of staff, evaluation of alternate methods to improve application to clinical practice, and collection of outcome data. The models presented provide a foundation for future refinement to accommodate different APN practice settings. ©2017 American Association of Nurse Practitioners.

  16. Permitting plan for project W-236B, initial pretreatment module

    International Nuclear Information System (INIS)

    Tollefson, K.S.

    1995-01-01

    The Tank Waste Remediation System pretreatment process mission is to separate high-level and low-level waste fractions. A comprehensive review of environmental regulations has indicated that several environmental reviews, permits, and approvals are required before construction and operation of the facility. This revised document provides a summary of permit application data requirements, alternative strategies for permit completion and approval, as well as the probability of success for each alternative for the Initial Pretreatment Module resulting from recent revisions to the Tri-Party Agreement

  17. PROJECT W-551 INTERIM PRETREATMENT SYSTEM TECHNOLOGY SELECTION SUMMARY DECISION REPORT AND RECOMMENDATION

    International Nuclear Information System (INIS)

    CONRAD EA

    2008-01-01

    This report provides the conclusions of the tank farm interim pretreatment technology decision process. It documents the methodology, data, and results of the selection of cross-flow filtration and ion exchange technologies for implementation in project W-551, Interim Pretreatment System. This selection resulted from the evaluation of specific scope criteria using quantitative and qualitative analyses, group workshops, and technical expert personnel

  18. R&D implementation in a department of laboratory medicine and pathology: a systematic review based on pharmaceutical companies.

    Science.gov (United States)

    Feulefack, Joseph; Sergi, Consolato

    2015-01-01

    A systematic literature review on pharmaceutical companies may be a tool for guiding some procedures of R&D implementation in a department of Laboratory Medicine and Pathology. The use of pharmaceutical companies for this specific analysis arises from less variability of standards than healthcare facilities. In this qualitative and quantitative analysis, we focused on three useful areas of implementation, including R&D productivity, commercialization strategies, and expenditures determinants of pharmaceutical companies. Studies and reports of online databases from 1965 to 2014 were reviewed according to specific search terms. Initially, 218 articles and reports were found and examined, but only 91 were considered appropriate and used for further analysis.  We identified some suggested implementation strategies relevant for marketing to enhance companies' own R&D strategies; such as reliability of companies on "sourcing-in" R&D facilities and "think-tank" events. Regardless of the study and of the country, cash flow and profitability always positively influenced R&D expenditure, while sales and firm size did not. We consider that handling R&D determinants should require caution. It seems critical that implementation of R&D systems is directly related with productivity, if it reflects dual embodiment of efficiency and effectiveness. Scrutinizing the determinants of R&D expenditures emphasizes significant factors that are worth to highlight when planning an R&D investment strategy. Although there is no receipt fitting every situation, we think that health care plan makers may find relevant data in this systematic review in creating an initial implementation framework.

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

    Science.gov (United States)

    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

  20. Development, implementation and evaluation of a peer review of teaching (PRoT) initiative in nursing education.

    Science.gov (United States)

    Mager, Diana R; Kazer, Meredith W; Conelius, Jaclyn; Shea, Joyce; Lippman, Doris T; Torosyan, Roben; Nantz, Kathryn

    2014-06-03

    For many years, an area of research in higher education has been emerging around the development and implementation of fair and effective peer evaluation programs. Recently, a new body of knowledge has developed regarding the development and implementation of fair and effective peer evaluation programs resulting in formative and summative evaluations. The purpose of this article is to describe the development, implementation, and evaluation of a peer review of teaching (PRoT) program for nursing faculty, initiated at one small comprehensive university in the northeastern United States. Pairs of nursing faculty evaluated each other's teaching, syllabi, and course materials after collaborating in a pre-evaluation conference to discuss goals of the classroom visit. Qualitative data gathered in post project focus groups revealed that faculty found their modified PRoT process to be a mutually beneficial experience that was more useful, flexible and collegial, and less stressful than their previous evaluation process.

  1. Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review

    Directory of Open Access Journals (Sweden)

    Leduc Yvan

    2011-04-01

    Full Text Available Abstract Background Electronic health record (EHR implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users. Methods Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users. Results Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health

  2. Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review.

    Science.gov (United States)

    Salloum, Ramzi G; Shenkman, Elizabeth A; Louviere, Jordan J; Chambers, David A

    2017-11-23

    One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE) is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science. We conducted a systematic literature search (up to December 2016) of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s), healthcare setting, and implementation outcome. Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1) characterizing demand for therapies and treatment technologies (n = 32), (2) comparing implementation strategies (n = 22), (3) incentivizing workforce participation (n = 11), and (4) prioritizing interventions (n = 10). Stakeholders included providers (n = 27), patients (n = 25), caregivers (n = 5), and administrators (n = 2). The remaining studies (n = 16) engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators). The following implementation outcomes were discussed: acceptability (n = 75), appropriateness (n = 34), adoption (n = 19), feasibility (n = 16), and fidelity (n = 3). The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the past decade. As DCEs are more widely used as a

  3. Leaders' experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review.

    Science.gov (United States)

    Baxter, Pamela E; Hewko, Sarah J; Pfaff, Kathryn A; Cleghorn, Laura; Cunningham, Barbara J; Elston, Dawn; Cummings, Greta G

    2015-08-01

    Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

  4. The Perception of Malaysian Architects towards the Implementation of Green Roofs: A Review of Practices, Methodologies and Future Research

    Directory of Open Access Journals (Sweden)

    Zahir M.H. Md.

    2014-01-01

    Full Text Available The implementation of green roofs or vegetated roof as a sustainable tool to mitigate the Urban Heat Island effect is relatively new in Malaysia. Although it has not been tested on an urban scale, many research findings have indicated that green roofs can contribute towards enhancing the environmental and aesthetical quality of the built environment. It was hypothesized that the low application of green roofs in the Malaysian construction industry is due to the lack of awareness, understanding and experience in its benefits especially among building practitioners. As a result, this research was initiated to determine the perception and understanding of Malaysian architects in green roofs implementation issues, as well as to identify their level of acceptance and readiness. This paper reviews practices and different research approaches in understanding the factors that influence architect’s perception towards the implementation of green roofs in the Malaysian construction industry. Architects were chosen as the only respondents due to their intensive involvement in the conceptualisation, planning, design and construction stage of a built environment project. Extensive literature review was conducted to explore past experiences in green roof implementation and to develop the theoretical framework for this research.

  5. Barriers and facilitators to implementing family support and education in Early Psychosis Intervention programmes: A systematic review.

    Science.gov (United States)

    Selick, Avra; Durbin, Janet; Vu, Nhi; O'Connor, Karen; Volpe, Tiziana; Lin, Elizabeth

    2017-10-01

    Family support is a core component of the Early Psychosis Intervention (EPI) model, yet it continues to have relatively low rates of implementation in practice. This paper reports results of a literature review on facilitators and barriers to delivering family interventions in EPI programmes. A search was conducted of 4 electronic databases, Medline, EMBASE, PsycINFO and Joanna Briggs, from 2000 to 2015 using terms related to early onset psychosis, family work and implementation. Four thousand four hundred and two unique studies were identified, 7 of which met inclusion criteria. Barriers and facilitators were coded and aggregated to higher-level themes using a consensus approach. Five of 7 studies examined structured multifamily psychoeducation. Uptake by families was affected by: family/client interest and readiness to participate; ability to access supports; and support needs/preferences. Implementation by programmes was affected by staff access to training and resources to provide family support. A key finding across the identified studies was that families have different needs and preferences regarding the timing, length, intensity and content of the intervention. One size does not fit all and many families do not require the intensive psychoeducational programmes typically provided. The reviewed literature suggests that flexible, tiered approaches to care may better meet family needs and increase rates of uptake of family support. However, more research is needed on the effectiveness of different models of family support in early psychosis and how they can be successfully implemented. © 2017 John Wiley & Sons Australia, Ltd.

  6. Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review.

    Science.gov (United States)

    Gillman, Anna; Winkler, Renata; Taylor, Nicholas F

    2017-06-01

    The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unthickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required thickened fluids or were to remain 'nil by mouth', as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients' perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.

  7. Systematic review of qualitative literature on occupational health and safety legislation and regulatory enforcement planning and implementation.

    Science.gov (United States)

    MacEachen, Ellen; Kosny, Agnieszka; Ståhl, Christian; O'Hagan, Fergal; Redgrift, Lisa; Sanford, Sarah; Carrasco, Christine; Tompa, Emile; Mahood, Quenby

    2016-01-01

    The ability of occupational health and safety (OHS) legislation and regulatory enforcement to prevent workplace injuries and illnesses is contingent on political, economic, and organizational conditions. This systematic review of qualitative research articles considers how OHS legislation and regulatory enforcement are planned and implemented. A comprehensive search of peer-reviewed, English-language articles published between 1990 and 2013 yielded 11 947 articles. We identified 34 qualitative articles as relevant, 18 of which passed our quality assessment and proceeded to meta-ethnographic synthesis. The synthesis yielded four main themes: OHS regulation formation, regulation challenges, inspector organization, and worker representation in OHS. It illuminates how OHS legislation can be based on normative suppositions about worker and employer behavior and shaped by economic and political resources of parties. It also shows how implementation of OHS legislation is affected by "general duty" law, agency coordination, resourcing of inspectorates, and ability of workers to participate in the system. The review identifies methodological gaps and identifies promising areas for further research in "grey" zones of legislation implementation.

  8. Implementing health promotion in schools: protocol for a realist systematic review of research and experience in the United Kingdom (UK

    Directory of Open Access Journals (Sweden)

    Pearson Mark

    2012-10-01

    Full Text Available Abstract Background School-based interventions and campaigns are used to promote health and address a wide variety of public health problems. Schools are considered to be key sites for the implementation of health promotion programmes for their potential to reach the whole population in particular age-groups and instil healthy patterns of behavior early in life. However, evidence for the effectiveness of school-based health promotion interventions is highly variable. Systematic reviews of the evidence of school-based interventions tend to be highly problem- or intervention- specific, thereby missing potential generic insights into implementation and effectiveness of such programmes across problems. Methods/design A realist systematic review will be undertaken to explain how, why and in what circumstances schools can provide feasible settings for effective health promotion programmes in the United Kingdom (UK. The review will be conducted in two phases. Phase 1 will identify programme theories about implementation (ideas about what enables or inhibits effective health promotion to be delivered in a school setting. Phase 2 will test the programme theories so that they can be challenged, endorsed and/or refined. A Review Advisory Group of education and health professionals will be convened to help identify and choose potential programme theories, provide a ‘reality check’ on the clarity and explanatory strength of the mechanisms to be tested, and help shape the presentation of findings to be usable by practitioners and decision-makers. Review findings will be disseminated through liaison with decision-makers, and voluntary and professional groups in the fields of education and health.

  9. Five years after implementation: A review of the Irish Mental Health Act 2001.

    LENUS (Irish Health Repository)

    Ramsay, Hugh

    2013-01-01

    The Mental Health Act 2001 (MHA 2001) was implemented in November 2006. Since that time, there has been considerable research into its impact, including the impact on service provision, use of coercive practices and the perceptions by key stakeholders. Our objective is to present a summary of research into the MHA 2001 since its implementation in the Irish state in the context of international standards and practice.

  10. The current state of Lean implementation in health care: literature review.

    Science.gov (United States)

    Poksinska, Bozena

    2010-01-01

    The purpose of this article is to discuss the current state of implementation of Lean production in health care. The study focuses on the definition of Lean in health care and implementation process, barriers, challenges, enablers, and outcomes of implementing Lean production methods in health care. A comprehensive search of the literature concerning the implementation of Lean production in health care was used to generate a synthesis of the literature around the chosen research questions. Lean production in health care is mostly used as a process improvement approach and focuses on 3 main areas: (1) defining value from the patient point of view, (2) mapping value streams, and (3) eliminating waste in an attempt to create continuous flow. Value stream mapping is the most frequently applied Lean tool in health care. The usual implementation steps include conducting Lean training, initiating pilot projects, and implementing improvements using interdisciplinary teams. One of the barriers is lack of educators and consultants who have their roots in the health care sector and can provide support by sharing experience and giving examples from real-life applications of Lean in health care. The enablers of Lean in health care seem not to be different from the enablers of any other change initiative. The outcomes can be divided into 2 broad areas: the performance of the health care system and the development of employees and work environment.

  11. Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework.

    Science.gov (United States)

    Iwelunmor, Juliet; Blackstone, Sarah; Veira, Dorice; Nwaozuru, Ucheoma; Airhihenbuwa, Collins; Munodawafa, Davison; Kalipeni, Ezekiel; Jutal, Antar; Shelley, Donna; Ogedegebe, Gbenga

    2016-03-23

    Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained. We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region. The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment

  12. Implementing a Standardised Annual Programme Review Process in a Third-Level Institution

    Science.gov (United States)

    Wickham, Sheelagh; Brady, Malcolm; Ingle, Sarah; McMullan, Caroline; Nic Giolla Mhichíl, Mairéad; Walshe, Ray

    2017-01-01

    Purpose: Ideally, quality should be, and is, an integral element of education, yet capturing and articulating quality is not simple. Programme quality reviews in third-level education can demonstrate quality and identify areas for improvement, offering many potential benefits. However, details on the process of quality programme review are limited…

  13. Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review.

    Science.gov (United States)

    Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

    2016-02-01

    Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.

  14. 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.

  15. LESSONS LEARNED IN DEVELOPMENT OF THE HANFORD SWOC MASTER DOCUMENTED SAFETY ANALYSIS (MDSA) and IMPLEMENTATION VALIDATION REVIEW (IVR)

    International Nuclear Information System (INIS)

    MORENO, M.R.

    2004-01-01

    DOE set clear expectations on a cost-effective approach for achieving compliance with the Nuclear Safety Management requirements (20 CFR 830, Nuclear Safety Rule), which ensured long-term benefit to Hanford, via issuance of a nuclear safety strategy in February 2003. To facilitate implementation of these expectations, tools were developed to streamline and standardize safety analysis and safety document development with the goal of a shorter and more predictable DOE approval cycle. A Hanford Safety Analysis and Risk Assessment Handbook (SARAH) was approved to standardize methodologies for development of safety analyses. A Microsoft Excel spreadsheet (RADIDOSE) was approved for the evaluation of radiological consequences for accident scenarios often postulated at Hanford. Standard safety management program chapters were approved for use as a means of compliance with the programmatic chapters of DOE-STD-3009, ''Preparation Guide for U.S. Department of Energy Nonreactor Nuclear Facility Safety Analysis Reports''. An in-process review was developed between DOE and the Contractor to facilitate DOE approval and provide early course correction. The new Documented Safety Analysis (DSA) developed to address the operations of four facilities within the Solid Waste Operations Complex (SWOC) necessitated development of an Implementation Validation Review (IVR) process. The IVR process encompasses the following objectives: safety basis controls and requirements are adequately incorporated into appropriate facility documents and work instructions, facility personnel are knowledgeable of controls and requirements, and the DSA/TSR controls have been implemented. Based on DOE direction and safety analysis tools, four waste management nuclear facilities were integrated into one safety basis document. With successful completion of implementation of this safety document, lessons-learned from the in-process review, safety analysis tools and IVR process were documented for future action

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

    Science.gov (United States)

    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

  17. Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.

    Science.gov (United States)

    Lowres, Nicole; Krass, Ines; Neubeck, Lis; Redfern, Julie; McLachlan, Andrew J; Bennett, Alexandra A; Freedman, S Ben

    2015-12-01

    Atrial fibrillation guidelines advocate screening to identify undiagnosed atrial fibrillation. Community pharmacies may provide an opportunistic venue for such screening. To explore the experience of implementing an atrial fibrillation screening service from the pharmacist's perspective including: the process of study implementation; the perceived benefits; the barriers and enablers; and the challenges for future sustainability of atrial fibrillation screening within pharmacies. Setting Interviews were conducted face-to-face in the pharmacy or via telephone, according to pharmacist preference. The 'SEARCH-AF study' screened 1000 pharmacy customers aged ≥65 years using an iPhone electrocardiogram, identifying 1.5 % with undiagnosed atrial fibrillation. Nine pharmacists took part in semi-structured interviews. Interviews were transcribed in full and thematically analysed. Qualitative analysis of the experience of implementing an AF screening service from the pharmacist's perspective. Four broad themes relating to service provision were identified: (1) interest and engagement in atrial fibrillation screening by pharmacists, customers, and doctors with the novel, easy-to-use electrocardiogram technology serving as an incentive to undergo screening and an education tool for pharmacists to use with customers; (2) perceived benefits to the pharmacist including increased job satisfaction, improvement in customer relations and pharmacy profile by fostering enhanced customer care and the educational role of pharmacists; (3) implementation barriers including managing workflow, and enablers such as personal approaches for recruitment, and allocating time to discuss screening process and fears; and, (4) potential for sustainable future implementation including remuneration linked to government or pharmacy incentives, combined cardiovascular screening, and automating sections of risk-assessments using touch-screen technology. Atrial fibrillation screening in pharmacies is well

  18. California State Implementation Plan; Butte County Air Quality Management District; New Source Review (NSR) Permitting Program

    Science.gov (United States)

    EPA is proposing to approve a revision to the Butte County Air Quality Management District (BCAQMD) portion of the California SIP concerning the District's New Source Review (NSR) permitting program for new and modified sources of air pollution.

  19. Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

    Science.gov (United States)

    Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

    2017-09-01

    Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

  20. 78 FR 45 - Approval and Promulgation of Implementation Plans; Georgia: New Source Review-Prevention of...

    Science.gov (United States)

    2013-01-02

    ... fermentation processes; CO 2 from combustion of the biological fraction of municipal solid waste or biosolids... approve portions of a revision to the Georgia State Implementation Plan (SIP) submitted by the State of... are not required by the Act as part of an approvable SIP program. EPA believes that most states are...

  1. Identification of circulating prostate cancer cells: A challenge to the clinical implementation of molecular biology (Review)

    NARCIS (Netherlands)

    Schamhart, Denis H. J.; Maiazza, Ruth; Kurth, Karl-Heinz

    2005-01-01

    Conventional diagnosis of prostate cancer does not appear to be sensitive enough to differentiate pre-operatively between organ-confined and extracapsular disease. New technologies. arising from the field of molecular biology, have been introduced to improve diagnosis and their implementation into

  2. Teacher Competencies for the Implementation of Collaborative Learning in the Classroom: A Framework and Research Review

    Science.gov (United States)

    Kaendler, Celia; Wiedmann, Michael; Rummel, Nikol; Spada, Hans

    2015-01-01

    This article describes teacher competencies for implementing collaborative learning in the classroom. Research has shown that the effectiveness of collaborative learning largely depends on the quality of student interaction. We therefore focus on what a "teacher" can do to foster student interaction. First, we present a framework that…

  3. A Literature Review of Indexing and Searching Techniques Implementation in Educational Search Engines

    Science.gov (United States)

    El Guemmat, Kamal; Ouahabi, Sara

    2018-01-01

    The objective of this article is to analyze the searching and indexing techniques of educational search engines' implementation while treating future challenges. Educational search engines could greatly help in the effectiveness of e-learning if used correctly. However, these engines have several gaps which influence the performance of e-learning…

  4. The Essence Of Government Shares Subscription A Review The Implementation Of State-Owned Enterprises

    Directory of Open Access Journals (Sweden)

    Urbanisasi

    2015-08-01

    Full Text Available The purpose of this study was to determine and explain the mechanisms and the implementation of government share subscription in the implementation of SOEs legal standing of the government shares subscription in the implementation of the state budget that separated in the implementation of SOEs and its legal implications of state loss or not and also legal accountability for losses arising out of shares subscription of SOE. In this study the authors use normative legal research. The data obtained in this study will be analyzed using qualitative normative method with inductive logic. Results from the study indicate that state shares subscription in the establishment of SOE or limited company with funds derived from State Budget are separated. Thus the government no longer has any authority in the field of civil law as a business entity. A clear separation of the status of country as business and as government organizer carries consequences. With the separation then there is clarity about the concept of the state financial losses. SOE as one form of business entity that aim to make a profit is a separate legal entity and has responsibilities that are separately anyway though formed and capital originating from the state finances and the loss of one transaction or in legal entity cannot be categorized as a state finance loss because the state has functioned as a private legal entity.

  5. 77 FR 35862 - Approval and Promulgation of Implementation Plans; State of Florida: New Source; Review...

    Science.gov (United States)

    2012-06-15

    ...: Final rule. SUMMARY: EPA is taking final action to approve changes to the Florida State Implementation... taking final action to approve changes to the Florida SIP such that it is consistent with federal.... EPA notes that Florida's October 19, 2007, SIP submission makes clarifying changes to rule 62-212.400...

  6. Promise of combined hydrothermal/chemical and mechanical refining for pretreatment of woody and herbaceous biomass.

    Science.gov (United States)

    Kim, Sun Min; Dien, Bruce S; Singh, Vijay

    2016-01-01

    Production of advanced biofuels from woody and herbaceous feedstocks is moving into commercialization. Biomass needs to be pretreated to overcome the physicochemical properties of biomass that hinder enzyme accessibility, impeding the conversion of the plant cell walls to fermentable sugars. Pretreatment also remains one of the most costly unit operations in the process and among the most critical because it is the source of chemicals that inhibit enzymes and microorganisms and largely determines enzyme loading and sugar yields. Pretreatments are categorized into hydrothermal (aqueous)/chemical, physical, and biological pretreatments, and the mechanistic details of which are briefly outlined in this review. To leverage the synergistic effects of different pretreatment methods, conducting two or more pretreatments consecutively has gained attention. Especially, combining hydrothermal/chemical pretreatment and mechanical refining, a type of physical pretreatment, has the potential to be applied to an industrial plant. Here, the effects of the combined pretreatment (combined hydrothermal/chemical pretreatment and mechanical refining) on energy consumption, physical structure, sugar yields, and enzyme dosage are summarized.

  7. Implementing China's circular economy concept at the regional level: a review of progress in Dalian, China.

    Science.gov (United States)

    Geng, Yong; Zhu, Qinghua; Doberstein, Brent; Fujita, Tsuyoshi

    2009-02-01

    The circular economy (CE) concept was introduced in China to address environmental degradation and resource scarcity associated with rapid economic development. Chosen as a demonstration city, Dalian has implemented the CE strategy as a means of conserving water, materials, energy and land. This paper outlines some of the regional CE initiatives that have been successful to date in Dalian, including those focusing on conserving energy and water resources and others focusing on reduced industrial emissions. The paper details the approach used in implementing the CE concept in Dalian, tracing the foci and goals of the program, and the sectoral approach used to implement a CE. Although Dalian municipality has achieved many successes in implementing a CE, our paper identifies several challenges that, until recently, have held back complete implementation. These include: the lack of incentives for older industries to 'green' their operations, the lack of financial support to expand the CE concept, and a broad-based need for heightened public awareness and participation in CE initiatives. Our paper then identifies several responses by Dalian municipality to overcome these challenges, including pricing and tax reforms that serve as conservation incentives, the provision of financial support for CE promotion through budget reorganization, and the organization of CE training programs. Our paper concludes that, although CE initiatives have been successful in Dalian, more is possible and more is needed before Dalian can be designated a true 'eco-city'. The approach used by Dalian can provide guidance for other Chinese cities, although it is recognized that each city must tailor its own approach for differing contexts and conditions.

  8. Pediatric eMental healthcare technologies: a systematic review of implementation foci in research studies, and government and organizational documents.

    Science.gov (United States)

    Gehring, Nicole D; McGrath, Patrick; Wozney, Lori; Soleimani, Amir; Bennett, Kathryn; Hartling, Lisa; Huguet, Anna; Dyson, Michele P; Newton, Amanda S

    2017-06-21

    Researchers, healthcare planners, and policymakers convey a sense of urgency in using eMental healthcare technologies to improve pediatric mental healthcare availability and access. Yet, different stakeholders may focus on different aspects of implementation. We conducted a systematic review to identify implementation foci in research studies and government/organizational documents for eMental healthcare technologies for pediatric mental healthcare. A search of eleven electronic databases and grey literature was conducted. We included research studies and documents from organization and government websites if the focus included eMental healthcare technology for children/adolescents (0-18 years), and implementation was studied and reported (research studies) or goals/recommendations regarding implementation were made (documents). We assessed study quality using the Mixed Methods Appraisal Tool and document quality using the Appraisal of Guidelines for Research & Evaluation II. Implementation information was grouped according to Proctor and colleagues' implementation outcomes-acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability-and grouped separately for studies and documents. Twenty research studies and nine government/organizational documents met eligibility criteria. These articles represented implementation of eMental healthcare technologies in the USA (14 studies), United Kingdom (2 documents, 3 studies), Canada (2 documents, 1 study), Australia (4 documents, 1 study), New Zealand (1 study), and the Netherlands (1 document). The quality of research studies was excellent (n = 11), good (n = 6), and poor (n = 1). These eMental health studies focused on the acceptability (70%, n = 14) and appropriateness (50%, n = 10) of eMental healthcare technologies to users and mental healthcare professionals. The quality of government and organizational documents was high (n = 2), medium (n = 6

  9. Separations/pretreatment considerations for Hanford privatization phase 2

    Energy Technology Data Exchange (ETDEWEB)

    Hunt, R.D.; McGinnis, C.P.; Welch, T.D.

    1998-05-01

    The Tank Focus Area is funded to develop, demonstrate, and deploy technologies that will assist in the treatment and closure of its nuclear waste tanks. Pretreatment technologies developed to support the privatization effort by the Department of Energy are reviewed. Advancements in evaporation, solid-liquid separation, sludge treatment, solids controls, sodium management, and radionuclide removal are considered.

  10. Tank Focus Area pretreatment activities

    International Nuclear Information System (INIS)

    McGinnis, C.P.; Welch, T.D.; Manke, K.L.

    1997-01-01

    Plans call for the high-level wastes to be retrieved from the tanks and immobilized in a stable waste form suitable for long-term isolation. Chemistry and chemical engineering operations are required to retrieve the wastes, to condition the wastes for subsequent steps, and to reduce the costs of the waste management enterprise. Pretreatment includes those processes between retrieval and immobilization, and includes preparation of suitable feed material for immobilization and separations to partition the waste into streams that yield lower life-cycle costs. Some of the technologies being developed by the Tank Focus Area (TFA) to process these wastes are described. These technologies fall roughly into three areas: (1) solid/liquid separation (SLS), (2) sludge pretreatment, and (3) supernate pretreatment

  11. Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review

    Science.gov (United States)

    Peña-Rosas, Juan Pablo; Saxena, Abha; Zamora, Gerardo

    2017-01-01

    Background The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts. Aim The goal of this scoping review is to delineate and “map” the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise. Methods A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O’Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications. Results The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented. Discussion The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this

  12. Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review.

    Science.gov (United States)

    Hurlimann, Thierry; Peña-Rosas, Juan Pablo; Saxena, Abha; Zamora, Gerardo; Godard, Béatrice

    2017-01-01

    The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts. The goal of this scoping review is to delineate and "map" the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise. A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O'Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications. The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented. The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues

  13. Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review.

    Directory of Open Access Journals (Sweden)

    Thierry Hurlimann

    Full Text Available The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc. contexts.The goal of this scoping review is to delineate and "map" the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise.A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O'Malley. Searches using PubMed with Medical Subject Headings (MeSH categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications.The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented.The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these

  14. Pretreatment of agricultural biomass for anaerobic digestion: Current state and challenges.

    Science.gov (United States)

    Paudel, Shukra Raj; Banjara, Sushant Prasad; Choi, Oh Kyung; Park, Ki Young; Kim, Young Mo; Lee, Jae Woo

    2017-12-01

    The anaerobic digestion (AD) of agricultural biomass is an attractive second generation biofuel with potential environmental and economic benefits. Most agricultural biomass contains lignocellulose which requires pretreatment prior to AD. For optimization, the pretreatment methods need to be specific to the characteristics of the biomass feedstock. In this review, cereal residue, fruit and vegetable wastes, grasses and animal manure were selected as the agricultural biomass candidates, and the fundamentals and current state of various pretreatment methods used for AD of these feedstocks were investigated. Several nonconventional methods (electrical, ionic liquid-based chemicals, ruminant biological pretreatment) offer potential as targeted pretreatments of lignocellulosic biomass, but each comes with its own challenges. Pursuing an energy-intensive route, a combined bioethanol-biogas production could be a promising a second biofuel refinery option, further emphasizing the importance of pretreatment when lignocellulosic feedstock is used. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Advances in paper-based sample pretreatment for point-of-care testing.

    Science.gov (United States)

    Tang, Rui Hua; Yang, Hui; Choi, Jane Ru; Gong, Yan; Feng, Shang Sheng; Pingguan-Murphy, Belinda; Huang, Qing Sheng; Shi, Jun Ling; Mei, Qi Bing; Xu, Feng

    2017-06-01

    In recent years, paper-based point-of-care testing (POCT) has been widely used in medical diagnostics, food safety and environmental monitoring. However, a high-cost, time-consuming and equipment-dependent sample pretreatment technique is generally required for raw sample processing, which are impractical for low-resource and disease-endemic areas. Therefore, there is an escalating demand for a cost-effective, simple and portable pretreatment technique, to be coupled with the commonly used paper-based assay (e.g. lateral flow assay) in POCT. In this review, we focus on the importance of using paper as a platform for sample pretreatment. We firstly discuss the beneficial use of paper for sample pretreatment, including sample collection and storage, separation, extraction, and concentration. We highlight the working principle and fabrication of each sample pretreatment device, the existing challenges and the future perspectives for developing paper-based sample pretreatment technique.

  16. TH-A-16A-01: Image Quality for the Radiation Oncology Physicist: Review of the Fundamentals and Implementation

    International Nuclear Information System (INIS)

    Seibert, J; Imbergamo, P

    2014-01-01

    The expansion and integration of diagnostic imaging technologies such as On Board Imaging (OBI) and Cone Beam Computed Tomography (CBCT) into radiation oncology has required radiation oncology physicists to be responsible for and become familiar with assessing image quality. Unfortunately many radiation oncology physicists have had little or no training or experience in measuring and assessing image quality. Many physicists have turned to automated QA analysis software without having a fundamental understanding of image quality measures. This session will review the basic image quality measures of imaging technologies used in the radiation oncology clinic, such as low contrast resolution, high contrast resolution, uniformity, noise, and contrast scale, and how to measure and assess them in a meaningful way. Additionally a discussion of the implementation of an image quality assurance program in compliance with Task Group recommendations will be presented along with the advantages and disadvantages of automated analysis methods. Learning Objectives: Review and understanding of the fundamentals of image quality. Review and understanding of the basic image quality measures of imaging modalities used in the radiation oncology clinic. Understand how to implement an image quality assurance program and to assess basic image quality measures in a meaningful way

  17. GIS-based multicriteria municipal solid waste landfill suitability analysis: a review of the methodologies performed and criteria implemented.

    Science.gov (United States)

    Demesouka, O E; Vavatsikos, A P; Anagnostopoulos, K P

    2014-04-01

    Multicriteria spatial decision support systems (MC-SDSS) have emerged as an integration of the geographical information systems (GIS) and multiple criteria decision analysis (MCDA) methods. GIS-based MCDA allows the incorporation of conflicting objectives and decision maker (DM) preferences into spatial decision models. During recent decades, a variety of research articles have been published regarding the implementation of methods and/or tools in a variety of real-world case studies. The article discusses, in detail, the criteria and methods that are implemented in GIS-based landfill siting suitability analysis and especially the exclusionary and non-exclusionary criteria that can be considered when selecting sites for municipal solid waste (MSW) landfills. This paper reviews 36 seminal articles in which the evaluation of candidate landfill sites is conducted using MCDA methods. After a brief description of the main components of a MC-SDSS and the applied decision rules, the review focuses on the criteria incorporated into the decision models. The review provides a comprehensive guide to the landfill siting analysis criteria, providing details regarding the utilization methods, their decision or exclusionary nature and their monotonicity.

  18. A Qualitative Assessment of Current CCF Guidance Based on a Review of Safety System Digital Implementation Changes with Evolving Technology

    Energy Technology Data Exchange (ETDEWEB)

    Korsah, Kofi [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Muhlheim, Michael David [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Wood, Richard [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-04-01

    The US Nuclear Regulatory Commission (NRC) is initiating a new rulemaking project to develop a digital system common-cause failure (CCF) rule. This rulemaking will review and modify or affirm the NRC's current digital system CCF policy as discussed in the Staff Requirements Memorandum to the Secretary of the Commission, Office of the NRC (SECY) 93-087, Policy, Technical, and Licensing Issues Pertaining to Evolutionary and Advanced Light Water Reactor (ALWR) Designs, and Branch Technical Position (BTP) 7-19, Guidance on Evaluation of Defense-in-Depth and Diversity in Digital Computer-Based Instrumentation and Control Systems, as well as Chapter 7, Instrumentation and Controls, in NRC Regulatory Guide (NUREG)-0800, Standard Review Plan for Review of Safety Analysis Reports for Nuclear Power Plants (ML033580677). The Oak Ridge National Laboratory (ORNL) is providing technical support to the NRC staff on the CCF rulemaking, and this report is one of several providing the technical basis to inform NRC staff members. For the task described in this report, ORNL examined instrumentation and controls (I&C) technology implementations in nuclear power plants in the light of current CCF guidance. The intent was to assess whether the current position on CCF is adequate given the evolutions in digital safety system implementations and, if gaps in the guidance were found, to provide recommendations as to how these gaps could be closed.

  19. Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities.

    Science.gov (United States)

    Sempértegui, Gabriela A; Karreman, Annemiek; Arntz, Arnoud; Bekker, Marrie H J

    2013-04-01

    Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Young's schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Fluid mechanics relevant to flow through pretreatment of cellulosic biomass.

    Science.gov (United States)

    Archambault-Léger, Véronique; Lynd, Lee R

    2014-04-01

    The present study investigates fluid mechanical properties of cellulosic feedstocks relevant to flow through (FT) pretreatment for biological conversion of cellulosic biomass. The results inform identifying conditions for which FT pretreatment can be implemented in a practical context. Measurements of pressure drop across packed beds, viscous compaction and water absorption are reported for milled and not milled sugarcane bagasse, switchgrass and poplar, and important factors impacting viscous flow are deduced. Using biomass knife-milled to pass through a 2mm sieve, the observed pressure drop was highest for bagasse, intermediate for switchgrass and lowest for poplar. The highest pressure drop was associated with the presence of more fine particles, greater viscous compaction and the degree of water absorption. Using bagasse without particle size reduction, the instability of the reactor during pretreatment above 140kg/m(3) sets an upper bound on the allowable concentration for continuous stable flow. Copyright © 2014. Published by Elsevier Ltd.

  1. Panel Resource Management (PRM) Implementation and Effects within Safety Review Panel Settings and Dynamics

    Science.gov (United States)

    Taylor, Robert W.; Nash, Sally K.

    2007-01-01

    While technical training and advanced degree's assure proficiency at specific tasks within engineering disciplines, they fail to address the potential for communication breakdown and decision making errors familiar to multicultural environments where language barriers, intimidating personalities and interdisciplinary misconceptions exist. In an effort to minimize these pitfalls to effective panel review, NASA's lead safety engineers to the ISS Safety Review Panel (SRP), and Payload Safety Review Panel (PSRP) initiated training with their engineers, in conjunction with the panel chairs, and began a Panel Resource Management (PRM) program. The intent of this program focuses on the ability to reduce the barriers inhibiting effective participation from all panel attendees by bolstering participants confidence levels through increased communication skills, situational awareness, debriefing, and a better technical understanding of requirements and systems.

  2. KPIs for measuring the sustainability performance of ecodesign implementation into product development and related processes: a systematic literature review

    DEFF Research Database (Denmark)

    Rodrigues, Vinicius Picanco; Pigosso, Daniela Cristina Antelmi; McAloone, Tim C.

    , many difficulties still surround the implementation and management of ecodesign. The main challenges in embedding ecodesign into PDRP are: (i) the lack of support to select key performance indicators (KPI) to measure how well a company is being successful in ecodesign integration from a product......’s impact on the overall corporate behaviour.This research aims at presenting a comprehensive set of sustainability KPI to measure the ecodesign implementation into the PDRP by systematically reviewing the relevant literature regarding sustainability KPIs (social, economic and environmental dimensions......). The underlying research question is “which arethe KPIs for measuring sustainability of ecodesign integration into the product development and related processes?” This research excludes the indicators dealing directly and exclusively with product’s attributes and properties, such as energy and material...

  3. Review of Research on and Implementation of Recycled Concrete Aggregate in the GCC

    Directory of Open Access Journals (Sweden)

    Akmal S. Abdelfatah

    2011-01-01

    Full Text Available The goal of sustainable construction is to reduce the environmental impact of a constructed facility over its lifetime. Concrete is the main material used in construction in the Gulf Cooperation Council (GCC. Therefore, it makes economic and environmental sense to use recycled materials in the making of new concrete for different applications. The objectives of this study are to summarize published research on the use of recycled concrete aggregates in new concrete mixes and examine its implementation in construction and industry in the GCC region. The study showed that while there is reasonable research on recycled concrete, the practical implementation in the region greatly lacks behind, especially due to the lack of economic viability and awareness of such applications at the current time.

  4. 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

  5. Bike sharing: A review of evidence on impacts and processes of implementation and operation

    OpenAIRE

    Ricci, M.

    2015-01-01

    Despite the growing popularity of bike sharing, there is a lack of in-depth impact and process evaluations of existing schemes, especially with regard to measuring the ‘success’ of a scheme against its original objectives. This paper is concerned with identifying and critically interpreting the available evidence on bike sharing to date, on both impacts and processes of implementation and operation. The growing yet limited evidence base suggests that bike sharing can increase cycling levels b...

  6. Systems Antecedents for Dissemination and Implementation: A Review and Analysis of Measures

    Science.gov (United States)

    Emmons, Karen M.; Weiner, Bryan; Fernandez, Maria; Tu, Shin-Ping

    2011-01-01

    There is a growing emphasis on the role of organizations as settings for dissemination and implementation. Only recently has the field begun to consider features of organizations that impact on dissemination and implementation of evidence-based interventions. This manuscript identifies and evaluates available measures for 5 key organizational-level constructs: (1) leadership; (2) vision; (3) managerial relations; (4) climate; and (5) absorptive capacity. Overall the picture was the same across the five constructs—no measure was used in more than one study, many studies did not report the psychometric properties of the measures, some assessments were based on a single response per unit, and the level of the instrument and analysis did not always match. We must seriously consider the development and evaluation of a robust set of measures that will serve as the basis of building the field, allow for comparisons across organizational types and intervention topics, and allow a robust area of dissemination and implementation research to develop. PMID:21724933

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

    Science.gov (United States)

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

    2017-01-05

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

  8. Systematic review of the cost-effectiveness of implementing guidelines on low back pain management in primary care

    DEFF Research Database (Denmark)

    Jensen, Cathrine Elgaard; Jensen, Martin Bach; Riis, Allan

    2016-01-01

    be included in a comparison with a Danish implementation study to establish which strategy procures most value for money. DESIGN: Systematic review. DATA SOURCES: The search was conducted in Embase, PubMed, Cochrane Library, NHS Economic Evaluation Database, Scopus, CINAHL and EconLit. No restrictions were...... made concerning language, year of publication or publication type. The bibliographies of the included studies were searched for any studies not captured in the literature search. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: To be included, a study must be: (1) based on a randomised controlled trial...

  9. Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review

    Directory of Open Access Journals (Sweden)

    Ramzi G. Salloum

    2017-11-01

    Full Text Available Abstract Background One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science. Methods We conducted a systematic literature search (up to December 2016 of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s, healthcare setting, and implementation outcome. Results Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1 characterizing demand for therapies and treatment technologies (n = 32, (2 comparing implementation strategies (n = 22, (3 incentivizing workforce participation (n = 11, and (4 prioritizing interventions (n = 10. Stakeholders included providers (n = 27, patients (n = 25, caregivers (n = 5, and administrators (n = 2. The remaining studies (n = 16 engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators. The following implementation outcomes were discussed: acceptability (n = 75, appropriateness (n = 34, adoption (n = 19, feasibility (n = 16, and fidelity (n = 3. Conclusions The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the

  10. Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges.

    Science.gov (United States)

    Minh, Hoang Van; Ngan, Tran Thu; Mai, Vu Quynh; My, Nguyen Thi Tuyet; Chung, Le Hong; Kien, Vu Duy; Anh, Tran Tuan; Ngoc, Nguyen Bao; Giap, Vu Van; Cuong, Nguyen Manh; Manh, Pham Duc; Giang, Kim Bao

    2016-01-01

    In Vietnam, the WHO Framework Convention on Tobacco Control (WHO FCTC) took effect in March 2005 while MPOWER has been implemented since 2008. This paper describes the progress and challenges of implementation of the MPOWER package in Vietnam. We can report that, in term of monitoring, Vietnam is very active in the Global Tobacco Surveillance System, completing two rounds of the Global Adult Tobacco Survey (GATS) and three rounds of the Global Youth Tobacco Survey (GYTS). To protect people from tobacco smoke, Vietnam has issued and enforced a law requiring comprehensive smoking bans at workplaces and public places since 2013. Tobacco advertising and promotion are also prohibited with the exception of points of sale displays of tobacco products. Violations come in the form of promotion girls, corporate social responsibility activities from tobacco manufacturers and packages displayed by retail vendors. Vietnam is one of the 77 countries that require pictorial health warnings to be printed on cigarette packages to warn about the danger of tobacco and the warnings have been implemented effectively. Cigarette tax is 70% of factory price which is equal to less than 45% of retail price and much lower than the recommendation of WHO. However, Vietnam is one of the very few countries that require manufacturers and importers to make "compulsory contributions" at 1-2% of the factory price of cigarettes sold in Vietnam for the establishment of a Tobacco Control Fund (TCF). The TCF is being operated well. In 2015, 67 units of 63 provinces/cities, 22 ministries and political-social organizations and 6 hospitals received funding from TCF to implement a wide range of tobacco control activities. Cessation services have been starting with a a toll-free quit-line but need to be further strengthened. In conclusion, Vietnam has constantly put efforts into the tobacco control field with high commitment from the government, scientists and activists. Though several remarkable achievements

  11. Systematic review of implementation strategies for risk tables in the prevention of cardiovascular diseases.

    NARCIS (Netherlands)

    Steenkiste, B.C. van; Grol, R.P.T.M.; Weijden, G.D.E.M. van der

    2008-01-01

    BACKGROUND: Cardiovascular disease prevention is guided by so-called risk tables for calculating individual's risk numbers. However, they are not widely used in routine practice and it is important to understand the conditions for their use. OBJECTIVES: Systematic review of the literature on

  12. Implementation of a Quality Assurance Review System for the Scalable Development of Online Courses

    Science.gov (United States)

    Ozdemir, Devrim; Loose, Rich

    2014-01-01

    With the growing demand for quality online education in the US, developing quality online courses and online programs, and more importantly maintaining this quality, have been an inevitable concern for higher education institutes. Current literature on quality assurance in online education mostly focuses on the development of review models and…

  13. Stakeholders' opinions on the implementation of Child Death Review in the Netherlands

    NARCIS (Netherlands)

    Gijzen, S.; Hoir, M.P. L; Boere-Boonekamp, M.M.; Need, A.

    2016-01-01

    Background The death of a child is an enormous tragedy for both the family and others involved. A child’s death appeals to everyone’s responsibility to take measures to prevent similar deaths in the future. Child Death Review (CDR) is an interagency approach in which a child’s death is

  14. Stakeholders’ opinions on the implementation of Child Death Review in the Netherlands

    NARCIS (Netherlands)

    Knoeff-Gijzen, Sandra; L'Hoir, Monique P.; Boere-Boonekamp, Magdalena M.; Need, Ariana

    2016-01-01

    Background The death of a child is an enormous tragedy for both the family and others involved. A child’s death appeals to everyone’s responsibility to take measures to prevent similar deaths in the future. Child Death Review (CDR) is an interagency approach in which a child’s death is

  15. Implementation and Outcomes of a Faculty-Based, Peer Review Manuscript Writing Workshop.

    Science.gov (United States)

    Kulage, Kristine M; Larson, Elaine L

    2016-01-01

    The publication of scholarly work and research findings is an important expectation for nursing faculty; however, academic writing is often neglected, leaving dissemination through manuscript writing an area of concern for the nursing profession. Writing initiatives have been utilized to promote scholarly dissemination in schools of nursing, but those described in the literature have been primarily non-United States based and student focused. This article describes a faculty-based manuscript writing workshop, assesses participants' impressions, and describes its impact on scholarly output. The workshop is a collaborative learning process utilizing peer review to improve manuscript quality and model behaviors for improving writing and peer-reviewing skills. Seventeen workshop participants including three predoctoral students, 6 postdoctoral fellows, and 8 faculty members completed an anonymous workshop survey (81% response rate). All but 1 of 17 manuscripts reviewed in the workshop are published, accepted, or in the review process. All participants indicated that the workshop was a valuable use of time and would recommend it to colleagues. The greatest reported workshop benefit was its function as an impetus to complete and submit manuscripts. We recommend the manuscript writing workshop model for other schools of nursing seeking ways to expand their scholarly output and create accountability for dissemination through manuscript writing. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Success in Implementation of a Resident In-Service Examination Review Series

    Science.gov (United States)

    Forcucci, Jessica A.; Hyer, J. Madison; Bruner, Evelyn T.; Lewin, David N.; Batalis, Nicholas I.

    2017-01-01

    Abstract Objectives: Primary pathology board certification has been correlated with senior resident in-service examination (RISE) performance. We describe our success with an annual, month-long review series. Methods: Aggregate program RISE performance data were gathered for 3 years prior to and 3 years following initiation of the review series. In addition, mean United States Medical Licensing Examination Step 1 and 2 Clinical Knowledge scores for residents participating in each RISE examination were obtained to control for incoming knowledge and test-taking ability. Linear models were used to evaluate differences in average RISE performance prior to and following the initiation of the review series in addition to controlling for relevant covariates. Results: Significant improvement was noted in the grand total, anatomic pathology section average, clinical pathology section average, and transfusion medicine section. Although not statistically significant, improvement was noted on the cytopathology and clinical chemistry sections. There was no significant difference in scores in hematopathology, molecular pathology, and the special topics section average. In addition, improvement in primary pathology board certification rates was also noted. Conclusions: Institution of a month-long RISE review series demonstrated improved overall performance within our training program. The success could easily be replicated in any training program without significant disruption to an annual didactic series. PMID:28340222

  17. Success in Implementation of a Resident In-Service Examination Review Series.

    Science.gov (United States)

    Forcucci, Jessica A; Hyer, J Madison; Bruner, Evelyn T; Lewin, David N; Batalis, Nicholas I

    2017-04-01

    Primary pathology board certification has been correlated with senior resident in-service examination (RISE) performance. We describe our success with an annual, month-long review series. Aggregate program RISE performance data were gathered for 3 years prior to and 3 years following initiation of the review series. In addition, mean United States Medical Licensing Examination Step 1 and 2 Clinical Knowledge scores for residents participating in each RISE examination were obtained to control for incoming knowledge and test-taking ability. Linear models were used to evaluate differences in average RISE performance prior to and following the initiation of the review series in addition to controlling for relevant covariates. Significant improvement was noted in the grand total, anatomic pathology section average, clinical pathology section average, and transfusion medicine section. Although not statistically significant, improvement was noted on the cytopathology and clinical chemistry sections. There was no significant difference in scores in hematopathology, molecular pathology, and the special topics section average. In addition, improvement in primary pathology board certification rates was also noted. Institution of a month-long RISE review series demonstrated improved overall performance within our training program. The success could easily be replicated in any training program without significant disruption to an annual didactic series. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  18. 75 FR 29884 - Implementation of Changes from the 2009 Annual Review of the Entity List

    Science.gov (United States)

    2010-05-28

    ... DEPARTMENT OF COMMERCE Bureau of Industry and Security 15 CFR Part 744 [Docket No. 100311137-0138...: Bureau of Industry and Security, Commerce. ACTION: Final Rule. SUMMARY: This rule amends the Export..., Ireland or Taiwan were not included in the 2009 annual review because they were added to the Entity List...

  19. Assessment of Programming Language Learning Based on Peer Code Review Model: Implementation and Experience Report

    Science.gov (United States)

    Wang, Yanqing; Li, Hang; Feng, Yuqiang; Jiang, Yu; Liu, Ying

    2012-01-01

    The traditional assessment approach, in which one single written examination counts toward a student's total score, no longer meets new demands of programming language education. Based on a peer code review process model, we developed an online assessment system called "EduPCR" and used a novel approach to assess the learning of computer…

  20. 77 FR 20582 - Approval and Promulgation of Implementation Plans; State of Florida: New Source Review Prevention...

    Science.gov (United States)

    2012-04-05

    ... quality planning and air pollution control technology requirements. The CAA NSR program is comprised of... protection, Air pollution control, Intergovernmental relations, Ozone, Oxides of nitrogen, Recordkeeping and... preconstruction review program for the construction and modification of any stationary source of air pollution to...

  1. Surface pretreatments for medical application of adhesion

    Directory of Open Access Journals (Sweden)

    Weber Michael

    2003-09-01

    Full Text Available Abstract Medical implants and prostheses (artificial hips, tendono- and ligament plasties usually are multi-component systems that may be machined from one of three material classes: metals, plastics and ceramics. Typically, the body-sided bonding element is bone. The purpose of this contribution is to describe developments carried out to optimize the techniques , connecting prosthesis to bone, to be joined by an adhesive bone cement at their interface. Although bonding of organic polymers to inorganic or organic surfaces and to bone has a long history, there remains a serious obstacle in realizing long-term high-bonding strengths in the in vivo body environment of ever present high humidity. Therefore, different pretreatments, individually adapted to the actual combination of materials, are needed to assure long term adhesive strength and stability against hydrolysis. This pretreatment for metal alloys may be silica layering; for PE-plastics, a specific plasma activation; and for bone, amphiphilic layering systems such that the hydrophilic properties of bone become better adapted to the hydrophobic properties of the bone cement. Amphiphilic layering systems are related to those developed in dentistry for dentine bonding. Specific pretreatment can significantly increase bond strengths, particularly after long term immersion in water under conditions similar to those in the human body. The bond strength between bone and plastic for example can be increased by a factor approaching 50 (pealing work increasing from 30 N/m to 1500 N/m. This review article summarizes the multi-disciplined subject of adhesion and adhesives, considering the technology involved in the formation and mechanical performance of adhesives joints inside the human body.

  2. End User and Implementer Experiences of mHealth Technologies for Noncommunicable Chronic Disease Management in Young Adults: Systematic Review.

    Science.gov (United States)

    Slater, Helen; Campbell, Jared M; Stinson, Jennifer N; Burley, Megan M; Briggs, Andrew M

    2017-12-12

    Chronic noncommunicable diseases (NCDs) such as asthma, diabetes, cancer, and persistent musculoskeletal pain impose an escalating and unsustainable burden on young people, their families, and society. Exploring how mobile health (mHealth) technologies can support management for young people with NCDs is imperative. The aim of this study was to identify, appraise, and synthesize available qualitative evidence on users' experiences of mHealth technologies for NCD management in young people. We explored the perspectives of both end users (young people) and implementers (health policy makers, clinicians, and researchers). A systematic review and meta-synthesis of qualitative studies. Eligibility criteria included full reports published in peer-reviewed journals from January 2007 to December 2016, searched across databases including EMBASE, MEDLINE (PubMed), Scopus, and PsycINFO. All qualitative studies that evaluated the use of mHealth technologies to support young people (in the age range of 15-24 years) in managing their chronic NCDs were considered. Two independent reviewers identified eligible reports and conducted critical appraisal (based on the Joanna Briggs Institute Qualitative Assessment and Review Instrument: JBI-QARI). Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive emergent themes across the included data. External validity checking was undertaken by an expert clinical researcher and for relevant content, a health policy expert. Themes were subsequently subjected to a meta-synthesis, with findings compared and contrasted between user groups and policy and practice recommendations derived. Twelve studies met our inclusion criteria. Among studies of end users (N=7), mHealth technologies supported the management of young people with diabetes, cancer, and asthma. Implementer studies (N=5) covered the management of cognitive and communicative disabilities, asthma

  3. Implementation of inclusive education for children with intellectual and developmental disabilities in African countries: a scoping review.

    Science.gov (United States)

    Okyere, Christiana; Aldersey, Heather Michelle; Lysaght, Rosemary; Sulaiman, Surajo Kamilu

    2018-04-25

    To advance understanding of practices that support inclusion of children with intellectual and developmental disabilities in inclusive education classrooms in Africa by conducting a review of the extant literature. Five academic databases were searched supplemented by a hand search of key journals and references of included studies. Two authors independently screened studies via a reference manager (Covidence) which allowed for blinding. A third author was consulted in cases of conflict. Thirty articles that provided empirical evidence of inclusive education implementation were included. Eight articles highlighted practices that support inclusion of children with intellectual and developmental disabilities. Using Bronfenbrenner's bioecological framework, findings revealed that inclusive education implementation is influenced by factors on the bio level, micro level, meso level, and macro level. Recommendations for promoting inclusive education implementation are provided. Inclusion goes beyond teachers and requires strong commitment of other stakeholders such as families and governments. To guarantee the smooth inclusion of children with special education needs and particularly with intellectual and developmental disabilities, a set of practices validated through rigorous research as supportive and unique and that can be universal to Africa is wise. Implications for rehabilitation A number of strategies were identified that can improve the classroom inclusion of children with intellectual and developmental disabilities. Development of policies that support such strategies could improve implementation. Inclusion goes beyond teachers. Rehabilitation professionals (i.e. occupational therapists) and educational professionals should partner to identify practical solutions to the challenges of creating inclusive environments for children with special education needs. Committing more resources and time towards the development and implementation of special education

  4. Implementing a Course Review Process for a Continuous Quality Improvement Model for a Medical School Curriculum.

    Science.gov (United States)

    Ward, Cassandra S; Andrade, Amy; Walker-Winfree, Lena

    2018-01-01

    In 1901, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, visited 155 medical schools in the United States and Canada to assess medical education. Flexner's recommendations became the foundation for the Liaison Committee on Medical Education accreditation, a voluntary, peer-reviewed quality assurance process to determine whether a medical education program meets established standards. The Meharry Medical College School of Medicine, a historically Black college/university (HBCU) established the Office of Curriculum Evaluation and Effectiveness in 2013 to ensure the consistent monitoring of the medical education program's compliance with accreditation standards. The motto and logo, LCME 24/7, highlight the school's emphasis on meeting accreditation standards. The school uses the 1994 Plan-Do-Study-Act Cycle for Learning and Improvement for continuous review of course content, outcomes, and evaluations. This process identifies strengths, challenges, and opportunities for innovative steps for continuous quality improvements to the curriculum.

  5. The CABRI facility: Implementation of a pressurized water loop and related safety review

    International Nuclear Information System (INIS)

    Cabrillat, J.C.; Maegey, M.; Bourguignon, D.; Miachon, G.; Forestier, F.; Coulon, J.P.; Faury, M.

    2003-01-01

    The CABRI reactor operated by CEA at the CADARACHE Nuclear Center in France provided the condition for safety studies on nuclear fuel. Initially designed to support investigations on Fast Reactor fuel, large modifications are underway to provide representative conditions for studies on Light Water Fuel types. A general overview of these modifications, the related safety review and supporting studies are described in the paper. (author)

  6. Review of Nuclear Criticality Safety Requirements Implementation for Hanford Tank Farms Facility

    International Nuclear Information System (INIS)

    DEFIGH PRICE, C.

    2000-01-01

    In November 1999, the Deputy Secretary of the Department of Energy directed a series of actions to strengthen the Department's ongoing nuclear criticality safety programs. A Review Plan describing lines of inquiry for assessing contractor programs was included. The Office of River Protection completed their assessment of the Tank Farm Contractor program in May 2000. This document supports that assessment by providing a compliance statement for each line of inquiry

  7. Implementation and reporting of causal mediation analysis in 2015: a systematic review in epidemiological studies.

    Science.gov (United States)

    Liu, Shao-Hsien; Ulbricht, Christine M; Chrysanthopoulou, Stavroula A; Lapane, Kate L

    2016-07-20

    Causal mediation analysis is often used to understand the impact of variables along the causal pathway of an occurrence relation. How well studies apply and report the elements of causal mediation analysis remains unknown. We systematically reviewed epidemiological studies published in 2015 that employed causal mediation analysis to estimate direct and indirect effects of observed associations between an exposure on an outcome. We identified potential epidemiological studies through conducting a citation search within Web of Science and a keyword search within PubMed. Two reviewers independently screened studies for eligibility. For eligible studies, one reviewer performed data extraction, and a senior epidemiologist confirmed the extracted information. Empirical application and methodological details of the technique were extracted and summarized. Thirteen studies were eligible for data extraction. While the majority of studies reported and identified the effects of measures, most studies lacked sufficient details on the extent to which identifiability assumptions were satisfied. Although most studies addressed issues of unmeasured confounders either from empirical approaches or sensitivity analyses, the majority did not examine the potential bias arising from the measurement error of the mediator. Some studies allowed for exposure-mediator interaction and only a few presented results from models both with and without interactions. Power calculations were scarce. Reporting of causal mediation analysis is varied and suboptimal. Given that the application of causal mediation analysis will likely continue to increase, developing standards of reporting of causal mediation analysis in epidemiological research would be prudent.

  8. ANALYTICAL AND SCIENTIFIC REVIEW OF PROJECTS AND PROGRAMMES ON CHANGES STRATEGY IMPLEMENTATION

    Directory of Open Access Journals (Sweden)

    MLODETSKYY V. R.

    2017-01-01

    Full Text Available Formulation of the problem. Sustainable and successful functioning of the organization in today's competitive market conditions is possible if the organization is an open dynamic system capable of timely and adequately adapt to changes in the environment, this organization should initiate the implementation of innovations, both in production and organizational structure. Most suited for these conditions are project-oriented organizations, when the program's development strategy is developed with a detailed individual relatively independent stages, which are implemented as part of projects. In accordance with the development and improvement of the organization of control systems in the direction of increasing emphasis on the development strategy in relation to operating activities is an important task. Goal and tasks. Explore the hierarchical control system of project-oriented organization towards establishing information flows combine program management system with project management subsystems, included in this program. Conclusions. Concretized the concept of "program" and "project" as a result assumed that the program management is a permanent process in the organization that is adaptable to external changes, and project management (as defined is temporary, so the project management structure are subject to program management structures and are not permanent in the organization's management system.

  9. Establishing partnership with traditional birth attendants for improved maternal and newborn health: a review of factors influencing implementation.

    Science.gov (United States)

    Miller, Tina; Smith, Helen

    2017-10-19

    Recent World Health Organization recommendations recognize the important role Traditional Birth Attendants (TBAs) can play in supporting the health of women and newborns. This paper provides an analysis of key factors that affect the implementation of interventions to develop partnerships with TBAs to promote improved access to skilled care at birth. We conducted a secondary analysis of 20 papers identified through two systematic reviews that examined the effectiveness of interventions to find new roles for TBAs on maternal and newborn health outcomes, as well as papers identified through a systematic mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and implementation barriers and facilitators, as well as other contextual issues. This analysis identified countries that have implemented interventions to support the transition from birth with a TBA to birth with a skilled birth attendant. Drawing on the experiences of these countries, the analysis highlights factors that are important to consider when designing and implementing such interventions. Barriers to implementation included resistance to change in more traditional communities, negative attitudes between TBAs and skilled attendants and TBAs concerns about the financial implications of assuming new roles. Facilitating factors included stakeholder involvement in devising and implementing interventions, knowledge sharing between TBAs and skilled birth attendants, and formalised roles and responsibilities and remuneration for TBAs. The implementation barriers identified in this analysis could, if not addressed, prevent or discourage TBAs from carrying out newly defined roles supporting women in pregnancy and childbirth and linking them to the formal health system. This paper also identifies the factors that seem critical to success, which new programmes could consider adopting

  10. Assessing the Implementation and Cost of High Quality Early Care and Education: A Review of the Literature. OPRE Report 2016-31

    Science.gov (United States)

    Caronongan, Pia; Kirby, Gretchen; Boller, Kimberly; Modlin, Emily; Lyskawa, Julia

    2016-01-01

    This report summarizes the findings of a literature review conducted as part of the Assessing the Implementation and Cost of High-Quality Early Care and Education (ECE-ICHQ) project. The project's goal is to create a technically sound and feasible instrument that will provide consistent, systematic measures of the implementation and costs of…

  11. Total Productive Maintenance And Role Of Interpretive Structural Modeling And Structural Equation Modeling In Analyzing Barriers In Its Implementation A Literature Review

    OpenAIRE

    Prasanth S. Poduval; Dr. Jagathy Raj V. P.; Dr. V. R. Pramod

    2015-01-01

    Abstract - The aim of the authors is to present a review of literature of Total Productive Maintenance and the barriers in implementation of Total Productive Maintenance TPM. The paper begins with a brief description of TPM and the barriers in implementation of TPM. Interpretive Structural Modeling ISM and its role in analyzing the barriers in TPM implementation is explained in brief. Applications of ISM in analyzing issues in various fields are highlighted with special emphasis on TPM. T...

  12. Adaptive radiotherapy strategies for pelvic tumors - a systematic review of clinical implementations

    DEFF Research Database (Denmark)

    Thörnqvist, Sara; Hysing, Liv B; Tuomikoski, Laura

    2016-01-01

    Med. For each tumor site, the identified papers were screened independently by two researches for selection of studies describing all processes of an ART workflow: treatment monitoring and evaluation, decision and execution of adaptations. Both brachytherapy and external beam studies were eligible for review...... patients were treated with offline re-planning, all to account for tumor regression detected by magnetic resonance imaging (MRI)/computed tomography (CT). For bladder and gyne, 161 and 64 patients, respectively, were treated with library-based online plan selection to account for target volume and shape...

  13. Implementation plan for the Waste Experimental Reduction Facility Restart Operational Readiness Review

    International Nuclear Information System (INIS)

    1993-03-01

    The primary technical objective for the WERF Restart Project is to assess, upgrade where necessary, and implement management, documentation, safety, and operation control systems that enable the resumption and continued operation of waste treatment and storage operations in a manner that is compliant with all environment, safety, and quality requirements of the US Department of Energy and Federal and State regulatory agencies. Specific processes that will be resumed at WERF include compaction of low-level compatible waste; size reduction of LLW, metallic and wood waste; incineration of combustible LLW and MLLW; and solidification of low-level and mixed low-level incinerator bottom ash, baghouse fly ash, and compatible sludges and debris. WERF will also provide for the operation of the WWSB which includes storage of MLLW in accordance with Resource Conservation and Recovery Act requirements

  14. Interdisciplinary Bachelor Degrees in Federal University of Bahia: a review of the Project implementation

    Directory of Open Access Journals (Sweden)

    Monica Lima

    2015-11-01

    Full Text Available We discuss conceptual framework, operational perspective and political-institutional features of the Interdisciplinary Bachelor Degree (BI implementation in the Federal University of Bahia, between 2009 and 2012, as compared to existing university education models which, until then, only offered disciplinary professional courses. We analyze narratives of key agents of the process, three UFBA teachers who performed administrative functions, and a BI student, engaged in the student movement. We have concluded that the perspective for the BI to become the first cycle at UFBA is on hold; support and resistance movements have accompanied it, suggesting large institutional challenges. However, the experience has led to a vigorous revision of rules and regulations naturalized for a long time and enabled reflections on the traditional concept of university education in Brazil.

  15. Integrated ecological-economic fisheries models - evaluation, review and challenges for implementation

    DEFF Research Database (Denmark)

    Nielsen, J. Rasmus; Thunberg, Eric; Holland, Daniel S.

    2018-01-01

    and comparative evaluation of 35 IESFM´s applied to marine fisheries and marine ecosystem resources to identify the characteristics that determine their usefulness, effectiveness and implementation. The focus is on fully integrated models that allow for feedbacks between ecological and human processes though......Marine ecosystems evolve under many interconnected and area-specific pressures. In order to fulfill society's intensifying and diversifying needs whilst ensuring ecologically sustainable development, more effective marine spatial planning and broader-scope management of marine resources...... is necessary. Integrated ecological–socioeconomic fisheries models (IESFM) of marine systems are nee¬ded to evaluate impacts and sustainability of potential management actions and understand, and anti¬ci¬pate ecological, economic, and social dynamics at a range of scales from local to national and regional...

  16. Implementation Plan for the Hawaii Geothermal Project Environmental Impact Statement (DOE Review Draft:)

    Energy Technology Data Exchange (ETDEWEB)

    None

    1992-09-18

    The US Department of Energy (DOE) is preparing an Environmental Impact Statement (EIS) that identifies and evaluates the environmental impacts associated with the proposed Hawaii Geothermal Project (HGP), as defined by the State of Hawaii in its 1990 proposal to Congress (DBED 1990). The location of the proposed project is shown in Figure 1.1. The EIS is being prepared pursuant to the requirements of the National Environmental Policy Act of 1969 (NEPA), as implemented by the President's Council on Environmental Quality (CEQ) regulations (40 CFR Parts 1500-1508) and the DOE NEPA Implementing Procedures (10 CFR 1021), effective May 26, 1992. The State's proposal for the four-phase HGP consists of (1) exploration and testing of the geothermal resource beneath the slopes of the active Kilauea volcano on the Island of Hawaii (Big Island), (2) demonstration of deep-water power cable technology in the Alenuihaha Channel between the Big Island and Mau, (3) verification and characterization of the geothermal resource on the Big Island, and (4) construction and operation of commercial geothermal power production facilities on the Big Island, with overland and submarine transmission of electricity from the Big Island to Oahu and possibly other islands. DOE prepared appropriate NEPA documentation for separate federal actions related to Phase 1 and 2 research projects, which have been completed. This EIS will consider Phases 3 and 4, as well as reasonable alternatives to the HGP. Such alternatives include biomass coal, solar photovoltaic, wind energy, and construction and operation of commercial geothermal power production facilities on the Island of Hawaii (for exclusive use on the Big Island). In addition, the EIs will consider the reasonable alternatives among submarine cable technologies, geothermal extraction, production, and power generating technologies; pollution control technologies; overland and submarine power transmission routes; sites reasonably suited to

  17. SUCCESSFUL IMPLEMENTATION OF LEAN AS A MANAGERIAL PRINCIPLE IN HEALTH CARE: A CONCEPTUAL ANALYSIS FROM SYSTEMATIC LITERATURE REVIEW.

    Science.gov (United States)

    Maijala, Riikka; Eloranta, Sini; Reunanen, Tero; Ikonen, Tuija S

    2018-01-01

    The aim of this study was to identify and analyze the characteristics of leadership and management associated with a successful Lean thinking adaptation in healthcare. A systematic literature review was undertaken using electronic databases: PubMed, PubMed Systematic Review, ABI/INFORM, Business Source Complete, Emerald, JBI, and Cinahl. Inclusion criteria were: (i) a description of Lean management or leadership in health care, (ii) a reference to Lean thinking, (iii) a peer-reviewed original research article or a literature review, and (iv) a full text article available in English. Among the 1,754 peer-reviewed articles identified, nine original articles and three systematic reviews met the inclusion criteria. Data on informants, methods, and settings were extracted and collated. Content analysis was used to conduct a review of the nine original studies describing and analyzing the success factors of Lean adaptation. The characteristics of leadership and management were analyzed by using the concept of a managerial windshield that divides leadership and management into four ontological dimensions: activities, style, focus, and purpose, each with typical developmental stages of skills and capabilities. The current study has some limitations: some papers from the journals not indexed in the searched databases may have been overlooked and the literature searches were carried out only for a 5-year period. Considering the results using the windshield concept emphasizes the philosophy, principles, and tools of Lean thinking. Lean leadership and management factors in health care were mainly conceptualized as skills and capabilities such as problem solving, making changes occur, empowering, communicating, coaching, supporting, facilitating, being democratic, organizational learning, and organizational success, all of which represented middle-stage or advanced managerial skills and capabilities. A conceptual analysis of systematically reviewed studies of Lean leadership

  18. Business Education for Plastic Surgeons: A Systematic Review, Development, and Implementation of a Business Principles Curriculum in a Residency Program.

    Science.gov (United States)

    Zarrabi, Bahar; Burce, Karen K; Seal, Stella M; Lifchez, Scott D; Redett, Richard J; Frick, Kevin D; Dorafshar, Amir H; Cooney, Carisa M

    2017-05-01

    Rising health care costs, decreasing reimbursement rates, and changes in American health care are forcing physicians to become increasingly business-minded. Both academic and private plastic surgeons can benefit from being educated in business principles. The authors conducted a systematic review to identify existing business curricula and integrated a business principles curriculum into residency training. The authors anonymously surveyed their department regarding perceived importance of business principles and performed a systematic literature review from 1993 to 2013 using PubMed and Embase to identify residency training programs that had designed/implemented business curricula. Subsequently, the authors implemented a formal, quarterly business curriculum. Thirty-two of 36 physicians (88.9 percent; 76.6 percent response rate) stated business principles are either "pretty important" or "very important" to being a doctor. Only 36 percent of faculty and 41 percent of trainees had previous business instruction. The authors identified 434 articles in the systematic review: 29 documented formal business curricula. Twelve topics were addressed, with practice management/administration (n = 22) and systems-based practice (n = 6) being the most common. Four articles were from surgical specialties: otolaryngology (n = 1), general surgery (n = 2), and combined general surgery/plastic surgery (n = 1). Teaching formats included lectures and self-directed learning modules; outcomes and participant satisfaction were reported inconsistently. From August of 2013 to June of 2015, the authors held eight business principles sessions. Postsession surveys demonstrated moderately to extremely satisfied responses in 75 percent or more of resident/fellow respondents (n = 13; response rate, 48.1 percent) and faculty (n = 9; response rate, 45.0 percent). Business principles can be integrated into residency training programs. Having speakers familiar with the physician audience and a

  19. Non-invasive prenatal testing: a review of international implementation and challenges

    Directory of Open Access Journals (Sweden)

    Allyse M

    2015-01-01

    Full Text Available Megan Allyse,1 Mollie A Minear,2 Elisa Berson,3 Shilpa Sridhar,3 Margaret Rote,3 Anthony Hung,3 Subhashini Chandrasekharan4 1Institute for Health and Aging, University of California San Francisco, San Francisco, California, USA, 2Duke Science & Society, Duke University, Durham, NC, USA, 3Trinity College of Arts and Sciences, Duke University, Durham, NC, USA; 4Duke Global Health Institute, Duke University, Durham, NC, USA Abstract: Noninvasive prenatal genetic testing (NIPT is an advance in the detection of fetal chromosomal aneuploidies that analyzes cell-free fetal DNA in the blood of a pregnant woman. Since its introduction to clinical practice in Hong Kong in 2011, NIPT has quickly spread across the globe. While many professional societies currently recommend that NIPT be used as a screening method, not a diagnostic test, its high sensitivity (true positive rate and specificity (true negative rate make it an attractive alternative to the serum screens and invasive tests currently in use. Professional societies also recommend that NIPT be accompanied by genetic counseling so that families can make informed reproductive choices. If NIPT becomes more widely adopted, States will have to implement regulation and oversight to ensure it fits into existing legal frameworks, with particular attention to returning fetal sex information in areas where sex-based abortions are prevalent. Although there are additional challenges for NIPT uptake in the developing world, including the lack of health care professionals and infrastructure, the use of NIPT in low-resource settings could potentially reduce the need for skilled clinicians who perform invasive testing. Future advances in NIPT technology promise to expand the range of conditions that can be detected, including single gene disorders. With these advances come questions of how to handle incidental findings and variants of unknown significance. Moving forward, it is essential that all stakeholders have

  20. Review of the factors affecting the selection and implementation of waste management technologies

    International Nuclear Information System (INIS)

    1999-08-01

    The objective of this publication is to identify and critically review the factors affecting the selection of waste management strategies and technologies; summarize and discuss the options available, and offer a systematic approach for considering these factors to design, install and operate appropriate technologies for waste streams generated. The scope of this publication includes the management of radioactive waste from all orientations including low and intermediate level waste arising from the production of radionuclides and their application in industry, agriculture, medicine, education and research; waste generated from research reactors, power reactors and from nuclear fuel cycle activities including reprocessing high level waste. Although waste from decommissioning is not specifically addressed, the management of this waste is not significantly different from other types of waste in the same category

  1. Review of the factors affecting the selection and implementation of waste management technologies

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-08-01

    The objective of this publication is to identify and critically review the factors affecting the selection of waste management strategies and technologies; summarize and discuss the options available, and offer a systematic approach for considering these factors to design, install and operate appropriate technologies for waste streams generated. The scope of this publication includes the management of radioactive waste from all orientations including low and intermediate level waste arising from the production of radionuclides and their application in industry, agriculture, medicine, education and research; waste generated from research reactors, power reactors and from nuclear fuel cycle activities including reprocessing high level waste. Although waste from decommissioning is not specifically addressed, the management of this waste is not significantly different from other types of waste in the same category 32 refs, 11 figs, 12 tabs

  2. The adoption and implementation of RFID technologies in healthcare: a literature review.

    Science.gov (United States)

    Yao, Wen; Chu, Chao-Hsien; Li, Zang

    2012-12-01

    Radio Frequency Identification (RFID) technology not only offers tracking capability to locate equipment, supplies and people in real time, but also provides efficient and accurate access to medical data for health professionals. However, the reality of RFID adoption in healthcare is far behind earlier expectation. This study reviews literature on the use of RFID in healthcare/hospitals following a formal innovation-decision framework. We aim to identify the common applications, potential benefits, barriers, and critical success factors. Our study facilitates quick assessment and provides guidance for researchers and practitioners in adopting RFID in medical arenas. Many earlier adopters in healthcare found RFID to be functional and useful in such areas as asset tracking and patient identification. Major barriers to adoption include technological limitations, interference concerns, prohibitive costs, lack of global standards and privacy concerns. Better designed RFID systems with low cost and privacy issues addressed are needed to increase acceptance of RFID in healthcare.

  3. 2015 Five-Yearly Review : one last formal step, with the implementation to follow

    CERN Multimedia

    Staff Association

    2015-01-01

    Taking into account the arbitration by the Director General the Staff Council decided that it did not oppose the Management proposals for the 2015 Five-Yearly Review (see Echo 234). Consequently, at the TREF meeting of Thursday 26 November, Management presented its consolidated proposals taking into account the outcome of the arbitration. The Staff Association was invited to express its point of view (the text of our declaration follows). After the Member States’ delegates got satisfactory answers to their questions for clarification, none of the 14 delegations represented opposed the proposals nor were there any abstentions. The Chair of TREF, B. Dormy, will thus report to Finance Committee and Council on 16 and 17 December that TREF recommends that these committees approve the Management proposals. A huge amount of work by many CERN colleagues, representatives of the Management, the Sectors, and the Staff Association has come to a successful conclusion. Now we move into the important implementati...

  4. An implementation of support vector machine on sentiment classification of movie reviews

    Science.gov (United States)

    Yulietha, I. M.; Faraby, S. A.; Adiwijaya; Widyaningtyas, W. C.

    2018-03-01

    With technological advances, all information about movie is available on the internet. If the information is processed properly, it will get the quality of the information. This research proposes to the classify sentiments on movie review documents. This research uses Support Vector Machine (SVM) method because it can classify high dimensional data in accordance with the data used in this research in the form of text. Support Vector Machine is a popular machine learning technique for text classification because it can classify by learning from a collection of documents that have been classified previously and can provide good result. Based on number of datasets, the 90-10 composition has the best result that is 85.6%. Based on SVM kernel, kernel linear with constant 1 has the best result that is 84.9%

  5. What's the Point?: A Review of Reward Systems Implemented in Gamification Interventions.

    Science.gov (United States)

    Lewis, Zakkoyya H; Swartz, Maria C; Lyons, Elizabeth J

    2016-04-01

    Rewards are commonly used in interventions to change behavior, but they can inhibit development of intrinsic motivation, which is associated with long-term behavior maintenance. Gamification is a novel intervention strategy that may target intrinsic motivation through fun and enjoyment. Before the effects of gamified interventions on motivation can be determined, there must be an understanding of how gamified interventions operationalize rewards, such as point systems. The purpose of this review is to determine the prevalence of different reward types, specifically point systems, within gamified interventions. Electronic databases were searched for relevant articles. Data sources included Medline OVID, Medline PubMed, Web of Science, CINAHL, Cochrane Central, and PsycINFO. Out of the 21 articles retrieved, 18 studies described a reward system and were included in this review. Gamified interventions were designed to target a myriad of clinical outcomes across diverse populations. Rewards included points (n = 14), achievements/badges/medals (n = 7), tangible rewards (n = 7), currency (n = 4), other unspecified rewards (n = 3), likes (n = 2), animated feedback (n = 1), and kudos (n = 1). Rewards, and points in particular, appear to be a foundational component of gamified interventions. Despite their prevalence, authors seldom described the use of noncontingent rewards or how the rewards interacted with other game features. The reward systems relying on tangible rewards and currency may have been limited by inhibited intrinsic motivation. As gamification proliferates, future research should explicitly describe how rewards were operationalized in the intervention and evaluate the effects of gamified rewards on motivation across populations and research outcomes.

  6. Bioavailability of heavy metals in soils: definitions and practical implementation--a critical review.

    Science.gov (United States)

    Kim, Rog-Young; Yoon, Jeong-Ki; Kim, Tae-Seung; Yang, Jae E; Owens, Gary; Kim, Kwon-Rae

    2015-12-01

    Worldwide regulatory frameworks for the assessment and remediation of contaminated soils have moved towards a risk-based approach, taking contaminant bioavailability into consideration. However, there is much debate on the precise definition of bioavailability and on the standardization of methods for the measurement of bioavailability so that it can be reliably applied as a tool for risk assessment. Therefore, in this paper, we reviewed the existing definitions of heavy metal bioavailability in relation to plant uptake (phytoavailability), in order to better understand both the conceptual and operational aspects of bioavailability. The related concepts of specific and non-specific adsorption, as well as complex formation and organic ligand affinity were also intensively discussed to explain the variations of heavy metal solubility and mobility in soils. Further, the most frequently used methods to measure bioavailable metal soil fractions based on both chemical extractions and mechanistic geochemical models were reviewed. For relatively highly mobile metals (Cd, Ni, and Zn), a neutral salt solution such as 0.01 M CaCl2 or 1 M NH4NO3 was recommended, whereas a strong acid or chelating solution such as 0.43 M HNO3 or 0.05 M DTPA was recommended for strongly soil-adsorbed and less mobile metals (Cu, Cr, and Pb). While methods which assessed the free metal ion activity in the pore water such as DGT and DMT or WHAM/Model VI, NICA-Donnan model, and TBLM are advantageous for providing a more direct measure of bioavailability, few of these models have to date been properly validated.

  7. Book review: Implementing the Endangered Species Act on the Platte Basin water commons

    Science.gov (United States)

    Sherfy, Mark H.

    2014-01-01

    The Platte River is a unique midcontinent ecosystem that is world-renowned for its natural resources, particularly the spectacular spring concentrations of migratory birds, such as sandhill cranes (Grus canadensis), ducks, and geese. The Platte River basin also provides habitat for four federally listed endangered or threatened species—interior least tern (Sternula antillarum athalassos), piping plover (Charadrius melodus), whooping crane (G. americana), and pallid sturgeon (Scaphirhynchus albus)—that require specific hydrological conditions in order for habitat to be suitable. Flows on the Platte River are subject to regulation by a number of dams, and it is heavily relied upon for irrigation in Colorado, Wyoming, and Nebraska. Accordingly, it also has become a political battleground for the simple reason that the demand for water exceeds supply. David Freeman’s book takes a detailed look at water-use issues on the Platte River, focusing on how implementation of the Endangered Species Act influences decision-making about water allocations. 

  8. SPIE Smart Structures Product Implementation Award: a review of the first ten years

    Science.gov (United States)

    Anderson, Eric H.; Sater, Janet M.

    2007-04-01

    The research field of smart materials and structures has been a distinct entity for two decades. Over the past ten years, the SPIE Industrial and Commercial Applications Conference has presented a Smart Structures Product Implementation Award at its annual symposium. This paper revisits the nine winning entries to date (1998-2007) and updates their status. The paper begins with a brief description of the original and current intent of the award and follows with a short overview of the evolution of smart structures, from research to products. The winning teams and their respective products are then described. The current status of the products is discussed based on publicly available information and input from the respective companies. Note however that it is not the purpose of the paper to rank the product winners in terms of success or sales. The paper concludes with an assessment of the larger trends in productization of smart structures technologies. The application "form" for the award as well as the evaluation criteria and suggestions for improving award application packages can be found in the appendix.

  9. Non-invasive prenatal testing: a review of international implementation and challenges

    Science.gov (United States)

    Allyse, Megan; Minear, Mollie A; Berson, Elisa; Sridhar, Shilpa; Rote, Margaret; Hung, Anthony; Chandrasekharan, Subhashini

    2015-01-01

    Noninvasive prenatal genetic testing (NIPT) is an advance in the detection of fetal chromosomal aneuploidies that analyzes cell-free fetal DNA in the blood of a pregnant woman. Since its introduction to clinical practice in Hong Kong in 2011, NIPT has quickly spread across the globe. While many professional societies currently recommend that NIPT be used as a screening method, not a diagnostic test, its high sensitivity (true positive rate) and specificity (true negative rate) make it an attractive alternative to the serum screens and invasive tests currently in use. Professional societies also recommend that NIPT be accompanied by genetic counseling so that families can make informed reproductive choices. If NIPT becomes more widely adopted, States will have to implement regulation and oversight to ensure it fits into existing legal frameworks, with particular attention to returning fetal sex information in areas where sex-based abortions are prevalent. Although there are additional challenges for NIPT uptake in the developing world, including the lack of health care professionals and infrastructure, the use of NIPT in low-resource settings could potentially reduce the need for skilled clinicians who perform invasive testing. Future advances in NIPT technology promise to expand the range of conditions that can be detected, including single gene disorders. With these advances come questions of how to handle incidental findings and variants of unknown significance. Moving forward, it is essential that all stakeholders have a voice in crafting policies to ensure the ethical and equitable use of NIPT across the world. PMID:25653560

  10. Pilot Implementations

    DEFF Research Database (Denmark)

    Manikas, Maria Ie

    by conducting a literature review. The concept of pilot implementation, although commonly used in practice, is rather disregarded in research. In the literature, pilot implementations are mainly treated as secondary to the learning outcomes and are presented as merely a means to acquire knowledge about a given...... objective. The prevalent understanding is that pilot implementations are an ISD technique that extends prototyping from the lab and into test during real use. Another perception is that pilot implementations are a project multiple of co-existing enactments of the pilot implementation. From this perspective......This PhD dissertation engages in the study of pilot (system) implementation. In the field of information systems, pilot implementations are commissioned as a way to learn from real use of a pilot system with real data, by real users during an information systems development (ISD) project and before...

  11. "Many miles to go …": a systematic review of the implementation of patient decision support interventions into routine clinical practice.

    Science.gov (United States)

    Elwyn, Glyn; Scholl, Isabelle; Tietbohl, Caroline; Mann, Mala; Edwards, Adrian G K; Clay, Catharine; Légaré, France; van der Weijden, Trudy; Lewis, Carmen L; Wexler, Richard M; Frosch, Dominick L

    2013-01-01

    Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a 'referral model' consistently report difficulties. We sense that the underlying issues that militate against the use of

  12. The design, implementation, and evaluation of online credit nutrition courses: a systematic review.

    Science.gov (United States)

    Cohen, Nancy L; Carbone, Elena T; Beffa-Negrini, Patricia A

    2011-01-01

    To assess how postsecondary online nutrition education courses (ONEC) are delivered, determine ONEC effectiveness, identify theoretical models used, and identify future research needs. Systematic search of database literature. Postsecondary education. Nine research articles evaluating postsecondary ONEC. Knowledge/performance outcomes and student satisfaction, motivation, or perceptions. Systematic search of 922 articles and review of 9 articles meeting search criteria. Little research regarding ONEC marketing/management existed. Studies primarily evaluated introductory courses using email/websites (before 2000), or course management systems (after 2002). None used true experimental designs; just 3 addressed validity or reliability of measures or pilot-tested instruments. Three articles used theoretical models in course design; few used theories to guide evaluations. Four quasi-experimental studies indicated no differences in nutrition knowledge/performance between online and face-to-face learners. Results were inconclusive regarding student satisfaction, motivation, or perceptions. Students can gain knowledge in online as well as in face-to-face nutrition courses, but satisfaction was mixed. More up-to-date investigations on effective practices are warranted, using theories to identify factors that enhance student outcomes, addressing emerging technologies, and documenting ONEC marketing, management, and delivery. Adequate training/support for faculty is needed to improve student experiences and faculty time management. Copyright © 2011 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

  13. How best can we plan & implement HIV prevention? A review of successful evidence based practices & research

    Directory of Open Access Journals (Sweden)

    Vijay Kumar Chattu

    2014-07-01

    Full Text Available Context: Around 2.5 million people become infected with HIV each year and its impact on human life and public health can only be tackled and reversed only by sound prevention strategies. Aim: This paper aims to provide the reader about different types of prevention strategies that are effective and practiced in various countries with special emphasis on evidence for success. It also highlights the importance of to the evidence based medicine& strategies. It describes about the importance of combination prevention, which encompasses complementary behavioral, biomedical and structural prevention strategies. Methods & Materials: Searches for peer reviewed journal articles was conducted using the search engines to gather the information from databases of medicine, health sciences and social sciences. Information for each strategy is organized & presented systematically with detailed discussion. Results: For a successful reduction in HIV transmission, there is a great need for combined effects of radical & sustainable behavioral changes among individuals who are potentially at risk. Second, combination prevention is essential for HIV prevention is neither simple nor simplistic. Reductions in HIV transmission need widespread and sustained efforts. A mix of communication channels are essential to disseminate messages to motivate people to engage in various methods of risk reduction. Conclusions: The effect of behavioral strategies could be increased by aiming for many goals that are achieved by use of multilevel approaches with populations both uninfected and infected with HIV. Combination prevention programs operate on different levels to address the specific, but diverse needs of the populations at risk of HIV infection.

  14. Increasing Coverage of Hepatitis B Vaccination in China: A Systematic Review of Interventions and Implementation Experiences.

    Science.gov (United States)

    Wang, Shengnan; Smith, Helen; Peng, Zhuoxin; Xu, Biao; Wang, Weibing

    2016-05-01

    This study used a system evaluation method to summarize China's experience on improving the coverage of hepatitis B vaccine, especially the strategies employed to improve the uptake of timely birth dosage. Identifying successful methods and strategies will provide strong evidence for policy makers and health workers in other countries with high hepatitis B prevalence.We conducted a literature review included English or Chinese literature carried out in mainland China, using PubMed, the Cochrane databases, Web of Knowledge, China National Knowledge Infrastructure, Wanfang data, and other relevant databases.Nineteen articles about the effectiveness and impact of interventions on improving the coverage of hepatitis B vaccine were included. Strong or moderate evidence showed that reinforcing health education, training and supervision, providing subsidies for facility birth, strengthening the coordination among health care providers, and using out-of-cold-chain storage for vaccines were all important to improving vaccination coverage.We found evidence that community education was the most commonly used intervention, and out-reach programs such as out-of-cold chain strategy were more effective in increasing the coverage of vaccination in remote areas where the facility birth rate was respectively low. The essential impact factors were found to be strong government commitment and the cooperation of the different government departments.Public interventions relying on basic health care systems combined with outreach care services were critical elements in improving the hepatitis B vaccination rate in China. This success could not have occurred without exceptional national commitment.

  15. Implementing the EcoDesign Directive in distribution transformers: First impacts review

    Directory of Open Access Journals (Sweden)

    Constantinos Charalampopoulos

    2017-01-01

    Full Text Available Since the commission of the Ecodesign Directive 2005/32/EC and the review of the Directive in 2009, there has been radical change on a multitude of aspects across the grid of electrical products. Because of their high volume sales, significant environmental impact and high potential for improvement, distribution transformers were set as a priority for the Ecodesign Working Period 2009–2011. As of July 2015, the requirements of the Directive affect every unit placed into market. This study addresses the impact that the Ecodesign Directive had on the distribution transformer industry financially, environmentally, and technologically. Data has been collected from various authoritative sources in order to give an inclusive picture of the current situation, and how it may improve by the measures presented. We need to ascertain both the importance of the existing difficulties and the validity of the actions and regulations in effect so far. The purpose of this paper will be considered fulfilled if the reader can clearly understand the current state of the distribution transformer industry, the problems that the Ecodesign Directive attempts to overcome, the methods of solving said problems, and the effects that those solutions can have in the near future.

  16. Mitomycin-C in dacryocystorhinostomy: From experimentation to implementation and the road ahead: A review

    Directory of Open Access Journals (Sweden)

    Akshay Gopinathan Nair

    2015-01-01

    Full Text Available Dacryocystorhinostomy (DCR is the procedure of choice in patients with epiphora due to primary acquired nasolacrimal duct obstruction. The evolution of surgical tools, fiber-optic endoscopes, effective anesthesia techniques, and the adjunct use of antimetabolites intraoperatively; namely mitomycin-C (MMC have significantly contributed to the advancement of DCR surgery. MMC is a systemic chemotherapeutic agent derived from Streptomyces caespitosus that inhibits the synthesis of DNA, cellular RNA, and protein by inhibiting the synthesis of collagen by fibroblasts. Even the cellular changes in the human nasal mucosal fibroblasts induced by MMC at an ultrastructural level have been documented. There, however, seems to be a lack of consensus regarding MMC: The dosage, the route of delivery/application, the time of exposure and subsequently what role each of these variables plays in the final outcome of the surgery. In this review, an attempt is made to objectively examine all the evidence regarding the role of MMC in DCR. MMC appears to improve the success rate of DCR.

  17. Enzymatic hydrolsis of pretreated rice straw

    Energy Technology Data Exchange (ETDEWEB)

    Vlasenko, E.Y.; Shoemaker, S.P. [California Inst. of Food and Agricultural Research, Davis, CA (United States); Ding, H. [California Univ., Davis (Canada). Dept. of Food Science and Technology; Labavitch, J.M. [California Univ., Davis, CA (United States). Dept. of Pomology

    1997-02-01

    California rice straw is being evaluated as a feedstock for production of power and fuel. This paper examines the initial steps in the process: pretreatment of rice straw and enzymatic hydrolysis of the polysaccharides in the pretreated material to soluble sugars. Rice straw was subjected to three distinct pretreatment procedures: acid-catalyzed steam explosion (Swan Biomass Company), acid hydrolysis (U.S. DOE National Renewable Energy Laboratory), and ammonia fiber explosion or AFEX (Texas A and M University). Standard conditions for each pretreatment were used, but none was optimized for rice straw specifically. Six commercial cellulases, products of Genencor International (USA), Novo (Denmark), Iogen (Canada) and Fermtech (Russia) were used for hydrolysis. The Swan- and the acid-pretreatments effectively removed hemicellulose from rice straw, providing high yields of fermentable sugars. The AFEX-pretreatment was distinctly different from other pretreatments in that it did not significantly solubilize hemicellulose. All three pretreatment procedures substantially increased enzymatic digestibility of rice straw. Three commercial Trichoderma-reesei-derived enzyme preparations: Cellulase 100L (Iogen), Spezyme CP (Genencor), and Al (Fermtech), were more active on pretreated rice straw compared than others tested. Conditions for hydrolysis of rice straw using Cellulase 100L were evaluated. The supplementation of this enzyme preparation with cellobiase (Novozyme 188) significantly improved the parameters of hydrolysis for the Swan- and the acid-pretreated materials, but did not affect the hydrolysis of the AFEX-pretreated rice straw. (Author)

  18. Pretreatment Solution for Water Recovery Systems

    Science.gov (United States)

    Muirhead, Dean (Inventor)

    2018-01-01

    Chemical pretreatments are used to produce usable water by treating a water source with a chemical pretreatment that contains a hexavalent chromium and an acid to generate a treated water source, wherein the concentration of sulfate compounds in the acid is negligible, and wherein the treated water source remains substantially free of precipitates after the addition of the chemical pretreatment. Other methods include reducing the pH in urine to be distilled for potable water extraction by pretreating the urine before distillation with a pretreatment solution comprising one or more acid sources selected from a group consisting of phosphoric acid, hydrochloric acid, and nitric acid, wherein the urine remains substantially precipitate free after the addition of the pretreatment solution. Another method described comprises a process for reducing precipitation in urine to be processed for water extraction by mixing the urine with a pretreatment solution comprising hexavalent chromium compound and phosphoric acid.

  19. Evidence-based competencies for improving communication skills in graduate medical education: a review with suggestions for implementation.

    Science.gov (United States)

    Henry, Stephen G; Holmboe, Eric S; Frankel, Richard M

    2013-05-01

    Communicating with patients is arguably the most common and important activity in medical practice, but this activity receives relatively little emphasis in graduate medical education. We propose 12 evidence-based communication competencies that program directors can adopt as a framework for teaching and evaluating residents' communication skills. We review supporting evidence for these competencies and argue that communication should be treated like a procedural skill that must be taught and evaluated by observing real resident-patient interactions. We make practical suggestions for implementing these competencies by addressing three critical components of a competency-based approach to communication skills: patient safety, faculty development, and direct observation of residents. This approach to teaching and assessing communication skills provides a rationale for incorporating routine direct observation into graduate medical education programs and also for designing communication skills training that ensures graduating residents develop the skills needed to provide safe, effective patient care.

  20. Implementing systematic review techniques in chemical risk assessment: Challenges, opportunities and recommendations.

    Science.gov (United States)

    Whaley, Paul; Halsall, Crispin; Ågerstrand, Marlene; Aiassa, Elisa; Benford, Diane; Bilotta, Gary; Coggon, David; Collins, Chris; Dempsey, Ciara; Duarte-Davidson, Raquel; FitzGerald, Rex; Galay-Burgos, Malyka; Gee, David; Hoffmann, Sebastian; Lam, Juleen; Lasserson, Toby; Levy, Len; Lipworth, Steven; Ross, Sarah Mackenzie; Martin, Olwenn; Meads, Catherine; Meyer-Baron, Monika; Miller, James; Pease, Camilla; Rooney, Andrew; Sapiets, Alison; Stewart, Gavin; Taylor, David

    2016-01-01

    Systematic review (SR) is a rigorous, protocol-driven approach designed to minimise error and bias when summarising the body of research evidence relevant to a specific scientific question. Taking as a comparator the use of SR in synthesising research in healthcare, we argue that SR methods could also pave the way for a "step change" in the transparency, objectivity and communication of chemical risk assessments (CRA) in Europe and elsewhere. We suggest that current controversies around the safety of certain chemicals are partly due to limitations in current CRA procedures which have contributed to ambiguity about the health risks posed by these substances. We present an overview of how SR methods can be applied to the assessment of risks from chemicals, and indicate how challenges in adapting SR methods from healthcare research to the CRA context might be overcome. Regarding the latter, we report the outcomes from a workshop exploring how to increase uptake of SR methods, attended by experts representing a wide range of fields related to chemical toxicology, risk analysis and SR. Priorities which were identified include: the conduct of CRA-focused prototype SRs; the development of a recognised standard of reporting and conduct for SRs in toxicology and CRA; and establishing a network to facilitate research, communication and training in SR methods. We see this paper as a milestone in the creation of a research climate that fosters communication between experts in CRA and SR and facilitates wider uptake of SR methods into CRA. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Early Child Development and Nutrition: A Review of the Benefits and Challenges of Implementing Integrated Interventions1234

    Science.gov (United States)

    Hurley, Kristen M; Yousafzai, Aisha K; Lopez-Boo, Florencia

    2016-01-01

    Poor nutrition (substandard diet quantity and/or quality resulting in under- or overnutrition) and the lack of early learning opportunities contribute to the loss of developmental potential and life-long health and economic disparities among millions of children aged child development (ECD) or nutrition have been linked to positive child development and/or nutritional status, and recommendations currently advocate for the development and testing of integrated interventions. We reviewed the theoretical and practical benefits and challenges of implementing integrated nutrition and ECD interventions along with the evidence for best practice and benefit-cost and concluded that the strong theoretical rationale for integration is more nuanced than the questions that the published empirical evidence have addressed. For example, further research is needed to 1) answer questions related to how integrated messaging influences caregiver characteristics such as well-being, knowledge, and behavior and how these influence early child nutrition and development outcomes; 2) understand population and nutritional contexts in which integrated interventions are beneficial; and 3) explore how varying implementation processes influence the efficacy, uptake, and cost-benefit of integrated nutrition and ECD interventions. PMID:26980819

  2. Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person's Pathway.

    LENUS (Irish Health Repository)

    2018-01-25

    We addressed the research question "what factors enable the successful development and implementation of a frail older person\\'s pathway within the acute setting". A rapid realist review (RRR) was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources)-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as the systematic approach to improving care for frail older adults (SAFE) study by producing accounts of what works based on a wide range of sources and innovative engagement with stakeholders. It is evident from our provisional model that numerous factors need to combine and interact to enable and sustain a successful frail older person\\'s pathway.

  3. Patient-perceived barriers and facilitators to the implementation of a medication review in primary care: a qualitative thematic analysis.

    Science.gov (United States)

    Uhl, Mirella Carolin; Muth, Christiane; Gerlach, Ferdinand Michael; Schoch, Goentje-Gesine; Müller, Beate Sigrid

    2018-01-05

    Although polypharmacy can cause adverse health outcomes, patients often know little about their medication. A regularly conducted medication review (MR) can help provide an overview of a patient's medication, and benefit patients by enhancing their knowledge of their drugs. As little is known about patient attitudes towards MRs in primary care, the objective of this study was to gain insight into patient-perceived barriers and facilitators to the implementation of an MR. We conducted a qualitative study with a convenience sample of 31 patients (age ≥ 60 years, ≥3 chronic diseases, taking ≥5 drugs/d); in Hesse, Germany, in February 2016. We conducted two focus groups and, in order to ensure the participation of elderly patients with reduced mobility, 16 telephone interviews. Both relied on a semi-structured interview guide dealing with the following subjects: patients' experience of polypharmacy, general design of MRs, potential barriers and facilitators to implementation etc. Interviews were audio-recorded, transcribed verbatim, and analysed by two researchers using thematic analysis. Patients' average age was 74 years (range 62-88 years). We identified barriers and facilitators for four main topics regarding the implementation of MRs in primary care: patient participation, GP-led MRs, pharmacist-led MRs, and the involvement of healthcare assistants in MRs. Barriers to patient participation concerned patient autonomy, while facilitators involved patient awareness of medication-related problems. Barriers to GP-led MRs concerned GP's lack of resources while facilitators related to the trusting relationship between patient and GP. Pharmacist-led MRs might be hindered by a lack of patients' confidence in pharmacists' expertise, but facilitated by pharmacies' digital records of the patients' medications. Regarding the involvement of healthcare assistants in MRs, a potential barrier was patients' uncertainty regarding the extent of their training. Patients

  4. Method for pretreating lignocellulosic biomass

    Science.gov (United States)

    Kuzhiyil, Najeeb M.; Brown, Robert C.; Dalluge, Dustin Lee

    2015-08-18

    The present invention relates to a method for pretreating lignocellulosic biomass containing alkali and/or alkaline earth metal (AAEM). The method comprises providing a lignocellulosic biomass containing AAEM; determining the amount of the AAEM present in the lignocellulosic biomass; identifying, based on said determining, the amount of a mineral acid sufficient to completely convert the AAEM in the lignocellulosic biomass to thermally-stable, catalytically-inert salts; and treating the lignocellulosic biomass with the identified amount of the mineral acid, wherein the treated lignocellulosic biomass contains thermally-stable, catalytically inert AAEM salts.

  5. Development and evaluation of 'briefing notes' as a novel knowledge translation tool to aid the implementation of sex/gender analysis in systematic reviews: a pilot study.

    Science.gov (United States)

    Doull, Marion; Welch, Vivian; Puil, Lorri; Runnels, Vivien; Coen, Stephanie E; Shea, Beverley; O'Neill, Jennifer; Borkhoff, Cornelia; Tudiver, Sari; Boscoe, Madeline

    2014-01-01

    There is increasing recognition of sex/gender differences in health and the importance of identifying differential effects of interventions for men and women. Yet, to whom the research evidence does or does not apply, with regard to sex/gender, is often insufficiently answered. This is also true for systematic reviews which synthesize results of primary studies. A lack of analysis and reporting of evidence on sex/gender raises concerns about the applicability of systematic reviews. To bridge this gap, this pilot study aimed to translate knowledge about sex/gender analysis (SGA) into a user-friendly 'briefing note' format and evaluate its potential in aiding the implementation of SGA in systematic reviews. Our Sex/Gender Methods Group used an interactive process to translate knowledge about sex/gender into briefing notes, a concise communication tool used by policy and decision makers. The briefing notes were developed in collaboration with three Cochrane Collaboration review groups (HIV/AIDS, Hypertension, and Musculoskeletal) who were also the target knowledge users of the briefing notes. Briefing note development was informed by existing systematic review checklists, literature on sex/gender, in-person and virtual meetings, and consultation with topic experts. Finally, we held a workshop for potential users to evaluate the notes. Each briefing note provides tailored guidance on considering sex/gender to reviewers who are planning or conducting systematic reviews and includes the rationale for considering sex/gender, with examples specific to each review group's focus. Review authors found that the briefing notes provided welcome guidance on implementing SGA that was clear and concise, but also identified conceptual and implementation challenges. Sex/gender briefing notes are a promising knowledge translation tool. By encouraging sex/gender analysis and equity considerations in systematic reviews, the briefing notes can assist systematic reviewers in ensuring the

  6. Development and evaluation of 'briefing notes' as a novel knowledge translation tool to aid the implementation of sex/gender analysis in systematic reviews: a pilot study.

    Directory of Open Access Journals (Sweden)

    Marion Doull

    Full Text Available BACKGROUND: There is increasing recognition of sex/gender differences in health and the importance of identifying differential effects of interventions for men and women. Yet, to whom the research evidence does or does not apply, with regard to sex/gender, is often insufficiently answered. This is also true for systematic reviews which synthesize results of primary studies. A lack of analysis and reporting of evidence on sex/gender raises concerns about the applicability of systematic reviews. To bridge this gap, this pilot study aimed to translate knowledge about sex/gender analysis (SGA into a user-friendly 'briefing note' format and evaluate its potential in aiding the implementation of SGA in systematic reviews. METHODS: Our Sex/Gender Methods Group used an interactive process to translate knowledge about sex/gender into briefing notes, a concise communication tool used by policy and decision makers. The briefing notes were developed in collaboration with three Cochrane Collaboration review groups (HIV/AIDS, Hypertension, and Musculoskeletal who were also the target knowledge users of the briefing notes. Briefing note development was informed by existing systematic review checklists, literature on sex/gender, in-person and virtual meetings, and consultation with topic experts. Finally, we held a workshop for potential users to evaluate the notes. RESULTS: Each briefing note provides tailored guidance on considering sex/gender to reviewers who are planning or conducting systematic reviews and includes the rationale for considering sex/gender, with examples specific to each review group's focus. Review authors found that the briefing notes provided welcome guidance on implementing SGA that was clear and concise, but also identified conceptual and implementation challenges. CONCLUSIONS: Sex/gender briefing notes are a promising knowledge translation tool. By encouraging sex/gender analysis and equity considerations in systematic reviews, the

  7. Implementation of the Individual Placement and Support approach for people with mental illness – a systematic review of facilitators and barriers

    DEFF Research Database (Denmark)

    Bonfils, Inge Storgaard; Hansen, Henrik; Stentoft Dalum, Helle

    2015-01-01

    /evaluations and reviews included in the review. Results: Factors influencing the implementation process exist on the contextual, local organizational, cooperation/team and individual level. There is an inherent interdependency between various factors. Key element is the use of fidelity scale and skilled local leadership...... and IPS specialist. A general awareness towards how attitudes, values and institutional logics influence the implementation process is needed to change the systems logic from a “caring perspective” towards a” rehabilitation approach”. Conclusion: Existing research points to how multiple factors influence...

  8. Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review.

    Science.gov (United States)

    Forman-Hoffman, Valerie L; Middleton, Jennifer Cook; McKeeman, Joni L; Stambaugh, Leyla F; Christian, Robert B; Gaynes, Bradley N; Kane, Heather Lynne; Kahwati, Leila C; Lohr, Kathleen N; Viswanathan, Meera

    2017-07-24

    Some outcomes for children with mental health problems remain suboptimal because of poor access to care and the failure of systems and providers to adopt established quality improvement strategies and interventions with proven effectiveness. This review had three goals: (1) assess the effectiveness of quality improvement, implementation, and dissemination strategies intended to improve the mental health care of children and adolescents; (2) examine harms associated with these strategies; and (3) determine whether effectiveness or harms differ for subgroups based on system, organizational, practitioner, or patient characteristics. Sources included MEDLINE®, the Cochrane Library, PsycINFO, and CINAHL, from database inception through February 17, 2017. Additional sources included gray literature, additional studies from reference lists, and technical experts. Two reviewers selected relevant randomized controlled trials (RCTs) and observational studies, extracted data, and assessed risk of bias. Dual analysis, synthesis, and grading of the strength of evidence for each outcome followed for studies meeting inclusion criteria. We also used qualitative comparative analysis to examine relationships between combinations of strategy components and improvements in outcomes. We identified 18 strategies described in 19 studies. Eleven strategies significantly improved at least one measure of intermediate outcomes, final health outcomes, or resource use. Moderate strength of evidence (from one RCT) supported using provider financial incentives such as pay for performance to improve the competence with which practitioners can implement evidence-based practices (EBPs). We found inconsistent evidence involving strategies with educational meetings, materials, and outreach; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information. We also found low strength of evidence for no benefit for initiatives that

  9. An example of the practical application of ALARP in planning, implementation and review at BNFL's Bradwell Power Station

    International Nuclear Information System (INIS)

    Devine, I.R.; James, C.

    2000-01-01

    The paper will describe three examples of the practical application of ALARP principles as applied to some major projects associated with enhancement of the safety cases for heat exchanger or reactor core support structures at some Magnox Power Stations operated by BNFL Magnox Generation. It will summarise and discuss some of the issues encountered during the pre-planning, engineering development/implementation, work in progress and post completion review phases. The first example is the response to minor defects discovered during an inspection of a sample of some welds in an upper restraint beam inside the concrete reactor pressure vessel at Oldbury Power Station. These inspections were carried out to enhance the existing safety case to justify a proposed increase in the period between statutory inspections from two to three years. The presence or absence of similar defects in the other welds was not sufficiently well characterised nor could be sufficiently accurately predicted without extensive additional NDT inspection. This would in itself have incurred a significant dose commitment. The engineering/ALARP assessment was required address the justification of the work and even determine what should be proposed. Available options included: extensive inspection to determine the status of load bearing welds to enable a subsequent assessment of the required remedial work (if any) which may include weld dressing, repair or reinforcement; pre-emptive reinforcement on a 'worst case scenario', or pre-emptive complete or partial weld repair. The second and third case studies relate to the response to minor defects in welds associated with support beams inside heat exchangers at Bradwell and Hinkley Point Power Stations. In these cases, pre-emptive repair or reinforcement was clearly justified and optimal. The engineering/ALARP assessments were required to address the optimisation of the required repair or reinforcement strategy and tasks associated with its implementation

  10. The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review

    Science.gov (United States)

    Shields, Michael D.; Heaney, Liam G.; Kendall, Marilyn; Pearce, Christina J.; Hui, Chi Yan; Pinnock, Hilary

    2017-01-01

    Introduction Financial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets. Objectives To systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management. Methods We followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017) including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies. Results We identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7), UK (n = 4) and Canada (n = 1). Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10), written action plans for asthma (n = 1) and hospital/emergency department visits (n = 1). Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving ‘perfect care’ (including providing a written action plan) increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one. Conclusions Results for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health

  11. Review of technical justification of assumptions and methods used by the Environmental Protection Agency for estimating risks avoided by implementing MCLs for radionuclides

    International Nuclear Information System (INIS)

    Morris, S.C.; Rowe, M.D.; Holtzman, S.; Meinhold, A.F.

    1992-11-01

    The Environmental Protection Agency (EPA) has proposed regulations for allowable levels of radioactive material in drinking water (40 CFR Part 141, 56 FR 33050, July 18, 1991). This review examined the assumptions and methods used by EPA in calculating risks that would be avoided by implementing the proposed Maximum Contaminant Levels for uranium, radium, and radon. Proposed limits on gross alpha and beta-gamma emitters were not included in this review

  12. Provider-initiated testing and counselling programmes in sub-Saharan Africa: a systematic review of their operational implementation.

    Science.gov (United States)

    Roura, Maria; Watson-Jones, Deborah; Kahawita, Tanya M; Ferguson, Laura; Ross, David A

    2013-02-20

    The routine offer of an HIV test during patient-provider encounters is gaining momentum within HIV treatment and prevention programmes. This review examined the operational implementation of provider-initiated testing and counselling (PITC) programmes in sub-Saharan Africa. PUBMED, EMBASE, Global Health, COCHRANE Library and JSTOR databases were searched systematically for articles published in English between January 2000 and November 2010. Grey literature was explored through the websites of international and nongovernmental organizations. Eligibility of studies was based on predetermined criteria applied during independent screening by two researchers. We retained 44 studies out of 5088 references screened. PITC polices have been effective at identifying large numbers of previously undiagnosed individuals. However, the translation of policy guidance into practice has had mixed results, and in several studies of routine programmes the proportion of patients offered an HIV test was disappointingly low. There were wide variations in the rates of acceptance of the test and poor linkage of those testing positive to follow-up assessments and antiretroviral treatment. The challenges encountered encompass a range of areas from logistics, to data systems, human resources and management, reflecting some of the weaknesses of health systems in the region. The widespread adoption of PITC provides an unprecedented opportunity for identifying HIV-positive individuals who are already in contact with health services and should be accompanied by measures aimed at strengthening health systems and fostering the normalization of HIV at community level. The resources and effort needed to do this successfully should not be underestimated.

  13. Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence.

    Science.gov (United States)

    Goldenberg, Mitchell G; Lee, Jason Y; Kwong, Jethro C C; Grantcharov, Teodor P; Costello, Anthony

    2018-03-31

    To systematically review and synthesise the validity evidence supporting intraoperative and simulation-based assessments of technical skill in urological robot-assisted surgery (RAS), and make evidence-based recommendations for the implementation of these assessments in urological training. A literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation-based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis. Multiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing. There have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high-stakes decisions is likely insufficient at present. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

  14. Implementing risk-stratified screening for common cancers: a review of potential ethical, legal and social issues.

    Science.gov (United States)

    Hall, A E; Chowdhury, S; Hallowell, N; Pashayan, N; Dent, T; Pharoah, P; Burton, H

    2014-06-01

    The identification of common genetic variants associated with common cancers including breast, prostate and ovarian cancers would allow population stratification by genotype to effectively target screening and treatment. As scientific, clinical and economic evidence mounts there will be increasing pressure for risk-stratified screening programmes to be implemented. This paper reviews some of the main ethical, legal and social issues (ELSI) raised by the introduction of genotyping into risk-stratified screening programmes, in terms of Beauchamp and Childress's four principles of biomedical ethics--respect for autonomy, non-maleficence, beneficence and justice. Two alternative approaches to data collection, storage, communication and consent are used to exemplify the ELSI issues that are likely to be raised. Ultimately, the provision of risk-stratified screening using genotyping raises fundamental questions about respective roles of individuals, healthcare providers and the state in organizing or mandating such programmes, and the principles, which underpin their provision, particularly the requirement for distributive justice. The scope and breadth of these issues suggest that ELSI relating to risk-stratified screening will become increasingly important for policy-makers, healthcare professionals and a wide diversity of stakeholders. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health.

  15. Comparison of different pretreatment methods for separation hemicellulose from straw during the lignocellulosic bioethanol production

    Science.gov (United States)

    Eisenhuber, Katharina; Krennhuber, Klaus; Steinmüller, Viktoria; Kahr, Heike; Jäger, Alexander

    2013-04-01

    lead to increasing conversion of hemicellulose to xylose. In contrast, increasing sodium hydroxide concentrations degrade the hemicellulose to unknown derivates. Consequently, almost no sugars from hemicellulose remain for fermentation. The hydrolysis of sulfuric acid pretreated straw results in a maximum glucose concentration of 100 g/kg straw and a xylose concentration of nearly 30 g/kg. Sodium hydroxide pretreated and hydrolyzed straw leads to a maximum glucose concentration of 90 g/kg straw and a xylose concentration of nearly 20 g/kg. In comparison to the two chemical pretreatment methods (sodium hydroxide and sulfuric acid pretreatment), the steam explosion pretreatment (conditions: temperature 190°C, time 20 minutes) results in a higher glucose concentration of about 190 g/kg straw and a xylose concentration of nearly 75 g/kg straw after enzymatic hydrolysis of the dried straw. Because of the small effect the sodium hydroxide pretreatment has on xylose recovery, this method won't be used for separation and conversion of hemicellulose into xylose and arabinose. Although pretreatment with sulfuric acid achieved promising results, further research and economical considerations have to be performed. In conclusion, the steam explosion method is still the state of the art pretreatment method for the production of lignocellulosic biofuels. Alkaline methods destroy most of the xylose part of the sugar fraction and a loss of up to 25 % of the fermentable sugars is not acceptable for a sustainable biofuel production. The acid pretreatment yields high amounts of accessible hemicellulose and cellulose, but the consumption of chemicals for acid pretreatment and neutralization has to be taken into account when considering technical implementation.

  16. Wash water waste pretreatment system

    Science.gov (United States)

    1977-01-01

    Investigations were completed on wash waters based on each candidate personal cleansing agent. Evaluations of coagulants, antifoam agents, and the effect of promising antifoams on the chemical precipitation were included. Based on these evaluations two candidate soaps as well as their companion antifoam agents were selected for further work. Operating parameters included the effect of soap concentration, ferric chloride concentration, duration of mixing, and pore size of depth filters on the degree of soap removal. The effect of pressure on water flow through filter cartridges and on the rate of decline of water flow was also investigated. The culmination of the program was the recommendation of a pretreatment concept based on chemical precipitation followed by pressure filtration.

  17. Biomass Deconstruction and Pretreatment | Bioenergy | NREL

    Science.gov (United States)

    Deconstruction and Pretreatment Biomass Deconstruction and Pretreatment Our mission is to transform -cyclohexane hydrocarbons were produced by noble metal and acid zeoloite catalytic upgrading of biomass-derived by mechanical refining process. The left side shows biomass feedstock (represented by brown spheres

  18. Understanding the Attributes of Implementation Frameworks to Guide the Implementation of a Model of Community-based Integrated Health Care for Older Adults with Complex Chronic Conditions: A Metanarrative Review

    Directory of Open Access Journals (Sweden)

    Ann McKillop

    2017-06-01

    Full Text Available Introduction: Many studies have investigated the process of healthcare implementation to understand better how to bridge gaps between recommended practice, the needs and demands of healthcare consumers, and what they actually receive. However, in the implementation of integrated community-based and integrated health care, it is still not well known which approaches work best.  Methods: We conducted a systematic review and metanarrative synthesis of literature on implementation frameworks, theories and models in support of a research programme investigating CBPHC for older adults with chronic health problems. Results: Thirty-five reviews met our inclusion criteria and were appraised, summarised, and synthesised. Five metanarratives emerged 1 theoretical constructs; 2 multiple influencing factors; 3 development of new frameworks; 4 application of existing frameworks; and 5 effectiveness of interventions within frameworks/models. Four themes were generated that exposed the contradictions and synergies among the metanarratives. Person-centred care is fundamental to integrated CBPHC at all levels in the health care delivery system, yet many implementation theories and frameworks neglect this cornerstone.  Discussion: The research identified perspectives central to integrated CBPHC that were missing in the literature. Context played a key role in determining success and in how consumers and their families, providers, organisations and policy-makers stay connected to implementing the best care possible.  Conclusions: All phases of implementation of a new model of CBPHC call for collaborative partnerships with all stakeholders, the most important being the person receiving care in terms of what matters most to them.

  19. Evaluation of chemical, thermobaric and thermochemical pre-treatment on anaerobic digestion of high-fat cattle slaughterhouse waste.

    Science.gov (United States)

    Harris, Peter W; Schmidt, Thomas; McCabe, Bernadette K

    2017-11-01

    This work aimed to enhance the anaerobic digestion of fat-rich dissolved air flotation (DAF) sludge through chemical, thermobaric, and thermochemical pre-treatment methods. Soluble chemical oxygen demand was enhanced from 16.3% in the control to 20.84% (thermobaric), 40.82% (chemical), and 50.7% (thermochemical). Pre-treatment altered volatile fatty acid concentration by -64% (thermobaric), 127% (chemical) and 228% (thermochemical). Early inhibition was reduced by 20% in the thermochemical group, and 100% in the thermobaric group. Specific methane production was enhanced by 3.28% (chemical), 8.32% (thermobaric), and 8.49% (thermochemical) as a result of pre-treatment. Under batch digestion, thermobaric pre-treatment demonstrated the greatest improvement in methane yield with respect to degree of pre-treatment applied. Thermobaric pre-treatment was also the most viable for implementation at slaughterhouses, with potential for heat-exchange to reduce pre-treatment cost. Further investigation into long-term impact of pre-treatments in semi-continuous digestion experiments will provide additional evaluation of appropriate pre-treatment options for high-fat slaughterhouse wastewater. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  20. Design And Implementation Of Online Submission and Peer Review System A Case Study Of E-Journal Of University Of Zakho

    Directory of Open Access Journals (Sweden)

    Karwan Jacksi

    2015-08-01

    Full Text Available Abstract With the aim of designing and implementing a web-based article submission management system for academic research papers several international models such as Elsevier Editorial System and ICOCI International Conference on Computing and Informatics are studied and analyzed. Through this analysis an open access web-based article submission and peer review system for Journal of University of Zakho JUOZ is employed. This kind of systems is not only capable of solving issues such as complex manuscript management time-delays in the process of reviewing and loss of manuscripts that occurs often in off-line paper submission and review processes but also is capable to build the foundation for e-journal publications. Consequently an active and rapid scholarly communication medium can be made. The implementation and deployment of this system can improve the rank of the university and the reputation and the globalization of science and technology research journals.

  1. Pretreatment of the macroalgae Chaetomorpha linum for the production of bioethanol - Comparison of five pretreatment technologies

    DEFF Research Database (Denmark)

    Schultz-Jensen, Nadja; Thygesen, Anders; Thomsen, Sune Tjalfe

    2013-01-01

    -assisted pretreatment (PAP) and ball milling (BM), to determine effects of the pretreatment methods on the conversion of C. linum into ethanol by simultaneous saccharification and fermentation (SSF). WO and BM showed the highest ethanol yield of 44. g ethanol/100. g glucan, which was close to the theoretical ethanol......A qualified estimate for pretreatment of the macroalgae Chaetomorpha linum for ethanol production was given, based on the experience of pretreatment of land-based biomass. C. linum was subjected to hydrothermal pretreatment (HTT), wet oxidation (WO), steam explosion (STEX), plasma...... yield of 57. g ethanol/100. g glucan. A 64% higher ethanol yield, based on raw material, was reached after pretreatment with WO and BM compared with unpretreated C. linum, however 50% of the biomass was lost during WO. Results indicated that the right combination of pretreatment and marine macroalgae...

  2. Total Productive Maintenance And Role Of Interpretive Structural Modeling And Structural Equation Modeling In Analyzing Barriers In Its Implementation A Literature Review

    Directory of Open Access Journals (Sweden)

    Prasanth S. Poduval

    2015-08-01

    Full Text Available Abstract - The aim of the authors is to present a review of literature of Total Productive Maintenance and the barriers in implementation of Total Productive Maintenance TPM. The paper begins with a brief description of TPM and the barriers in implementation of TPM. Interpretive Structural Modeling ISM and its role in analyzing the barriers in TPM implementation is explained in brief. Applications of ISM in analyzing issues in various fields are highlighted with special emphasis on TPM. The paper moves on to introduction to Structural Equation Modeling SEM and its role in validating ISM in analyzing barriers in implementation of TPM. The paper concludes with a gap analysis from the current literature research that can be carried out and expected outcomes from the proposed research.

  3. The characterization of radioactive waste: a critical review of techniques implemented or under development at CEA, France

    Science.gov (United States)

    Pérot, Bertrand; Jallu, Fanny; Passard, Christian; Gueton, Olivier; Allinei, Pierre-Guy; Loubet, Laurent; Estre, Nicolas; Simon, Eric; Carasco, Cédric; Roure, Christophe; Boucher, Lionel; Lamotte, Hervé; Comte, Jérôme; Bertaux, Maïté; Lyoussi, Abdallah; Fichet, Pascal; Carrel, Frédérick

    2018-03-01

    This review paper describes the destructive and non-destructive measurements implemented or under development at CEA, in view to perform the most complete radioactive waste characterization. First, high-energy photon imaging (radiography, tomography) brings essential information on the waste packages, such as density, position and shape of the waste inside the container and in the possible binder, quality of coating and blocking matrices, presence of internal shields or structures, presence of cracks, voids, or other defects in the container or in the matrix, liquids or other forbidden materials, etc. Radiological assessment is then performed using a series of non-destructive techniques such as gamma-ray spectroscopy, which allows characterizing a wide range of radioactive and nuclear materials, passive neutron coincidence counting and active neutron interrogation with the differential die-away technique, or active photon interrogation with high-energy photons (photofission), to measure nuclear materials. Prompt gamma neutron activation analysis (PGNAA) can also be employed to detect toxic chemicals or elements which can greatly influence the above measurements, such as neutron moderators or absorbers. Digital auto-radiography can also be used to detect alpha and beta contaminated waste. These non-destructive assessments can be completed by gas measurements, to quantify the radioactive and radiolysis gas releases, and by destructive examinations such as coring homogeneous waste packages or cutting the heterogeneous ones, in view to perform visual examination and a series of physical, chemical, and radiochemical analyses on samples. These last allow for instance to check the mechanical and containment properties of the package envelop, or of the waste binder, to measure toxic chemicals, to assess the activity of long-lived radionuclides or pure beta emitters, to determine the isotopic composition of nuclear materials, etc.

  4. Façade insulation retrofitting policy implementation process and its effects on health equity determinants: A realist review

    International Nuclear Information System (INIS)

    Camprubí, Lluís; Malmusi, Davide; Mehdipanah, Roshanak

    2016-01-01

    Fuel poverty and cold housing constitute a significant public health problem. Energy efficiency interventions, such as façade retrofitting, address the problem from a structural and long-term perspective. Despite evidence of the health benefits of insulation, little is known about the political and social contexts that contribute to social inequalities in receiving and experiencing health benefits from these interventions. We used a realist review methodology to better understand the mechanisms that explain how and why variations across different social groups appear in receiving energy efficiency façade retrofitting interventions and in their impact on health determinants. We considered the four stages of the policy implementation framework: public policy approach; policy; receiving intervention and impact on health determinants. We found strong evidence that certain social groups (low-income, renters, elderly) suffering most from fuel poverty, experience more barriers for undertaking a building retrofitting (due to factors such as upfront costs, “presentism” thinking, split incentives, disruption and lack of control), and that some public policies on housing energy efficiency may exacerbate these inequalities. This can be avoided if such policies specifically aim at tackling fuel poverty or social inequities, are completely free to users, target the most affected groups and are adapted to their needs. - Highlights: •Health benefits of housing façade insulation more pronounced in fuel poor groups. •Social groups suffering most from fuel poverty least likely to undergo insulation. •Energy efficiency policies focused solely on CO_2 reduction may increase inequalities. •Split Incentives and “Take-Back” effect show socioeconomic and contextual variability. •Universal policies without targeting increase inequalities in retrofitting uptake.

  5. 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

  6. Factors influencing the implementation, adoption, use, sustainability and scalability of eLearning for family medicine specialty training: a systematic review protocol.

    Science.gov (United States)

    Cotič, Živa; Rees, Rebecca; Wark, Petra A; Car, Josip

    2016-10-19

    In 2013, there was a shortage of approximately 7.2 million health workers worldwide, which is larger among family physicians than among specialists. eLearning could provide a potential solution to some of these global workforce challenges. However, there is little evidence on factors facilitating or hindering implementation, adoption, use, scalability and sustainability of eLearning. This review aims to synthesise results from qualitative and mixed methods studies to provide insight on factors influencing implementation of eLearning for family medicine specialty education and training. Additionally, this review aims to identify the actions needed to increase effectiveness of eLearning and identify the strategies required to improve eLearning implementation, adoption, use, sustainability and scalability for family medicine speciality education and training. A systematic search will be conducted across a range of databases for qualitative studies focusing on experiences, barriers, facilitators, and other factors related to the implementation, adoption, use, sustainability and scalability of eLearning for family medicine specialty education and training. Studies will be synthesised by using the framework analysis approach. This study will contribute to the evaluation of eLearning implementation, adoption, use, sustainability and scalability for family medicine specialty training and education and the development of eLearning guidelines for postgraduate medical education. PROSPERO http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016036449.

  7. Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya.

    Science.gov (United States)

    Njoroge, Martin; Zurovac, Dejan; Ogara, Esther A A; Chuma, Jane; Kirigia, Doris

    2017-02-10

    The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.

  8. Alkaline pretreatment of Mexican pine residues for bioethanol ...

    African Journals Online (AJOL)

    Alkaline pretreatment of Mexican pine residues for bioethanol production. ... Keywords: Lignocellulosic biomass, alkaline pretreatment, enzymatic hydrolysis, fermentable sugars, fermentation. African Journal of Biotechnology Vol. 12(31), pp.

  9. Commission to review the financing for the phase-out of nuclear energy. Results, evaluation, implementation; Kommission zur Ueberpruefung der Finanzierung des Kernenergieausstiegs (KFK). Ergebnisse, Bewertung, Umsetzung

    Energy Technology Data Exchange (ETDEWEB)

    Brandmair, Lothar [Wirtschaftskanzlei Graf von Westphalen, Muenchen (Germany)

    2016-07-15

    The German Commission to Review the Financing for the Phase-out of Nuclear Energy (Kommission zur Ueberpruefung der Finanzierung des Kernenergieausstiegs, KFK) has unanimously adopted its report on 27 April 2016. Now the Federal Government is working on the implementation of the recommendations, which are directed to profound changes in the present system of financing and action responsibilities of government and operators. The proposals by KFK on their meaning and scope are described and analyzed. An overview of the tasks to implement the recommendations at the legislative and contractual level is given. The work of KFK is also classified in its social context and assessed as a viable compromise.

  10. [Advances in research on mechanisms of seed pre-treatments.

    Science.gov (United States)

    Liu, Xu; Liu, Juan; Liu, Qian; Gao, Ya Ni; Wang, Quan Zhen

    2016-11-18

    Seeds play a vital role in nature and agro-ecosystems. The success of seed germination and the establishment of a normal seedling determine the propagation and survival of a plant species, but seed vigor is often seriously damaged because of seed aging, dormancy and the deterioration of natural habitat. Thus, exploring methods for improving germination quality is of great significance to ecology and the economy. Based on the latest international reports, seed pre-treatments are the most practical and effective methods for improving plant performance, increasing yields and enhancing stress resistance. This review provided a summary of the current pre-sowing treatment technologies and the physiological and biochemical responses of plants to these methods by addressing gene expression, cytological effects, enzyme system activities, material and energy metabolism, antioxidation mechanisms and signal transduction pathways. We also interpreted the mechanisms of the seed pre-treatment methods from aspects of seed germination acceleration and stress resistance enhancement. The bottleneck in seed pre-treatments at the cytological and molecular levels and the problems involved in their application were also discussed. Thus far, most studies had largely focused on the partial reaction alterations of plant biochemistry and enzyme activities, and they had generally been characterized by a lack of systematic and holistic study for applications to crop production. Finally, we proposed an outlook for further study in an attempt to provide a prospective and scientific reference for plant germplasm conservation, high-efficiency organic agriculture development and ecological environment re-construction.

  11. Ultrasound pretreatment as an alternative to improve essential oils extraction

    Directory of Open Access Journals (Sweden)

    Flávia Michelon Dalla Nora

    Full Text Available ABSTRACT: Essential oils are substances originated from plants in general. These compounds are well known to have a high biological activity, specially the antioxidant and antimicrobial. Several extraction techniques are employed to obtain these substances. However, the majority of these techniques require a long extraction time. In this sense, innovative and alternative extraction techniques, such as ultrasound, have recently been the target of studies. In view of the small amount of publications using ultrasonic pretreatment, this review aimed to congregate current relevant information on ultrasound-assisted extraction of essential oils. In this sense, theoretical aspects, such as the main factors that influence the performance of this technique as well as the advantages and disadvantages of the use of ultrasound as an environmental friendly alternative technique to improve the extraction of essential oil in comparison to traditional methods, are shown. Considering the available studies in the literature on essential oil extraction using ultrasonic pretreatment, low frequencies ranged from 20 to 50kWz and times ranged from 20 to 40min were used. The use of ultrasonic pretreatment represents a time reduction to near 70% in relation to the conventional hydrodistillation. Also, these conditions enabled a growth in the extraction of bioactive compounds and consequently improving the antioxidant and antimicrobial activities of essential oils.

  12. Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them - a scoping review.

    Science.gov (United States)

    Scholl, Isabelle; LaRussa, Allison; Hahlweg, Pola; Kobrin, Sarah; Elwyn, Glyn

    2018-03-09

    Shared decision-making (SDM) is poorly implemented in routine care, despite being promoted by health policies. No reviews have solely focused on an in-depth synthesis of the literature around organizational- and system-level characteristics (i.e., characteristics of healthcare organizations and of healthcare systems) that may affect SDM implementation. A synthesis would allow exploration of interventions to address these characteristics. The study aim was to compile a comprehensive overview of organizational- and system-level characteristics that are likely to influence the implementation of SDM, and to describe strategies to address those characteristics described in the literature. We conducted a scoping review using the Arksey and O'Malley framework. The search strategy included an electronic search and a secondary search including gray literature. We included publications reporting on projects that promoted implementation of SDM or other decision support interventions in routine healthcare. We screened titles and abstracts, and assessed full texts for eligibility. We used qualitative thematic analysis to identify organizational- and system-level characteristics. After screening 7745 records and assessing 354 full texts for eligibility, 48 publications on 32 distinct implementation projects were included. Most projects (N = 22) were conducted in the USA. Several organizational-level characteristics were described as influencing the implementation of SDM, including organizational leadership, culture, resources, and priorities, as well as teams and workflows. Described system-level characteristics included policies, clinical guidelines, incentives, culture, education, and licensing. We identified potential strategies to influence the described characteristics, e.g., examples how to facilitate distribution of decision aids in a healthcare institution. Although infrequently studied, organizational- and system-level characteristics appear to play a role in the

  13. Understanding Ionic Liquid Pretreatment of Lignocellulosic Biomasses

    Science.gov (United States)

    Pretreatment of biomass is essential for breaking apart highly ordered and crystalline plant cell walls and loosening the lignin and hemicellulose conjugation to cellulose microfibrills, thereby facilitating enzyme accessibility and adsorption and reducing costs of downstream saccharification proces...

  14. Hydrothermal pretreatments of macroalgal biomass for biorefineries

    DEFF Research Database (Denmark)

    Ruiz, Héctor A.; Rodríguez-Jasso, Rosa M.; Aguedo, Mario

    2015-01-01

    in accordance with the integrated biorefineries. Furthermore, biorefinery concept requires processes that allow efficient utilization of all components of the biomass. The pretreatment step in a biorefinery is often based on hydrothermal principles of high temperatures in aqueous solution. Therefore...

  15. Hydrolysis of alkaline pretreated banana peel

    Science.gov (United States)

    Fatmawati, A.; Gunawan, K. Y.; Hadiwijaya, F. A.

    2017-11-01

    Banana peel is one of food wastes that are rich in carbohydrate. This shows its potential as fermentation substrate including bio-ethanol. This paper presented banana peel alkaline pretreatment and enzymatic hydrolysis. The pretreatment was intended to prepare banana peel in order to increase hydrolysis performance. The alkaline pretreatment used 10, 20, and 30% w/v NaOH solution and was done at 60, 70 and 80°C for 1 hour. The hydrolysis reaction was conducted using two commercial cellulose enzymes. The reaction time was varied for 3, 5, and 7 days. The best condition for pretreatment process was one conducted using 30% NaOH solution and at 80°C. This condition resulted in cellulose content of 90.27% and acid insoluble lignin content of 2.88%. Seven-day hydrolysis time had exhibited the highest reducing sugar concentration, which was7.2869 g/L.

  16. Ultrasonic sludge pretreatment under pressure.

    Science.gov (United States)

    Le, Ngoc Tuan; Julcour-Lebigue, Carine; Delmas, Henri

    2013-09-01

    The objective of this work was to optimize the ultrasound (US) pretreatment of sludge. Three types of sewage sludge were examined: mixed, secondary and secondary after partial methanisation ("digested" sludge). Thereby, several main process parameters were varied separately or simultaneously: stirrer speed, total solid content of sludge (TS), thermal operating conditions (adiabatic vs. isothermal), ultrasonic power input (PUS), specific energy input (ES), and for the first time external pressure. This parametric study was mainly performed for the mixed sludge. Five different TS concentrations of sludge (12-36 g/L) were tested for different values of ES (7000-75,000 kJ/kgTS) and 28 g/L was found as the optimum value according to the solubilized chemical oxygen demand in the liquid phase (SCOD). PUS of 75-150 W was investigated under controlled temperature and the "high power input - short duration" procedure was the most effective at a given ES. The temperature increase in adiabatic US application significantly improved SCOD compared to isothermal conditions. With PUS of 150 W, the effect of external pressure was investigated in the range of 1-16 bar under isothermal and adiabatic conditions for two types of sludge: an optimum pressure of about 2 bar was found regardless of temperature conditions and ES values. Under isothermal conditions, the resulting improvement of sludge disintegration efficacy as compared to atmospheric pressure was by 22-67% and 26-37% for mixed and secondary sludge, respectively. Besides, mean particle diameter (D[4,3]) of the three sludge types decreased respectively from 408, 117, and 110 μm to about 94-97, 37-42, and 36-40 μm regardless of sonication conditions, and the size reduction process was much faster than COD extraction. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Design And Implementation Of Online Submission and Peer Review System A Case Study Of E-Journal Of University Of Zakho

    OpenAIRE

    Karwan Jacksi

    2015-01-01

    Abstract With the aim of designing and implementing a web-based article submission management system for academic research papers several international models such as Elsevier Editorial System and ICOCI International Conference on Computing and Informatics are studied and analyzed. Through this analysis an open access web-based article submission and peer review system for Journal of University of Zakho JUOZ is employed. This kind of systems is not only capable of solving issues such as compl...

  18. Non-Chromate Aluminum Pretreatments

    Science.gov (United States)

    2012-03-01

    2) Potassium permanganate, seal: polyacrylic acid, poly propylene glycol, fatty acid esters Two solution (coating and seal), elevated temp...OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for...reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of

  19. Understanding of Factors that Enable Health Promoters in Implementing Health-Promoting Schools: A Systematic Review and Narrative Synthesis of Qualitative Evidence

    Science.gov (United States)

    Hung, Tommy Tsz Man; Chiang, Vico Chung Lim; Dawson, Angela; Lee, Regina Lai Tong

    2014-01-01

    Health-promoting schools have been regarded as an important initiative in promoting child and adolescent health in school settings using the whole-school approach. Quantitative research has proved its effectiveness in various school-based programmes. However, few qualitative studies have been conducted to investigate the strategies used by health promoters to implement such initiatives. In this study, the researchers conducted a systematic review and narrative synthesis of the qualitative literature to identify important enablers assisting the implementation of health-promoting schools from the perspectives of health promoters. Five enablers have been identified from the review: (a) Following a framework/guideline to implement health-promoting schools; (b) Obtaining committed support and contributions from the school staff, school board management, government authorities, health agencies and other stakeholders; (c) Adopting a multidisciplinary, collaborative approach to implementing HPS; (d) Establishing professional networks and relationships; and (e) Continuing training and education in school health promotion. This highlights the importance of developing school health policies that meet local health needs, and socio-cultural characteristics that can foster mutual understanding between the health and education sectors so as to foster health promotion in children and adolescents. PMID:25264789

  20. What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review.

    Science.gov (United States)

    Williams, Brett; Perillo, Samuel; Brown, Ted

    2015-02-01

    The responsibility to implement evidence-based practice (EBP) in a health care workplace does not fall solely on the individual health care professional. Organisational barriers relate to the workplace setting, administrational support, infrastructure, and facilities available for the retrieval, critique, summation, utilisation, and integration of research findings in health care practices and settings. Using a scoping review approach, the organisational barriers to the implementation of EBP in health care settings were sought. This scoping review used the first five of the six stage methodology developed by Levac et al. (2010). The five stages used are: 1) Identify the research question; 2) identify relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. The following databases were searched from January 2004 until February 2014: Medline, EMBASE, EBM Reviews, Google Scholar, The Cochrane Library and CINAHL. Of the 49 articles included in this study, there were 29 cross-sectional surveys, six descriptions of specific interventions, seven literature reviews, four narrative reviews, nine qualitative studies, one ethnographic study and one systematic review. The articles were analysed and five broad organisational barriers were identified. This scoping review sought to map the breadth of information available on the organisational barriers to the use of EBP in health care settings. Even for a health care professional who is motivated and competent in the use of EBP; all of these barriers will impact on their ability to increase and maintain their use of EBP in the workplace. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Adhesion improvement of lignocellulosic products by enzymatic pre-treatment.

    Science.gov (United States)

    Widsten, Petri; Kandelbauer, Andreas

    2008-01-01

    Enzymatic bonding methods, based on laccase or peroxidase enzymes, for lignocellulosic products such as medium-density fiberboard and particleboard are discussed with reference to the increasing costs of presently used petroleum-based adhesives and the health concerns associated with formaldehyde emissions from current composite products. One approach is to improve the self-bonding properties of the particles by oxidation of their surface lignin before they are fabricated into boards. Another method involves using enzymatically pre-treated lignins as adhesives for boards and laminates. The application of this technology to achieve wet strength characteristics in paper is also reviewed.

  2. Costs, effects and implementation of routine data emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions: a systematic review protocol.

    Science.gov (United States)

    Kingston, Mark Rhys; Evans, Bridie Angela; Nelson, Kayleigh; Hutchings, Hayley; Russell, Ian; Snooks, Helen

    2016-03-01

    Emergency admission risk prediction models are increasingly used to identify patients, typically with one or more chronic conditions, for proactive management in primary care to avoid admissions, save costs and improve patient experience. To identify and review the published evidence on the costs, effects and implementation of emergency admission risk prediction models in primary care for patients with, or at risk of, chronic conditions. We shall search for studies of healthcare interventions using routine data-generated emergency admission risk models. We shall report: the effects on emergency admissions and health costs; clinician and patient views; and implementation findings. We shall search ASSIA, CINAHL, the Cochrane Library, HMIC, ISI Web of Science, MEDLINE and Scopus from 2005, review references in and citations of included articles, search key journals and contact experts. Study selection, data extraction and quality assessment will be performed by two independent reviewers. No ethical permissions are required for this study using published data. Findings will be disseminated widely, including publication in a peer-reviewed journal and through conferences in primary and emergency care and chronic conditions. We judge our results will help a wide audience including primary care practitioners and commissioners, and policymakers. CRD42015016874; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations

    Directory of Open Access Journals (Sweden)

    Grimshaw Jeremy M

    2010-02-01

    Full Text Available Abstract Background There is growing interest in the use of cognitive, behavioural, and organisational theories in implementation research. However, the extent of use of theory in implementation research is uncertain. Methods We conducted a systematic review of use of theory in 235 rigorous evaluations of guideline dissemination and implementation studies published between 1966 and 1998. Use of theory was classified according to type of use (explicitly theory based, some conceptual basis, and theoretical construct used and stage of use (choice/design of intervention, process/mediators/moderators, and post hoc/explanation. Results Fifty-three of 235 studies (22.5% were judged to have employed theories, including 14 studies that explicitly used theory. The majority of studies (n = 42 used only one theory; the maximum number of theories employed by any study was three. Twenty-five different theories were used. A small number of theories accounted for the majority of theory use including PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation, diffusion of innovations, information overload and social marketing (academic detailing. Conclusions There was poor justification of choice of intervention and use of theory in implementation research in the identified studies until at least 1998. Future research should explicitly identify the justification for the interventions. Greater use of explicit theory to understand barriers, design interventions, and explore mediating pathways and moderators is needed to advance the science of implementation research.

  4. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations.

    Science.gov (United States)

    Davies, Philippa; Walker, Anne E; Grimshaw, Jeremy M

    2010-02-09

    There is growing interest in the use of cognitive, behavioural, and organisational theories in implementation research. However, the extent of use of theory in implementation research is uncertain. We conducted a systematic review of use of theory in 235 rigorous evaluations of guideline dissemination and implementation studies published between 1966 and 1998. Use of theory was classified according to type of use (explicitly theory based, some conceptual basis, and theoretical construct used) and stage of use (choice/design of intervention, process/mediators/moderators, and post hoc/explanation). Fifty-three of 235 studies (22.5%) were judged to have employed theories, including 14 studies that explicitly used theory. The majority of studies (n = 42) used only one theory; the maximum number of theories employed by any study was three. Twenty-five different theories were used. A small number of theories accounted for the majority of theory use including PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation), diffusion of innovations, information overload and social marketing (academic detailing). There was poor justification of choice of intervention and use of theory in implementation research in the identified studies until at least 1998. Future research should explicitly identify the justification for the interventions. Greater use of explicit theory to understand barriers, design interventions, and explore mediating pathways and moderators is needed to advance the science of implementation research.

  5. Hanford tank waste simulants specification and their applicability for the retrieval, pretreatment, and vitrification processes

    Energy Technology Data Exchange (ETDEWEB)

    GR Golcar; NG Colton; JG Darab; HD Smith

    2000-04-04

    A wide variety of waste simulants were developed over the past few years to test various retrieval, pretreatment and waste immobilization technologies and unit operations. Experiments can be performed cost-effectively using non-radioactive waste simulants in open laboratories. This document reviews the composition of many previously used waste simulants for remediation of tank wastes at the Hanford reservation. In this review, the simulants used in testing for the retrieval, pretreatment, and vitrification processes are compiled, and the representative chemical and physical characteristics of each simulant are specified. The retrieval and transport simulants may be useful for testing in-plant fluidic devices and in some cases for filtration technologies. The pretreatment simulants will be useful for filtration, Sr/TRU removal, and ion exchange testing. The vitrification simulants will be useful for testing melter, melter feed preparation technologies, and for waste form evaluations.

  6. Hanford tank waste simulants specification and their applicability for the retrieval, pretreatment, and vitrification processes

    International Nuclear Information System (INIS)

    GR Golcar; NG Colton; JG Darab; HD Smith

    2000-01-01

    A wide variety of waste simulants were developed over the past few years to test various retrieval, pretreatment and waste immobilization technologies and unit operations. Experiments can be performed cost-effectively using non-radioactive waste simulants in open laboratories. This document reviews the composition of many previously used waste simulants for remediation of tank wastes at the Hanford reservation. In this review, the simulants used in testing for the retrieval, pretreatment, and vitrification processes are compiled, and the representative chemical and physical characteristics of each simulant are specified. The retrieval and transport simulants may be useful for testing in-plant fluidic devices and in some cases for filtration technologies. The pretreatment simulants will be useful for filtration, Sr/TRU removal, and ion exchange testing. The vitrification simulants will be useful for testing melter, melter feed preparation technologies, and for waste form evaluations

  7. Interprofessional education for whom? --challenges and lessons learned from its implementation in developed countries and their application to developing countries: a systematic review.

    Directory of Open Access Journals (Sweden)

    Bruno F Sunguya

    Full Text Available BACKGROUND: Evidence is available on the potential efficacy of interprofessional education (IPE to foster interprofessional cooperation, improve professional satisfaction, and improve patient care. While the intention of the World Health Organization (WHO is to implement IPE in all countries, evidence comes from developed countries about its efficiency, challenges, and barriers to planning and implementing IPE. We therefore conducted this review to examine challenges of implementing IPE to suggest possible pathways to overcome the anticipated challenges in developing countries. METHODS: We searched for literatures on IPE in PubMed/MEDLINE, CINAHL, PsycINFO, and ERIC databases. We examined challenges or barriers and initiatives to overcome them so as to suggest methods to solve the anticipated challenges in developing countries. We could not conduct a meta-analysis because of the qualitative nature of the research question and the data; instead we conducted a meta-narrative of evidence. RESULTS: A total of 40 out of 2,146 articles were eligible for analyses in the current review. Only two articles were available from developing countries. Despite the known benefits of IPE, a total of ten challenges or barriers were common based on the retrieved evidence. They included curriculum, leadership, resources, stereotypes and attitudes, variety of students, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Out of ten, three had already been reported in developing countries: IPE curriculum, resource limitations, and stereotypes. CONCLUSION: This study found ten important challenges on implementing IPE. They are curriculum, leadership, resources, stereotypes, students' diversity, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Although only three of them are already experienced in developing countries, the remaining seven are potentially important for developing countries, too. By knowing these

  8. Interprofessional education for whom? --challenges and lessons learned from its implementation in developed countries and their application to developing countries: a systematic review.

    Science.gov (United States)

    Sunguya, Bruno F; Hinthong, Woranich; Jimba, Masamine; Yasuoka, Junko

    2014-01-01

    Evidence is available on the potential efficacy of interprofessional education (IPE) to foster interprofessional cooperation, improve professional satisfaction, and improve patient care. While the intention of the World Health Organization (WHO) is to implement IPE in all countries, evidence comes from developed countries about its efficiency, challenges, and barriers to planning and implementing IPE. We therefore conducted this review to examine challenges of implementing IPE to suggest possible pathways to overcome the anticipated challenges in developing countries. We searched for literatures on IPE in PubMed/MEDLINE, CINAHL, PsycINFO, and ERIC databases. We examined challenges or barriers and initiatives to overcome them so as to suggest methods to solve the anticipated challenges in developing countries. We could not conduct a meta-analysis because of the qualitative nature of the research question and the data; instead we conducted a meta-narrative of evidence. A total of 40 out of 2,146 articles were eligible for analyses in the current review. Only two articles were available from developing countries. Despite the known benefits of IPE, a total of ten challenges or barriers were common based on the retrieved evidence. They included curriculum, leadership, resources, stereotypes and attitudes, variety of students, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Out of ten, three had already been reported in developing countries: IPE curriculum, resource limitations, and stereotypes. This study found ten important challenges on implementing IPE. They are curriculum, leadership, resources, stereotypes, students' diversity, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Although only three of them are already experienced in developing countries, the remaining seven are potentially important for developing countries, too. By knowing these challenges and barriers in advance, those who implement IPE programs

  9. Online Radiology Reporting with Peer Review as a Learning and Feedback Tool in Radiology; Implementation, Validity, and Student Impressions

    DEFF Research Database (Denmark)

    McEvoy, Fintan; Shen, Nicholas W; Nielsen, Dorte Hald

    2017-01-01

    for student-generated radiological reports were compared to scores obtained in the summative multiple choice (MCQ) examination for the course. Student satisfaction was measured using a bespoke questionnaire. There was a weak positive correlation (Pearson correlation coefficient = 0.32, p ... scores awarded by the students and the scores they obtained in the MCQ examination (Pearson correlation coefficient = 0.17, p = 0.14). In conclusion, we have created a realistic radiology imaging exercise with readily available software. The peer review scores are valid in that to a limited degree...... review scores students received and the student scores obtained in the MCQ examination. The difference in peer review scores received by students grouped according to their level of course performance (high vs. low) was statistically significant (p correlation was found between peer review...

  10. 78 FR 4339 - Approval and Promulgation of Implementation Plans; New Mexico; Revisions to the New Source Review...

    Science.gov (United States)

    2013-01-22

    ..., and conflict with our intentions for the use of SILs to demonstrate compliance with CAA section 163(a... submitted on May 23, 2011, will remain before EPA for review. EPA will revisit these submitted revisions...

  11. Challenges in the Selection, Design and Implementation of an Online Submission and Peer Review System for STM Journals

    OpenAIRE

    J. Best; R. Akerman

    2007-01-01

    Two international scientific publishers collaborated to develop an Online Submission and Peer Review System (OSPREY) for their journals. Our goals were to meet market demand, increase editorial efficiency and streamline the transition from peer review to publishing. One of the publishers (National Research Council (NRC) Research Press, Canada) had previously purchased a third-party system that was subsequently discontinued by the vendor. Because of this experience and its complex requirements...

  12. Enzymatic hydrolysis of pretreated soybean straw

    International Nuclear Information System (INIS)

    Xu Zhong; Wang Qunhui; Jiang Zhaohua; Yang Xuexin; Ji Yongzhen

    2007-01-01

    In order to produce lactic acid, from agricultural residues such as soybean straw, which is a raw material for biodegradable plastic production, it is necessary to decompose the soybean straw into soluble sugars. Enzymatic hydrolysis is one of the methods in common use, while pretreatment is the effective way to increase the hydrolysis rate. The optimal conditions of pretreatment using ammonia and enzymatic hydrolysis of soybean straw were determined. Compared with the untreated straw, cellulose in straw pretreated by ammonia liquor (10%) soaking for 24 h at room temperature increased 70.27%, whereas hemicellulose and lignin in pretreated straw decreased to 41.45% and 30.16%, respectively. The results of infrared spectra (IR), scanning electron microscope (SEM) and X-ray diffraction (XRD) analysis also showed that the structure and the surface of the straw were changed through pretreatment that is in favor of the following enzymatic hydrolysis. maximum enzymatic hydrolysis rate of 51.22% was achieved at a substrate concentration of 5% (w/v) at 50 deg. C and pH 4.8 using cellulase (50 fpu/g of substrate) for 36 h

  13. Facilitators for the development and implementation of health promoting policy and programs – a scoping review at the local community level

    Directory of Open Access Journals (Sweden)

    Daniel Weiss

    2016-02-01

    Full Text Available Abstract Background Health promotion, with a focus on multidimensional upstream factors and an ecological, life-course approach, is establishing itself as the guiding philosophy for addressing public health. Action at the political and programmatic level on the Social Determinants of Health has proven effective for promoting and building public health at all levels but has been particularly evident at the national and international levels – due in large part to available documents and guidelines. Although research and experience establish that health promotion is most effective when settings-based, the development of health promoting policies and programs at the local level is still difficult. This study intended to investigate available knowledge on the development and implementation of health promoting policies and programs at the local level and identify factors most important for facilitating capacity building and outcome achievement. Methods We used a scoping review in order to review the current literature on local policy development and program implementation. Keywords were chosen based on results of a previous literature review. A total of 53 articles were divided into two categories: policy and implementation. Critical analysis was conducted for each article and a summary assembled. Data was charted with specific focus on the aims of the study, data acquisition, key theories/concepts/frameworks used, outcome measures, results, and conclusions. Results The articles included in this study primarily focused on discussing factors that facilitate the development of health promoting policy and the implementation of health promotion programs. Most significant facilitators included: collaborative decision-making, agreement of objectives and goals, local planning and action, effective leadership, building and maintaining trust, availability of resources, a dynamic approach, a realistic time-frame, and trained and knowledgeable staff. Within

  14. [Priorization of facilitators for the implementation of medication review with follow-up service in Spanish community pharmacies through exploratory factor analysis].

    Science.gov (United States)

    Gil, Modesta Inmaculada; Benrimoj, Shalom Isaac; Martínez-Martínez, Fernando; Cardero, Manuel; Gastelurrutia, Miguel Ángel

    2013-01-01

    to prioritize previously identified in Spain facilitators for the implementation of new Pharmaceutical Services that allow designing strategies for the implementation of Medication Review with follow-up (MRFup) service. Exploratory factor analysis (EFA). A draft of a questionnaire was performed based on a previous literature review and following the RAND/UCLA methodology. An expert panel worked with it and generated a definitive questionnaire which, after piloting, was used with a representative sample of pharmacists, owners or staff members, who were working in community pharmacy, using computer-assisted telephone interviewing (CATI) methodology. To understand underlying constructs in the questionnaire an EFA was performed. Different approaches were tested such as principal components factor analysis and principal axis factoring method. The best interpretability was achieved using the Factorization of Principal axis method with Direct Oblimin rotation, which explained the 40.0% of total variance. This produced four factors defined as: «Incentives», «External campaigns», «Expert in MRFup» and «Professionalism of the pharmacist». It can be stated that for implementation and sustainability of MRFup Service it is necessary being paid; also it must be explained to health professional and society in general. Practice of MRFup service demands pharmacists receiving a more clinical education and assuming more responsibilities as health professionals. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  15. Translating knowledge on best practice into improving quality of RRT care: a systematic review of implementation strategies

    NARCIS (Netherlands)

    van der Veer, Sabine N.; Jager, Kitty J.; Nache, Azri M.; Richardson, Donald; Hegarty, Janet; Couchoud, Cécile; de Keizer, Nicolette F.; Tomson, Charles R. V.

    2011-01-01

    Recent studies showed wide variation in the extent to which guidelines and other types of best practice have been implemented as part of routine health care. This is also true for the delivery of renal replacement therapy (RRT) for ESRD patients. Increasing uptake of best practice within such

  16. The relevance of team characteristics and team directed strategies in the implementation of nursing innovations : A literature review

    NARCIS (Netherlands)

    Theo van Achterberg; Joke Mintjes; G. Holleman; E. Poot

    2009-01-01

    Implementation of innovations is a complex and intensive procedure in which different strategies can be successful. In nursing, strategies often focus on intrinsic motivation, competencies and attitudes of individual nurses while ignoring the social context. Since nurses often work in teams,

  17. Review of the Reported Measures of Clinical Validity and Clinical Utility as Arguments for the Implementation of Pharmacogenetic Testing: A Case Study of Statin-Induced Muscle Toxicity

    Directory of Open Access Journals (Sweden)

    Marleen E. Jansen

    2017-08-01

    Full Text Available Advances from pharmacogenetics (PGx have not been implemented into health care to the expected extent. One gap that will be addressed in this study is a lack of reporting on clinical validity and clinical utility of PGx-tests. A systematic review of current reporting in scientific literature was conducted on publications addressing PGx in the context of statins and muscle toxicity. Eighty-nine publications were included and information was selected on reported measures of effect, arguments, and accompanying conclusions. Most authors report associations to quantify the relationship between a genetic variation an outcome, such as adverse drug responses. Conclusions on the implementation of a PGx-test are generally based on these associations, without explicit mention of other measures relevant to evaluate the test's clinical validity and clinical utility. To gain insight in the clinical impact and select useful tests, additional outcomes are needed to estimate the clinical validity and utility, such as cost-effectiveness.

  18. Review Of Implementation In Bunut Shoes Assistance Program In Order Of Micro, Small And Medium Enterprises Economic In Asahan Regency

    Science.gov (United States)

    Saleh Malawat, M.; Putra, M. Umar Maya

    2018-03-01

    This paper studies the implementation of business opportunities that can improve the revenue of Bunut Shoes Micro, Small and Medium Enterprises. Probit model with E Views 6 program was used to see how far the opportunity of variable efforts to improve the revenue such as education, training, capital assistance, technological procurement of them. The data used was the primary data by conducting a survey using questionnaires to members of them with the observation period from 2013 to 2015. The results showed that all variables of implementation did not have a business opportunity correlation to the increase in revenue and Asahan District Governments are asked to create a creative breakthrough in order to achieve optimal business revenue and cooperate with other private institutions related to increase the business income.

  19. Temperature Modelling of the Biomass Pretreatment Process

    DEFF Research Database (Denmark)

    Prunescu, Remus Mihail; Blanke, Mogens; Jensen, Jakob M.

    2012-01-01

    In a second generation biorefinery, the biomass pretreatment stage has an important contribution to the efficiency of the downstream processing units involved in biofuel production. Most of the pretreatment process occurs in a large pressurized thermal reactor that presents an irregular temperature...... that captures the environmental temperature differences inside the reactor using distributed parameters. A Kalman filter is then added to account for any missing dynamics and the overall model is embedded into a temperature soft sensor. The operator of the plant will be able to observe the temperature in any...

  20. Measuring the implementation of ecodesign management practices: a review and consolidation of process-oriented performance indicators

    DEFF Research Database (Denmark)

    Rodrigues, Vinicius Picanco; Pigosso, Daniela Cristina Antelmi; McAloone, Tim C.

    2017-01-01

    Ecodesign plays an important role in manufacturing companies’ quest for improved sustainability performance. However, many ecodesign efforts are geared towards tackling single-issue discrete improvements, in contrast to operationalizing, measuring and acting upon the consistent improvement...... towards enhanced sustainability performance. In face of this challenge, this paper aims at providing organizations with a set of process-oriented indicators to supporting and enhancing ecodesign implementation and management. This research was grounded on a 2-phase approach to (i) cross...

  1. Implementation of the International Code of Practice on Dosimetry in Diagnostic Radiology (TRS 457): Review of Test Results

    International Nuclear Information System (INIS)

    2011-01-01

    In 2007, the IAEA published Dosimetry in Diagnostic Radiology: An International Code of Practice (IAEA Technical Reports Series No. 457). This publication recommends procedures for calibration and dosimetric measurement for the attainment of standardized dosimetry. It also addresses requirements both in standards dosimetry laboratories, especially Secondary Standards Dosimetry Laboratories (SSDLs), and in clinical centres for radiology, as found in most hospitals. The implementation of TRS No. 457 decreases the uncertainty in the dosimetry of diagnostic radiology beams and provides Member States with a unified and consistent framework for dosimetry in diagnostic radiology, which previously did not exist. A coordinated research project (CRP E2.10.06) was established in order to provide practical guidance to professionals at SSDLs and to clinical medical physicists on the implementation of TRS No. 457. This includes the calibration of radiological dosimetry instrumentation, the dissemination of calibration coefficients to clinical centres and the establishment of dosimetric measurement processes in clinical settings. The main goals of the CRP were to: Test the procedures recommended in TRS No. 457 for calibration of radiation detectors in different types of diagnostic beams and measuring instruments for varying diagnostic X ray modalities; Test the clinical dosimetry procedures, including the use of phantoms and patient dose surveys; Report on the practical implementation of TRS No. 457 at both SSDLs and hospital sites. Testing of TRS No. 457 was performed by a group of medical physicists from hospitals and SSDLs from various institutions worldwide

  2. Barriers and facilitators to the implementation of orthodontic mini-implants in clinical practice: a protocol for a systematic review and meta-analysis.

    Science.gov (United States)

    Meursinge Reynders, Reint; Ronchi, Laura; Ladu, Luisa; Di Girolamo, Nicola; de Lange, Jan; Roberts, Nia; Mickan, Sharon

    2016-02-05

    Most orthodontic treatment plans need some form of anchorage to control the reciprocal forces of tooth movement. Orthodontic mini implants (OMIs) have been hailed for having revolutionized orthodontics, because they provide anchorage without depending on the collaboration of patients, they have a favorable effectiveness compared with conventional anchorage devices, and they can be used for a wide scale of treatment objectives. However, surveys have shown that many orthodontists never or rarely use them. To understand the rationale behind this knowledge-to-action gap, we will conduct a systematic review that will identify and quantify potential barriers and facilitators to the implementation of OMIs in clinical practice for all potential stakeholders, i.e., patients, family members, clinicians, office staff, clinic owners, policy makers, etc. The prevalence of clinicians that do not use OMIs will be our secondary outcome. The Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 Statement was adopted as the framework for reporting this manuscript. We will apply broad-spectrum search strategies and will search MEDLINE and more than 40 other databases. We will conduct searches in the gray literature, screen reference lists, and hand-search 12 journals. All study designs, stakeholders, interventions, settings, and languages will be eligible. We will search studies that report on barriers or facilitators to the implementation of orthodontic mini implants (OMIs) in clinical practice. Implementation constructs and their prevalence among pertinent stakeholders will be our primary outcomes. All searching and data extraction procedures will be conducted by three experienced reviewers. We will also contact authors and investigators to obtain additional information on data items and unidentified studies. Risk of bias will be scored with tools designed for the specific study designs. We will assess heterogeneity, meta-biases, and the

  3. Improving obstetric care in low-resource settings: implementation of facility-based maternal death reviews in five pilot hospitals in Senegal

    Directory of Open Access Journals (Sweden)

    Fournier Pierre

    2009-07-01

    Full Text Available Abstract Background In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal. Methods This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches. Results Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1 bad quality of information in medical files; (2 non-participation of the head of department in the audit meetings; (3 lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1 high level of professional qualifications or experience of the data collector; (2 involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3 participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths. Conclusion The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We

  4. Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Fadlallah, Racha; El-Jardali, Fadi; Hemadi, Nour; Morsi, Rami Z; Abou Samra, Clara Abou; Ahmad, Ali; Arif, Khurram; Hishi, Lama; Honein-AbouHaidar, Gladys; Akl, Elie A

    2018-01-29

    Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. We searched six electronic databases and grey literature. We included both quantitative and qualitative studies written in English language and published after year 1992. Two reviewers worked in duplicate and independently to complete study selection, data abstraction, and assessment of methodological features. We synthesized the findings based on thematic analysis and categorized according to the ecological model into individual, interpersonal, community and systems levels. Of 15,510 citations, 51 met the eligibility criteria. Individual factors included awareness and understanding of the concept of CBHI, trust in scheme and scheme managers, perceived service quality, and demographic characteristics, which influenced enrollment and sustainability. Interpersonal factors such as household dynamics, other family members enrolled in the scheme, and social solidarity influenced enrollment and renewal of membership. Community-level factors such as culture and community involvement in scheme development influenced enrollment and sustainability of scheme. Systems-level factors encompassed governance, financial and delivery arrangement. Government involvement, accountability of scheme management, and strong policymaker-implementer relation facilitated implementation and sustainability of scheme. Packages that covered outpatient and inpatient care and those tailored to community needs contributed to increased enrollment. Amount and timing of premium collection was reported to negatively influence enrollment while factors reported as threats to sustainability included facility

  5. Practitioner Review: Reading Disorders--What Are the Effective Interventions and How Should They Be Implemented and Evaluated?

    Science.gov (United States)

    Duff, Fiona J.; Clarke, Paula J.

    2011-01-01

    Background: Two developmental reading disorders, dyslexia and reading comprehension impairment, are identified by different behavioural characteristics and traced back to different underlying cognitive impairments. Thus, reading interventions designed to address each of these reading disorders differ in content. Method: This review summarises the…

  6. Review of transmission routes of 24 infectious diseases preventable by biosecurity measures and comparison of the implementation of these measures in pig herds in six European countries

    DEFF Research Database (Denmark)

    Filippitzi, M. E.; Kruse, Amanda Brinch; Postma, M.

    2018-01-01

    This study aimed to review the transmission routes of important infectious pig diseases and to translate these into biosecurity measures preventing or reducing the transmission between and within pig herds. Furthermore, it aimed to identify the level of implementation of these measures in different...... European countries and discuss the observed variations to identify potentials for improvement. First, a literature review was performed to show which direct and indirect transmission routes of 24 infectious pig diseases can be prevented through different biosecurity measures. Second, a quantitative...... on biosecurity since 1971 in Denmark. However, the observed pattern may also be attributed to differences in data collection methods. The qualitative analysis identified differences in applied policies, legislation, disease status, pig farm density, farming culture and habits between countries that can be used...

  7. How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework.

    Science.gov (United States)

    Burstrom, Bo; Nylen, Lotta; Clayton, Stephen; Whitehead, Margaret

    2011-01-01

    Under the national framework law in Sweden, all eligible people should have equal chances of receiving vocational rehabilitation. We aimed to review the evidence on (1) whether access to vocational rehabilitation is equitable in practice and (2) whether the outcomes vary for different groups in the population. Systematic review of studies in Sweden that reported diagnostic or socio-demographic characteristics of people offered or taking up rehabilitation programmes and outcomes of such programmes for different diagnostic and socio-demographic groups. Searches of 11 relevant electronic databases, 15 organisational websites, citation searching and contact with experts in the field, for the period 1990-2009. A total of 11 studies were included in the final review, six of which addressed review question (1) and seven addressed review question (2). All the six observational studies of access reported biased selection into vocational rehabilitation: greater likelihood for men, younger people, those with longer-term sick leave, those with lower income, employed rather than unemployed people and those with musculoskeletal and mental disorders or alcohol abuse. Having had a rehabilitation investigation also increased the likelihood of receiving vocational rehabilitation. Differential outcome of rehabilitation was reported in seven studies: outcomes were better for men, younger people, employed individuals, those with shorter sick leave and those with higher income. Selection into vocational rehabilitation was perceived as important for successful outcomes, but success also depended on the state of the local labour market. There is evidence of socio-demographic differences in access to and outcomes of vocational rehabilitation in Sweden, even though the national framework law is meant to apply to everyone. Few studies have deliberately measured differential access or outcomes, and there is a need for this kind of equity analysis of population-wide policies. Studies

  8. Recent developments in sample preparation and data pre-treatment in metabonomics research.

    Science.gov (United States)

    Li, Ning; Song, Yi peng; Tang, Huiru; Wang, Yulan

    2016-01-01

    Metabonomics is a powerful approach for biomarker discovery and an effective tool for pinpointing endpoint metabolic effects of external stimuli, such as pathogens and disease development. Due to its wide applications, metabonomics is required to deal with various biological samples of different properties. Hence sample preparation and corresponding data pre-treatment become important factors in ensuring validity of an investigation. In this review, we summarize some recent developments in metabonomics sample preparation and data-pretreatment procedures. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. 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

  10. The role of organisational and cultural factors in the implementation of system-wide interventions in acute hospitals to improve patient outcomes: protocol for a systematic literature review.

    Science.gov (United States)

    Nosrati, Hadis; Clay-Williams, Robyn; Cunningham, Frances; Hillman, Ken; Braithwaite, Jeffrey

    2013-03-09

    Little is known about the role of the organisational culture in the success and sustainability of the hospital-wide interventions, and how local culture affects patient outcomes in acute hospitals. A systematic literature review will be conducted to identify organisational factors influencing hospital-wide interventions and patient outcomes. A search of English language articles will be performed in MEDLINE, CINAHL, EMBASE, Web of Science, PsychInfo and Global Health databases using Medical Subject Headings and keywords. Randomised controlled trials, quasi-randomised trials, controlled before and after design studies and interrupted time-series analysis studies will be included. 'Grey literature' will be excluded, however peer-reviewed journals that are likely to publish relevant studies (JAMA, BMJ, BMJ Quality and Safety, Lancet and New England Journal of Medicine and Implementation Science) will be hand searched for the last 5 years. Two reviewers will independently undertake a title and abstract review using inclusion and exclusion criteria. Studies will be excluded only after discussion between at least two reviewers, who will assess and agree on the inclusion, risk of bias and quality rating of the studies. One author will extract summary descriptive data from these studies; the other author will review this documentation for accuracy and completeness. It is likely that the studies will be heterogeneous in nature, therefore a narrative synthesis of the findings will be conducted. We will discuss characteristics of the studies and stratify the results according to the type of hospital-wide interventions, organisational factors associated with them and outcomes measured.

  11. Overview of technical barriers and implementation of cellulosic ethanol in the U.S

    International Nuclear Information System (INIS)

    Kim, Tae Hoon; Kim, Tae Hyun

    2014-01-01

    There is mounting concern about the buildup of carbon dioxide (CO 2 ) and other so-called greenhouse gases in the atmosphere. In general, bioethanol production requires minimal fossil fuel input in the conversion step, and ethanol is considered a promising alternative fuel to petroleum-derived products. It is anticipated that ethanol production with second-generation biomass, i.e. lignocellulosic materials, will be possible on a large scale in the near future. Latest efforts have been focused on overcoming technical challenges in bioconversion, particularly pretreatment, and finding the solutions required to implement biorefinery on a large scale. This paper introduces and reviews the current status of research, and of the ethanol industry in the U.S. In addition, other important concepts in biofuels, cellulosic ethanol, and biorefinery in general are reviewed, and the key technical issues in bioconversion of cellulosic ethanol, such as pretreatment and factors affecting bioconversion of biomass are also discussed. - Highlights: • The current status of research, and of the ethanol industry in the U.S. • Important concepts in biofuels, cellulosic ethanol, and biorefinery. • The key technical issues in bioconversion of cellulosic ethanol. • Pretreatment and factors affecting bioconversion of biomass

  12. Estimation of potential benefits of the implementation of the fundamental review of the trading book and leverage ratio

    OpenAIRE

    ALESSI LUCIA; CANNAS GIUSEPPINA; DI GIROLAMO FRANCESCA; OSSOLA ELISA; PAPANAGIOTOU EVANGELIA; PETRACCO GIUDICI Marco; ROSSI EDUARDO

    2016-01-01

    The Fundamental Review of the Trading Book (FRTB) introduces changes in capital requirements as a consequence of changes in the calculation of risk weighted assets (RWAs), as agreed in the Basel Committee on Banking Supervision. This report performs an ex-ante assessment of the benefits of this new legislative proposal and is included as an annex to the Impact Assessment of the Capital Requirement Regulation II (CRR II). The analysis is conducted by estimating the required variation in ban...

  13. Antibacterial effect of surface pretreatment techniques against ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to evaluate the antibacterial surface pretreatment methods against Streptococcus mutans within the infected dentin surface using a tooth cavity model. Material and Methods: Seventy-two cavities were prepared on caries-free third molars (n = 8). After sterilization, teeth were inoculated ...

  14. Bromine pretreated chitosan for adsorption of lead

    Indian Academy of Sciences (India)

    Pollution by heavy metals like lead (II) is responsible for health hazards and environmental degradation. Adsorption is a prevalent method applied for removal of heavy metal pollutants from water. This study explored adsorption performances of 30% bromine pretreated chitosan for lead (II) abatement from water. Bromine ...

  15. Effective pretreatment of coal for briquetting

    Energy Technology Data Exchange (ETDEWEB)

    Sunami, Y; Nishioka, K; Sugimoto, Y

    1980-01-01

    The pretreatment of coal for briquetting is considered in an attempt to improve the quality of the briquets produced. Crushing of coal to obtain a size distribution suitable for close packing was found to be effective in improving coking properties while drying of coal was found to be effective in increasing briquet density. (In Japanese)

  16. Biomass Deconstruction and Pretreatment Publications | Bioenergy | NREL

    Science.gov (United States)

    Analysis, ACS Sustainable Chemistry & Engineering Eight black-and-white micrograph images of corn Hydrocarbons via Aqueous Phase Hydrodeoxygenation, Green Chemistry Image of a diagram with a curved line Chemistry & Engineering Image of a diagram corn stover pretreatment showing arrows pointing from "

  17. Pretreatment of lignocellulosic biomass using Fenton chemistry

    Science.gov (United States)

    Pretreatment is a necessary step in “biomass to biofuel conversion” due to the recalcitrant nature of lignocellulosic biomass. White-rot fungi utilize peroxidases and hydrogen peroxide (in vivo Fenton chemistry) to degrade lignin. In an attempt to mimic this process, solution phase Fenton chemistry ...

  18. Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries.

    Science.gov (United States)

    Kousoulis, Antonis A; Patelarou, Evridiki; Shea, Sue; Foss, Christina; Ruud Knutsen, Ingrid A; Todorova, Elka; Roukova, Poli; Portillo, Mari Carmen; Pumar-Méndez, María J; Mujika, Agurtzane; Rogers, Anne; Vassilev, Ivaylo; Serrano-Gil, Manuel; Lionis, Christos

    2014-10-02

    Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as

  19. Negative pressure wound therapy literature review of efficacy, cost effectiveness, and impact on patients' quality of life in chronic wound management and its implementation in the United kingdom.

    Science.gov (United States)

    Othman, Diaa

    2012-01-01

    This is a paper reviewing the National Health Service (NHS) agenda in relation to the use of Negative Pressure Wound Therapy (NPWT) in chronic wound management and assesses the evidence behind it, its cost effectiveness and the outcome it has on patients' satisfaction and life style. Multiple studies over the last 10 years looking at clinical efficacy of NPWT with its cost effectiveness and the implementation of this service in the UK were reviewed. NPWT has showed a reasonable body of evidence to support its usage in chronic wounds with potential positive outcomes on finance and patients' satisfaction. However, the NHS system shows significant variations in the availability and implementation of this useful tool, depending on care providers and resources availabilities. The paper concluded that the NPWT can be a useful source of cutting down costs of chronic wound managements and saving money by its effect on expediting wound healing, which can address a part of the financial crises facing the NHS, however, has to be considered according to specific case needs. There should also be a national standard for the availability and indication of this tool to assure equal opportunities for different patients in different areas in the country.

  20. Negative Pressure Wound Therapy Literature Review of Efficacy, Cost Effectiveness, and Impact on Patients' Quality of Life in Chronic Wound Management and Its Implementation in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Diaa Othman

    2012-01-01

    Full Text Available This is a paper reviewing the National Health Service (NHS agenda in relation to the use of Negative Pressure Wound Therapy (NPWT in chronic wound management and assesses the evidence behind it, its cost effectiveness and the outcome it has on patients’ satisfaction and life style. Multiple studies over the last 10 years looking at clinical efficacy of NPWT with its cost effectiveness and the implementation of this service in the UK were reviewed. NPWT has showed a reasonable body of evidence to support its usage in chronic wounds with potential positive outcomes on finance and patients’ satisfaction. However, the NHS system shows significant variations in the availability and implementation of this useful tool, depending on care providers and resources availabilities. The paper concluded that the NPWT can be a useful source of cutting down costs of chronic wound managements and saving money by its effect on expediting wound healing, which can address a part of the financial crises facing the NHS, however, has to be considered according to specific case needs. There should also be a national standard for the availability and indication of this tool to assure equal opportunities for different patients in different areas in the country.

  1. Identifying emerging trends for implementing learning technology in special education: a state-of-the-art review of selected articles published in 2008-2012.

    Science.gov (United States)

    Liu, Gi-Zen; Wu, No-Wei; Chen, Yi-Wen

    2013-10-01

    As electronic learning (e-learning) becomes increasingly popular in education worldwide, learning technology (LT) has been applied in various learning environments and activities to promote meaningful, efficient, and effective learning. LT has also been adopted by researchers and teacher-practitioners in the field of special education, but as yet little review-based research has been published. This review research thus carefully examined the trends of LT implementations in special education, providing a comprehensive analysis of 26 studies published in indexed journals in the past five years (2008-2012). Two research questions were addressed: (a) What are the major research aims, methodologies, and outcomes in these studies of implementing LT in the field of special education? and (b) What types of LT are mainly used with special education students, and for what kinds of students? Major findings include that examining the learning effectiveness of LT using was the most common research purpose (75%); researchers primarily relied on experimental studies (46%, 12 studies), followed by interviews and questionnaires (19%, 5 studies). Moreover, the most common use of LT was computer-assisted technology (such as web-based mentoring, educational computer games, laptop computers) in special education; studies investigating the use of LT with mentally disabled students were more than those with physically disabled ones. It is expected that the findings of this work and their implications will serve as valuable references with regard to the use of LT with special education students. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. NON-POLLUTING METAL SURFACE FINISHING PRETREATMENT AND PRETREATMENT/CONVERSION COATING

    Science.gov (United States)

    Picklex, a proprietary formulation, is an alterantive to conventional metal surface pretreatments and is claimed not to produce waste or lower production or lower performance. A laboratory program was designed to evaluate Picklex in common, large scale, polluting surface finishin...

  3. Chemical Pretreatment Methods for the Production of Cellulosic Ethanol: Technologies and Innovations

    Directory of Open Access Journals (Sweden)

    Edem Cudjoe Bensah

    2013-01-01

    Full Text Available Pretreatment of lignocellulose has received considerable research globally due to its influence on the technical, economic and environmental sustainability of cellulosic ethanol production. Some of the most promising pretreatment methods require the application of chemicals such as acids, alkali, salts, oxidants, and solvents. Thus, advances in research have enabled the development and integration of chemical-based pretreatment into proprietary ethanol production technologies in several pilot and demonstration plants globally, with potential to scale-up to commercial levels. This paper reviews known and emerging chemical pretreatment methods, highlighting recent findings and process innovations developed to offset inherent challenges via a range of interventions, notably, the combination of chemical pretreatment with other methods to improve carbohydrate preservation, reduce formation of degradation products, achieve high sugar yields at mild reaction conditions, reduce solvent loads and enzyme dose, reduce waste generation, and improve recovery of biomass components in pure forms. The use of chemicals such as ionic liquids, NMMO, and sulphite are promising once challenges in solvent recovery are overcome. For developing countries, alkali-based methods are relatively easy to deploy in decentralized, low-tech systems owing to advantages such as the requirement of simple reactors and the ease of operation.

  4. Biodelignification of lignocellulose substrates: An intrinsic and sustainable pretreatment strategy for clean energy production.

    Science.gov (United States)

    Chandel, Anuj K; Gonçalves, Bruna C M; Strap, Janice L; da Silva, Silvio S

    2015-01-01

    Lignocellulosic biomass (LB) is a promising sugar feedstock for biofuels and other high-value chemical commodities. The recalcitrance of LB, however, impedes carbohydrate accessibility and its conversion into commercially significant products. Two important factors for the overall economization of biofuel production is LB pretreatment to liberate fermentable sugars followed by conversion into ethanol. Sustainable biofuel production must overcome issues such as minimizing water and energy usage, reducing chemical usage and process intensification. Amongst available pretreatment methods, microorganism-mediated pretreatments are the safest, green, and sustainable. Native biodelignifying agents such as Phanerochaete chrysosporium, Pycnoporous cinnabarinus, Ceriporiopsis subvermispora and Cyathus stercoreus can remove lignin, making the remaining substrates amenable for saccharification. The development of a robust, integrated bioprocessing (IBP) approach for economic ethanol production would incorporate all essential steps including pretreatment, cellulase production, enzyme hydrolysis and fermentation of the released sugars into ethanol. IBP represents an inexpensive, environmentally friendly, low energy and low capital approach for second-generation ethanol production. This paper reviews the advancements in microbial-assisted pretreatment for the delignification of lignocellulosic substrates, system metabolic engineering for biorefineries and highlights the possibilities of process integration for sustainable and economic ethanol production.

  5. Negative impact of pretreatment anemia on local control after neoadjuvant chemoradiotherapy and surgery for rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hye Bin; Park, Hee Chul; Park, Won [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); and others

    2012-09-15

    Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.

  6. Negative impact of pretreatment anemia on local control after neoadjuvant chemoradiotherapy and surgery for rectal cancer

    International Nuclear Information System (INIS)

    Lee, Hye Bin; Park, Hee Chul; Park, Won

    2012-01-01

    Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.

  7. Barriers and Facilitators to the Implementation of Interventions to Prevent Youth Violence in Latin America: A Systematic Review and Qualitative Evidence Synthesis.

    Science.gov (United States)

    Atienzo, Erika E; Kaltenthaler, Eva; Baxter, Susan K

    2016-08-12

    Youth violence in Latin America is an important public health problem. However, the evidence from preventive programs within the region to address this problem is limited. Identifying context-specific factors that facilitate or hinder the success of interventions is necessary to guarantee the successful implementation of new preventive strategies. We present a systematic review and synthesis of qualitative studies to identify factors affecting the implementation of programs to prevent youth violence in Latin America. We searched 10 electronic databases and websites of international institutions. The quality of the studies was assessed using the critical appraisal skills program checklist, while the certainty of the findings of the synthesis was assessed using the certainty of the qualitative evidence approach. We included eight papers describing five programs in Argentina, Venezuela, Peru, El Salvador, and Mexico. Most of the factors affecting the implementation of programs were aspects related to features of the programs and social/political constraints. The synthesis suggests that future programs can benefit from having a multidisciplinary and/or multisectoral approach involving different key players. At the same time, potential strategies for avoiding problems related to such active engagement should be planned via promoting effective channels for communication and supervision. The review also suggests the importance of increasing awareness and motivation toward the problem of youth violence among relevant agencies and stakeholders. While the limited volume and quality of the literature impact on the ability to draw conclusions, the results could be useful for new programs being designed and the ones seeking to be adapted from other contexts. © The Author(s) 2016.

  8. Influence of organisational culture on the implementation of health sector reforms in low- and middle-income countries: a qualitative interpretive review.

    Science.gov (United States)

    Mbau, Rahab; Gilson, Lucy

    2018-01-01

    Health systems, particularly in low- and middle-income countries, are commonly plagued by poor access, poor performance, inefficient use and inequitable distribution of resources. To improve health system efficiency, equity and effectiveness, the World Development Report of 1993 proposed a first wave of health sector reforms, which has been followed by further waves. Various authors, however, suggest that the early reforms did not lead to the anticipated improvements. They offer, as one plausible explanation for this gap, the limited consideration given to the influence over implementation of the software aspects of the health system, such as organisational culture - which has not previously been fully investigated. To identify, interpret and synthesise existing literature for evidence on organisational culture and how it influences implementation of health sector reforms in low- and middle-income countries. We conducted a systematic search of eight databases: PubMed; Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Econlit, PsycINFO, SocINDEX with full text, Emerald and Scopus. Eight papers were identified. We analysed and synthesised these papers using thematic synthesis. This review indicates the potential influence of dimensions of organisational culture such as power distance, uncertainty avoidance, and in-group and institutional collectivism over the implementation of health sector reforms. This influence is mediated through organisational practices such as communication and feedback, management styles, commitment and participation in decision-making. This interpretive review highlights the dearth of empirical literature around organisational culture and therefore its findings can only be tentative. There is a need for health policymakers and health system researchers to conduct further analysis of organisational culture and change within the health system.

  9. Pretreatment of Reed by Wet Oxidation and Subsequent Utilization of the Pretreated Fibers for Ethanol Production

    DEFF Research Database (Denmark)

    Szijarto, Nora; Kádár, Zsófia; Varga, Eniko

    2009-01-01

    lignocelluloses usually do. In the present study, wet oxidation was investigated as the pretreatment method to enhance the enzymatic digestibility of reed cellulose to soluble sugars and thus improve the convertibility of reed to ethanol. The most effective treatment increased the digestibility of reed cellulose...... of cellulose to glucose was 82.4%. Simultaneous saccharification and fermentation of pretreated solids resulted in a final ethanol concentration as high as 8.7 g/L, yielding 73% of the theoretical....

  10. Earthdata Search Client: Usability Review Process, Results, and Implemented Changes, Using Earthdata Search Client as a Case Study

    Science.gov (United States)

    Siarto, Jeff; Reese, Mark; Shum, Dana; Baynes, Katie

    2016-01-01

    User experience and visual design are greatly improved when usability testing is performed on a periodic basis. Design decisions should be tested by real users so that application owners can understand the effectiveness of each decision and identify areas for improvement. It is important that applications be tested not just once, but as a part of a continuing process that looks to build upon previous tests. NASA's Earthdata Search Client has undergone a usability study to ensure its users' needs are being met and that users understand how to use the tool efficiently and effectively. This poster will highlight the process followed for usability study, the results of the study, and what has been implemented in light of the results to improve the application's interface.

  11. Analytical Methods for Biomass Characterization during Pretreatment and Bioconversion

    Energy Technology Data Exchange (ETDEWEB)

    Pu, Yunqiao [ORNL; Meng, Xianzhi [University of Tennessee, Knoxville (UTK); Yoo, Chang Geun; Li, Mi; Ragauskas, Arthur J [ORNL

    2016-01-01

    Lignocellulosic biomass has been introduced as a promising resource for alternative fuels and chemicals because of its abundance and complement for petroleum resources. Biomass is a complex biopolymer and its compositional and structural characteristics largely vary depending on its species as well as growth environments. Because of complexity and variety of biomass, understanding its physicochemical characteristics is a key for effective biomass utilization. Characterization of biomass does not only provide critical information of biomass during pretreatment and bioconversion, but also give valuable insights on how to utilize the biomass. For better understanding biomass characteristics, good grasp and proper selection of analytical methods are necessary. This chapter introduces existing analytical approaches that are widely employed for biomass characterization during biomass pretreatment and conversion process. Diverse analytical methods using Fourier transform infrared (FTIR) spectroscopy, gel permeation chromatography (GPC), and nuclear magnetic resonance (NMR) spectroscopy for biomass characterization are reviewed. In addition, biomass accessibility methods by analyzing surface properties of biomass are also summarized in this chapter.

  12. Review of transmission routes of 24 infectious diseases preventable by biosecurity measures and comparison of the implementation of these measures in pig herds in six European countries.

    Science.gov (United States)

    Filippitzi, M E; Brinch Kruse, A; Postma, M; Sarrazin, S; Maes, D; Alban, L; Nielsen, L R; Dewulf, J

    2018-04-01

    This study aimed to review the transmission routes of important infectious pig diseases and to translate these into biosecurity measures preventing or reducing the transmission between and within pig herds. Furthermore, it aimed to identify the level of implementation of these measures in different European countries and discuss the observed variations to identify potentials for improvement. First, a literature review was performed to show which direct and indirect transmission routes of 24 infectious pig diseases can be prevented through different biosecurity measures. Second, a quantitative analysis was performed using the Biocheck.UGent™, a risk-based scoring system to evaluate biosecurity in pig herds, to obtain an insight into the implementation of these biosecurity measures. The database contained farm-specific biosecurity data from 574 pig farms in Belgium, Denmark, France, Germany, the Netherlands and Sweden, entered between January 2014 and January 2016. Third, a qualitative analysis based on a review of literature and other relevant information resources was performed for every subcategory of internal and external biosecurity in the Biocheck.UGent™ questionnaire. The quantitative analysis indicated that at the level of internal, external and overall biosecurity, Denmark had a significantly distinct profile with higher external biosecurity scores and less variation than the rest of the countries. This is likely due to a widely used specific pathogen-free (SPF) system with extensive focus on biosecurity since 1971 in Denmark. However, the observed pattern may also be attributed to differences in data collection methods. The qualitative analysis identified differences in applied policies, legislation, disease status, pig farm density, farming culture and habits between countries that can be used for shaping country-specific biosecurity advice to attain improved prevention and control of important pig diseases in European pig farms. © 2017 Blackwell

  13. A Review of Protocol Implementations and Energy Efficient Cross-Layer Design for Wireless Body Area Networks

    Directory of Open Access Journals (Sweden)

    Tao Chen

    2012-11-01

    Full Text Available The issues inherent in caring for an ever-increasing aged population has been the subject of endless debate and continues to be a hot topic for political discussion. The use of hospital-based facilities for the monitoring of chronic physiological conditions is expensive and ties up key healthcare professionals. The introduction of wireless sensor devices as part of a Wireless Body Area Network (WBAN integrated within an overall eHealth solution could bring a step change in the remote management of patient healthcare. Sensor devices small enough to be placed either inside or on the human body can form a vital part of an overall health monitoring network. An effectively designed energy efficient WBAN should have a minimal impact on the mobility and lifestyle of the patient. WBAN technology can be deployed within a hospital, care home environment or in the patient’s own home. This study is a review of the existing research in the area of WBAN technology and in particular protocol adaptation and energy efficient cross-layer design. The research reviews the work carried out across various layers of the protocol stack and highlights how the latest research proposes to resolve the various challenges inherent in remote continual healthcare monitoring.

  14. The impacts of pretreatment on the fermentability of pretreated lignocellulosic biomass: a comparative evaluation between ammonia fiber expansion and dilute acid pretreatment

    Directory of Open Access Journals (Sweden)

    Dale Bruce E

    2009-12-01

    Full Text Available Abstract Background Pretreatment chemistry is of central importance due to its impacts on cellulosic biomass processing and biofuels conversion. Ammonia fiber expansion (AFEX and dilute acid are two promising pretreatments using alkaline and acidic pH that have distinctive differences in pretreatment chemistries. Results Comparative evaluation on these two pretreatments reveal that (i AFEX-pretreated corn stover is significantly more fermentable with respect to cell growth and sugar consumption, (ii both pretreatments can achieve more than 80% of total sugar yield in the enzymatic hydrolysis of washed pretreated solids, and (iii while AFEX completely preserves plant carbohydrates, dilute acid pretreatment at 5% solids loading degrades 13% of xylose to byproducts. Conclusion The selection of pretreatment will determine the biomass-processing configuration, requirements for hydrolysate conditioning (if any and fermentation strategy. Through dilute acid pretreatment, the need for hemicellulase in biomass processing is negligible. AFEX-centered cellulosic technology can alleviate fermentation costs through reducing inoculum size and practically eliminating nutrient costs during bioconversion. However, AFEX requires supplemental xylanases as well as cellulase activity. As for long-term sustainability, AFEX has greater potential to diversify products from a cellulosic biorefinery due to lower levels of inhibitor generation and lignin loss.

  15. Mental health and public policies implemented in the Northeast of Brazil: A systematic review with meta-analysis.

    Science.gov (United States)

    Januário, Sonilde Saraiva; das Neves Peixoto, Florido Sampaio; Lima, Nádia Nara Rolim; do Nascimento, Vânia Barbosa; de Sousa, Danilo Ferreira; Pereira Luz, Dayse Christina Rodrigues; da Silva, Claúdio Gleidiston Lima; Rolim Neto, Modesto Leite

    2017-02-01

    Studies about mental disorders are very rare in the Northeast of Brazil, especially when psychopathologies in children and adolescents are considered. The consequence is a small availability of data and an absence of a real epidemiological profile. This is a systematic review with meta-analysis, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol, in the period from 2003 to 2015, using the databases LILACS, SciELO and BVS. The analysis comprised the keywords 'models of primary and secondary healthcare in mental health', 'psychiatric reform' and 'policies and services in mental health', using the Boolean operator '# AND'. Original texts based on secondary data from the Hospital Information System of the Brazilian Unified Health System were also included via the Citizen Electronic Record System, Instituto Brasileiro de Geografia e Estatística, and Ministry of Health. Grey literature was used by means of hand searching. A combined analysis of the strategies mentioned in the analyzed articles shows a combined odds ratio of 1.291 (confidence interval (CI) = 1.054-1.582), thus it demonstrates the efficacy of using such strategies in the elaboration of institutional apparatus in mental health. The p-value of the chi-square distribution resulted in .9753, which does not reject the hypothesis of association between strategies in mental health and possible development of institutional apparatus in mental health. A combined analysis of all strategies mentioned in the analyzed studies shows efficacy of using strategies to elaborate institutional apparatus in mental health.

  16. Measuring the effectiveness of mentoring as a knowledge translation intervention for implementing empirical evidence: a systematic review.

    Science.gov (United States)

    Abdullah, Ghadah; Rossy, Dianne; Ploeg, Jenny; Davies, Barbara; Higuchi, Kathryn; Sikora, Lindsey; Stacey, Dawn

    2014-10-01

    Mentoring as a knowledge translation (KT) intervention uses social influence among healthcare professionals to increase use of evidence in clinical practice. To determine the effectiveness of mentoring as a KT intervention designed to increase healthcare professionals' use of evidence in clinical practice. A systematic review was conducted using electronic databases (i.e., MEDLINE, CINAHL), grey literature, and hand searching. Eligible studies evaluated mentoring of healthcare professionals responsible for patient care to enhance the uptake of evidence into practice. Mentoring is defined as (a) a mentor more experienced than mentee; (b) individualized support based on mentee's needs; and (c) involved in an interpersonal relationship as indicated by mutual benefit, engagement, and commitment. Two reviewers independently screened citations for eligibility, extracted data, and appraised quality of studies. Data were analyzed descriptively. Of 10,669 citations from 1988 to 2012, 10 studies were eligible. Mentoring as a KT intervention was evaluated in Canada, USA, and Australia. Exposure to mentoring compared to no mentoring improved some behavioral outcomes (one study). Compared to controls or other multifaceted interventions, multifaceted interventions with mentoring improved practitioners' knowledge (four of five studies), beliefs (four of six studies), and impact on organizational outcomes (three of four studies). There were mixed findings for changes in professionals' behaviors and impact on practitioners' and patients' outcomes: some outcomes improved, while others showed no difference. Only one study evaluated the effectiveness of mentoring alone as a KT intervention and showed improvement in some behavioral outcomes. The other nine studies that evaluated the effectiveness of mentoring as part of a multifaceted intervention showed mixed findings, making it difficult to determine the added effect of mentoring. Further research is needed to identify effective

  17. Measuring the Effectiveness of Mentoring as a Knowledge Translation Intervention for Implementing Empirical Evidence: A Systematic Review

    Science.gov (United States)

    Abdullah, Ghadah; Rossy, Dianne; Ploeg, Jenny; Davies, Barbara; Higuchi, Kathryn; Sikora, Lindsey; Stacey, Dawn

    2014-01-01

    Background Mentoring as a knowledge translation (KT) intervention uses social influence among healthcare professionals to increase use of evidence in clinical practice. Aim To determine the effectiveness of mentoring as a KT intervention designed to increase healthcare professionals’ use of evidence in clinical practice. Methods A systematic review was conducted using electronic databases (i.e., MEDLINE, CINAHL), grey literature, and hand searching. Eligible studies evaluated mentoring of healthcare professionals responsible for patient care to enhance the uptake of evidence into practice. Mentoring is defined as (a) a mentor more experienced than mentee; (b) individualized support based on mentee's needs; and (c) involved in an interpersonal relationship as indicated by mutual benefit, engagement, and commitment. Two reviewers independently screened citations for eligibility, extracted data, and appraised quality of studies. Data were analyzed descriptively. Results Of 10,669 citations from 1988 to 2012, 10 studies were eligible. Mentoring as a KT intervention was evaluated in Canada, USA, and Australia. Exposure to mentoring compared to no mentoring improved some behavioral outcomes (one study). Compared to controls or other multifaceted interventions, multifaceted interventions with mentoring improved practitioners’ knowledge (four of five studies), beliefs (four of six studies), and impact on organizational outcomes (three of four studies). There were mixed findings for changes in professionals’ behaviors and impact on practitioners’ and patients’ outcomes: some outcomes improved, while others showed no difference. Linking Evidence to Action Only one study evaluated the effectiveness of mentoring alone as a KT intervention and showed improvement in some behavioral outcomes. The other nine studies that evaluated the effectiveness of mentoring as part of a multifaceted intervention showed mixed findings, making it difficult to determine the added effect

  18. Factors influencing the development and implementation of advanced and consultant radiographer practice - A review of the literature

    International Nuclear Information System (INIS)

    Kelly, Judith; Piper, Keith; Nightingale, Julie

    2008-01-01

    United Kingdom (UK) government policy, which has focused on modernising the NHS and making it more responsive to patients' needs, has, in fact, created significant service demand. The Department of Health (DoH) committed itself to changing and improving the organisation and delivery of health care through professional role development and blurring of traditional professional boundaries. In 2000, the DoH announced an intention to create consultant allied health professional posts to facilitate career development opportunities for expert and experienced staff. There are currently 31 consultant radiographers in the UK who have been appointed to new posts, and 2 trainees. Such posts are created subject to a formal approval panel process as laid down by the DoH. This paper will begin by outlining the current scope of radiographic consultant practice and advanced clinical roles in the UK. Key factors that have facilitated the development and implementation of such roles will then be explored and discussed. It will also consider what specific factors can inhibit innovative change and whether there appears to be any perceived threats to the current momentum of change

  19. Review of disaster management implementation for the community safety in the vicinity of oil and gas field

    Energy Technology Data Exchange (ETDEWEB)

    Musa, R. Abdullah; Heni, Siti [JOB Pertamina Petrochina East Java, Lingkar Pertamina - Soko, Tuban 62372 (Indonesia); Harjanto, Meddy, E-mail: mharja@gmail.com [JOB Pertamina Petrochina East Java, Lingkar Pertamina - Soko, Tuban 62372 (Indonesia); Occupational Health and Safety of Airlangga University, Surabaya 60115 (Indonesia)

    2015-04-24

    Sukowati site which is operated by Production Sharing Contract (PSC) Joint Operating Body Pertamina Petrochina East Java (JOB P-PEJ) located at Bojonegoro regency East Java Province. This site is close to densely populated settlements with approximately 6,010 people within a radius less than 600 m. The fluid produced have a dangerous potential to the above mention community, due to accompanying of hydrogen sulphide gas (H2S) with a concentration about 0.6% – 2% from the total gas produced. In 2006, there was incident of gas leak from drilling development well of Sukowati # 5. The incident made the surrounding community panic due to lack of preparedness and awareness. Learning from the incident, the company together with the government and local communities initiated to make improvements through the disaster management system approach. The efforts are carried out in accordance with the 4 (four) periods in a continuous cycle consist of (1) mitigation; (2) preparation; (3) response and (4) recovery. Emergency response drills conducted regularly at least once a year, its main purpose is to find out the results of the implementation of the existing disaster management. The results of the drills showed an increase in public awareness and responsiveness to emergency situations caused by the operational failures of oil and gas exploration and production activities near their settlement.

  20. Review of disaster management implementation for the community safety in the vicinity of oil and gas field

    International Nuclear Information System (INIS)

    Musa, R. Abdullah; Heni, Siti; Harjanto, Meddy

    2015-01-01

    Sukowati site which is operated by Production Sharing Contract (PSC) Joint Operating Body Pertamina Petrochina East Java (JOB P-PEJ) located at Bojonegoro regency East Java Province. This site is close to densely populated settlements with approximately 6,010 people within a radius less than 600 m. The fluid produced have a dangerous potential to the above mention community, due to accompanying of hydrogen sulphide gas (H2S) with a concentration about 0.6% – 2% from the total gas produced. In 2006, there was incident of gas leak from drilling development well of Sukowati # 5. The incident made the surrounding community panic due to lack of preparedness and awareness. Learning from the incident, the company together with the government and local communities initiated to make improvements through the disaster management system approach. The efforts are carried out in accordance with the 4 (four) periods in a continuous cycle consist of (1) mitigation; (2) preparation; (3) response and (4) recovery. Emergency response drills conducted regularly at least once a year, its main purpose is to find out the results of the implementation of the existing disaster management. The results of the drills showed an increase in public awareness and responsiveness to emergency situations caused by the operational failures of oil and gas exploration and production activities near their settlement

  1. Radiation pretreatment of cellulose for energy production

    Science.gov (United States)

    Dela Rosa, A. M.; Dela Mines, A. S.; Banzon, R. B.; Simbul-Nuguid, Z. F.

    The effect of radiation pretreatment of agricultural cellulosic wastes was investigated through hydrolytic reactions of cellulose. Gamma irradiation significantly increased the acid hydrolysis of rice straw, rice hull and corn husk. The yields of reducing sugar were higher with increasing radiation dose in these materials. The observed radiation effect varied with the cellulosic material but it correlated with neither the cellulose content nor the lignin content. Likewise, the radiation pretreatment accelerated the subsequent enzymatic hydrolysis of rice straw and rice hull by cellulase. The irradiated rice straw appeared to be a better growth medium for the cellulolytic microorganism, Myrothecium verrucaria, than the non-irradiated material. This was attributed to increased digestibility of the cellulose by the microorganism.

  2. Radiation pretreatment of cellulose for energy production

    International Nuclear Information System (INIS)

    Dela Rosa, A.M.; Dela Mines, A.S.; Banzon, R.B.; Simbul-Nuguid, Z.F.

    1983-01-01

    The effect of radiation pretreatment of agricultural cellulosic wastes was investigated through hydrolytic reactions of cellulose. Gamma irradiation significantly increased the acid hydrolysis of rice straw, rice hull and corn husk. The yields of reducing sugar were higher with increasing radiation dose in these materials. The observed radiation effect varied with the cellulose material but it correlated with neither the cellulose content nor the lignin content. Likewise, the radiation pretreatment accelerated the subsequent enzymatic hydrolysis of rice straw and rice hull by cellulase. The irradiated rice straw appeared to be a better growth medium for the cellulolytic microorganism, Myrothecium verrucaria, than the non-irradiated material. This was attributed to increased digestibility of the cellulose by the microorganism. (author)

  3. PRETREATMENT OF LIGNOCELLULOSIC BIOMASS FOR ENZYMATIC HYDROLYSIS

    Directory of Open Access Journals (Sweden)

    Doan Thai Hoa

    2017-11-01

    Full Text Available The cost of raw materials continues to be a limiting factor in the production of bio-ethanol from traditional raw materials, such as sugar and starch. At the same time, there are large amount of agricultural residues as well as industrial wastes that are of low or negative value (due to costs of current effluent disposal methods. Dilute sulfuric acid pretreatment of elephant grass and wood residues for the enzymatic hydrolysis of cellulose has been investigated in this study.    Elephant grass (agricultural residue and sawdust (Pulp and Paper Industry waste with a small particulate size were treated using different dilute sulfuric acid concentrations at a temperature  of 140-170°C within 0.5-3 hours. The appropriate pretreatment conditions give the highest yield of soluble saccharides and total reducing sugars.

  4. Apple's dehydration by the irradiation pretreatment

    International Nuclear Information System (INIS)

    Fu Junjie; Chao Yan; Shen Weiqiao; Wang Jun

    2001-01-01

    "6"0 Co γ-ray irradiation was used as a pre-treatment method to dry the apple. The aim of this study was to discover the effect factor concerning the change of the apple cell structure which would affect the speed of drhydration and the relation between the speed of hot air dehydration and the irradiation dose. The results demonstrated that with the increasing of irradiation dose. The damage of apple's vacuole membrane increased. The positive correlation was shown in slice thickness and dehydration rate, the relation of the irradiation dose and the temperature of hot air was negatively correlated. The optimum of pre-treatment was gained for slice thickness, the irradiation dose and dry temperature of hot air. (authors)

  5. Misoprostol for postpartum hemorrhage prevention at home birth: an integrative review of global implementation experience to date.

    Science.gov (United States)

    Smith, Jeffrey Michael; Gubin, Rehana; Holston, Martine M; Fullerton, Judith; Prata, Ndola

    2013-02-20

    Hemorrhage continues to be a leading cause of maternal death in developing countries. The 2012 World Health Organization guidelines for the prevention and management of postpartum hemorrhage (PPH) recommend oral administration of misoprostol by community health workers (CHWs). However, there are several outstanding questions about distribution of misoprostol for PPH prevention at home births. We conducted an integrative review of published research studies and evaluation reports from programs that distributed misoprostol at the community level for prevention of PPH at home births. We reviewed methods and cadres involved in education of end-users, drug administration, distribution, and coverage, correct and incorrect usage, and serious adverse events. Eighteen programs were identified; only seven reported all data of interest. Programs utilized a range of strategies and timings for distributing misoprostol. Distribution rates were higher when misoprostol was distributed at a home visit during late pregnancy (54.5-96.9%) or at birth (22.5-83.6%), compared to antenatal care (ANC) distribution at any ANC visit (22.5-49.1%) or late ANC visit (21.0-26.7%). Coverage rates were highest when CHWs and traditional birth attendants distributed misoprostol and lower when health workers/ANC providers distributed the medication. The highest distribution and coverage rates were achieved by programs that allowed self-administration. Seven women took misoprostol prior to delivery out of more than 12,000 women who were followed-up. Facility birth rates increased in the three programs for which this information was available. Fifty-one (51) maternal deaths were reported among 86,732 women taking misoprostol: 24 were attributed to perceived PPH; none were directly attributed to use of misoprostol. Even if all deaths were attributable to PPH, the equivalent ratio (59 maternal deaths/100,000 live births) is substantially lower than the reported maternal mortality ratio in any of these

  6. Technical Basis of Scaling Relationships for the Pretreatment Engineering Platform

    Energy Technology Data Exchange (ETDEWEB)

    Kuhn, William L.; Arm, Stuart T.; Huckaby, James L.; Kurath, Dean E.; Rassat, Scot D.

    2008-07-15

    Pacific Northwest National Laboratory has been tasked by Bechtel National Inc. (BNI) on the River Protection Project-Waste Treatment Plant (RPP-WTP) project to perform research and development activities. The Pretreatment Engineering Platform (PEP) is being designed and constructed as part of a plan to respond to an issue raised by the WTP External Flowsheet Review Team (EFRT) entitled “Undemonstrated Leaching Processes” and numbered M12. The PEP replicates the WTP leaching process using prototypic equipment and control strategies. The approach for scaling PEP performance data to predict WTP performance is critical to the successful resolution of the EFRT issue. This report describes the recommended PEP scaling approach, PEP data interpretation and provides recommendations on test conduct and data requirements.

  7. Technical Basis of Scaling Relationships for the Pretreatment Engineering Platform

    International Nuclear Information System (INIS)

    Kuhn, William L.; Arm, Stuart T.; Huckaby, James L.; Kurath, Dean E.; Rassat, Scot D.

    2008-01-01

    Pacific Northwest National Laboratory has been tasked by Bechtel National Inc. (BNI) on the River Protection Project-Waste Treatment Plant (RPP-WTP) project to perform research and development activities. The Pretreatment Engineering Platform (PEP) is being designed and constructed as part of a plan to respond to an issue raised by the WTP External Flowsheet Review Team (EFRT) entitled 'Undemonstrated Leaching Processes' and numbered M12. The PEP replicates the WTP leaching process using prototypic equipment and control strategies. The approach for scaling PEP performance data to predict WTP performance is critical to the successful resolution of the EFRT issue. This report describes the recommended PEP scaling approach, PEP data interpretation and provides recommendations on test conduct and data requirements

  8. Waste Separations and Pretreatment Workshop report

    International Nuclear Information System (INIS)

    Cruse, J.M.; Harrington, R.A.; Quadrel, M.J.

    1994-01-01

    This document provides the minutes from the Waste Separations and Pretreatment Workshop sponsored by the Underground Storage Tank-Integrated Demonstration in Salt Lake City, Utah, February 3--5, 1993. The Efficient Separations and Processing-Integrated Program and the Hanford Site Tank Waste Remediation System were joint participants. This document provides the detailed minutes, including responses to questions asked, an attendance list, reproductions of the workshop presentations, and a revised chart showing technology development activities

  9. Design Criteria for Process Wastewater Pretreatment Facilities

    Science.gov (United States)

    1988-05-01

    Stripping Column H13 ’Re Purpose: The purpose of this report, is to provide design criteria for pretreatment needs for ’ I. INTRODUCTION ’". discharge of...which a portion of the vessel is filled with packing. Packing materials vary from corrugated steel to bundles of fibers (Langdon et al., 1972) to beds...concentration(s) using Table 20. Wastewater treatability studies should be considered as a process-screening tool for all wastewater streams for

  10. Pretreatment on Corn Stover with Low Concentration of Formic Acid

    DEFF Research Database (Denmark)

    Xu, Jian; Thomsen, Mette Hedegaard; Thomsen, Anne Belinda

    2009-01-01

    the cellulose easily degraded into sugars and further fermented to ethanol. In this work, hydrothermal pretreatment on corn stover at 195 degrees for 15 min with and without lower concentration of formic acid was compared in terms of sugar recoveries and ethanol fermentation. For pretreatment with formic acid...... pretreatment without formic acid. Toxicity tests of liquor parts showed that there were no inhibitions found for both pretreatment conditions. After simultaneous saccharification and fermentation (SSF) of the pretreated corn stover with Baker's yeast, the highest ethanol yield of 76.5% of the theoretical...

  11. Radioprotection of mice following garlic pretreatment

    International Nuclear Information System (INIS)

    Singh, S.P.; Abraham, S.K.; Kesavan, P.C.

    1996-01-01

    Freshly prepared aqueous extract of garlic was tested in mice for its possible in vivo protective effect against gamma-radiation-induced chromosomal damage. In the same animals, the changes in the sulphydryl content and glutathione S-transferase activity were evaluated. Three doses of garlic extract [125, 250 and 500 mg kg-1 body weight (bw)] were administered orally for five consecutive days and the animals were exposed to 0.25, 0.5, 1.0 and 2.0 Gy gamma-radiation 2 h after the final feeding. The results of the bone marrow micronucleus test revealed that pretreatment with garlic extract was effective in reducing gamma-radiation-induced chromosomal damage. Against 0.25 Gy gamma-radiation, a high dose of 500 mg kg-1 bw garlic extract was required to significantly reduce the chromosomal damage. All the three doses of garlic extract were effective in exerting a protective effect against 0.5, 1.0 and 2.0 Gy gamma-radiation. However a dose-related effect was observed only against 2.0 Gy. The sulphydryl content and glutathione S-transferase activity registered a significant increase after either pretreatment with garlic with extract or irradiation. In the garlic extract pretreated irradiated animals, a significant reduction was observed in the sulphydryl content and glutathione S-transferase activity

  12. Cost comparison for REDC pretreatment project

    International Nuclear Information System (INIS)

    Robinson, S.M.; Homan, F.J.

    1997-06-01

    This analysis has been prepared to support the planned expenditure to provide the Radiochemical Engineering Development Center (REDC) with the capability to pretreat their liquid low-level waste (LLLW) before discharging it to the Oak Ridge National Laboratory (ORNL) LLLW system. Pretreatment will remove most of the radioactivity, particularly the transuranic isotopes and Cs-137 from the waste to be discharged. This will render the supernates that accumulate in the storage tanks low-activity Class B low-level wastes rather than high-activity Class B or Class C wastes. The sludges will be Class C rather than remote-handled transuranic (RH-TRU) wastes. When REDC wastes are commingled with other ORNL LLLW, the present-worth treatment and transport costs are higher by a factor of 1.3 for the no-pretreatment cases. This result is consistent with data from similar studies conducted at other sites. Based on the information presented in this analysis, the recommendation is to proceed with REDC treatment projects

  13. The effect of wastewater pretreatment on nanofiltration membrane performance

    Directory of Open Access Journals (Sweden)

    Ali Hashlamon

    2017-03-01

    Full Text Available Membrane fouling is considered a serious obstacle for operation and cost efficiency in wastewater treatment using nanofiltration (NF. However, pretreatment is the most practical way to reduce this prior to NF. In this research, two types of wastewaters were pretreated with different methods prior to NF to examine the effect of pretreatment on membrane fouling in terms of turbidity, chemical oxygen demand (COD and permeate flux. Turbidity and COD were measured to assess solid foulants and organic species in the wastewater, respectively. The first sample was secondary treated sewage, which was pretreated using coagulation-flocculation-sedimentation (CFS only. Steady flux was increased from 24 L/m2h for wastewater without pretreatment to 32.1 L/m2h with pretreatment. COD was also eliminated after CFS/NF, and turbidity was reduced to 0.6 NTU. The second sample was diluted biodiesel wastewater, which was pretreated using a combination of powdered-activated carbon (PAC adsorption and CFS (PAC/CFS. Steady flux was increased from 22.3 L/m2h for wastewater without pretreatment to 28.7 L/m2h with pretreatment; biodiesel wastewater quality also improved. Turbidity was reduced from 12 to 0.6 NTU, and COD was reduced from 526 to 4 mg/L after NF with PAC/CFS pretreatment, while COD was reduced from 526 to 95 mg/L using NF without pretreatment.

  14. Research on implementation of interventions in tuberculosis control in low- and middle-income countries: a systematic review.

    Directory of Open Access Journals (Sweden)

    Frank Cobelens

    interventions, and nine addressed their cost-effectiveness. CONCLUSIONS: There are substantial gaps in published evidence for scale-up for five WHO-recommended TB interventions settings at country level, which for many countries possibly precludes program-wide implementation of these interventions. There is a strong need for rigorous operational research studies to be carried out in programmatic settings to inform on best use of existing and new interventions in TB control.

  15. Reducing biomass recalcitrance via mild sodium carbonate pretreatment.

    Science.gov (United States)

    Mirmohamadsadeghi, Safoora; Chen, Zhu; Wan, Caixia

    2016-06-01

    This study examined the effects of mild sodium carbonate (Na2CO3) pretreatment on enzymatic hydrolysis of different feedstocks (i.e., corn stover, Miscanthus, and switchgrass). The results showed that sodium carbonate pretreatment markedly enhanced the sugar yields of the tested biomass feedstocks. The pretreated corn stover, Miscanthus, and switchgrass gave the glucose yields of 95.1%, 62.3%, and 81.3%, respectively, after enzymatic hydrolysis. The above glucose yields of pretreated feedstocks were 2-4 times that of untreated ones. The pretreatment also enhanced the xylose yields, 4 times for corn stover and 20 times for both Miscanthus and switchgrass. Sodium carbonate pretreatment removed 40-59% lignin from the tested feedstocks while preserving most of cellulose (sodium carbonate pretreatment was effective for reducing biomass recalcitrance and subsequently improving the digestibility of lignocellulosic biomass. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Individual performance review in hospital practice: the development of a framework and evaluation of doctors' attitudes to its value and implementation.

    Science.gov (United States)

    Trebble, T M; Cruickshank, L; Hockey, P M; Heyworth, N; Powell, T; Clarke, N

    2013-11-01

    Appraisal, or independent performance review (IPR) is used in human resources management in the commercial and public sectors to evaluate the performance of an employee against agreed local organisational expectations and objectives, and to identify their requirements for development and effective management. IPR for NHS consultants may provide essential information for job planning, contribute towards medical appraisal for revalidation, and facilitate productivity and quality improvement. To develop a framework for IPR for consultants, and to determine attitudes on its value, process and content. Information from commercial, public and voluntary sector models and published and other literature sources were used to develop an IPR framework. This was assessed through a three-cycle action research methodology involving qualitative interviews with 22 consultants (predominantly with medical management roles). The domains of the IPR framework included: (1) performance against objectives; (2) behaviour and leadership; (3) talent management; (4) agreed future objectives. A number of themes were identified from the consultant interviews including: ineffective current appraisal systems reflecting a lack of valid performance data and allotted time; a lack of empowerment of medical managers to address performance issues; IPR as a more explicit system, offering value in evaluating doctors performance; and the dependence of successful implementation on the engagement of the Trust executive. IPR may have value for performance evaluation of consultants, contributing toward job planning and complementing medical appraisal. Support by their employing organisation and engagement with medical managers in design and implementation is likely to be essential.

  17. Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research.

    Science.gov (United States)

    Meißner, Anne; Schnepp, Wilfried

    2014-06-20

    Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses' experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process. A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities. The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents' records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude. In summary, the findings showed that members of staff experience IT as a benefit when

  18. Antenatal HIV Testing in Sub-Saharan Africa During the Implementation of the Millennium Development Goals: A Systematic Review Using the PEN-3 Cultural Model.

    Science.gov (United States)

    Blackstone, Sarah R; Nwaozuru, Ucheoma; Iwelunmor, Juliet

    2018-01-01

    This study systematically explored the barriers and facilitators to routine antenatal HIV testing from the perspective of pregnant women in sub-Saharan Africa during the implementation period of the Millennium Development Goals. Articles published between 2000 and 2015 were selected after reviewing the title, abstract, and references. Twenty-seven studies published in 11 African countries were eligible for the current study and reviewed. The most common barriers identified include communication with male partners, patient convenience and accessibility, health system and health-care provider issues, fear of disclosure, HIV-related stigma, the burden of other responsibilities at home, and the perception of antenatal care as a "woman's job." Routine testing among pregnant women is crucial for the eradication of infant and child HIV infections. Further understanding the interplay of social and cultural factors, particularly the role of women in intimate relationships and the influence of men on antenatal care seeking behaviors, is necessary to continue the work of the Millennium Development Goals.

  19. Undertaking a Collaborative Rapid Realist Review to Investigate What Works in the Successful Implementation of a Frail Older Person’s Pathway

    Directory of Open Access Journals (Sweden)

    Éidín Ní Shé

    2018-01-01

    Full Text Available We addressed the research question “what factors enable the successful development and implementation of a frail older person’s pathway within the acute setting”. A rapid realist review (RRR was conducted by adopting the RAMESES standards. We began with a sample of 232 articles via database searches supplemented with 94 additional records including inputs from a twitter chat and a hospital site visit. Our final sample consisted of 18 documents. Following review and consensus by an expert panel we identified a conceptual model of context-mechanism-(resources-outcomes. There was overall agreement frailty should be identified at the front door of the acute hospital. Significant challenges identified related to organisational boundaries both within the acute setting and externally, the need to shift outcomes to patient orientated ones, to support staff to sustain the pathway by providing ongoing education and by providing role clarity. RRRs can support research such as the systematic approach to improving care for frail older adults (SAFE study by producing accounts of what works based on a wide range of sources and innovative engagement with stakeholders. It is evident from our provisional model that numerous factors need to combine and interact to enable and sustain a successful frail older person’s pathway.

  20. Enzymatic saccharification and bioethanol production from Cynara cardunculus pretreated by steam explosion.

    Science.gov (United States)

    Fernandes, Maria C; Ferro, Miguel D; Paulino, Ana F C; Mendes, Joana A S; Gravitis, Janis; Evtuguin, Dmitry V; Xavier, Ana M R B

    2015-06-01

    The correct choice of the specific lignocellulosic biomass pretreatment allows obtaining high biomass conversions for biorefinery implementations and cellulosic bioethanol production from renewable resources. Cynara cardunculus (cardoon) pretreated by steam explosion (SE) was involved in second-generation bioethanol production using separate hydrolysis and fermentation (SHF) or simultaneous saccharification and fermentation (SSF) processes. Steam explosion pretreatment led to partial solubilisation of hemicelluloses and increased the accessibility of residual polysaccharides towards enzymatic hydrolysis revealing 64% of sugars yield against 11% from untreated plant material. Alkaline extraction after SE pretreatment of cardoon (CSEOH) promoted partial removal of degraded lignin, tannins, extractives and hemicelluloses thus allowing to double glucose concentration upon saccharification step. Bioethanol fermentation in SSF mode was faster than SHF process providing the best results: ethanol concentration 18.7 g L(-1), fermentation efficiency of 66.6% and a yield of 26.6g ethanol/100 g CSEOH or 10.1 g ethanol/100 g untreated cardoon. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa.

    Science.gov (United States)

    Aranda-Jan, Clara B; Mohutsiwa-Dibe, Neo; Loukanova, Svetla

    2014-02-21

    Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa. A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards. Forty-four studies on mHealth projects in Africa were included and classified as: "patient follow-up and medication adherence" (n = 19), "staff training, support and motivation" (n = 2), "staff evaluation, monitoring and guidelines compliance" (n = 4), "drug supply-chain and stock management" (n = 2), "patient education and awareness" (n = 1), "disease surveillance and intervention monitoring" (n = 4), "data collection/transfer and reporting" (n = 10) and "overview of mHealth projects" (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or lack of resources. mHealth in Africa is an innovative approach

  2. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa

    Science.gov (United States)

    2014-01-01

    Background Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa. Methods A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards. Results Forty-four studies on mHealth projects in Africa were included and classified as: “patient follow-up and medication adherence” (n = 19), “staff training, support and motivation” (n = 2), “staff evaluation, monitoring and guidelines compliance” (n = 4), “drug supply-chain and stock management” (n = 2), “patient education and awareness” (n = 1), “disease surveillance and intervention monitoring” (n = 4), “data collection/transfer and reporting” (n = 10) and “overview of mHealth projects” (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or

  3. Hot Idea or Hot Air: A Systematic Review of Evidence for Two Widely Marketed Youth Suicide Prevention Programs and Recommendations for Implementation

    Science.gov (United States)

    Wei, Yifeng; Kutcher, Stan; LeBlanc, John C.

    2015-01-01

    Introduction: Youth suicide is highly related to mental disorders. While communities and schools are marketed to with a plethora of suicide prevention programs, they often lack the capacity to choose evidence-based programs. Methods: We conducted a systematic review of two youth suicide prevention programs to help determine if the quality of evidence available justifies their wide spread dissemination. We searched Medline, PsycINFO, EMBASE, CINAHL, the Cochrane Library, Campbell Collaboration SPECTR database, SocIndex, Sociological Abstracts, Social Services Abstracts, ERIC, Social Work Abstracts, Research Library, and Web of Science, for relevant studies. We included studies/systematic reviews/meta-analysis that evaluated the effectiveness, cost-effectiveness, and/or safety of Signs of Suicide (SOS) and Yellow Ribbon (YR) suicide prevention programs that target adolescents. We applied the Office of Justice Program What Works Repository (OJP-R) to evaluate the quality of the included studies as effective, effective with reservation, promising, inconclusive evidence, insufficient evidence, and ineffective. Two SOS studies were ranked as “inconclusive evidence” based on the OJP-R. One SOS study was ranked as having “insufficient evidence” on OJP-R. The YR study was ranked as “ineffective” using OJP-R. We only included studies in peer-reviewed journals in English and therefore may have missed reports in grey literature or non-English publications. Results: We cannot recommend that schools and communities implement either the SOS or YR suicide prevention programs. Purchasers of these programs should be aware that there is no evidence that their use prevents suicide. Conclusions: Academics and organizations should not overstate the positive impacts of suicide prevention interventions when the evidence is lacking. PMID:26336375

  4. Prognostic Value and Reproducibility of Pretreatment CT Texture Features in Stage III Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fried, David V. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, Texas (United States); Tucker, Susan L. [Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhou, Shouhao [Division of Quantitative Sciences, Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mawlawi, Osama [Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, Texas (United States); Ibbott, Geoffrey [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, Texas (United States); Court, Laurence E., E-mail: LECourt@mdanderson.org [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston, Houston, Texas (United States)

    2014-11-15

    Purpose: To determine whether pretreatment CT texture features can improve patient risk stratification beyond conventional prognostic factors (CPFs) in stage III non-small cell lung cancer (NSCLC). Methods and Materials: We retrospectively reviewed 91 cases with stage III NSCLC treated with definitive chemoradiation therapy. All patients underwent pretreatment diagnostic contrast enhanced computed tomography (CE-CT) followed by 4-dimensional CT (4D-CT) for treatment simulation. We used the average-CT and expiratory (T50-CT) images from the 4D-CT along with the CE-CT for texture extraction. Histogram, gradient, co-occurrence, gray tone difference, and filtration-based techniques were used for texture feature extraction. Penalized Cox regression implementing cross-validation was used for covariate selection and modeling. Models incorporating texture features from the 33 image types and CPFs were compared to those with models incorporating CPFs alone for overall survival (OS), local-regional control (LRC), and freedom from distant metastases