WorldWideScience

Sample records for primary tillage implements

  1. Changes in the fertility of a leached chernozem under different primary tillage technologies

    Science.gov (United States)

    Korolev, V. A.; Gromovik, A. I.; Borontov, O. K.

    2016-01-01

    Changes in the fertility of a leached chernozem under different tillage technologies (moldboard, non-inversive, and combined tillage) were studied in a multifactor stationary field experiment established in 1985 in Voronezh oblast on a low-humus medium-deep light clayey leached chernozem. The nine-field rotation of cereals and sugar beet was practiced. It was found that the major parameters of soil fertility—the content and qualitative composition of humus and the physicochemical and physical properties of the chernozem—remained relatively stable independently from the applied primary tillage technologies. However, taking into account economic characteristics (crop yields, production costs, energy expenses, etc.), the combined tillage system proved to be most efficient. It can be recommended for cereals-sugar beet rotation systems in the central chernozemic region, as it ensures the highest efficiency of crop growing and preserves the fertility of leached chernozems.

  2. Grassland soil tillage by three implements in an Ultisol and its physical and hydropedological implications

    Directory of Open Access Journals (Sweden)

    Manuel E. Camacho

    2015-11-01

    Full Text Available A field study was conducted to test the effects of soil tillage with 3 different implements on compaction, physical and hydropedological properties of an Ultisol under cattle production, located in San Mateo, Alajuela. An area of approximately 10 000 m2 was selected and divided into 16 plots (650 m2 each and was tilled with 3 different implements corresponding to the treatments, following an unrestricted random experimental design, with a plot as experimental unit. Soil without tillage (T, tillage by spader plow (PM, tillage by chisel plow (C or tillage by subsoiler (S were established as treatments. Forty days after tillage treatments, soil penetration resistance every 5 cm up to 50 cm deep was assessed, and gravimetric moisture content, bulk and particle density, water infiltration and hydraulic conductivity, all of them up to the first 10 cm deep, all of them were measured. Soil compaction, expressed as soil penetration resistance, was reduced by tillage treatments; the lowest values for soil compaction were found in the spader plow treatment (PM. This same treatment enhanced cumulated infiltration (38.70±3.60 mm at 150 min significantly, comparing with those obtained in T treatment (0.09±0.02 mm at 150 min. No significant differences were found among tillage treatments for bulk density, total porosity and airspace, but comparing with control treatment (T they were found. Subsoiler treatment (S favored the highest values for hydraulic conductivity, but no significant differences with the other treatments were found (p>0.05.

  3. Evaluation of Net Primary Productivity and Carbon Allocation to Different Parts of Corn in Different Tillage and Nutrient Management Systems

    Directory of Open Access Journals (Sweden)

    esmat mohammadi

    2017-09-01

    Full Text Available Evaluation of net primary productivity and carbon allocation to different organs of corn under nutrient management and tillage systems Introduction Agriculture operations produce 10 to 20 percent of greenhouse gases. As a result of conventional operations of agriculture, greenhouse gases have been increased (Osborne et al., 2010. Therefor it is necessary to notice to carbon sequestration to reduce greenhouse gases emissions. In photosynthesis process, plants absorb CO2 and large amounts of organic carbon accumulate in their organs. Biochar is produced of pyrolysis of organic compounds. Biochar is an appropriate compound for improved of soil properties and carbon sequestration (Whitman and Lehmann, 2009; Smith et al., 2010. Conservation tillage has become an important technology in sustainable agriculture due to its benefits. So the aim of this study was to evaluate the effect of nutrient management and tillage systems on net primary production and carbon allocation to different organs of corn in Shahrood. Material and methods This study was conducted at the Shahrood University of Technology research farm. Experiment was done as split plot in randomized complete block design with three replications. Tillage systems with two levels (conventional tillage and minimum tillage were as the main factor and nutrient management in seven levels including (control, chemical fertilizer, manure, biochar, chemical fertilizer + manure, chemical fertilizer + biochar, manure + biochar were considered as sub plot. At the time of maturity of corn, was sampled from its aboveground and belowground biomasses. Carbon content of shoot, seed and root was considered almost 45 percent of yield of each of these biomasses and carbon in root exudates almost 65 percent of carbon in the root. Statistical analysis of the data was performed using SAS program. Comparison of means was conducted with LSD test at the 5% level. Results and discussion Effect of nutrient management was

  4. Integrated Palmer Amaranth Management in Glufosinate-Resistant Cotton: II. Primary, Secondary and Conservation Tillage

    Directory of Open Access Journals (Sweden)

    Michael G. Patterson

    2013-01-01

    Full Text Available A three year field experiment was conducted to evaluate the role of soil inversion, cover crops and spring tillage methods for Palmer amaranth between-row (BR and within-row (WR management in glufosinate-resistant cotton. Main plots were two soil inversion treatments: fall inversion tillage (IT and non-inversion tillage (NIT. Subplots were three cover treatments: crimson clover, cereal rye or none (i.e., winter fallow; and the sub subplots were four secondary spring tillage methods: disking followed by (fb cultivator (DCU, disking fb chisel plow (DCH, disking fb disking (DD and no tillage (NT. Averaged over years and soil inversion, the crimson clover produced maximum cover biomass (4390 kg ha−1 fb cereal rye (3698 kg ha−1 and winter fallow (777 kg ha−1. Two weeks after planting (WAP and before the postemergence (POST application, Palmer amaranth WR and BR density were two- and four-times less, respectively, in IT than NIT. Further, Palmer amaranth WR and BR density were reduced two-fold following crimson clover and cereal rye than following winter fallow at 2 WAP. Without IT, early season Palmer amaranth densities were 40% less following DCU, DCH and DD, when compared with IT. Following IT, no spring tillage method improved Palmer amaranth control. The timely application of glufosinate + S-metolachlor POST tank mixture greatly improved Palmer amaranth control in both IT and NIT systems. The highest cotton yields were obtained with DD following cereal rye (2251 kg ha−1, DD following crimson clover (2213 kg ha−1 and DD following winter fallow (2153 kg ha−1. On average, IT cotton yields (2133 kg ha−1 were 21% higher than NIT (1766 kg ha−1. Therefore, from an integrated weed management standpoint, an occasional fall IT could greatly reduce Palmer amaranth emergence on farms highly infested with glyphosate-resistant Palmer amaranth. In addition, a cereal rye or crimson clover cover crop can effectively reduce early season Palmer

  5. Soil tillage

    OpenAIRE

    Dierauer, Hansueli

    2013-01-01

    The web platform offers a compilation of various formats and materials dealing with reduced tillage and its challenges regarding weeds. A selection of short movies about mechanical weeding, green manure and tailor-made machinery is listed. Leaflets and publications on reduced tillage can be downloaded. In there, different treatments and machinery are tested and compared to advice farmers on how to conserve soil while keeping weed under control. For Swiss farmers information on the leg...

  6. Optimal Draft requirement for vibratory tillage equipment using Genetic Algorithm Technique

    Science.gov (United States)

    Rao, Gowripathi; Chaudhary, Himanshu; Singh, Prem

    2018-03-01

    Agriculture is an important sector of Indian economy. Primary and secondary tillage operations are required for any land preparation process. Conventionally different tractor-drawn implements such as mouldboard plough, disc plough, subsoiler, cultivator and disc harrow, etc. are used for primary and secondary manipulations of soils. Among them, oscillatory tillage equipment is one such type which uses vibratory motion for tillage purpose. Several investigators have reported that the requirement for draft consumption in primary tillage implements is more as compared to oscillating one because they are always in contact with soil. Therefore in this paper, an attempt is made to find out the optimal parameters from the experimental data available in the literature to obtain minimum draft consumption through genetic algorithm technique.

  7. The effect of conservation tillage forward speed and depth on farm fuel consumption

    Directory of Open Access Journals (Sweden)

    A Jalali

    2015-09-01

    Full Text Available Introduction: In recent years, production techniques and equipment have been developed for conservation tillage systems that have been adopted by many farmers. With proper management, overall yield averages for conventional and reduced tillage systems are nearly identical. Sometimes, field operations can be combined by connecting two or more implements. Much research has focused on either reducing or eliminating tillage operations to develop sustainable crop production methods. The greatest costs in farm operations are associated with tillage due to greater specific energy requirement in tillage and the high fuel costs. Combined operations reduce both fuel consumption and time and labor requirements by eliminating at least one individual trip over the field. Light tillage, spraying, or fertilizing operations can be combined with eitherprimary or secondary tillage or planting operations. The amount of fuel saved depends on the combined operations. Generally, light tillage, spraying, and fertilizing operations consume between 0.25 and 0.50 gallons of diesel fuel per acre. Fuel savings of 0.12 to 0.33 gallons per acre can usually be expected from combining operations. Eliminating one primary tillage operation and combining one light tillage, spraying, or fertilizing operation with another tillage or planting operation can usually save at least a gallon of diesel fuel per acre. Combining operations has the added benefit of reducing wheel traffic and compaction. To improve the tillage energy efficiency, implementing effective and agronomic strategies should be improved. Different tillage systems should be tested to determine the most energy efficient ones. Tillage helps seed growth and germination through providing appropriate conditions for soil to absorb sufficient temperature and humidity. Tillage is a time consuming and expensive procedure. With the application of agricultural operations, we can save considerable amounts of fuel, time and

  8. TILLAGE EROSION: THE PRINCIPLES, CONTROLLING FACTORS AND MAIN IMPLICATIONS FOR FUTURE RESEARCH

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    Agnieszka Wysocka-Czubaszek

    2014-10-01

    Full Text Available Tillage erosion is one of the major contributors to landscape evolution in hummocky agricultural landscapes. This paper summarizes the available data describing tillage erosion caused by hand-held or other simple tillage implements as well as tools used in typical conventional agriculture in Europe and North America. Variations in equipment, tillage speed, depth and direction result in a wide range of soil translocation rates observed all over the world. The variety of tracers both physical and chemical gives a challenge to introduce the reliable model predicting tillage erosion, considering the number and type of tillage operation in the whole tillage sequence.

  9. The effects of forward speed and depth of conservation tillage on soil bulk density

    Directory of Open Access Journals (Sweden)

    A Mahmoudi

    2015-09-01

    Full Text Available Introduction: In recent years, production techniques and equipment have been developed for conservation of tillage systems that have been adopted by many farmers. With proper management, overall yield averages for conventional and reduced tillage systems are nearly identical. Sometimes, field operations can be combined by connecting two or more implements. Combined operations reduce both fuel consumption, and time and labor requirements by eliminating at least one individual trip over the field. Light tillage, spraying, or fertilizing operations can be combined with either primary or secondary tillage or planting operations. Tillage helps seed growth and germination through providing appropriate conditions for soil to absorb sufficient temperature and humidity. Moreover, it helps easier development of root through reducing soil penetration resistance. Tillage is a time-consuming and expensive procedure. With the application of agricultural operations, we can save substantial amounts of fuel, time and energy consumption. Conservation tillage loosens the soil without turning, but by remaining the plant left overs, stems and roots. Bulk density reflects the soil’s ability to function for structural support, water and solute movement, and soil aeration. Bulk densities above thresholds indicate impaired function. Bulk density is also used to convert between weight and volume of soil. It is used to express soil physical, chemical and biological measurements on a volumetric basis for soil quality assessment and comparisons between management systems. This increases the validity of comparisons by removing the error associated with differences in soil density at the time of sampling. The aim of conservation tillage is to fix the soil structure. This investigation was carried out considering the advantages of conservation tillage and less scientific research works on imported conservation tillage devices and those which are made inside the country

  10. Improving maize productivity through tillage and nitrogen management

    African Journals Online (AJOL)

    Continuous cultivation of fields with same implement (cultivator) creates a hard pan in the subsoil which adversely affects crop productivity. In addition to tillage, nitrogen management is a key factor for better crop growth and yield. Impact of different tillage systems and nitrogen management on yield attributes and grain yield ...

  11. YIELD OF MAIZE (ZEA MAYS L. ON DIFFERENT SOIL TILLAGE VARIANTS

    Directory of Open Access Journals (Sweden)

    Danijel Jug

    2006-12-01

    Full Text Available Reduced tillage, as well as the most reduced tillage – No-till – every year are becoming more important in our region. Unfortunately, the areas under reduced tillage are still very small. In order to establish optimal system of reduced soil tillage, the experimental trials were set on Chernozem soil type in northern Baranja during three vege¬tation seasons (1998/1999-2000/2001 and five soil tillage systems: CT Conventional Tillage (primary soil tillage by moldboard ploughing at 30-35 cm depth, DH Multiple Diskharrowing at 10-15 cm as primary tillage, CH Chiseling and diskharrowing (chiseling at 30-35 cm and diskharrowing at 10-15 cm as primary tillage, PD One diskharro-wing pass (diskharrowing at 10-15 cm as primary tillage, and NT No-tillage system. The highest yields were recor¬ded at CT with three-year average of 9.29 t/ha, followed by CH with 8.37 t/ha, DH with 8.07 t/ha, PD with 6.99 t/ha, whereas the lowest yields were recorded at NT treatment, with three-year average of 5.94 t/ha. The highest profit was achieved at CT treatment (665,34 HRK/ha, followed by CH (189,24 HRK/ha, DH (77,20 HRK/ha, PD (-334,95 HRK/ha and NT (-459,81 HRK/ha.

  12. EFFECTS OF DIFFERENT SOIL TILLAGE SYSTEMS ON NODULATION AND YIELD OF SOYBEAN

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    D. Jug

    2005-12-01

    Full Text Available The primary soil tillage for different crops in Croatia is generally based on mouldboard ploughing which is the most expensive for crops production. Negative effects due to frequent passes by equipment and machines (deterioration of soil structure, soil compaction, lower biogenity and soil tilth, together with negative economical and energetical costs, can be lowered and avoided by introduction of reduced soil tillage or direct drilling (No-tillage. Accordingly, the main goal of this research was to determine effects of conventional and reduced soil tillage systems on yield components and nodulation ability of nitrogen fixing bacteria in soybean crop. The research was established at chernozem soil type of northern Baranja as monofactorial completely randomized block design in four repetitions. The soil tillage variants were as follows: CT Conventional Tillage (primary soil tillage by moldboard ploughing at 25-30 cm depth, DH Multiple Diskharrowing at 10-15 cm as primary tillage, and NT No-tillage system. Results show significantly lower plant density, mass of 1000 grains and grain yield at variants with reduced soil tillage in both investigation years. However, reduced tillage systems had positive trend on nitrogen-fixing bacteria nodulation, since the highest values of number and mass of nodules per plant were recorded. This research was run during the years 2002 and 2003, the last one extremely droughty, thus it requires continuation.

  13. The primary school teachers’ competence in implementing the 2013 curriculum

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    Maba Wayan

    2018-01-01

    Full Text Available This study was conducted to analyze the competence of primary school teachers in implementing the 2013 curriculum. The 2013 curriculum has been implemented in almost all schools and there are still many unsuccessful implementations in several Indonesian schools. Therefore it is important to study the teachers’ competence in implementing the 2013 curriculum. A qualitative research design was carried out in this study by utilizing argumentative descriptive analysis. The data was collected by carrying out in depth interviews to the primary schools teachers who were selected by random sampling techniques. The results of this study indicated that primary school teachers have insufficient competence in implementing the 2013 curriculum especially in designing lesson plan, lesson plan implementation and assessment practices. Consequently, it is recommended that further intensive training and focus group discussion should be held to improve the teachers’ competence in implementing the 2013 curriculum.

  14. EFFECTS OF DIFFERENT SOIL TILLAGE SYSTEMS ON NODULATION AND YIELD OF SOYBEAN

    OpenAIRE

    D. Jug; Mihaela Blažinkov; S. Redžepović; Irena Jug; B. Stipešević

    2005-01-01

    The primary soil tillage for different crops in Croatia is generally based on mouldboard ploughing which is the most expensive for crops production. Negative effects due to frequent passes by equipment and machines (deterioration of soil structure, soil compaction, lower biogenity and soil tilth), together with negative economical and energetical costs, can be lowered and avoided by introduction of reduced soil tillage or direct drilling (No-tillage). Accordingly, the main goal of this resear...

  15. Implementation of primary health care - package or process ...

    African Journals Online (AJOL)

    After establishing the commitment of the government to comprehensive primary health care (PHC), the Department of Health and provinces are now faced with the challenge of implementation. An important response has come with the recent proposed'core package of primary health care services'.' After consultation with ...

  16. Implementing Cooperative Learning in Australian Primary Schools: Generalist Teachers' Perspectives

    Science.gov (United States)

    Hennessey, Angela; Dionigi, Rylee A.

    2013-01-01

    To implement cooperative learning successfully in practice, teachers require knowledge of cooperative learning, its features and terms, and how it functions in classrooms. This qualitative study examined 12 Australian generalist primary teachers', understandings of cooperative learning and perceived factors affecting its implementation. Using…

  17. Toward interdependence: Implementation of cooperative learning in primary schools

    NARCIS (Netherlands)

    Krol-Pot, K.

    2005-01-01

    The present dissertation concerns the implementation of cooperative learning in Dutch primary schools. The focus was on the process of implementation in four experimental schools and on the outcomes at the levels of the school, the teacher and the student. Chapters 1, 2, and 3 constitute the

  18. Monitoring of Conservation Tillage and Tillage Intensity by Ground and Satellite Imagery

    Directory of Open Access Journals (Sweden)

    M.A Rostami

    2014-09-01

    Full Text Available Local information about tillage intensity and ground residue coverage is useful for policies in agricultural extension, tillage implement design and upgrading management methods. The current methods for assessing crop residue coverage and tillage intensity such as residue weighing methods, line-transect and photo comparison methods are tedious and time-consuming. The present study was devoted to investigate accurate methods for monitoring residue management and tillage practices. The satellite imagery technique was used as a rapid and spatially explicit method for delineating crop residue coverage and as an estimator of conservation tillage adoption and intensity. The potential of multispectral high-spatial resolution WorldView-2 local data was evaluated using the total of eleven satellite spectral indices and Linear Spectral Unmixing Analysis (LSUA. The total of ninety locations was selected for this study and for each location the residue coverage was measured by the image processing method and recorded as ground control. The output of indices and LSUA method were individually correlated to the control and the relevant R2 was calculated. Results indicated that crop residue cover was related to IPVI, RVI1, RVI2 and GNDVI spectral indices and satisfactory correlations were established (0.74 - 0.81. The crop residue coverage estimated from the LSUA approach was found to be correlated with the ground residue data (0.75. Two effective indices named as Infrared Percentage Vegetation Index (IPVI and Ratio Vegetation Index (RVI with maximum R2 were considered for classification of tillage intensity. Results indicated that the classification accuracy with IPVI and RVI indices in different conditions varied from 78-100 percent and therefore in good agreement with ground measurement, observations and field records.

  19. Identifying conservation hotspots using tillage erosion modeling

    Science.gov (United States)

    Tillage operations redistribute soil within agricultural landscapes due to deviations in the quantity of soil moved during tillage. Tillage erosion is the net loss or accumulation of soil at any spot within an agricultural landscape due to soil being directly moved by tillage; it is a dominant erosi...

  20. Implementation strategies for collaborative primary care-mental health models.

    Science.gov (United States)

    Franx, Gerdien; Dixon, Lisa; Wensing, Michel; Pincus, Harold

    2013-09-01

    Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice. Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives. Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted.

  1. Barriers to Implementation of Primary Percutaneous Coronary Intervention in Europe

    DEFF Research Database (Denmark)

    Laut, Kristina Grønborg; Pedersen, Alma Becic; Lash, Timothy

    2011-01-01

    Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45% of European STEMI patients are currently treated with PPCI and there are large ...... is needed. Keywords Primary percutaneous coronary intervention, acute ST-elevation myocardial infarction, implementation, practice variation, registry data......Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45% of European STEMI patients are currently treated with PPCI and there are large...... the diffusion of PPCI in Europe. The lack of complete implementation and large national and regional differences arise from the interplay between technology, patients, policy makers, culture and resources. Explanations for the variation in treatment access still remain a puzzle and access to valid data...

  2. Implementing health promotion tools in Australian Indigenous primary health care.

    Science.gov (United States)

    Percival, Nikki A; McCalman, Janya; Armit, Christine; O'Donoghue, Lynette; Bainbridge, Roxanne; Rowley, Kevin; Doyle, Joyce; Tsey, Komla

    2018-02-01

    In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services. Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model. An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing. The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  3. Energy indices in irrigated wheat production under conservation and conventional tillage and planting methods

    Directory of Open Access Journals (Sweden)

    S. M Hosseini

    2016-04-01

    Full Text Available Introduction: Conservation tillage system was recommended for soil erosion control in North America for the first time 60 years ago (Wang et al., 2006. Using this tillage system including minimum and zero tillage has been rapidly developed in recent years. Thearea covered by zero tillage in 2006 was 95 million ha all over the world (Dumanski et al., 2006. In addition to saving soil and water resources, conservation tillage system reduces energy consumption and improves energy indices by combining different tillage and planting operations. Results of research conducted in Fars province shows that conservation tillage saves fuel consumption for 77% compared to the conventional system (Afzalinia et al., 2009. Conservation tillage also reduces energy consumption from 23.6 to 42.8% in comparison to the conventional tillage (Rusu, 2005. Since energy indices would be affected by reduced input energies in conservation tillage, this research was conducted to evaluate the effect of different tillage and planting methods on energy inputs and energy indices in irrigated wheat production in Eghlid region. Materials and Methods: This research was performed to evaluate and compare the energy indices in irrigated wheat production under different tillage and planting methods. The study was conducted in the form of a randomized complete block experimental design with five treatments and three replications in Eghlid region. The treatments were included, conventional tillage and seed broadcasting (A, conventional tillage and planting with Machine Barzegar grain drill (B, reduced tillage and seeding with Roto-seeder (C, direct seeding with Jairan Sanaat grain drill (D, and direct seeding with Sfoggia direct drill (E. Experimental plots with 10 by 50 m dimensions were used in this study. Loss crop residues were taken out of the experimental plots and standing crop residues were retained in the plots. In the conventional tillage method, primary tillage was performed

  4. Implementation of the Brazilian primary standard for x-rays

    International Nuclear Information System (INIS)

    Peixoto, J.G.P.; Almeida, C.E.V. de

    2002-01-01

    In the field of ionizing radiation metrology, a primary standard of a given physical quantity is essentially an experimental set-up which allows one to attribute a numerical value to a particular sample of that quantity in terms of a unit given by an abstract definition. The absolute measurement of the radiation quantity air kerma, is performed with a free-air ionization chamber. A great deal of research to determine the absolute measurement resulted in different designs for primary standard free-air ionization chambers such as cilindrics or plane parallel chambers. The implementation of primary standard dosimetry with free-air ionization chambers is limited to the National Metrology Institutes - NMIs. Since 1975, the Bureau International des Poids et Mesures - BIPM has been conducting comparisons of NMIs primary free-air standard chambers in the medium energy x-rays range. These comparisons are carried out indirectly through the calibration at both the BIPM and at the NMI of one or more transfer ionization chambers at a series of four reference radiation qualities. The scientific work programme of the National Laboratory for Ionizing Radiation Metrology - LNMRI of the Institute of Radioprotection and Dosimetry - IRD, which belongs to the National Commission of Nuclear Energy - CNEN, includes the establishment of a primary standard for x-rays of medium energy x-ray range. This activity is justified by the demand to calibrate periodically Brazilian network of the secondary standards without losing quality of the measurement. The LNMRI decided to implement four reference radiation qualities establishing the use of a transfer chamber calibrated at BIPM. The LNMRI decided to implement the primary standard dosimetry using a free-air ionization chamber with variable volume, made by Victoreen, model 480. Parameters related to the measurement of the quantity air kerma were evaluated, such as: air absorption, scattering inside the ionization chamber, saturation, beam

  5. Hypertension guideline implementation: experiences of Finnish primary care nurses

    DEFF Research Database (Denmark)

    Alanen, Seija; Ijäs, Jarja; Kaila, Minna

    2008-01-01

    RATIONALE, AIMS AND OBJECTIVES: Evidence-based guidelines on hypertension have been developed in many western countries. Yet, there is little evidence of their impact on the clinical practices of primary care nurses. METHOD: We assessed the style of implementation and adoption of the national...... Hypertension Guideline (HT Guideline) in 32 Finnish health centres classified in a previous study as 'disseminators' (n = 13) or 'implementers' (n = 19). A postal questionnaire was sent to all nurses (n = 409) working in the outpatient services in these health centres. Additionally, senior nursing officers...... were telephoned to enquire if the implementation of the HT Guideline had led to a new division of labour between nurses and doctors. RESULTS: Questionnaires were returned from 327 nurses (80.0%), while all senior nursing officers (n = 32) were contacted. The majority of nurses were of the opinion...

  6. Tillage practices and identity formation in High Plains farming

    DEFF Research Database (Denmark)

    Strand, Katherine; Arnould, Eric; Press, Melea

    2014-01-01

    farming, recognition and denunciation of other farmers’ practices, and recognition and justification of their own contribute to identity formation. This research contributes to the ongoing discussion of how identity is formed through day-to-day activities in the material world. The plow creates divisions...... landscape. Specifically, they compare conservation tillage wedded to ‘modern’ ideologies of scientific farming with conventional tillage newly linked to beliefs about both organic and traditional farming, and examine how farmers use these different forms of tillage to create their identities. Roadside...... in the High Plains community between organic farmers who continue to rely on this implement in their material engagement with the land and the chemical farmers who distance their practices from the plow as they distinguish themselves as stewards of the soil....

  7. [Implementation of evidence based medicine in primary care].

    Science.gov (United States)

    Rinnerberger, Andreas; Grafinger, Michaela; Melchardt, Thomas; Sönnichsen, Andreas

    2009-01-01

    The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.

  8. Improvement of native grassland by legumes introduction and tillage techniques

    Directory of Open Access Journals (Sweden)

    Syamsu Bahar

    1999-10-01

    Full Text Available A factorial design using three species of legumes (Siratro, Centro and Stylo and three different of tillage techniques (no-tillage, minimum tillage and total tillage was applied in this experiment. The results showed that there was no interaction between species and tillage techniques. There was significant reductions on bulk density from 1.23±0.03 g/cm3 (no-tillage to 1.07±0.02 g/cm3 (minimum tillage and 1.05±0.03 g/cm3 (total tillage. Also reductions on penetration resistance from 17.47±3.84 kg/cm2 (no-tillage to 3.31±0.43 kg/cm2 (minimum tillage and 3.19±0.45 kg/cm2 (total tillage. Otherwise significant increasing on aeration porosity from 12.80±0.80% vol. (no-tillage to 21.70±0.95% vol. (minimum tillage and 20.70±0.35% vol. (total tillage. Total tillage gives increased dry matter yield. Also both total tillage and minimum tillage give yields with a higher percentage of legumes compared with no-tillage. It was concluded that total tillage and minimum tillage could be used for improving native grassland.

  9. Use of multispectral Ikonos imagery for discriminating between conventional and conservation agricultural tillage practices

    Science.gov (United States)

    Vina, Andres; Peters, Albert J.; Ji, Lei

    2003-01-01

    There is a global concern about the increase in atmospheric concentrations of greenhouse gases. One method being discussed to encourage greenhouse gas mitigation efforts is based on a trading system whereby carbon emitters can buy effective mitigation efforts from farmers implementing conservation tillage practices. These practices sequester carbon from the atmosphere, and such a trading system would require a low-cost and accurate method of verification. Remote sensing technology can offer such a verification technique. This paper is focused on the use of standard image processing procedures applied to a multispectral Ikonos image, to determine whether it is possible to validate that farmers have complied with agreements to implement conservation tillage practices. A principal component analysis (PCA) was performed in order to isolate image variance in cropped fields. Analyses of variance (ANOVA) statistical procedures were used to evaluate the capability of each Ikonos band and each principal component to discriminate between conventional and conservation tillage practices. A logistic regression model was implemented on the principal component most effective in discriminating between conventional and conservation tillage, in order to produce a map of the probability of conventional tillage. The Ikonos imagery, in combination with ground-reference information, proved to be a useful tool for verification of conservation tillage practices.

  10. Effect of Tillage Systems with Corn Residue on Grain Yield of Rapeseed in Moghan Region

    Directory of Open Access Journals (Sweden)

    J Taghinazhad

    2014-09-01

    Full Text Available This study carried out to evaluate the effect of different tillage systems on rapeseed yield (hayola 401 planted in corn residues. This experiment was done in Moghan region with clay soils during 2009-2012. Different seedbed preparation methods include MT: moldboard + disk tillage (conventional tillage was included, SCT: Stem Crusher + chisel + disk tandem harrow, STT: Stem Crusher + double-disc, CT: chisel + disk tillage and DD: two heavy disks. The experiment was conducted in a randomized complete block design with four replications. The results showed that soil bulk density in the 0-10 cm layer was not significant in different tillage treatments, but it was significantly higher than the conventional tillage in 10-20 cm depth. However, penetration resistance in 10-30 cm under DD was significantly higher than other treatments, but it was not significant in 0-10 cm layer among all tillage treatments. Thus, Comparison of the soil bulk density, penetration resistance, and plant establishment showed that the reduced tillage in canola seedbed preparation was effective. Besides, the surveys indicated that there was a significant different between MWD after primary and secondary tillage. The mean diameter weighted under SCT and DD, were 1.19 and 1.24 cm, respectively had the best status. The highest value and the worst status of this parameter observed for MT which was 1.92 cm. The highest rate of grain yield obtained by application of treatment SCT, and it was 2563.8 kg ha-1, The SCT treatment can be recommended as an effective canola bed preparation due to its significant saving in time and cost after corn harvesting.

  11. Long-term effects of conventional and reduced tillage systems on soil condition and yield of maize

    Science.gov (United States)

    Rátonyi, Tamás; Széles, Adrienn; Harsányi, Endre

    2015-04-01

    As a consequence of operations which neglect soil condition and consist of frequent soil disturbance, conventional tillage (primary tillage with autumn ploughing) results in the degradation and compaction of soil structure, as well as the reduction of organic matter. These unfavourable processes pose an increasing economic and environmental protection problem today. The unfavourable physical condition of soils on which conventional tillage was performed indicate the need for preserving methods and tools. The examinations were performed in the multifactorial long-term tillage experiment established at the Látókép experiment site of DE MÉK. The experiment site is located in the Hajdúság loess ridge (Hungary) and its soil is loess-based calcareous chernozem with deep humus layer. The physical soil type is mid-heavy adobe. The long-term experiment has a split-split plot design. The main plots are different tillage methods (autumn ploughing, spring shallow tillage) without replication. In this paper, the effect of conventional and reduced (shallow) tillage methods on soil conditions and maize yield was examined. A manual penetrometer was used to determine the physical condition and compactedness of the soil. The soil moisture content was determined with deep probe measurement (based on capacitive method). In addition to soil analyses, the yield per hectare of different plots was also observed. In reduced tillage, one compacted layer is shown in the soil resistance profile determined with a penetrometer, while there are two compacted layers in autumn ploughing. The highest resistance was measured in the case of primary tillage performed at the same depth for several years in the compacted (pan disk) layer developed under the developed layer in both treatments. The unfavourable impact of spring shallow primary tillage on physical soil conditions is shown by the fact that the compaction of the pan disk exceed the critical limit value of 3 MPa. Over the years, further

  12. The influence of conservation tillage methods on soil water regimes in semi-arid southern Zimbabwe

    Science.gov (United States)

    Mupangwa, W.; Twomlow, S.; Walker, S.

    Planting basins and ripper tillage practices are major components of the recently introduced conservation agriculture package that is being extensively promoted for smallholder farming in Zimbabwe. Besides preparing land for crop planting, these two technologies also help in collecting and using rainwater more efficiently in semi-arid areas. The basin tillage is being targeted for households with limited or no access to draught animals while ripping is meant for smallholder farmers with some draught animal power. Trials were established at four farms in Gwanda and Insiza in southern Zimbabwe to determine soil water contributions and runoff water losses from plots under four different tillage treatments. The tillage treatments were hand-dug planting basins, ripping, conventional spring and double ploughing using animal-drawn implements. The initial intention was to measure soil water changes and runoff losses from cropped plots under the four tillage practices. However, due to total crop failure, only soil water and runoff were measured from bare plots between December 2006 and April 2007. Runoff losses were highest under conventional ploughing. Planting basins retained most of the rainwater that fell during each rainfall event. The amount of rainfall received at each farm significantly influenced the volume of runoff water measured. Runoff water volume increased with increase in the amount of rainfall received at each farm. Soil water content was consistently higher under basin tillage than the other three tillage treatments. Significant differences in soil water content were observed across the farms according to soil types from sand to loamy sand. The basin tillage method gives a better control of water losses from the farmers’ fields. The planting basin tillage method has a greater potential for providing soil water to crops than ripper, double and single conventional ploughing practices.

  13. Implementing primary health care: some problems of creating national programmes.

    Science.gov (United States)

    Vaughan, J P; Walt, G

    1984-07-01

    While there is a great deal of agreement about the principles underlying Primary Health Care (PHC), there exist many problems, political, planning and management, involved in putting the approach into effect. Some of these difficulties are discussed. It is clear that the PHC approach is essentially political; the way it is implemented in each country will reflect the political priorities and systems of that country. Moreover, ministries of health are not known for their strong position in the ministerial pecking order. Finance and planning ministeries would have to be won over to the importance of the concept of PHC to try to eexpand the health budget and to change the emphasis of existing resource allocation patterns. Costs incurred by a PHC approach ( e.g., expensive transport and communication systems), and resources needed to finance it may be available; however, they may not be channelled to the politically less articulate groups in rural areas. Political implications are not limited to national levels; considerable conflict may exist between different status groups and classes at the village level, thus sabotaging PHC plans. Professional politics will also be played at all levels. It is equally essential to recognize the historical context in which PHC is being introduced. Many countries have inherited colonial infrastructures. Changing the values, perceptions, expectations, administration and organization that accompany such systems is extremely hard, and to put PHC into effect demands radical changes. The planning difficulties which beset PHC are related to the still large private provision of social services like health, and to a flourishing traditional private sector in many developing countries. These may limit the implementation of a national health policy and PHC may thus result in a very patchy service throughout the country. The level of centralized planning will also affect resource allocation and therefore the policy, planning and implementation

  14. Primary English Language Education Policy in Vietnam: Insights from Implementation

    Science.gov (United States)

    Nguyen, Hoa Thi Mai

    2011-01-01

    The introduction of English in primary education curricula is a phenomenon occurring in many non-English-speaking countries in Asia, including Vietnam. Recently, the Ministry of Education and Training (MOET) in Vietnam issued guidelines for the piloting of an English as a foreign language (EFL) primary curriculum in which English is taught as a…

  15. Soil tillage practices and crops rotations effects on yields and ...

    African Journals Online (AJOL)

    Methodology and Results: Three soil tillage practices in main plot (T1 = no tillage with direct sowing, T2 = minimum tillage by soil scarifying with IR12 tool and T3 = conventional tillage with animals drawn plough) were compared and combined to four crops rotation systems, in a split-plot experimental design. Soil chemical ...

  16. Politicising curriculum implementation: The case of primary schools

    African Journals Online (AJOL)

    Department of Educational Leadership and Management, University of South Africa, Pretoria, South Africa pillav2@unisa.ac. ... primary school educators; South Africa; teacher unions ...... Science and Technology Education, 16(3):273–. 288.

  17. The Energy Effectiveness Of Crops In Crop Rotation Under Different Soil Tillage Systems

    Directory of Open Access Journals (Sweden)

    Strašil Zdeněk

    2015-09-01

    Full Text Available The paper identifies and compares the energy balance of winter wheat, spring barley and white mustard – all grown in crop rotation under different tillage conditions. The field trial included the conventional tillage (CT method, minimum tillage (MT and a system with no tillage (NT. The energy inputs included both the direct and indirect energy component. Energy outputs are evaluated as gross calorific value (gross heating value of phytomass dry matter of the primary product and the total harvested production. The energy effectiveness (energy output: energy input was selected for evaluation. The greatest energy effectiveness for the primary product was established as 6.35 for barley, 6.04 for wheat and 3.68 for mustard; in the case of total production, it was 9.82 for barley, 10.08 for wheat and 9.72 for mustard. When comparing the different tillage conditions, the greatest energy effectiveness was calculated for the evaluated crops under the MT operation and represented the primary product of wheat at 6.49, barley at 6.69 and mustard at 3.92. The smallest energy effectiveness for the primary product was found in wheat 5.77 and barley 6.10 under the CT option; it was 3.55 for mustard under the option of NT. Throughout the entire cropping pattern, the greatest energy effectiveness was established under the minimum tillage option – 5.70 for the primary product and 10.47 for the total production. On the other hand, the smallest values were calculated under CT – 5.22 for the primary product and 9.71 for total production.

  18. Implementing Inclusive Education in Primary Schools in Bangladesh: Recommended Strategies

    Science.gov (United States)

    Ahmmed, Masud; Mullick, Jahirul

    2014-01-01

    Continued discrimination towards, and exclusion of, children with special needs, combined with the high dropout rate of students from socio-economically disadvantaged backgrounds, creates considerable pressure on the inclusive education (IE) reform initiatives of developing countries. To minimise the challenges to implementing IE reform policies…

  19. BLENDED LEARNING COURSE FOR FUTURE PRIMARY SCHOOL TEACHERS IMPLEMENTATION

    Directory of Open Access Journals (Sweden)

    Vira V. Kotkova

    2017-09-01

    Full Text Available Ukrainian and foreign scientists’ views on the essence of blended learning are analyzed in the article. The author's definition of a blended learning course is presented. The process of such course designing is described according to target, motivational, substantive, operational and diagnostic components. Both the structure of the blended learning course implementation as well as students’ educational-cognitive activity distribution between classroom learning and distance course are shown. The problems for students, teachers, and educational institutions of blended courses effective implementation are summarized. Students’ academic performance of three years study is analyzed. The results of students’ questioning to determine their perception of blended learning course are described according to the following categories: the effectiveness of blended course, evaluation objectivity, motivation to study, the use of plagiarism in studies, understanding of blended learning course.

  20. [Pharmacogenetics in primary health care: implementation and future expectations].

    Science.gov (United States)

    Houwink, Elisa J F; Rigter, Tessel; Swen, Jesse J; Cornel, Martina C; Kienhuis, Anne; Rodenburg, Wendy; Weda, Marjolein

    2015-01-01

    Personalised medicine is a targeted approach to the prevention, diagnosis and treatment of disorders on the basis of the specific genetic profile of the patient. Pharmacogenetics research shows that differences in the genetic profile of patients explain the interindividual differences in efficacy and side effects of medicines. Although there are high expectations of personalised medicine and pharmacogenetics in healthcare, both are only used to a limited extent to date. Pharmacogenetics seems particularly important in diseases with a poor prognosis and treatments with potentially serious side effects. Pharmacogenetics testing is reimbursed in the case of serious side effects or unexpected ineffectiveness. 95% of patients in the Netherlands have at least one abnormality in the panel of genes for which guidance is available. The KNMP (Royal Dutch Pharmacists' Association) provides dosing advice based on genotype for 80 medicines, 27 of which are regularly prescribed in primary health care.

  1. Implementation of a primary standard for x-ray exposure

    International Nuclear Information System (INIS)

    Peixoto, Jose Guilherme Pereira

    1991-04-01

    In the scientific program of the National Laboratory for Ionizing Radiation Metrology of the Instituto de Radioprotecao e Dosimetria, which belongs to the Comissao Nacional de Energia Nuclear, a free-air ionization chamber should be established as an exposure primary standard for X-ray s of 10OKV to 250kV of potential range. Preliminary results showed that the available free-air ionization chamber was suitable to be used. The absolute measurement of the radiation quantity exposure, is performed with a free-air ionization chamber. Its geometrical volume, which allows the determination of the air mass, is defined by the effective aperture area and by the length of the region where an electrical field is applied. Most of the ions produced in such volume are collected as an ionization current. Since the collecting rod is small, and positioned far away from the X-ray beam, only a negligible fraction of ionization (0,01 %) is lost due to interactions with it. Parameters related to the measurement of the quantity exposure were evaluated, such as: air absorption, scattering inside the ionization chamber, saturation , beam homogeneity, influence Of beam size and influences of temperature, humidity and atmospheric pressure.Preliminary determination of correction factors has showed good results with 99.9% of repeatability and has demonstrated the reliability of the checked chamber as a standard instrument. (author)

  2. The effect of different tillage methods and organic fertilizers on soil physical state and crop yield

    OpenAIRE

    Ožeraitienė, Danutė; Čiuberkis, Steponas

    2006-01-01

    The present paper summarises the data of field and laboratory trials conducted in Lithuania (Vežaiciai Branch of the Lithuanian Institute of Agriculture) during the period 2003-2006. The effects of primary soil tillage: 1) deep (22-25 cm) ploughing; 2) shallow (10-12 cm) ploughing; 3) shallow (8-10 cm) tillage with a disc harrow as well as the effects of different organic fertilizers (farmyard manure, green manure and straw) on the main physical indicators of moraine loam soil (structure, bul...

  3. Do primary care professionals agree about progress with implementation of primary care teams: results from a cross sectional study.

    Science.gov (United States)

    Tierney, E; O'Sullivan, M; Hickey, L; Hannigan, A; May, C; Cullen, W; Kennedy, N; Kineen, L; MacFarlane, A

    2016-11-22

    Primary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals' views of this process. This study compares Primary Healthcare Professionals' perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland. Design and Setting: e-survey of (1) General Practitioners (GPs) associated with a Graduate Medical School (N = 100) and (2) Primary Care Professionals in 3 of 4 Health Service Executive (HSE) regions (N = 2309). After piloting, snowball sampling was used to administer the survey. Descriptive analysis was carried out using SPSS. Ratings across groups were compared using non-parametric tests. There were 569 responses. Response rates varied across disciplines (71 % for GPs, 22 % for other Primary Healthcare Professionals (PCPs). Respondents across all disciplines viewed interdisciplinary working as important. Respondents agreed on lack of progress of implementation of formal PCTs (median rating of 2, where 1 is no progress at all and 5 is complete implementation). GPs were more negative about the effectiveness of the Strategy to promote different disciplines to work together (median rating of 2 compared to 3 for clinical therapists and 3.5 for nurses, P = 0.001). Respondents identified resources and GP participation as most important for effective team working. Protected time for meetings and capacity to manage workload for meetings were rated as very important factors for effective team working by GPs, clinical therapists and nurses. A building for co-location of teams was rated as an important factor by nurses and clinical therapists though GPs rated it as less important. Payment to attend meetings and contractual arrangements were considered important factors by

  4. Developing and Implementing a Mobile Conservation Education Unit for Rural Primary School Children in Lao PDR

    Science.gov (United States)

    Hansel, Troy; Phimmavong, Somvang; Phengsopha, Kaisone; Phompila, Chitana; Homduangpachan, Khiaosaphan

    2010-01-01

    In this article, the authors examine the implementation and success of a mobile conservation education unit targeting primary schools in central Lao PDR (People's Democratic Republic). The mobile unit conducted 3-hour interactive programs for school children focused on the importance of wildlife and biodiversity around the primary schools in rural…

  5. The Implementation of Character Education Model Based on Empowerment Theatre for Primary School Students

    Science.gov (United States)

    Anggraini, Purwati; Kusniarti, Tuti

    2016-01-01

    This study aimed at constructing character education model implemented in primary school. The research method was qualitative with five samples in total, comprising primary schools in Malang city/regency and one school as a pilot model. The pilot model was instructed by theatre coach teacher, parents, and school society. The result showed that…

  6. Implementing clinical decision support for primary care professionals – the process

    DEFF Research Database (Denmark)

    Kortteisto, Tiina; Komulainen, Jorma; Kunnamo, Ilkka

    2012-01-01

    implementation of eCDS requires time and repeated supportive input. Primary care professionals need time and training for adapting eCDS in their daily routine. In addition, the eCDS content should be tailored to fulfil different professionals’ information needs in primary care practice....

  7. Implementing Curriculum-Embedded Formative Assessment in Primary School Science Classrooms

    Science.gov (United States)

    Hondrich, Annika Lena; Hertel, Silke; Adl-Amini, Katja; Klieme, Eckhard

    2016-01-01

    The implementation of formative assessment strategies is challenging for teachers. We evaluated teachers' implementation fidelity of a curriculum-embedded formative assessment programme for primary school science education, investigating both material-supported, direct application and subsequent transfer. Furthermore, the relationship between…

  8. The effect of tillage systems and mulching on soil microclimate ...

    African Journals Online (AJOL)

    STORAGESEVER

    2008-12-17

    Dec 17, 2008 ... Most of these traditional farmers employ zero tillage system and mulching .... Based on tillage systems, some researchers have ... The planting activity took ... tree as practised by most traditional farmers, owing to the high cost.

  9. 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

  10. Determination of crop residues and the physical and mechanical properties of soil in different tillage systems

    Directory of Open Access Journals (Sweden)

    P Ahmadi Moghaddam

    2016-04-01

    achieved using chisel and disk plows. Finally, disk plough is recommended as an appropriate tool in this research due to the high percentage of crop residues, lower mechanical resistance, lower bulk density, and higher stability of aggregates in the soil. Generally, in short-term period, conservation tillage (reduced tillage and minimum tillage results the improvement of soil physical quality in comparison with tillage operation. Further studies on long-term effects of various tillage systems are suggested in order to select and implement of optimum tillage method in the region.

  11. Tillage system affects microbiological properties of soil

    Science.gov (United States)

    Delgado, A.; de Santiago, A.; Avilés, M.; Perea, F.

    2012-04-01

    Soil tillage significantly affects organic carbon accumulation, microbial biomass, and subsequently enzymatic activity in surface soil. Microbial activity in soil is a crucial parameter contributing to soil functioning, and thus a basic quality factor for soil. Since enzymes remain soil after excretion by living or disintegrating cells, shifts in their activities reflect long-term fluctuations in microbial biomass. In order to study the effects of no-till on biochemical and microbiological properties in comparison to conventional tillage in a representative soil from South Spain, an experiment was conducted since 1982 on the experimental farm of the Institute of Agriculture and Fisheries Research of Andalusia (IFAPA) in Carmona, SW Spain (37o24'07''N, 5o35'10''W). The soil at the experimental site was a very fine, montomorillonitic, thermic Chromic Haploxerert (Soil Survey Staff, 2010). A randomized complete block design involving three replications and the following two tillage treatments was performed: (i) Conventional tillage, which involved mouldboard plowing to a depth of 50 cm in the summer (once every three years), followed by field cultivation to a depth of 15 cm before sowing; crop residues being burnt, (ii) No tillage, which involved controlling weeds before sowing by spraying glyphosate and sowing directly into the crop residue from the previous year by using a planter with double-disk openers. For all tillage treatments, the crop rotation (annual crops) consisted of winter wheat, sunflower, and legumes (pea, chickpea, or faba bean, depending on the year), which were grown under rainfed conditions. Enzymatic activities (ß-glucosidase, dehydrogenase, aryl-sulphatase, acid phosphatase, and urease), soil microbial biomass by total viable cells number by acridine orange direct count, the density of cultivable groups of bacteria and fungi by dilution plating on semi-selective media, the physiological profiles of the microbial communities by BiologR, and the

  12. Implementing Digital Storytelling as a Technology Integration Approach with Primary School Children

    Directory of Open Access Journals (Sweden)

    Nuala Sweeney-Burt

    2014-06-01

    Full Text Available Irish educational policy acknowledges the importance of integrating technology meaningfully into teaching and learning at the primary level. Much remains to be done, however, in terms of developing, practically implementing and evaluating the use of technology in the Irish primary classroom. This paper describes a study on the use of a structured approach to digital storytelling as a tool for meaningful technology integration with children at primary level. In this study, the researcher developed a structured approach for implementing digital storytelling with primary school children, and collaborated with a class teacher in an Irish primary school to prepare to implement the approach. Multiple qualitative methods were used to evaluate the implementation, including interviews with the teacher, classroom observation, and focus group interviews with participating children. The results suggested that this structured approach to digital storytelling has the potential to be used successfully as a meaningful technology integration approach with this cohort. The findings also explored implications for the implementation of digital storytelling at primary level, and identified aspects on which further research should be undertaken to enhance and extend the approach that was used.

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

    Science.gov (United States)

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

    2018-01-30

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

  14. Implementing change in primary care practices using electronic medical records: a conceptual framework.

    Science.gov (United States)

    Nemeth, Lynne S; Feifer, Chris; Stuart, Gail W; Ornstein, Steven M

    2008-01-16

    Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting

  15. Translocation of Soil Particles during Secondary Soil Tillage along Contour Lines

    Directory of Open Access Journals (Sweden)

    Novák Petr

    2018-04-01

    Full Text Available A high percentage of arable land and erosion risk on agricultural land are typical of current agriculture. While tillage erosion is a less frequently studied issue, it impacts vast areas of agricultural land. Not all relationships between cultivation equipment, the gradient of the plot and other factors have been known until now. Intensive soil tillage can be a crucial erosive factor mainly when the cultivation equipment moves in a fall line direction. Nevertheless, even when the equipment moves along contour lines, soil particles can be translocated perpendicular to the direction of the equipment movement (in a fall line direction. This phenomenon has not yet been adequately studied. For measurements, a field trial with secondary tillage of soil was laid out (a seedbed preparation implement was used. The objective of the trial was to evaluate the effect of the working tools of the cultivation equipment on the crosswise and lengthwise translocation of soil particles during soil tillage. Aluminium cubes, with a side length of 16 mm, were used as tracers. Before the operation, the tracers were inserted in a row perpendicular (at a right angle to a direction of the equipment passes. After the equipment passes, position of tracers was evaluated within a two-axis grid. The trial was performed at three gradients of the plot (2°, 6° and 11°. For each gradient, the 1-pass, 2-pass and 3-pass treatments were tested. The equipment always moved along the plot contour line. After the equipment passes in all treatments, all tracers were localized on an orthogonal grid. The results of the trial demonstrate the effect of the slope gradient on the crosswise translocation of particles during secondary tillage of soil in the slope direction. The tillage equipment translocated particles in the fall line direction even if it passed along the contour line. With the increasing intensity of passes, the effect of the equipment on crosswise translocation increases

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

    OpenAIRE

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

    1996-01-01

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

  17. Project Experiences of the Implementation of the Primary Bleed and Feed System

    International Nuclear Information System (INIS)

    Sanz, S.; Lang, J.; Schmid, J.

    2015-01-01

    Modernization activities play a very important role in the enhancement of the safety and reliability of nuclear power plants. The main focus is on increasing the plant availability, the operational flexibility or the integration of new, additional equipment to satisfy safety requirements, as in this case with the implementation of the design modification primary circuit “Primary Bleed & Feed” (PB&F) of the primary circuit, in the consideration of a beyond design basis accident. Primary B&F prevents the high pressure core melt path and allows an additional alternative heat removal by depressurising the primary system and coolant injection with passive and/or active low pressure systems, when the normal core cooling is not available because of loss of water inventory in the steam generators. The goal of this paper is to show some general good practices gained during the implementation of the Primary Bleed and Feed, System from the project conception to the system implementation. Basically, practice shows that some of the crucial factors which contributed to a successful project execution were based on (i) good interface management between the new system and the existing plant components, (ii) a close coordination of the single engineering disciplines and simultaneous activities, (iii) safety culture and quality assurance were set as priority during the entire project development. (author)

  18. Modeling Edge Effects of Tillage Erosion

    Science.gov (United States)

    Tillage erosion has been recognized as an important factor in redistribution of soil over time and in the development of morphological changes within agricultural fields. Field borders, fences, and vegetated strips that interrupt soil fluxes lead to the creation topographic discontinuities or lynche...

  19. The effect of conservation tillage on crop yield in China

    Directory of Open Access Journals (Sweden)

    Hongwen LI,Jin HE,Huanwen GAO,Ying CHEN,Zhiqiang ZHANG

    2015-06-01

    Full Text Available Traditional agricultural practices have resulted in decreased soil fertility, shortage of water resources and deterioration of agricultural ecological environment, which are seriously affecting grain production. Conservation tillage (CT research has been developed and applied in China since the 1960s and 1970s, and a series of development policies have been issued by the Chinese government. Recent research and application have shown that CT has positive effects on crop yields in China. According to the data from the Conservation Tillage Research Center (CTRC, Chinese Ministry of Agriculture (MOA, the mean crop yield increase can be at least 4% in double cropping systems in the North China Plain and 6% in single cropping systems in the dryland areas of North-east and North-west China. Crop yield increase was particularly significant in dryland areas and drought years. The mechanism for the yield increase in CT system can be attributed to enhanced soil water content and improved soil properties. Development strategies have been implemented to accelerate the adoption of CT in China.

  20. Tillage Effects on Soil Properties & Respiration

    Science.gov (United States)

    Rusu, Teodor; Bogdan, Ileana; Moraru, Paula; Pop, Adrian; Duda, Bogdan; Cacovean, Horea; Coste, Camelia

    2015-04-01

    Soil tillage systems can be able to influence soil compaction, water dynamics, soil temperature and soil structural condition. These processes can be expressed as changes of soil microbiological activity, soil respiration and sustainability of agriculture. Objectives of this study were: 1) to assess the effects of tillage systems (Conventional System-CS, Minimum Tillage-MT, No-Tillage-NT) on soil compaction, soil temperature, soil moisture and soil respiration and 2) to establish the relationship that exists in changing soil properties. Three treatments were installed: CS-plough + disc; MT-paraplow + rotary grape; NT-direct sowing. The study was conducted on an Argic-Stagnic Faeoziom. The MT and NT applications reduce or completely eliminate the soil mobilization, due to this, soil is compacted in the first year of application. The degree of compaction is directly related to soil type and its state of degradation. The state of soil compaction diminished over time, tending toward a specific type of soil density. Soil moisture was higher in NT and MT at the time of sowing and in the early stages of vegetation and differences diminished over time. Moisture determinations showed statistically significant differences. The MT and NT applications reduced the thermal amplitude in the first 15 cm of soil depth and increased the soil temperature by 0.5-2.20C. The determinations confirm the effect of soil tillage system on soil respiration; the daily average was lower at NT (315-1914 mmoli m-2s-1) and followed by MT (318-2395 mmoli m-2s-1) and is higher in the CS (321-2480 mmol m-2s-1). Comparing with CS, all the two conservation tillage measures decreased soil respiration, with the best effects of no-tillage. An exceeding amount of CO2 produced in the soil and released into the atmosphere, resulting from aerobic processes of mineralization of organic matter (excessive loosening) is considered to be not only a way of increasing the CO2 in the atmosphere, but also a loss of

  1. Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices.

    Science.gov (United States)

    Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D

    2015-08-01

    There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. © The Author(s) 2015.

  2. Primary Pre-Service Teachers' Perspectives on Constructivism and Its Implementation in the Schools

    Science.gov (United States)

    Savas Basturk

    2016-01-01

    The aim of this study was to determine pre-service teachers' perspectives on constructivism and its implementation in schools. In order to do this, a semi-structured interview was conducted with 12 primary pre-service teachers from the grades 2, 3, and 4. Four pre-service teachers were voluntarily selected from each grade for interview. Each…

  3. Results of a multidisciplinary program for patients with fibromyalgia implemented in the primary care

    NARCIS (Netherlands)

    van Wilgen, C.P.; Bloten, H.; Oeseburg, B.

    2007-01-01

    Purpose. Fibromyalgia is a syndrome of unknown origin with a high prevalence. Multimodal approaches seem to be the treatment of choice in fibromyalgia. A multidisciplinary program was developed and implemented for patients with fibromyalgia in the primary care setting. The program included education

  4. Lessons from the implementation of a near patient anticoagulant monitoring service in primary care

    Directory of Open Access Journals (Sweden)

    Simon DeLusignan

    2004-02-01

    Conclusions The group, by sharing their experiences through a structured series of workshops, developed an understanding of when it might be appropriate to vary from the decision support software’s recommendations and how this could be audited. The technological solution modelled on hospital practice proved hard to implement in primary care.

  5. Impact of Implementing a Primary Enforcement Seat Belt Law in Florida : A Case Study

    Science.gov (United States)

    2012-08-01

    On June 30, 2009, Florida implemented a primary seat belt law. The State was already engaged in a Rural : Demonstration Program (RDP) to increase belt usage in rural areas in the northern part of the State and participated : regularly in annual Click...

  6. Estimated medical cost savings in Utah by implementation of a primary seat belt law

    Science.gov (United States)

    2010-05-01

    This report examines 2007 hospital discharge data reporting cases where the external cause of injury to : a vehicle occupant was a motor vehicle crash to predict the estimated savings to Utah if a primary seat : belt law is implemented. The savings a...

  7. Estimated medical cost savings in Nevada by implementation of a primary seat belt law

    Science.gov (United States)

    2008-09-01

    This report examines 2007 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Nevada if a primary seat belt law is implemented. The savings are...

  8. Estimated medical cost savings in Rhode Island by implementation of a primary seat belt law

    Science.gov (United States)

    2008-09-01

    This report examines 2006 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Rhode Island if a primary seat belt law is implemented. The savin...

  9. Estimated medical cost savings in Massachusetts by implementation of a primary seat belt law

    Science.gov (United States)

    2008-12-01

    This report examines 2006 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to Massachusetts if a primary seat belt law is implemented. The savi...

  10. Estimated medical cost savings in Vermont by implementation of a primary seat belt law

    Science.gov (United States)

    2008-09-01

    This report examines 2005 hospital discharge data reporting cases where the external cause of injury to a vehicle occupant was a motor vehicle crash to predict the estimated savings to the State of Vermont if a primary seat belt law is implemented. T...

  11. Importance of the Primary Radioactivity Standard Laboratory and Implementation of its Quality Management

    Science.gov (United States)

    Sahagia, Maria; Razdolescu, Anamaria Cristina; Luca, Aurelian; Ivan, Constantin

    2007-04-01

    The paper presents some specific aspects of the implementation of the quality management in the Radionuclide Metrology Laboratory, from IFIN-HH, the owner of the primary Romanian standard in radioactivity. The description of the accreditation, according to the EN ISO/IEC 17025:2005, is presented.

  12. Importance of the Primary Radioactivity Standard Laboratory and Implementation of its Quality Management

    International Nuclear Information System (INIS)

    Sahagia, Maria; Razdolescu, Anamaria Cristina; Luca, Aurelian; Ivan, Constantin

    2007-01-01

    The paper presents some specific aspects of the implementation of the quality management in the Radionuclide Metrology Laboratory, from IFIN-HH, the owner of the primary Romanian standard in radioactivity. The description of the accreditation, according to the EN ISO/IEC 17025:2005, is presented

  13. Implementation of the principles of primary health care in a rural area of South Africa.

    Science.gov (United States)

    Visagie, Surona; Schneider, Marguerite

    2014-02-18

    The philosophy of primary healthcare forms the basis of South Africa's health policy and provides guidance for healthcare service delivery in South Africa. Healthcare service provision in South Africa has shown improvement in the past five years. However, it is uncertain as to whether the changes have reached rural areas and if primary healthcare is implemented successfully in these areas. The aim of this article is to explore the extent to which the principles of primary healthcare are implemented in a remote, rural setting in South Africa. A descriptive, qualitative design was implemented. Data were collected through interviews and case studies with 36 purposively-sampled participants, then analysed through Interpretative Phenomenological Analysis. Findings indicated challenges with regard to client-centred care, provision of health promotion and rehabilitation, the way care was organised, the role of the doctor, health worker attitudes, referral services and the management of complex conditions. The principles of primary healthcare were not implemented successfully. The community was not involved in healthcare management, nor were users involved in their personal health management. The initiation of a community-health forum is recommended. Service providers, users and the community should identify and address the determinants of ill health in the community. Other recommendations include the training of service managers in the logistical management of ensuring a constant supply of drugs, using a Kombi-type vehicle to provide user transport for routine visits to secondary- and tertiary healthcare services and increasing the doctors' hours.

  14. Implementation of the principles of primary health care in a rural area of South Africa

    Directory of Open Access Journals (Sweden)

    Surona Visagie

    2014-02-01

    Full Text Available Background: The philosophy of primary healthcare forms the basis of South Africa’s health policy and provides guidance for healthcare service delivery in South Africa. Healthcare service provision in South Africa has shown improvement in the past five years. However, it is uncertain as to whether the changes have reached rural areas and if primary healthcare is implemented successfully in these areas. Objectives: The aim of this article is to explore the extent to which the principles of primary healthcare are implemented in a remote, rural setting in South Africa. Method: A descriptive, qualitative design was implemented. Data were collected through interviews and case studies with 36 purposively-sampled participants, then analysed through Interpretative Phenomenological Analysis. Results: Findings indicated challenges with regard to client-centred care, provision of health promotion and rehabilitation, the way care was organised, the role of the doctor, healthworker attitudes, referral services and the management of complex conditions. Conclusion: The principles of primary healthcare were not implemented successfully. The community was not involved in healthcare management, nor were users involved in their personal health management. The initiation of a community-health forum is recommended. Service providers, users and the community should identify and address the determinants of ill health in the community. Other recommendations include the training of service managers in the logistical management of ensuring a constant supply of drugs, using a Kombi-type vehicle to provide user transport for routine visits to secondary- and tertiary healthcareservices and increasing the doctors’ hours.

  15. Reduced tillage and cover crops as a strategy for mitigating atmospheric CO2 increase through soil organic carbon sequestration in dry Mediterranean agroecosystems.

    Science.gov (United States)

    Almagro, María; Garcia-Franco, Noelia; de Vente, Joris; Boix-Fayos, Carolina; Díaz-Pereira, Elvira; Martínez-Mena, María

    2016-04-01

    The implementation of sustainable land management (SLM) practices in semiarid Mediterranean agroecosystems can be beneficial to maintain or enhance levels of soil organic carbon and mitigate current atmospheric CO2 increase. In this study, we assess the effects of different tillage treatments (conventional tillage (CT), reduced tillage (RT), reduced tillage combined with green manure (RTG), and no tillage (NT)) on soil CO2 efflux, aggregation and organic carbon stabilization in two semiarid organic rainfed almond (Prunus dulcis Mill., var. Ferragnes) orchards located in SE Spain Soil CO2 efflux, temperature and moisture were measured monthly between May 2012 and December 2014 (site 1), and between February 2013 and December 2014 (site 2). In site 1, soil CO2 efflux rates were also measured immediately following winter and spring tillage operations. Aboveground biomass inputs were estimated at the end of the growing season in each tillage treatment. Soil samples (0-15 cm) were collected in the rows between the trees (n=4) in October 2012. Four aggregate size classes were distinguished by sieving (large and small macroaggregates, free microaggregates, and free silt plus clay fraction), and the microaggregates occluded within macroaggregates (SMm) were isolated. Soil CO2efflux rates in all tillage treatments varied significantly during the year, following changes during the autumn, winter and early spring, or changes in soil moisture during late spring and summer. Repeated measures analyses of variance revealed that there were no significant differences in soil CO2 efflux between tillage treatments throughout the study period at both sites. Average annual values of C lost by soil respiration were slightly but not significantly higher under RT and RTG treatments (492 g C-CO2 m-2 yr-1) than under NT treatment (405 g C-CO2 m-2 yr-1) in site 1, while slightly but not significantly lower values were observed under RT and RTG treatments (468 and 439 g C-CO2 m-2 yr-1

  16. Possibilities And Limitations In The Implementation Of The Policy For Men's Health In Primary Care

    Directory of Open Access Journals (Sweden)

    Flávio William Brito de Azevedo Ramalho

    2017-05-01

    Full Text Available Objective: Investigate the possibilities and limitations to implement the National Policy for Integrated Healthcare in Human Primary João Pessoa - Paraíba. Method: An exploratory study with a qualitative approach using semi-structured interviews. Data were collected from September 2010 to February 2011. The study subjects were 12 nurses who engage in Integrated Health Units in João Pessoa-Paraíba. Results: In the treatment of the results we used the Content Analysis of Bardin. All respondents were female, aged 28-43 years, operating time of 7-12 years and most have expertise. The research affirms the occurrence of major deficits in the perception of health professionals regarding the implementation of the policy. Conclusion: The limits revealed require actions by users, professionals and management, so that policy becomes a reality in everyday primary care. Descriptors: Primary Health Care; Health Policy; Men's Health. Nursing.

  17. Implementation of municipal health promoting projects in primary schools: teachers perspective

    DEFF Research Database (Denmark)

    Nordin, Lone Lindegard

    2013-01-01

    . The project is funded by the Danish Ministry of Science, University of Aarhus and Silkeborg municipality, and involves 5 primary schools, 23 teachers and 233 pupils from 7th to 9 class. The project is positioned within the critical approach to school health education and health promotion, developed......Implementation of municipally health promoting projects' in primary schools: teachers perspective Research question This paper discusses the findings from a qualitative research, that aimed to investigate how teachers in primary schools implemented municipal health promoting projects focusing...... that there is a “gap” between policy and practice according to aim, content and methods, and that teachers practice can be explained as coping mechanism. The key findings include: • Teachers practice is closer to traditional health education than critical health education. • Teachers priorities the mandatory teaching...

  18. Weed-Species Abundance and Diversity Indices in Relation to Tillage Systems and Fertilization

    Directory of Open Access Journals (Sweden)

    Ilias S. Travlos

    2018-04-01

    Full Text Available Weeds pose a major threat to world agriculture by reducing detrimentally crop yield and quality. However, at the same time, weeds are major interacting components of the agroecosystems. Abundance and diversity of weeds vary significantly among the several communities. In order to evaluate each community's structure and the interactions among them, several population indices are used as key tools. In parallel, various cultivation and land management strategies, such as tillage and fertilization, are commonly used in terms of integrated weed management. Estimating the response of weed species on those practices is crucial for both biodiversity maintenance and alternative weed control methods. Many experiments have confirmed the fundamental role of tillage intensity and nutrition supply in weed species' abundance and diversity. For instance, in some studies, the abundance of perennial weeds was doubled under reduced tillage intensity. In addition, higher values of Shannon-Weiner and Pielou indices were reported in the PK fertilization treatment compared to the control and NK fertilization treatments. The objective of this paper is to provide a brief overview of the key results of these experiments and summarize the part of the literature related to the effect of tillage systems and fertilization on weed species abundance and diversity. Such knowledge could contribute to the sound design and implementation of integrated weed management programs which in turn may lead to a decrease in the density of serious and noxious weeds and an increase in the overall balance of agroecosystems.

  19. Zero tillage: A potential technology to improve cotton yield

    Directory of Open Access Journals (Sweden)

    Abbas Hafiz Ghazanfar

    2016-01-01

    Full Text Available Zero tillage technology revealed with no use of any soil inverting technique to grow crops. The crop plant seed is planted in the soil directly after irrigation to make the soil soft without any replenishing in soil layers. A study was conducted to evaluate cotton genotypes FH-114 and FH-142 for the consecutive three years of growing seasons from 2013-15. The seed of both genotypes was sown with two date of sowing, 1 March and 1 May of each three years of sowing under three tillage treatments (zero tillage, minimum tillage and conventional tillage in triplicate completely randomized split-split plot design. It was found from results that significant differences were recorded for tillage treatments, date of sowing, genotypes and their interactions. Multivariate analysis was performed to evaluate the yield and it attributed traits for potential of FH-114 and FH-142 cotton genotypes. The genotype FH-142 was found with higher and batter performance as compared to FH-114 under zero tillage, minimum tillage and conventional tillage techniques. The traits bolls per plant, boll weight, fibre fineness, fibre strength, plant height, cotton yield per plant and sympodial branches per plant were found as most contributing traits towards cotton yield and production. It was also found that FH-142 gives higher output in terms of economic gain under zero tillage with 54% increase as compared to conventional tillage technique. It was suggested that zero tillage technology should be adopted to improve cotton yield and quality. It was also recommended that further study to evaluate zero tillage as potential technology should be performed with different regions, climate and timing throughout the world.

  20. The Impact of an Implementation Project on Primary Care Staff Perceptions of Delivering Brief Alcohol Advice

    Directory of Open Access Journals (Sweden)

    Hanna Reinholdz

    2016-01-01

    Full Text Available Objective. To explore how the perceptions and experiences of working with risky drinkers change over time among primary health care staff during a systematic implementation project. Methods. Qualitative focus group interviews took place before and after the implementation of the project. Results. The staff displayed a positive change during the implementation period with regard to awareness, knowledge, and confidence that led to a change in routine practice. Throughout the project, staff were committed to engaging with risky drinkers and appeared to have been learning-by-doing. Conclusions. The results indicated a positive attitude to alcohol prevention work but staff lack knowledge and confidence in the area. The more practical experience during the study is, the more confidence seems to have been gained. This adds new knowledge to the science of implementation studies concerning alcohol prevention measures, which have otherwise shown disappointing results, emphasizing the importance of learning in practice.

  1. Desempenho de trator-implemento na cana-de-açúcar em sistemas de plantio direto e convencional Tractor-implement performance in sugarcane under no-tillage and conventional planting systems

    Directory of Open Access Journals (Sweden)

    José B. Duarte Júnior

    2008-12-01

    Full Text Available Com este trabalho objetivou-se avaliar o desempenho de conjuntos mecanizados, através da patinagem, da velocidade do trator e da viabilidade de operação de plantio da cana-de-açúcar (Saccharum sp. em sistema de plantio direto (SPD e convencional (PC sobre diferentes plantas de cobertura. O delineamento experimental utilizado foi o inteiramente casualizado (DIC, com três repetições, em esquema de faixas. Constituíram-se 24 tratamentos pelas combinações de parcelas: A1-PD da cana sobre crotalária; a²-PD da cana sobre feijão de porco; A3-PC da cana sobre mucuna preta incorporada; A4-PC da cana (testemunha; de subparcelas: B1-FORD 8430 DT + plantadora de duas linhas; B2-FORD 8430 DT + sulcador de três linhas; B3-FORD 5610 + sulcador de duas linhas; e de sub-subparcelas: C1 - 1ª marcha reduzida e C2 - 2ª marcha reduzida. Observou-se que as operações de sulcagem para posterior plantio manual ou sulcagem e plantio mecanizado da cana-de-açúcar em SPD sobre as plantas de cobertura sem serem manejadas anteriormente com roçadora ou rolo-faca, foram possíveis e igualmente eficientes quando comparadas ao PC, portanto, é possível reduzir o tempo de implantação da cultura e os custos operacionais devido à diminuição do número de operações no SPD da cana-de-açúcar.This research evaluated the performance of automated groups using slippage, tractor speed, and operational viability of planting sugarcane (Saccharum spp. in no-tillage (SPD and conventional (PC systems under different plant coverings. The experimental design was completely randomized, using three repetitions in a split-split plot. There were twenty four treatments: A1-SPD the sugarcane on sunnhemp (Crotalaria juncea; a²-SPD the sugarcane on the jack bean (Canavalia ensiformis; A3-PC the sugarcane on incorporated black mucuna (Stilozobium aterrimum; A4-PC the sugarcane (control; sub-plots: B1-FORD 8430 DT + two row crop planter; B2-FORD 8430 DT + three lines furrow

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

    Science.gov (United States)

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

    2014-05-29

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

  3. [Effect of implementation of essential medicine system in the primary health care institution in China].

    Science.gov (United States)

    Huang, Donghong; Ren, Xiaohua; Hu, Jingxuan; Shi, Jingcheng; Xia, Da; Sun, Zhenqiu

    2015-02-01

    Our primary health care institution began to implement national essential medicine system in 2009. In past fi ve years, the goal of national essential medicine system has been initially achieved. For examples, medicine price is steadily reducing, the quality of medical services is improving and residents' satisfaction is substantial increasing every year. However, at the same time, we also found some urgent problems needed to be solved. For examples, the range of national essential medicine is limited, which is difficult to guarantee the quality of essential medication. In addition, how to compensate the primary health care institution is still a question.

  4. Implementation of the structural integrity analysis for PWR primary components and piping

    International Nuclear Information System (INIS)

    Pellissier-Tanon, A.

    1982-01-01

    The trends on the definition, the assessment and the application of fracture strength evaluation methodology, which have arisen through experience in the design, construction and operation of French 900-MW plants are reviewed. The main features of the methodology proposed in a draft of Appendix ZG of the RCC-M code of practice for the design verification of fracture strength of primary components are presented. The research programs are surveyed and discussed from four viewpoints, first implementation of the LEFM analysis, secondly implementation of the fatigue crack propagation analysis, thirdly analysis of vessel integrity during emergency core cooling, and fourthly methodology for tear fracture analysis. (author)

  5. Conservation tillage impacts on soil, crop and the environment

    Directory of Open Access Journals (Sweden)

    Mutiu Abolanle Busari

    2015-06-01

    Full Text Available There is an urgent need to match food production with increasing world population through identification of sustainable land management strategies. However, the struggle to achieve food security should be carried out keeping in mind the soil where the crops are grown and the environment in which the living things survive. Conservation agriculture (CA, practising agriculture in such a way so as to cause minimum damage to the environment, is being advocated at a large scale world-wide. Conservation tillage, the most important aspect of CA, is thought to take care of the soil health, plant growth and the environment. This paper aims to review the work done on conservation tillage in different agro-ecological regions so as to understand its impact from the perspectives of the soil, the crop and the environment. Research reports have identified several benefits of conservation tillage over conventional tillage (CT with respect to soil physical, chemical and biological properties as well as crop yields. Not less than 25% of the greenhouse gas effluxes to the atmosphere are attributed to agriculture. Processes of climate change mitigation and adaptation found zero tillage (ZT to be the most environmental friendly among different tillage techniques. Therefore, conservation tillage involving ZT and minimum tillage which has potential to break the surface compact zone in soil with reduced soil disturbance offers to lead to a better soil environment and crop yield with minimal impact on the environment. Keywords: Atmosphere, Greenhouse gases, Conservation tillage, Sustainable crop yield

  6. Implementation and evaluation of a clinical data management programme in a primary care centre.

    LENUS (Irish Health Repository)

    Sweeney, J

    2014-11-01

    Electronic health records (EHR) support clinical management, administration, quality assurance, research, and service planning. The aim of this study was to evaluate a clinical data management programme to improve consistency, completeness and accuracy of EHR information in a large primary care centre with 10 General Practitioners (GPs). A Clinical Data Manager was appointed to implement a Data Management Strategy which involved coding consultations using ICPC-2 coding, tailored support and ongoing individualised feedback to clinicians. Over an eighteen month period there were improvements in engagement with and level of coding. Prior to implementation (August 2011) 4 of the 10 GPs engaged in regular coding and 69% of their consultation notes were coded. After 12 months, all 10 GPs and 6 nurses were ICPC-2 coding their consultations and monthly coding levels had increased to 98%. This structured Data Management Strategy provides a feasible sustainable way to improve information management in primary care.

  7. SPECIFICS OF IMPLEMENTING TECHNOLOGY OF ASSOCIATIVE TEACHING ENGLISH AT PRIMARY SCHOOL

    Directory of Open Access Journals (Sweden)

    Iryna Lobachova

    2016-11-01

    Full Text Available The article deals with the problem of the application of the associative teaching technology at primary school and the peculiarities of its implementation in teaching English to primary schoolchildren. It is found out that the modern primary school student should be able to think creatively, to solve given tasks, find associative links between objects, and be able to intercultural communication. So, a teacher has to master the innovative teaching technologies that optimize and intensify the educational process to forming primary schoolchildren’s abilities of this kind. It is determined that the technology of associative teaching English to primary schoolchildren is one of the most effective technologies because it meets quite new goals and tasks of teaching foreign languages at primary school, age and individual characteristics, needs, and interests of primary schoolchildren. It is shown that the associative teaching technology is based on the principle of harmony with nature and it creates conditions that are close to life situations, makes learning the foreign language accessible and relaxed. Associative teaching a foreign language and its various aspects are performed in accordance with the primary schoolchildren’s individual characteristics. The psychological mechanism is very important in the organization of associative teaching; it is taken into account in teaching children of primary school because human beings think with images and words are sound images that allow you to express what a person sees, feels, and thinks. Associative teaching combines both verbal and non-verbal means of communication. Associative teaching contributes to learning a foreign language based on the child’s real actions in the form of the active actions with items in accordance with the human linguistic programme that defines phased sequence of the language development. An effective method of teaching a foreign language is a method of Mind Mapping, which

  8. Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory.

    Science.gov (United States)

    Glynn, Liam G; Glynn, Fergus; Casey, Monica; Wilkinson, Louise Gaffney; Hayes, Patrick S; Heaney, David; Murphy, Andrew W M

    2018-05-02

    Problematic translational gaps continue to exist between demonstrating the positive impact of healthcare interventions in research settings and their implementation into routine daily practice. The aim of this qualitative evaluation of the SMART MOVE trial was to conduct a theoretically informed analysis, using normalisation process theory, of the potential barriers and levers to the implementation of a mhealth intervention to promote physical activity in primary care. The study took place in the West of Ireland with recruitment in the community from the Clare Primary Care Network. SMART MOVE trial participants and the staff from four primary care centres were invited to take part and all agreed to do so. A qualitative methodology with a combination of focus groups (general practitioners, practice nurses and non-clinical staff from four separate primary care centres, n = 14) and individual semi-structured interviews (intervention and control SMART MOVE trial participants, n = 4) with purposeful sampling utilising the principles of Framework Analysis was utilised. The Normalisation Process Theory was used to develop the topic guide for the interviews and also informed the data analysis process. Four themes emerged from the analysis: personal and professional exercise strategies; roles and responsibilities to support active engagement; utilisation challenges; and evaluation, adoption and adherence. It was evident that introducing a new healthcare intervention demands a comprehensive evaluation of the intervention itself and also the environment in which it is to operate. Despite certain obstacles, the opportunity exists for the successful implementation of a novel healthcare intervention that addresses a hitherto unresolved healthcare need, provided that the intervention has strong usability attributes for both disseminators and target users and coheres strongly with the core objectives and culture of the health care environment in which it is to operate. We

  9. Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.

    Science.gov (United States)

    Dorflinger, Lindsey M; Ruser, Christopher; Sellinger, John; Edens, Ellen L; Kerns, Robert D; Becker, William C

    2014-12-01

    The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps. Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care. A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics. An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction. In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services. Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned. Wiley Periodicals, Inc.

  10. Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers.

    Science.gov (United States)

    Reifels, Lennart; Nicholas, Angela; Fletcher, Justine; Bassilios, Bridget; King, Kylie; Ewen, Shaun; Pirkis, Jane

    2018-01-01

    Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers. We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively. Agency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy). This study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and

  11. Comparison of effects of machine performance parameters and energy indices of soybean production in conservation and conventional tillage systems

    Directory of Open Access Journals (Sweden)

    A Sharifi

    2016-09-01

    also calculated. Results and Discussion The results showed that no-tillage methods by grain drill and row crop planter had the lowest field efficiency (56% and 58.9%, respectively, but had the highest field capacity (0.76 and 0.71 ha h-1, respectively, as the passage of implements in the field was less than that of conventional tillage. Peruzi et al., (1996 also reported that required time for minimum tillage and no-till was 80% less than conventional tillage. No-till using grain drill with the total field capacity of 0.76 ha h-1 and conventional tillage with 0.33 ha h-1 had the highest and lowest field capacity among the treatments, respectively. Minimum tillage had the best horizontal distribution uniformity for seed placement on the row. No-till using seed drill had the highest energy ratio of 4.5 and yield of 3612 kg ha-1, which were higher than the other treatments. No-till also produced 0.19 kg crop per each MJ energy consumption. It consumed the lowest amount of energy with 5.3 MJ for production of 1 kg soybean and had the highest net energy gain among treatments. Minimum tillage had the lowest consumption of energy with 2030.2 MJ ha-1 among the treatments. It had the lowest amount of net energy gain because of having lowest yield (2794 kg ha-1. Zentner et al., (2004 and Razzaghi et al., (2012 also concluded that conservation tillage systems had the lowest amount of energy consumption compared to the conventional tillage. Conclusions The study of energy indices is important for producing agricultural crops to decrease energy consumption. Among the tillage methods, no-till method had the best indices about reducing energy consumption. Although the size of no-till grain drill will increase the weight and energy consumption of machine, but it well penetrates on the soil. Results showed that minimum tillage and no-till methods are proper alternatives for replacement of conventional method for producing soybean, according to the precise of planting and improvement of

  12. Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study.

    Science.gov (United States)

    Vest, Bonnie M; York, Trevor R M; Sand, Jessica; Fox, Chester H; Kahn, Linda S

    2015-01-01

    Primary care physicians (PCPs) are optimally situated to identify and manage early stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national, mixed-methods, cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. As part of the mixed-methods process evaluation, semistructured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the 4 domains of Normalization Process Theory (NPT). Identified themes illuminated the complex work undertaken to manage CKD in primary care practices. Barriers to guideline implementation were identified in each of the 4 NPT domains, including (1) lack of knowledge and understanding around CKD (coherence), (2) difficulties engaging providers and patients in CKD management (cognitive participation), (3) limited time and competing demands (collective action), and (4) challenges obtaining and using data to monitor progress (reflexive monitoring). Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care. © Copyright 2015 by the American Board of Family Medicine.

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

    Science.gov (United States)

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

    2015-01-01

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

  14. Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean.

    Science.gov (United States)

    Oldenburger, David; De Bortoli Cassiani, Silvia Helena; Bryant-Lukosius, Denise; Valaitis, Ruta Kristina; Baumann, Andrea; Pulcini, Joyce; Martin-Misener, Ruth

    2017-06-08

    SYNOPSIS Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

  15. Medical Home Implementation Gaps for Seniors: Perceptions and Experiences of Primary Care Medical Practices.

    Science.gov (United States)

    Hoff, Timothy; DePuccio, Matthew

    2018-07-01

    The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation. Qualitative data from 51 in-depth, semi-structured interviews across six different National Committee for Quality Assurance (NCQA)-accredited primary care practices were collected and analyzed. Physicians and staff identified PCMH implementation gaps for their seniors: (a) performing in-depth clinical assessments, (b) identifying seniors' life needs and linking them with community resources, and (c) care management and coordination, in particular self-management support for seniors. Prior experiences trying to perform these aspects of PCMH care for older adults produced collective understandings that led to inaction and avoidance by medical practices around the first two gaps, and proactive behavior that took strategic advantage of external incentives for addressing the third gap. Greater understanding of physician and staff's PCMH implementation experiences, and the learning that accumulates from these experiences, allows for a deeper understanding of how primary care practices choose to enact the medical home model for seniors on an everyday basis.

  16. Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance.

    Science.gov (United States)

    Campbell, S M; Sheaff, R; Sibbald, B; Marshall, M N; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M O

    2002-03-01

    To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Qualitative case studies using semi-structured interviews and documentation review. Twelve purposively sampled PCG/Ts in England. Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Participants' perceptions of the role of clinical governance in PCG/Ts. PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.

  17. Patient-centered medical home implementation and primary care provider turnover.

    Science.gov (United States)

    Sylling, Philip W; Wong, Edwin S; Liu, Chuan-Fen; Hernandez, Susan E; Batten, Adam J; Helfrich, Christian D; Nelson, Karin; Fihn, Stephan D; Hebert, Paul L

    2014-12-01

    The Veterans Health Administration (VHA) began implementing a patient-centered medical home (PCMH) model of care delivery in April 2010 through its Patient Aligned Care Team (PACT) initiative. PACT represents a substantial system reengineering of VHA primary care and its potential effect on primary care provider (PCP) turnover is an important but unexplored relationship. This study examined the association between a system-wide PCMH implementation and PCP turnover. This was a retrospective, longitudinal study of VHA-employed PCPs spanning 29 calendar quarters before PACT and eight quarters of PACT implementation. PCP employment periods were identified from administrative data and turnover was defined by an indicator on the last quarter of each uncensored period. An interrupted time series model was used to estimate the association between PACT and turnover, adjusting for secular trend and seasonality, provider and job characteristics, and local unemployment. We calculated average marginal effects (AME), which reflected the change in turnover probability associated with PACT implementation. The quarterly rate of PCP turnover was 3.06% before PACT and 3.38% after initiation of PACT. In adjusted analysis, PACT was associated with a modest increase in turnover (AME=4.0 additional PCPs per 1000 PCPs per quarter, P=0.004). Models with interaction terms suggested that the PACT-related change in turnover was increasing in provider age and experience. PACT was associated with a modest increase in PCP turnover, concentrated among older and more experienced providers, during initial implementation. Our findings suggest that policymakers should evaluate potential workforce effects when implementing PCMH.

  18. Tillage and manure effect on soil microbial biomass and respiration ...

    African Journals Online (AJOL)

    The objective of this study was to determine the influence of both tillage and liquid pig manure application on soil microbial biomass, enzyme activities and microbial respiration in a meadow soil. The results obtained did not show any significant effect of tillage and manure on microbial biomass carbon (C) and nitrogen (N) ...

  19. Tillage effects on soil. Physical properties and sunflower ...

    African Journals Online (AJOL)

    Soil physical properties and sunflower (Helianthus annuus) yield under convectional tillage (CT) and zero-tillage (Z,TJ. was monitored for 3 consecutive years in Ilorin, Southern Guinea Savannah zone of Nigeria (SGSZN). While bulk density of CT increased slightly over the years, significant decrease of 12 and 8% were ...

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

    Science.gov (United States)

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

    2018-03-19

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

  1. Opportunities and Challenges for Public Primary School Head Teachers in the Implementation of Free Primary Education in Kisumu Municipality, Kenya: An Analytical Assessment

    Science.gov (United States)

    Akech, Benta Achieng' Opul; Simatwa, Enose M. W.

    2010-01-01

    This study investigated opportunities and challenges for public primary school head teachers in the implementation of Free Primary Education in Kisumu municipality. Being a descriptive research, the study population consisted of 114 head teachers, 17,100 class seven and eight pupils in the municipality. Out of this, a sample of 37 head teachers…

  2. Impact of tillage intensity on clay loam soil structure

    DEFF Research Database (Denmark)

    Daraghmeh, Omar; Petersen, Carsten; Munkholm, Lars Juhl

    Soil structure and structural stability are key parameters in sustainable soil management and optimum cropping practices. Locally and temporally adapted precision tillage may improve crop performance while at the same time reduce environmental impacts. The main objective of this study...... was to improve the knowledge of precision tillage practices through characterizing the effect of varied tillage intensities on structural properties of a clay loam soil. A field experiment was conducted using a randomized complete block design with two main factors, i.e. operational speed (OS, 2 levels......) and rotovating speed (RS, 3 levels). The tillage was conducted using a PTO-driven rotovator equipped to measure angular velocity. The effect of traffic compaction, made directly after tillage, was measured on soil taken from wheel track (WT) compared with soil outside wheel track (NWT). Soil samples from 0-3 cm...

  3. Earthworms influenced by reduced tillage, conventional tillage and energy forest in Swedish agricultural field experiments

    Energy Technology Data Exchange (ETDEWEB)

    Lagerloef, Jan (SLU, Department of Ecology, Swedish University of Agricultural Sciences, Uppsala (Sweden)), Email: Jan.Lagerlof@ekol.slu.se; Paalsson, Olof; Arvidsson, Johan (SLU, Department of Soil and Environment, Swedish University of Agricultural Sciences, Uppsala (Sweden))

    2012-03-15

    We compared earthworm density, depth distribution and species composition in three soil cultivation experiments including the treatments ploughless tillage and mouldboard ploughing. Sampling was done in September 2005 and for one experiment also in 1994. By yearly sampling 1995-2005, earthworms in an energy forest of Salix viminalis were compared with those in an adjacent arable field. Sampling method was digging of soil blocks and hand sorting and formalin sampling in one cultivation experiment. Both methods were used in the energy forest and arable land comparison. In two soil cultivation experiments, highest abundances or biomass were found in ploughless tillage. Earthworm density was higher in the upper 10 cm, especially in the ploughless tillage. Earthworm density was significantly higher in the energy forest than in the arable field. Formalin sampling revealed c. 36% of the earthworm numbers found by digging in the energy forest and gave almost no earthworms in the arable field. In all treatments with soil cultivation, species living and feeding in the rhizosphere and soil dominated. One such species, Allolobophora chlorotica, was more abundant under mouldboard ploughing than ploughless tillage. Lumbricus terrestris, browsing on the surface and producing deep vertical burrows, was more common in the ploughless tillage. Species living and feeding close to the soil surface were almost only found in the energy forest, which had not been soil cultivated since 1984. The findings support earlier studies pointing out possibilities to encourage earthworms by reduced soil cultivation. This is one of the first published studies that followed earthworm populations in an energy forest plantation during several years. Explanation of earthworm reactions to management and environmental impacts should be done with consideration of the ecology of species or species groups. Earthworm sampling by formalin must always be interpreted with caution and calibrated by digging and

  4. Primary problems associated with the health and welfare of employees observed when implementing lean manufacturing projects.

    Science.gov (United States)

    Rampasso, Izabela Simon; Anholon, Rosley; Gonçalves Quelhas, Osvaldo Luiz; Filho, Walter Leal

    2017-01-01

    Lean philosophy is used by companies to increase productivity and reduce costs. Although uncontested benefits are created, it is necessary to highlight the problems related to employees' health and welfare caused by implementing lean manufacturing projects. The primary objective of this paper is to review the literature and identify the most relevant problems created by lean philosophy for employees. Research about the theme was performed on many international databases over three months, and an initial sample of 77 papers was found. Twenty-seven sources were utilized. We identified 22 categories of problems related to health and welfare of employees. The most cited problem was work intensification, mentioned by thirteen papers. Increased stress and increased responsibilities, demands and, consequently, pressure on the workers are among the primary problems observed in the research.

  5. POSSIBILITY OF THE WHO GREEN PAGE ENVIRONMENTAL HEALTH DIAGNOSTICS IMPLEMENTATION IN PRIMARY CARE

    Directory of Open Access Journals (Sweden)

    Donata Kurpas

    2010-12-01

    Full Text Available The aim is to define workable framework for implementation of the WHO Green Page Environmental Health Diagnostics in primary care. The study was carried out with the employment standard form questionnaire among parents of children. 159 parents took part in the study. 34 (24.3% of parents expressed their concern about the child’s environment. 23.7% of the examined demonstrated awareness of existing environmental risks. The Green Page allows for an approximation to environmental diagnostics to characterize positive or negative factors and detection of the most vulnerable individuals or groups.

  6. A Primary Human Critical Success Factors Model for the ERP System Implementation

    Directory of Open Access Journals (Sweden)

    Jenko Aleksander

    2016-08-01

    Full Text Available Background and Purpose: Many researchers have investigated various Critical success factors (CSFs and the different causes of ERP implementation project failures. Despite a detailed literature preview, we were unable to find an appropriate research with a comprehensive overview of the true causes behind CSFs, observed from a human factors perspective. The objective of this research was therefore to develop and evaluate the Primary human factors (PHFs model and to confirm the significant impact of PHFs on traditional CSFs and on the project success.

  7. Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.

    Science.gov (United States)

    Licskai, Christopher; Sands, Todd; Ong, Michael; Paolatto, Lisa; Nicoletti, Ivan

    2012-10-01

    Quality problem International guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets. Initial assessment Regional pilot data demonstrated a knowledge-to-practice gap. Choice of solutions We engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework. Implementation Knowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient. Evaluation Six guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ± 24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ± 7) months. Lessons learned A knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1.

  8. Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care

    Science.gov (United States)

    Licskai, Christopher; Sands, Todd; Ong, Michael; Paolatto, Lisa; Nicoletti, Ivan

    2012-01-01

    Quality problem International guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets. Initial assessment Regional pilot data demonstrated a knowledge-to-practice gap. Choice of solutions We engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework. Implementation Knowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient. Evaluation Six guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ±24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (Pabsenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ±7) months. Lessons learned A knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1 PMID:22893665

  9. Optimize the cost of cultivation with using low-tillage in the wheat fields of Tehran province

    OpenAIRE

    KAMALI, Hossein; PARHIZGAR, Mohammad Mahdi

    2015-01-01

    Abstract. In appropriate patterns of tillage in wheat, three methods commonly cultivated as a maximum for tillage, planting a multifunctional device as minimum tillage and direct seeding cultivation system as no tillage operations together are comparable. Analysis of variance and mean cost of land preparation and time spent on the three methods of tillage operations shows that maximum conventional tillage and planting allocated to the most and direct seeding without tillage operations allocat...

  10. Barriers in the implementation of a physical activity intervention in primary care settings: lessons learned.

    Science.gov (United States)

    Josyula, Lakshmi K; Lyle, Roseann M

    2013-01-01

    Barriers encountered in implementing a physical activity intervention in primary health care settings, and ways to address them, are described in this paper. A randomized comparison trial was designed to examine the impact of health care providers' written prescriptions for physical activity, with or without additional physical activity resources, to adult, nonpregnant patients on preventive care or chronic disease monitoring visits. Following abysmal recruitment outcomes, the research protocol was altered to make it more appealing to all the participants, i.e., health care providers, office personnel, and patients. Various barriers--financial, motivational, and executive--to the implementation of health promotion interventions in primary health care settings were experienced and identified. These barriers have been classified by the different participants in the research process, viz., healthcare providers, administrative personnel, researchers, and patients. Some of the barriers identified were lack of time and reimbursement for health promotion activities, and inadequate practice capacity, for health care providers; increased time and labor demands for administrative personnel; constrained access to participants, and limited funding, for researchers; and superseding commitments, and inaccurate comprehension of the research protocol, for patients. Solutions suggested to overcome these barriers include financial support, e.g., funding for researchers, remuneration for health care organization personnel, reimbursement for providers, payment for participants, and free or subsidized postage, and use of health facilities; motivational strategies such as inspirational leadership, and contests within health care organizations; and partnerships, with other expert technical and creative entities, to improve the quality, efficiency, and acceptability of health promotion interventions.

  11. Implementing a stepped-care approach in primary care: results of a qualitative study

    Directory of Open Access Journals (Sweden)

    Franx Gerdien

    2012-01-01

    Full Text Available Abstract Background Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC was initiated in the Netherlands. Methods Alongside the QIC, an intervention study using a controlled before-and-after design was performed. Part of the study was a process evaluation, utilizing semi-structured group interviews, to provide insight into the perceptions of the participating clinicians on the implementation of stepped care for depression into their daily routines. Participants were primary care clinicians, specialist clinicians, and other healthcare staff from eight regions in the Netherlands. Analysis was supported by the Normalisation Process Theory (NPT. Results The introduction of a stepped-care model for depression to primary care teams within the context of a depression QIC was generally well received by participating clinicians. All three elements of the proposed stepped-care model (patient differentiation, stepped-care treatment, and outcome monitoring, were translated and introduced locally. Clinicians reported changes in terms of learning how to differentiate between patient groups and different levels of care, changing antidepressant prescribing routines as a consequence of having a broader treatment package to offer to their patients, and better working relationships with patients and colleagues. A complex range of factors influenced the implementation process. Facilitating factors were the stepped-care model itself, the structured team meetings (part of the QIC method, and the positive reaction from patients to stepped care. The differing views of depression and depression care within multidisciplinary health teams, lack of resources, and poor information systems hindered the rapid introduction of the stepped-care model. The NPT

  12. GRANULOMETRIC AND HUMIC FRACTIONS CARBON STOCKS OF SOIL ORGANIC MATTER UNDER NO-TILLAGE SYSTEM IN UBERABA, BRAZIL

    Directory of Open Access Journals (Sweden)

    Marcos Gervasio Pereira

    2011-12-01

    Full Text Available The cover plant use preceding grain crops in Cerrado soil can increase the carbon stocks of chemical and physical fractions of soil organic matter (SOM. The present study aimed to quantify the carbon stocks of SOM granulometric and humic fractions in a Cerrado area under no-tillage system with different cover plant, and compare the results with those from conventional tillage and fallow areas, in Uberaba, MG, Brazil. The implemented cover crops were: millet, tropical grass and sunn hemp. Furthermore, an area was used in fallow and another as a control area (conventional tillage. After cover crop removal, the areas were subdivided for the corn and soybean plantation. Soil samples were collected in the 0.0-0.025, 0.025-0.05, 0.05-0.10 and 0.10-0.20 m depths, with posterior quantification of total organic carbon (TOC levels and chemical and granulometric fractionation of SOM. Humic acid carbon (C-HAF, fulvic acids (C-FAF and humin (C-HUM were quantified through these fractionations. The granulometric fractions consisted in particulate organic matter (POM and mineral organic matter (MOM. Using the carbon levels for each fraction, the respective stocks for each depth were calculated, including the 0.0-0.20 m layer. In the 0.0-0.20 m layer, TOC had the highest stocks for the millet area. The highest POM stocks were found for the corn plantation over sunn hemp and the fallow and soybean area over millet and tropical grass (0.0-0.20 m. In relation to the MOM stocks, the highest values were observed in the areas with millet, sunn hemp and tropical (palisade grass, all superior to those found in the conventional tillage and fallow areas, independent of evaluated culture (0.10-0.20 m. The highest C-HUM stocks were observed in the area with tropical grass (0.025-0.05 m and areas with tropical grass and sunn hemp (0.10-0.20 m, when compared to conventional tillage, independent of evaluated culture (corn and soybean. The highest C-FAH stocks in the depth of 0

  13. Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting

    Directory of Open Access Journals (Sweden)

    Angela Cooper

    2017-11-01

    Full Text Available Medically unexplained symptoms (MUS are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 (d = 0.4. A statistically significant (23% decrease in family physicians’ visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a ‘Primary Care Psychological Consultation and Treatment Service’.

  14. Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting.

    Science.gov (United States)

    Cooper, Angela; Abbass, Allan; Town, Joel

    2017-11-29

    Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 ( d = 0.4). A statistically significant (23%) decrease in family physicians' visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a 'Primary Care Psychological Consultation and Treatment Service'.

  15. Vibration analysis on driver’s seat of agricultural tractors during tillage tests

    International Nuclear Information System (INIS)

    Gialamas, T.; Gravalos, I.; Kateris, D.; Xyradakis, P.; Dimitriadis, C.

    2016-01-01

    The vibration of the driver’s seat of agricultural tractors was investigated during three alternative tillage operations. Three tractors including a range of specifications were considered, at a range of forward speeds. The interactions between the tractors, implements and speeds were examined using the SPSS program and the GLM-ANOVA method. The results analysis indicated that the tractors played the first major role in vibration development in the lateral axis and was followed by the implements. In contrast, the implements played the first major role in the development of vibration in the horizontal axis and are followed by factor tractors. The statistically significant effect in vertical and horizontal axes shows the factor implements. In addition, the statistically significant effect in the vertical and lateral axes shows again the implements to be the most significant factor. Of the implements, the plough shows the highest vibration and displays statistically significant difference in comparison with the other implements.

  16. Vibration analysis on driver’s seat of agricultural tractors during tillage tests

    Energy Technology Data Exchange (ETDEWEB)

    Gialamas, T.; Gravalos, I.; Kateris, D.; Xyradakis, P.; Dimitriadis, C.

    2016-07-01

    The vibration of the driver’s seat of agricultural tractors was investigated during three alternative tillage operations. Three tractors including a range of specifications were considered, at a range of forward speeds. The interactions between the tractors, implements and speeds were examined using the SPSS program and the GLM-ANOVA method. The results analysis indicated that the tractors played the first major role in vibration development in the lateral axis and was followed by the implements. In contrast, the implements played the first major role in the development of vibration in the horizontal axis and are followed by factor tractors. The statistically significant effect in vertical and horizontal axes shows the factor implements. In addition, the statistically significant effect in the vertical and lateral axes shows again the implements to be the most significant factor. Of the implements, the plough shows the highest vibration and displays statistically significant difference in comparison with the other implements.

  17. Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies.

    Science.gov (United States)

    Nathan, Nicole; Wolfenden, Luke; Butler, Michelle; Bell, Andrew Colin; Wyse, Rebecca; Campbell, Elizabeth; Milat, Andrew J; Wiggers, John

    2011-08-01

    School-based vegetable and fruit programs can increase student consumption of vegetables and fruit and have been recommended for adoption by Australian schools since 2005. An understanding of the prevalence and predictors of and the barriers to the adoption of school-based vegetable and fruit programs is necessary to maximize their adoption by schools and ensure that the health benefits of such programs to children are realized. The aim of this study was to determine Australian primary school Principals' attitudes and barriers to the implementation of vegetable and fruit breaks; the prevalence of vegetable and fruit breaks in schools and the implementation strategies used and associated with their recommended adoption (daily in at least 80% of classes). A random sample of 384 school Principals completed a 20-min telephone interview. While Principals were highly supportive of vegetable and fruit breaks, only 44% were implementing these to a recommended level. When controlling for all school characteristics, recommended vegetable and fruit break adoption was 1.9 and 2.2 times greater, respectively, in schools that had parent communication strategies and teachers trained. A substantial opportunity exists to enhance the health of children through the adoption of vegetable and fruit breaks in schools.

  18. Implementation of healthy lifestyle promotion in primary care: patients as coproducers.

    Science.gov (United States)

    Thomas, Kristin; Bendtsen, Preben; Krevers, Barbro

    2014-11-01

    To explore and theorize how patients perceive, interpret, and reactin healthy lifestyle promotion situations in primary care and to investigate patients' role in implementation of lifestyle promotion illustrated by typologies. Grounded theory was used to assess qualitative interview data from 22 patients with varied experience of healthy lifestyle promotion. Data were analyzed by constant comparative analysis. A substantive theory of being healthy emerged from the data. The theory highlights the processes that are important for implementation before, during, and after lifestyle promotion. Three interconnected categories emerged from the data: conditions for being healthy, managing being healthy, and interactions about being healthy; these formed the core category: being healthy. A typology proposed four patient trajectories on being healthy: resigned, receivers, coworkers, and leaders. Patients coproduced the implementation of lifestyle promotion through the degree of transparency, which was a result of patients' expectations and situation appraisals. Different approaches are needed during lifestyle promotion depending on a variety of patient-related factors. The typology could guide practitioners in their lifestyle promotion practice. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Energy indices in irrigated wheat production under conservation and conventional tillage and planting methods

    OpenAIRE

    S. M Hosseini; S Afzalinia; K Mollaei

    2016-01-01

    Introduction: Conservation tillage system was recommended for soil erosion control in North America for the first time 60 years ago (Wang et al., 2006). Using this tillage system including minimum and zero tillage has been rapidly developed in recent years. Thearea covered by zero tillage in 2006 was 95 million ha all over the world (Dumanski et al., 2006). In addition to saving soil and water resources, conservation tillage system reduces energy consumption and improves energy indices by com...

  20. Twelve evidence-based principles for implementing self-management support in primary care.

    Science.gov (United States)

    Battersby, Malcolm; Von Korff, Michael; Schaefer, Judith; Davis, Connie; Ludman, Evette; Greene, Sarah M; Parkerton, Melissa; Wagner, Edward H

    2010-12-01

    Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.

  1. Impact of the implementation of electronic guidelines for cardiovascular prevention in primary care: study protocol

    Directory of Open Access Journals (Sweden)

    Eva Comin

    2013-03-01

    Full Text Available Background The electronic medical records software of the Catalan Institute of Health has recently incorporated an electronic version of clinical practice guidelines (e-CPGs. This study aims to assess the impact of the implementation of e-CPGs on the diagnosis, treatment, control and management of hypercholesterolaemia, diabetes mellitus type 2 and hypertension.Methods Eligible study participants are those aged 35–74 years assigned to family practitioners (FPs of the Catalan Institute of Health. Routinely collected data from electronic primary care registries covering 80% of the Catalan population will be analysed using two approaches: (1 a cross-sectional study to describe the characteristics of the sample before e-CPG implementation; (2 a controlled before-and-after study with 1-year follow-up to ascertain the effect of e-CPG implementation. Patients of FPs who regularly use the e-CPGs will constitute the intervention group; the control group will comprise patients assigned to FPs not regularly using the e-CPG. The outcomes are: (1 suspected and confirmed diagnoses, (2 control of clinical variables, (3 requests for tests and (4 proportions of patients with adequate drug prescriptions.Results This protocol should represent a reproducible process to assess the impact of the implementation of e-CPGs. We anticipate reporting results in late 2013.Conclusion This project will assess the effectiveness of e-CPGs to improve clinical decisions and healthcare procedures in the three disorders analysed. The results will shed light on the use of evidence-based medicine to improve clinical practice of FPs.

  2. Awareness, Facilitators, and Barriers to Policy Implementation Related to Obesity Prevention for Primary School Children in Malaysia.

    Science.gov (United States)

    Chan, Camelina; Moy, Foong Ming; Lim, Jennifer N W; Dahlui, Maznah

    2018-03-01

    To assess the awareness, facilitators, and barriers to policy implementation related to obesity prevention for primary school children. A cross-sectional study administered using an online questionnaire. Conducted in 447 primary schools in a state in Malaysia. One school administrator from each school served as a participant. The questionnaires consisted of 32 items on awareness, policy implementation, and facilitators and barriers to policy implementation. Descriptive analysis was used to describe the awareness, facilitators, and barriers of policies implementation. Association between schools' characteristics and policy implementation was assessed using logistic regression. The majority (90%) of school administrators were aware of the policies. However, only 50% to 70% of schools had implemented the policies fully. Reported barriers were lack of equipment, insufficient training, and limited time to complete implementation. Facilitators of policy implementation were commitment from the schools, staff members, students, and canteen operators. Policy implementation was comparable in all school types and locality; except the policy on "Food and Drinks sold at the school canteens" was implemented by more rural schools compared to urban schools (odds ratio: 1.74, 95% confidence interval: 1.13-2.69). Majority of the school administrators were aware of the existing policies; however, the implementation was only satisfactory. The identified barriers to policy implementation were modifiable and thus, the stakeholders should consider restrategizing plans in overcoming them.

  3. Reflections on Remaining Obstacles in a Primary-Care Oriented Pure PBL Curriculum after Twelve Years of Implementation

    Science.gov (United States)

    D'Ottavio, Alberto Enrique; Bassan, Norberto David

    2014-01-01

    A pioneer primary-care oriented pure PBL curriculum, based on constructivism and adult learning theories combined with Morin's complex thinking, was implemented in our medical school since 2002. Regardless of warnings opportunely made because the basic requirements for its successful implementation could not be fully fulfilled in practice, the…

  4. The Implementation of a Social Constructivist Approach in Primary Science Education in Confucian Heritage Culture: The Case of Vietnam

    Science.gov (United States)

    H?ng, Ngô Vu Thu; Meijer, Marijn Roland; Bulte, Astrid M. W.; Pilot, Albert

    2015-01-01

    Social constructivism has been increasingly studied and implemented in science school education. Nevertheless, there is a lack of holistic studies on the implementation of social constructivist approach in primary science education in Confucian heritage culture. This study aims to determine to what extent a social constructivist approach is…

  5. The implementation of a social constructivist approach in primary science education in Confucian heritage culture: the case of Vietnam

    NARCIS (Netherlands)

    Vu Thu Hang, N.; Meijer, M.R.; Bulte, A.M.W.; Pilot, A.

    2015-01-01

    Social constructivism has been increasingly studied and implemented in science school education. Nevertheless, there is a lack of holistic studies on the implementation of social constructivist approach in primary science education in Confucian heritage culture. This study aims to determine to what

  6. The use of the international classification of functioning, disability and health in primary care: Findings of exploratory implementation throughout life

    OpenAIRE

    Debrouwere, Inge; Lebeer, Jo; Prinzie, Peter

    2016-01-01

    markdownabstract__Purpose:__ The International Classification of Functioning (ICF) has found widespread acceptance since it was launched in 2001. Yet, little is known about its use in Primary Care. This paper aims to contribute to the dialogue about the practical use of the ICF by exploring how this framework constitutes a supplementary source to inform disability-related decision making in integrated Primary Care. __Method:__ The implementation process of the ICF in a Latin American Primary ...

  7. Agronomic performance of common bean in straw mulch systems and topdressing nitrogen rates in no-tillage

    Directory of Open Access Journals (Sweden)

    Tatiana Pagan Loeiro da Cunha

    2015-10-01

    Full Text Available ABSTRACTIn no-tillage systems, straw coverage on soil surface is the key to success, and the choice of crops for rotation is crucial to achieve the sustainability and quality that conservation agriculture requires. The objective of this study was to evaluate the agronomic performance of the common bean cultivar IAC Formoso sown in succession to three straw mulch systems (corn alone, corn/Urochloa ruziziensisintercrop and U. ruziziensisalone and topdress nitrogen rates (0; 40; 80; 120 and 160 kg ha-1N, at the four-leaf stage, three years after the implementation of no-tillage. The experiment was arranged in a randomized block split plot design, with three replications. Common bean highest yields were achieved in succession to U. ruziziensisalone and intercropped with corn. The corn/U. ruziziensisintercrop provided both straw and seed production, allowing for quality no-tillage. Topdressed nitrogen influenced the common bean yield when in succession to corn alone, U. ruziziensisalone and corn/U. ruziziensisintercrop in no-tillage.

  8. Performance of newly implemented Environmental Management Systems in primary schools in South Africa.

    Science.gov (United States)

    Hens, Luc; Wiedemann, Torsten; Raath, Schalk; Stone, Riana; Renders, Paul; Craenhals, Eric

    2010-01-01

    Quantitative results from Environmental Management Systems (EMS) at primary schools have rarely been examined in literature. This paper presents the monitoring results of environmental care in 39 primary schools in Northern South Africa. During 2 years, after the EMS was implemented in the curriculum and in the school's management, the progress of environmental performances of the participating schools has been measured, by means of detailed questionnaires, related to four environmental aspects: water, waste, energy and greening. At the beginning of the project, 50% of the schools performed well on water-related environmental actions. Two years later it was 76%. For waste-related activities the improvement was even stronger: from 50% to 100%. The environmental performances of the schools improved also for greening-related actions, from 50% at the start of the project to 64% two years later. Only energy-related activities did not improve significantly with only 24% of all schools performing well at the end of the survey period. In general, the introduction of an EMS succeeded in an improvement of the overall environmental performances of the schools, but cost-intensive activities were less successful than others. Copyright 2009 Elsevier Ltd. All rights reserved.

  9. Reliability centered maintenance pilot system implementation 241-AP-tank farm primary ventilation system final report

    International Nuclear Information System (INIS)

    MOORE TL

    2001-01-01

    When the Hanford Site Tank Farms' mission was safe storage of radioactive waste in underground storage tanks, maintenance activities focused on time-based preventive maintenance. Tank Farms' new mission to deliver waste to a vitrification plant where the waste will be processed into a form suitable for permanent storage requires a more efficient and proactive approach to maintenance. Systems must be maintained to ensure that they are operational and available to support waste feed delivery on schedule with a minimum of unplanned outages. This report describes the Reliability Centered Maintenance (RCM) pilot system that was implemented in the 241-AP Tank Farm Primary Ventilation System under PI-ORP-009 of the contract between the U.S. Department of Energy, Office of River Protection and CH2M HILL Hanford Group Inc. (CHG). The RCM analytical techniques focus on monitoring the condition of operating systems to predict equipment failures so that maintenance activities can be completed in time to prevent or mitigate unplanned equipment outages. This approach allows maintenance activities to be managed with minimal impact on plant operations. The pilot demonstration provided an opportunity for CHG staff-training in RCM principles and tailoring of the RCM approach to the Hanford Tank Farms' unique needs. This report details the implementation of RCM on a pilot system in Tank Farms

  10. [Implementation of nurse demand managment in primary health care service providers in Catalonia].

    Science.gov (United States)

    Brugués Brugués, Alba; Cubells Asensio, Irene; Flores Mateo, Gemma

    2017-11-01

    To describe and analyse the implementaction of nurse demand managment (NDM) among health care providers in Catalonia from 2005 to 2014. Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (i)health professional (competence, attitudes, motivation for change and individual characteristics); (ii)social context (patients and companions), and (iii)system related factors (organization and structure, economic incentives). Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  11. Influence of Tillage and Mulch on Soil Physical Properties and ...

    African Journals Online (AJOL)

    ... (M0); rice straw, (MRice); wheat straw, (MWheat); plastic sheet, (MPlastic) at 4 t ... Happy seeder and deep tillage along with plastic mulch have positive impact ... use efficiency and yield parameters by creating a favorable soil environment.

  12. 105-116 Effect of Winged Subsoiler and Traditional Tillage ...

    African Journals Online (AJOL)

    3) compared to traditional tillage (Qs = 34 mm-season-. 1, T = 49 ... Maresha plow that cuts soil deeper than achieved with the traditional .... Data Processing and Analysis. Statistical ... soil compaction and shallow depth could be addressed.

  13. Precise tillage systems for enhanced non-chemical weed management

    NARCIS (Netherlands)

    Kurstjens, D.A.G.

    2007-01-01

    Soil and residue manipulation can assist weed management by killing weeds mechanically, interfering in weed lifecycles, facilitating operations and enhancing crop establishment and growth. Current tillage systems often compromise these functions, resulting in heavy reliance on herbicides,

  14. Evaluation of Conservation Tillage Techniques for Maize Production ...

    African Journals Online (AJOL)

    conservation tillage techniques and evaluate the impacts of the system on ... biological soil manipulation to optimize conditions for seed germination, emergence and ..... planting and weeding operations as total expense and sales from maize ...

  15. Haplic Chernozem Properties as Affected by Different Tillage Systems

    Directory of Open Access Journals (Sweden)

    Magdalena Hábová

    2016-01-01

    Full Text Available During 2007–2011 we assessed content and quality of humic substances with relationship to soil structure. Object of study was Haplic Chernozem (Hrušovany nad Jevišovkou, Czech Republic under three different tillage systems: – conventional ploughing to a depth of 0.22 m (CP; – reduced tillage with shallow harrowing to a depth of 0.15 m (RTSH; – reduced tillage with subsoiling to a depth of 0.35–0.40 m (RTS. Isolation of humic acids was made according to IHSS standard method using spectrometer Shimadzu 8700. Aggregates stability was determined by wet sieving method. Results showed that macrostructure stability was directly connected with time of sampling and content and quality of humic substances. After five years of experiment statistically significant differences in humic substances content were found. The highest structure stability, quantity and quality of humic substances were achieved under reduced tillage with shallow harrowing.

  16. Artificial neural network approach for mapping contrasting tillage practices

    Science.gov (United States)

    Tillage information is crucial for environmental modeling as it directly affects evapotranspiration, infiltration, runoff, carbon sequestration, and soil losses due to wind and water erosion from agricultural fields. However, collecting this information can be time consuming and costly. Remote sensi...

  17. Predicting soil workability and fragmentation in tillage: a review

    DEFF Research Database (Denmark)

    Obour, Peter Bilson; Lamandé, Mathieu; Edwards, Gareth T. C.

    2017-01-01

    of SWRC and the drop-shatter tests or tensile strength; (i) to quantify the effects of soil texture, organic matter and compaction on soil workability; and (ii) to compare soil water content for workability in the field with theoretical soil workability, thereby improving the prediction of soil......Soil workability and friability are required parameters to consider when creating suitable seedbeds for crop establishment and growth. Knowledge of soil workability is important for scheduling tillage operations and for reducing the risk of tillage-induced structural degradation of soils....... A reliable evaluation of soil workability implies a distinctive definition of the critical water content (wet and dry limits) for tillage. In this review, we provide a comprehensive assessment of the methods for determining soil workability, and the effects of soil properties and tillage systems on soil...

  18. Ghana's community-based primary health care: Why women and children are 'disadvantaged' by its implementation.

    Science.gov (United States)

    Atinga, Roger A; Agyepong, Irene Akua; Esena, Reuben K

    2018-03-01

    Policy analysis on why women and children in low- and middle-income settings are still disadvantaged by access to appropriate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street-level bureaucracy theory, we explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana's community-based PHC implementation to the disadvantage of women and children accessing and using health services. This was a qualitative study conducted in 4 communities drawn from rural and urban districts of the Upper West region. Data were collected from 8 focus group discussions with community informants, 73 in-depth interviews with clients, 13 in-depth interviews with district health managers and FLP, and observations. Data were recorded, transcribed and coded deductively and inductively for themes with the aid of Nvivo 11 software. Findings showed that apart from FLP frequent lateness to, and absenteeism from work, that affected care seeking for children, their exercise of discretionary power in determining children who deserve care over others had ripple effects: families experienced financial hardships in seeking alternative care for children, and avoided that by managing symptoms with care provided in non-traditional spaces. FLP adverse behaviours were driven by weak implementation structures embedded in the district health systems. Basic obstetric facilities such as labour room, infusion stand, and beds for deliveries, detention and palpation were lacking prompting FLP to cope by conducting deliveries using a patchwork of improvised delivery methods which worked out to encourage unassisted home deliveries. Perceived poor conditions of service weakened FLP commitment to quality maternal and child care delivery. Findings suggest the need for strategies to induce behaviour change in FLP, strengthen district administrative structures, and improve on the supply chain and logistics

  19. The implementation evaluation of primary care groups of practice: a focus on organizational identity

    Directory of Open Access Journals (Sweden)

    Pozzebon Marlei

    2010-02-01

    Full Text Available Abstract Background Since 2002 the Health Ministry of Québec (Canada has been implementing a primary care organizational innovation called 'family medicine groups'. This is occurring in a political context in which the reorganization of primary care is considered necessary to improve health care system performance. More specifically, the purpose of this reform has been to overcome systemic deficiencies in terms of accessibility and continuity of care. This paper examines the first years of implementation of the family medicine group program, with a focus on the emergence of the organizational identity of one of the pilot groups located in the urban area of Montreal. Methods An in-depth longitudinal case study was conducted over two and a half years. Face to face individual interviews with key informants from the family medicine group under study were conducted over the research period considered. Data was gathered throuhg observations and documentary analysis. The data was analyzed using temporal bracketing and Fairclough's three-dimensional critical discourse analytical techniques. Results Three different phases were identified over the period under study. During the first phase, which corresponded to the official start-up of the family medicine group program, new resources and staff were only available at the end of the period, and no changes occurred in medical practices. Power struggles between physicians and nurses characterized the second phase, resulting in a very difficult integration of advanced nurse practitioners into the group. Indeed, the last phase was portrayed by initial collaborative practices associated with a sensegiving process prompted by a new family medicine group director. Conclusions The creation of a primary care team is a very challenging process that goes beyond the normative policy definitions of who is on the team or what the team has to do. To fulfil expectations of quality improvement through team-based care

  20. Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study.

    Science.gov (United States)

    Catalao, Raquel; Eshetu, Tigist; Tsigebrhan, Ruth; Medhin, Girmay; Fekadu, Abebaw; Hanlon, Charlotte

    2018-05-21

    In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. Task-sharing improved the accessibility of epilepsy care for

  1. Design and implementation of pay-for-quality in primary healthcare: A case study from Iran

    Directory of Open Access Journals (Sweden)

    Jafar Sadegh Tabrizi

    2017-06-01

    Full Text Available Background The common methods of payment to healthcare providers such as capitation and salary are not designed to be stimulation for high quality healthcare. The pay-for -quality (P4Q programs are designed to provide the financial incentives to the service providers in order to improve quality of services based on specified criteria. Aims This study describes the design and implementation of a P4Q program in the primary healthcare (PHc in East Azerbaijan Province, Iran. Methods The present study is a case study that describes the process of designing and implementing the P4Q program in PHC in East-Azerbaijan province in 2015. To design the P4Q program, after identifying core components of the program through literature review and Focus Group Discussion (FGD, final decision about each component was made by achieving consensus from a panel of recognised experts in the area of PHc. Altogether two FGD and seven expert panel sessions were hold in EAPHC in order to design the P4Q program. Results Key components of P4Q program were selected by qualitative studies and the results were categorized in five headings including P4Q formula, quality measures, payment strategy, data reporting and performance evaluation. The formula consists of five elements including fixed payment, individual, team and organization performance and managerial appraisal. A total of 37 measures, which covers the domains of quality of PHc, human resource development and responsibility were selected. ‘Improvement’ and ‘absolute level of measures’ were selected as the payment strategy. The methods of data reporting included valid questionnaire, organization’s documents and medical records. The final P4Q program was used for paying incentives to all primary health care providers in public health centres affiliated to Tabriz University of Medical Sciences. Conclusion Designing and implementing the P4Q program led to a shift in paying the incentives to healthcare providers

  2. Soil workability as a basis for advice on tillage activities

    OpenAIRE

    Cadena Zapata, M.

    1999-01-01

    In the tropical area of Mexico, when and how to carry out tillage is a qualitative decision. There is no quantified information about the interaction between a chosen process of cultivation, soil type and weather, which dictate the tool and power requirements. Waste of energy and soil degradation by erosion and compaction, and lack of timeliness are recognized problems caused by inadequate tillage management in the tropical area of Mexico.

    In this thesis, the workab...

  3. Influence of Tillage and Mulch on Soil Physical Properties and ...

    African Journals Online (AJOL)

    User

    tillage along with plastic mulch have positive impact on soil physical properties, root growth, water use efficiency ... positive effects on crop yield (Gla & Kulig,. 2008). ... potash fertilizers were applied at 120, 100 and 60 .... 0-10. 1.57B. 1.57B. 1.57B. 1.8B. 1.7B. 1.8B. Tillage × Soil depth. CTInitial. 0-5 ...... (Brassica napus). Eur.

  4. Variable penetration of primary angioplasty in Europe--what determines the implementation rate?

    Science.gov (United States)

    Kristensen, Steen D; Laut, Kristina G; Kaifoszova, Zuzana; Widimsky, Petr

    2012-08-01

    Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). A survey conducted in 2008 in the European Society of Cardiology (ESC) countries reported that the annual incidence of hospital admissions for acute STEMI is around 800 patients per million inhabitants. The survey also showed that STEMI patients' access to reperfusion therapy and the use of PPCI or thrombolytic therapy (TT) vary considerably among countries. Northern, Western and Central Europe already had well-developed PPCI services, offering PPCI to 60-90% of all STEMI patients. Southern Europe and the Balkans were still predominantly using TT and had a higher proportion of patients who were left without any reperfusion treatment. The survey concluded that a nationwide PPCI strategy results in more patients being offered reperfusion therapy. To address the inequalities in STEMI patients' access to life-saving PPCI and to support the implementation of the ESC STEMI treatment guidelines in Europe, the Stent for Life (SFL) Initiative was launched jointly by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and EuroPCR in 2008. The aim of the SFL Initiative is to improve the delivery of life-saving PPCI for STEMI patients. Currently, 10 national cardiac societies support the SFL Initiative in their respective countries. SFL national action programmes have been developed and are being implemented in several countries. The formation of regional PPCI networks involving emergency medical services, non-PPCI hospitals and PPCI centres is considered to be a critical factor in implementing PPCI services effectively. Better monitoring of STEMI incidence and prospective registration of PPCI in all countries is required to document improvements in health care and to identify areas where further effort is required. Furthermore, studies on potential factors or characteristics that explain the

  5. Evaluating the Implementation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil)

    Science.gov (United States)

    Wong, Eunice C.; Jaycox, Lisa H.; Ayer, Lynsay; Batka, Caroline; Harris, Racine; Naftel, Scott; Paddock, Susan M.

    2015-01-01

    Abstract A RAND team conducted an independent implementation evaluation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) Program, a system of care designed to screen, assess, and treat posttraumatic stress disorder and depression among active duty service members in the Army's primary care settings. Evaluating the Implementation of the Re-Engineering Systems of Primary Care Treatment in the Military (RESPECT-Mil) presents the results from RAND's assessment of the implementation of RESPECT-Mil in military treatment facilities and makes recommendations to improve the delivery of mental health care in these settings. Analyses were based on existing program data used to monitor fidelity to RESPECT-Mil across the Army's primary care clinics, as well as discussions with key stakeholders. During the time of the evaluation, efforts were under way to implement the Patient Centered Medical Home, and uncertainties remained about the implications for the RESPECT-Mil program. Consideration of this transition was made in designing the evaluation and applying its findings more broadly to the implementation of collaborative care within military primary care settings. PMID:28083389

  6. Effect of cover crops on emergence and growth of carrot (Daucus carota L. in no-plow and traditional tillage

    Directory of Open Access Journals (Sweden)

    Marzena Błażewicz-Woźniak

    2015-03-01

    Full Text Available The aim of the experiment was to determine the influence of cover crop biomass incorporated into the soil at different times and using different treatments on carrot emergence and growth. 7 species of cover crops were included in the study: Secale cereale, Avena sativa, Vicia sativa, Sinapis alba, Phacelia tanacetifolia, Fagopyrum esculentum, and Helianthus annuus.  Number of emerged carrot plants significantly depended on the cover crop used and on the method of pre-winter and spring pre-sowing tillage. Carrot emerged best after a rye or oats cover crop. Regardless of the cover crop species used, the largest number of carrots emerged in cultivation on ridges. In other variants of no-plow tillage, number of seedlings was significantly lower and did not differ from that under traditional plow tillage. The highest leaf rosettes were formed by carrot growing after a rye or oats cover crop. The highest rosettes were produced by carrots in the treatments where tillage was limited to the use of a tillage implement in spring and the lowest ones after pre-winter plowing. The effect of tillage on the emergence and height of carrot leaves largely depended on weather conditions in the successive years of the study. The largest number of leaves was found in carrots grown after a buckwheat cover crop and in cultivation without cover crop, while the smallest one after phacelia and white mustard. Carrots produced the largest number of leaves after a sunflower cover crop and the use of a tillage implement in spring, while the number of leaves was lowest when the mustard biomass was incorporated into the soil in spring. The use of cover crops significantly increased the mass of leaves produced by carrot as compared to the cultivation without cover crop. The largest mass of leaves was produced by carrots grown after the phacelia and mustard cover crops. Conventional plow tillage and pre-winter tillage using a stubble cultivator promoted an increase in the mass

  7. Energy balance and greenhouse gas emissions of dryland camelina as influenced by tillage and nitrogen

    International Nuclear Information System (INIS)

    Keshavarz-Afshar, Reza; Mohammed, Yesuf Assen; Chen, Chengci

    2015-01-01

    Despite the great potential of camelina (Camelina sativa L. Crantz) as a promising biofuel feedstock, in-farm energy flow of the crop and its associated environmental impacts has not received sufficient attention from researchers. In order to assess net energy gain and to identify energy saving and environmental friendly production operations, a two year study was conducted at central Montana. We investigated the effects of tillage method (CT (conventional tillage) vs. NT (no-tillage)) and N (nitrogen) fertilizer rate (0, 45, 90 kg N ha −1 ) on energy balance and GHG (greenhouse gas emission) of dryland camelina production. Results indicated that energy input and GHG emission were 5 and 8% lower in NT than in CT. Application of 45 and 90 kg N ha −1 increased camelina energy input by 186 and 365%, while increased energy output by only 21 and 64%, respectively. There was no significant difference in net energy gain in response to N fertilization, but lower energy efficiency in response to higher N inputs. Averaged across tillage systems, the GHG emission was 32.0 kg C eq ha −1 with 0 N applied, and the GHG emission increased by 206 and 389% when 45 and 90 kg N ha −1 was applied. Overall, N fertilizer had the biggest share in total energy input. Averaged over all experimental treatments, 14,945 MJ ha −1 net energy was obtained from camelina crop in this study which shows the potential of this crop as a bioenergy feedstock. Our result showed that implementation of NT is strongly recommendable for camelina production in this region. Moreover, improvement of N use efficiency has the highest priority to improve energy performance and reduce GHG emissions in camelina production. - Highlights: • Camelina produced 14,945 MJ ha −1 of net energy in this study. • No tillage operation reduced 5% energy input and 8% greenhouse gas emission. • Nitrogen fertilizer was the most energy-intensive input in camelina production.

  8. Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: a synthesis through meta-ethnography.

    Directory of Open Access Journals (Sweden)

    Maria Rubio-Valera

    Full Text Available Evidence supports the implementation of primary prevention and health promotion (PP&HP activities but primary care (PC professionals show resistance to implementing these activities. The aim was to synthesize the available qualitative research on barriers and facilitators identified by PC physicians and nurses in the implementation of PP&HP in adults.A systematic search of three databases was conducted and supported by manual searches. The 35 articles included were translated into each other and a new interpretation of the concepts extracted was generated. The factors affecting the implementation of PP&HP activities in PC according to professionals were fitted into a five-level ecological model: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. At the intrapersonal level we find professionals' beliefs about PP&HP, experiences, skills and knowledge, and selfconcept. The attitudes and behavior towards PP&HP of patients, specialists, practice managers and colleagues (interpersonal factors affect the feasibility of implementing PP&HP. Institutional level: PC is perceived as well-placed to implement PP&HP but workload, lack of time and referral resources, and the predominance of the biomedical model (which prioritizes disease treatment hamper the implementation of PP&HP. The effectiveness of financial incentives and tools such as guidelines and alarms/reminders is conditioned by professionals' attitudes to them. Community factors include patients' social and cultural characteristics (religion, financial resources, etc., local referral resources, mass-media messages and pharmaceutical industry campaigns, and the importance given to PP&HP in the curriculum in university. Finally, policies affect the distribution of resources, thus affecting the implementation of PP&HP.Research on barriers and facilitators in the implementation of PP&HP activities in multirisk management is scarce. The conceptual

  9. Social workers' perceptions of barriers to interpersonal therapy implementation for treating postpartum depression in a primary care setting in Israel.

    Science.gov (United States)

    Bina, Rena; Barak, Adi; Posmontier, Barbara; Glasser, Saralee; Cinamon, Tali

    2018-01-01

    Research on evidence-based practice (EBP) implementation in social work often neglects to include evaluation of application barriers. This qualitative study examined social workers' perspectives of provider- and organisational-related barriers to implementing a brief eight-session interpersonal therapy (IPT) intervention, a time-limited EBP that addresses reducing depressive symptoms and improving interpersonal functioning. Implementation took place in a primary care setting in Israel and was aimed at treating women who have postpartum depression (PPD) symptoms. Using purposeful sampling, 25 primary care licensed social workers were interviewed between IPT training and implementation regarding their perceived barriers to implementing IPT in practice. Data analysis was facilitated using a phenomenological approach, which entails identifying the shared themes and shared experiences of research participants regarding barriers to implementing IPT. Three themes emerged from the analysis of interviews: Perceived lack of flexibility of IPT intervention in comparison with more familiar methods social workers previously applied, specifically regarding the number of sessions and therapeutic topics included in the IPT protocol; insecurity and hesitance to gain experience with a new method of intervention; and organisational barriers, including difficulties with referrals, the perception of HMOs as health facilities not suitable for therapy, and time constraints. Addressing perceived barriers of social workers toward implementing EBPs, such as IPT for postpartum depression, during the training phase is crucial for enabling appropriate implementation. Future training should include examining practitioners' attitudes toward implementation of EBPs, as part of standardised training protocols. © 2017 John Wiley & Sons Ltd.

  10. Novel implementation of an ISO standard method for primary vibration calibration by laser interferometry

    CSIR Research Space (South Africa)

    Veldman, CS

    2003-01-01

    Full Text Available -11. The signal processing required for the successful implementation of this method of ISO 16063-11 has been implemented by various metrology institutes using various techniques. For the implementation of these techniques, different hardware and software...

  11. Leaching of pesticides through normal-tillage and low-tillage soil--a lysimeter study. I. Isoproturon.

    Science.gov (United States)

    Fomsgaard, Inge S; Spliid, Niels Henrik; Felding, Gitte

    2003-01-01

    Isoproturon is a herbicide, which was used in Denmark against grass weeds and broad-leaved weeds until 1998. Isoproturon has frequently been detected in ground water monitoring studies. Leaching of isoproturon (N,N-dimethyl-N'-(4-(1-methylethyl)-phenyl)urea) and its metabolites, N'-(4-isopropylphenyl)-N-methylurea and N'-(4-isopropylphenyl)urea was studied in four lysimetres, two of them being replicates from a low-tillage field (lysimeter 3 and 4), the other two being replicates from a normal tillage field (lysimeter 5 and 6). In both cases the soil was a sandy loam soil with 13-14% clay. The lysimetres had a surface area of 0.5 m2 and a depth of 110 cm. Lysimeter 3 and 4 were sprayed with unlabelled isoproturon while lysimeter 5 and 6 was sprayed with a mixture of 14C-labelled and unlabelled isoproturon. The total amount of isoproturon sprayed onto each lysimeter was 63 mg, corresponding to 1.25 kg active ingredient per ha. The lysimeters were sprayed with isoproturon on October 26, 1997. The lysimetres were installed in an outdoor system in Research Centre Flakkebjerg and were thus exposed to normal climatic conditions of the area. A mean of 360 l drainage water were collected from lysimeter 3 and 4 and a mean of 375 litres from lysimeter 5 and 6. Only negligible amounts of isoproturon and its primary metabolites were found in the drainage water samples, and thus no significant difference between the two lysimeter sets was shown. In a total of 82 drainage water samples, evenly distributed between the four lysimetres isoproturon was found in detectable amounts in two samples and N'-(4-isopropylphenyl)urea was found in detectable amounts in two other samples. The detection limit for all the compounds was 0.02 microg/l. 48% and 54% of the added radioactivity were recovered from the upper 10 cm soil layer in lysimeter 5 and 6, respectively, and 17 and 14% from 10-20 cm's depth. By extraction first with an aquatic CaCl2 solution 0.49% of the added radioactivity was

  12. Falling on stony ground? A qualitative study of implementation of clinical guidelines' prescribing recommendations in primary care.

    Science.gov (United States)

    Rashidian, Arash; Eccles, Martin P; Russell, Ian

    2008-02-01

    We aimed to explore key themes for the implementation of guidelines' prescribing recommendations. We interviewed a purposeful sample of 25 participants in British primary care in late 2000 and early 2001. Thirteen were academics in primary care and 12 were non-academic GPs. We asked about implementation of guidelines for five conditions (asthma, coronary heart disease prevention, depression, epilepsy, menorrhagia) ensuring variation in complexity, role of prescribing in patient management, GP role in prescribing and GP awareness of guidelines. We used the Theory of Planned Behaviour to design the study and the framework method for the analysis. Seven themes explain implementation of prescribing recommendations in primary care: credibility of content, credibility of source, presentation, influential people, organisational factors, disease characteristics, and dissemination strategy. Change in recommendations may hinder implementation. This is important since the development of evidence-based guidelines requires change in recommendations. Practitioners do not have a universal view or a common understanding of valid 'evidence'. Credibility is improved if national bodies develop primary care guidelines with less input from secondary care and industry, and with simple and systematic presentation. Dissemination should target GPs' perceived needs, improve ownership and get things right in the first implementation attempt. Enforcement strategies should not be used routinely. GPs were critical of guidelines' development, relevance and implementation. Guidelines should be clear about changes they propose. Future studies should quantify the relationship between evidence base of recommendations and implementation, and between change in recommendations and implementation. Small but important costs and side effects of implementing guidelines should be measured in evaluative studies.

  13. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    Directory of Open Access Journals (Sweden)

    Aina O. Odusola

    2016-02-01

    Full Text Available Background: Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA that can be modified through timely and long-term treatment in primary care. Objective: We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Design: Qualitative study using semi-structured individual interviews with primary care staff (n = 11 and health insurance managers (n=4. Data were analysed using standard qualitative techniques. Results: Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education. Conclusions: By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

  14. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers.

    Science.gov (United States)

    Odusola, Aina O; Stronks, Karien; Hendriks, Marleen E; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A

    2016-01-01

    Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider-insurer relationships; automated administration systems; and tailoring guidelines/patient education. By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

  15. Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation.

    Science.gov (United States)

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

    2017-02-17

    Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care. A descriptive study of 2-year implementation indicators for the PVS clinical intervention was conducted in four primary health care centers. A multifaceted collaborative modeling implementation strategy was developed to enhance the integration of a clinical intervention to promote healthy lifestyles into clinical practice. Process indicators were assessed for intervention reach, adoption, implementation, sustainability and their variability at center, practice, and patient levels. Mean rates of adoption by means of active collaboration among the three main professional categories (family physicians, nurses and administrative personnel) were 75% in all centers. Just over half of the patients that attended (n = 11650; 51.9%) were reached in terms of having their lifestyle habits assessed, while more than a third (33.7%; n = 7433) and almost 10% (n = 2175) received advice or a printed prescription for at least one lifestyle change, respectively. Only 3.7% of the target population received a repeat prescription. These process indicators significantly (p implementation period within centers. The implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of routine primary care. Sources of heterogeneity and instability in these indicators may improve our understanding of factors required to

  16. Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study.

    Science.gov (United States)

    Greiver, Michelle; Wintemute, Kimberly; Aliarzadeh, Babak; Martin, Ken; Khan, Shahriar; Jackson, Dave; Leggett, Jannet; Lambert-Lanning, Anita; Siu, Maggie

    2016-10-12

    Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions. Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada. Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%-8.2%, p Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

  17. Are primary health care providers prepared to implement an anti-smoking program in Syria?

    Science.gov (United States)

    Asfar, Taghrid; Al-Ali, Radwan; Ward, Kenneth D; Vander Weg, Mark W; Maziak, Wasim

    2011-11-01

    To document primary health care (PHC) providers' tobacco use, and how this influences their smoking cessation practices and attitudes towards tobacco-control policies. Anonymous questionnaires were distributed to PHC providers in 7 randomly selected PHC centers in Aleppo, Syria. All PHC providers completed the questionnaires (100% response rate). A quarter of these providers smoke cigarettes and more than 10% smoke waterpipes. Physicians who smoke were less likely to advise patients to quit (OR=0.29; 95% CI, 0.09-0.95), assess their motivation to quit (OR=0.13, 95% CI=0.02-0.72), or assist them in quitting (OR=0.24, 95% CI=0.06-0.99). PHC providers who smoke were less likely to support a ban on smoking in PHC settings (68.2% vs. 89.1%) and in enclosed public places (68.2% vs. 86.1%) or increases in the price of tobacco products (43.2% vs. 77.4%) (PSyria and will negatively influence implementation of anti-smoking program in PHC settings. Smoking awareness and cessation interventions targeted to PHC providers, and training programs to build providers' competency in addressing their patients' smoking is crucial in Syria. Published by Elsevier Ireland Ltd.

  18. Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care.

    Science.gov (United States)

    Holtrop, Jodi Summers; Luo, Zhehui; Piatt, Gretchen; Green, Lee A; Chen, Qiaoling; Piette, John

    2017-10-01

    To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.

  19. Implementation of collaborative depression management at community-based primary care clinics: an evaluation.

    Science.gov (United States)

    Bauer, Amy M; Azzone, Vanessa; Goldman, Howard H; Alexander, Laurie; Unützer, Jürgen; Coleman-Beattie, Brenda; Frank, Richard G

    2011-09-01

    This study evaluated a large demonstration project of collaborative care of depression at community health centers by examining the role of clinic site on two measures of quality care (early follow-up and appropriate pharmacotherapy) and on improvement of symptoms (score on Patient Health Questionnaire-9 reduced by 50% or ≤ 5). A quasi-experimental study examined data on the treatment of 2,821 patients aged 18 and older with depression symptoms between 2006 and 2009 at six community health organizations selected in a competitive process to implement a model of collaborative care. The model's key elements were use of a Web-based disease registry to track patients, care management to support primary care providers and offer proactive follow-up of patients, and organized psychiatric consultation. Across all sites, a plurality of patients achieved meaningful improvement in depression, and in many sites, improvement occurred rapidly. After adjustment for patient characteristics, multivariate logistic regression models revealed significant differences across clinics in the probability of receiving early follow-up (range .34-.88) or appropriate pharmacotherapy (range .27-.69) and in experiencing improvement (.36 to .84). Similarly, after adjustment for patient characteristics, Cox proportional hazards models revealed that time elapsed between first evaluation and the occurrence of improvement differed significantly across clinics (pquality indicators and outcomes. Sites that performed better on quality indicators had better outcomes, and the differences were not attributable to patients' characteristics.

  20. A methodological approach and framework for sustainability assessment in NGO-implemented primary health care programs.

    Science.gov (United States)

    Sarriot, Eric G; Winch, Peter J; Ryan, Leo J; Bowie, Janice; Kouletio, Michelle; Swedberg, Eric; LeBan, Karen; Edison, Jay; Welch, Rikki; Pacqué, Michel C

    2004-01-01

    An estimated 10.8 million children under 5 continue to die each year in developing countries from causes easily treatable or preventable. Non governmental organizations (NGOs) are frontline implementers of low-cost and effective child health interventions, but their progress toward sustainable child health gains is a challenge to evaluate. This paper presents the Child Survival Sustainability Assessment (CSSA) methodology--a framework and process--to map progress towards sustainable child health from the community level and upward. The CSSA was developed with NGOs through a participatory process of research and dialogue. Commitment to sustainability requires a systematic and systemic consideration of human, social and organizational processes beyond a purely biomedical perspective. The CSSA is organized around three interrelated dimensions of evaluation: (1) health and health services; (2) capacity and viability of local organizations; (3) capacity of the community in its social ecological context. The CSSA uses a participatory, action-planning process, engaging a 'local system' of stakeholders in the contextual definition of objectives and indicators. Improved conditions measured in the three dimensions correspond to progress toward a sustainable health situation for the population. This framework opens new opportunities for evaluation and research design and places sustainability at the center of primary health care programming.

  1. Literacy Infrastructure, Access to Books, and the Implementation of the School Literacy Movement in Primary Schools in Indonesia

    Science.gov (United States)

    Laksono, K.; Retnaningdyah, P.

    2018-01-01

    Literacy Infrastructure and access to books are the foundation of literacy activity. Indonesia has regulations from the Ministry of Education and Culture requiring that 15 minutes should be used each day before the learning begins to read books other than textbooks. However, many schools are not yet obeying this requirement. The purposes of this study are to describe the literacy infrastructure in primary schools in Indonesia, to analyze access to books in primary schools, to explain the School Literacy Movement implementation, and to identify issues around the implementation of reading strategies in a context in which there is limited access to books. The questionnaire and interview study were conducted in 30 primary schools in East Java, Indonesia. The study concluded that the literacy infrastructure and access to books in 30 primary schools are below standard, but the school community enthusiastically implements the objectives of the School Literacy Movement. Many primary schools are already implementing good many reading strategies although there are some problems related to teacher competence.

  2. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.

    Science.gov (United States)

    Cully, Jeffrey A; Armento, Maria E A; Mott, Juliette; Nadorff, Michael R; Naik, Aanand D; Stanley, Melinda A; Sorocco, Kristen H; Kunik, Mark E; Petersen, Nancy J; Kauth, Michael R

    2012-07-11

    Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews

  3. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design

    Directory of Open Access Journals (Sweden)

    Cully Jeffrey A

    2012-07-01

    Full Text Available Abstract Background Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. Methods This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1 to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases primary care patients and (2 to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200 or usual care (n = 120. Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points and

  4. Soil respiration in a long-term tillage treatment experiment

    Science.gov (United States)

    Gelybó, Györgyi; Birkás, Márta; Dencsö, Márton; Horel, Ágota; Kása, Ilona; Tóth, Eszter

    2016-04-01

    Regular soil CO2 efflux measurements have been carried out at Józsefmajor longterm tillage experimental site in 2014 and 2015 with static chamber technique in no-till and ploughing plots in seven spatial replicates. The trial was established in 2002 on a loamy chernozem soil at the experimental site of the Szent István University nearby the city Hatvan, northern Hungary. At the site sunflower (Helianthus A.) and wheat (Triticum A.) was grown in 2014 and 2015, respectively. Ancillary measurements carried out at the site included weather parameters, soil water content, soil temperature. The aim of the investigation was to detect the effect of soil disturbance and soil tillage treatments on soil CO2 emission in agricultural ecosystems. Soil respiration measurements were carried out every week during the vegetation period and campaign measurements were performed scheduled to tillage application. In this latter case, measurements were carried out 1, 2, 3, 4, 6, 12, 18, 24, 48, 72, 96, 120 hours and 7 days after tillage operation. Results showed that during the vegetation season in the majority of measurement occasions emission was higher in the no-till plots. These differences; however were not found to be statistically significant. Due to the short term effect of tillage treatment, emissions increased following tillage treatment in the ploughed plots. Soil water content was also examined as main driver of soil CO2 fluxes. Soil water content sharply decreases in the surface layer (5-10 cm depth) after tillage treatment indicating a fast drying due to soil disturbance. This effect slowly attenuated and eventually extincted in approx. two weeks. CO2 emission measurements were associated with high uncertainties as a result of the measurement technique. Our further aim is to reduce this uncertainty using independent measurement techniques on the field.

  5. The implementation of health promotion in primary and community care: a qualitative analysis of the 'Prescribe Vida Saludable' strategy.

    Science.gov (United States)

    Martinez, Catalina; Bacigalupe, Gonzalo; Cortada, Josep M; Grandes, Gonzalo; Sanchez, Alvaro; Pombo, Haizea; Bully, Paola

    2017-02-17

    The impact of lifestyle on health is undeniable and effective healthy lifestyle promotion interventions do exist. However, this is not a fundamental part of routine primary care clinical practice. We describe factors that determine changes in performance of primary health care centers involved in piloting the health promotion innovation 'Prescribe Vida Saludable' (PVS) phase II. We engaged four primary health care centers of the Basque Healthcare Service in an action research project aimed at changing preventive health practices. Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable) is focused on designing, planning, implementing and evaluating innovative programs to promote multiple healthy habits, feasible to be performed in routine primary health care conditions. After 2 years of piloting, centers were categorized as having high, medium, or low implementation effectiveness. We completed qualitative inductive and deductive analysis of five focus groups with the staff of the centers. Themes generated through consensual grounded qualitative analysis were compared between centers to identify the dimensions that explain the variation in actual implementation of PVS, and retrospectively organized and assessed against the Consolidated Framework for Implementation Research (CFIR). Of the 36 CFIR constructs, 11 were directly related to the level of implementation performance: intervention source, evidence strength and quality, adaptability, design quality and packaging, tension for change, learning climate, self-efficacy, planning, champions, executing, and reflecting and evaluating, with -organizational tracking added as a new sub-construct. Additionally, another seven constructs emerged in the participants' discourse but were not related to center performance: relative advantage, complexity, patients' needs and resources, external policy and incentives, structural characteristics, available resources, and formally appointed internal implementation

  6. Particulate emissions calculations from fall tillage operations using point and remote sensors.

    Science.gov (United States)

    Moore, Kori D; Wojcik, Michael D; Martin, Randal S; Marchant, Christian C; Bingham, Gail E; Pfeiffer, Richard L; Prueger, John H; Hatfield, Jerry L

    2013-07-01

    Soil preparation for agricultural crops produces aerosols that may significantly contribute to seasonal atmospheric particulate matter (PM). Efforts to reduce PM emissions from tillage through a variety of conservation management practices (CMPs) have been made, but the reductions from many of these practices have not been measured in the field. A study was conducted in California's San Joaquin Valley to quantify emissions reductions from fall tillage CMP. Emissions were measured from conventional tillage methods and from a "combined operations" CMP, which combines several implements to reduce tractor passes. Measurements were made of soil moisture, bulk density, meteorological profiles, filter-based total suspended PM (TSP), concentrations of PM with an equivalent aerodynamic diameter ≤10 μm (PM) and PM with an equivalent aerodynamic diameter ≤2.5 μm (PM), and aerosol size distribution. A mass-calibrated, scanning, three-wavelength light detection and ranging (LIDAR) procedure estimated PM through a series of algorithms. Emissions were calculated via inverse modeling with mass concentration measurements and applying a mass balance to LIDAR data. Inverse modeling emission estimates were higher, often with statistically significant differences. Derived PM emissions for conventional operations generally agree with literature values. Sampling irregularities with a few filter-based samples prevented calculation of a complete set of emissions through inverse modeling; however, the LIDAR-based emissions dataset was complete. The CMP control effectiveness was calculated based on LIDAR-derived emissions to be 29 ± 2%, 60 ± 1%, and 25 ± 1% for PM, PM, and TSP size fractions, respectively. Implementation of this CMP provides an effective method for the reduction of PM emissions. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  7. Influence of Tillage and Poultry Manure on the Physical Properties of ...

    African Journals Online (AJOL)

    User

    growth (Lampurlanes et al.,2001), grain yield and the ... Deep tillage improved the root length, root ... Data indicated that the deep tillage practice significantly improved the maize grain physical ... applied at the time of sowing while remaining.

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

    Science.gov (United States)

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

    2017-12-06

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

  9. Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.

    Science.gov (United States)

    Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora

    2016-01-27

    Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare

  10. Monoculture Maize (Zea mays L. Cropped Under Conventional Tillage, No-tillage and N Fertilization: (II Fumonisin Incidence on Kernels

    Directory of Open Access Journals (Sweden)

    Adriano Marocco

    2009-09-01

    Full Text Available Planting maize under no-tillage is an increasing farming practice for sustainable agriculture and sound environmental management. Although several studies on yield of no-till maize have been done, there is few information about the effect of tillage on fumonisin contamination. The present study was done to determine the effect of notillage and conventional tillage with two rates of nitrogen on fumonisin content in kernels of continuous maize. Average grain contamination with fumonisins B1 and B2 over the years 2004-06 was not significantly different, with mean values of 1682, 1984 and 2504 μg kg-1, respectively. Fumonisin B1 was the most abundant toxin found in the samples. No-tillage significantly affected the incidence of fumonisins during the first year of the trial, in which fumonisin content was significantly higher with no-till (2008 μg kg-1 compared with conventional tillage (1355 μg kg-1. However, no-tillage did not significantly affect the incidence of fumonisins in the second and third years of the study. Fumonisin content at the rate of 300 kg N ha-1 was not statistically different compared to that obtained without N fertilization. The interaction between the soil management system and the rate of applied nitrogen was only evident in the second year. Our results indicate that fumonisin contamination was affected by no-tillage only in the first year. Nitrogen fertilization had no significant effect on fumonisin content in any year. The weather conditions during susceptible stages of maize development have probably overridden the effect of nitrogen fertilization.

  11. Description of Sanitation Clinic Implementation in Primary Health Care Services in Bukittinggi

    Directory of Open Access Journals (Sweden)

    Vini Jamarin

    2016-01-01

    descriptive study used total sampling, in which all seven PHCS in Bukittinggi are included. This research was done from September to October 2013. Based on quedionaire result, all sanitarians are well-educated, but only two of them had sanitation clinic training. Only one PHCS has a special room, six has posters and leaflets, two allocates special budget for sanitation clinic, and six has all kind of manual books. Based on secondary data, the accumulation of environment-based disease’s cases in all PHCS is variative and fluctuative and the accumulation of clients come to sanitation clinic is still below the expectation. House-visitting activity has not met the expectation yet, while trans-program activity has been running well, trans-sector activity has been running well in almost all PHCS, and evaluation has been running in a variative frequency. All sanitation clinic graded good in implementing sanitation clinic, within the range of 50-100%.Keywords: sanitation clinic, primary health care service

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

    Directory of Open Access Journals (Sweden)

    Martín-Iglesias Susana

    2011-12-01

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

  13. Evaluating factors affecting the implementation of evidence based medicine in primary healthcare centers in Dubai.

    Science.gov (United States)

    Albarrak, Ahmed I; Ali Abbdulrahim, Suhair Aqil; Mohammed, Rafiuddin

    2014-07-01

    To assess the current evidence based medicine (EBM) knowledge, attitude and perceptions of physicians at Dubai Primary Health Care Sector (PHCS). Further to evaluate barrier and facilitator factors toward implementing the EBM practice. A cross-sectional study, at Dubai PHCS, UAE between June and August 2010. The survey was composed of two phases. The first phase was a self administrated questionnaire employed for data collection and the second phase was qualitative method, which was in the form of individual interviews. Statistical Package for Social Sciences (SPSS) was used for data analysis. In total 48 participants responded to the survey questionnaire and 13 responded to individual interviews. The response rate was 70.0%. Mean age was 42.18 (SD 10.46). The majority were females (64.6%). The physicians who attended EBM courses reported 70.30% using EBM and showed statistical significance (p = 0.002) from those who did not attend the EBM courses. 65.0% believe that 50-75% of the patients are capable of participating in clinical decision while 71.8% disagreed that the concept of EBM is not applicable to their culture. In addition they showed significance (p = 0.03) between physician beliefs with regard to patient capacity to take decision. About 67.0% of the family physicians were knowledgeable and followed systematic review as the strongest evidence. They had no access to the EBM resources (37.0%) and had no time to practice the EBM (38.0%). Nearly 40.0% interviewees reported lack of encouragement to attend EBM courses. EBM activities (22.0%) and active audit (18.0%) were top rated facilitating factors. EBM is not fully utilized by indefinite physicians in the Dubai PHC sector. Factors associated with non-utilization of EBM in the PHCS are lack of encouragement to attend EBM courses, senior physicians resist adoption of EBM, lack of time and insufficient dissemination process for implementing the clinical guideline.

  14. Tillage, fertilization systems and chemical attributes of a Paleudult

    Directory of Open Access Journals (Sweden)

    Evelyn Penedo Dorneles

    2015-02-01

    Full Text Available Tillage and fertilization methods may affect soil fertility. With the aim of assessing changes in soil chemical properties over a period of ten years, soil samples of a Paleudult were collected over nine seasons at three layer depths (0-5, 5-10, 10-20 cm and were chemically analyzed. Grain yield and nutrient export in two summer crops, soybean (Glycine max and corn (Zea mays, in a field experiment set in Eldorado do Sul, in the state of Rio Grande do Sul, Brazil, were determined. Three soil tillage systems were evaluated, conventional (CT, reduced (RT and no-tillage (NT, combined with mineral (lime and fertilizers and organic (poultry litter fertilization. The no-tillage system stood out as compared to the others, especially in the surface layer, in terms of values of organic matter, soil pH, available phosphorus, cation exchange capacity and base saturation. Phosphorus content was higher under organic than mineral fertilization due to the criteria used for the establishment of fertilizer doses. Under organic fertilization, soil pH values were similar to those obtained in limed soil samples because of the cumulative effect of the organic fertilizer. Soybean yield was lower under NT in comparison to the RT and CT systems. Consequently, soybean grain exported a lower content of nutrients than maize grain. Maize yield was not affected by either tillage or fertilization systems.

  15. Soil biological activity as affected by tillage intensity

    Science.gov (United States)

    Gajda, A. M.; Przewłoka, B.

    2012-02-01

    The effect of tillage intensity on changes of microbiological activity and content of particulate organic matter in soil under winter wheat duirng 3 years was studied. Microbial response related to the tillage-induced changes in soil determined on the content of biomass C and N, the rate of CO2 evolution, B/F ratio, the activity of dehydrogenases, acid and alkaline phosphatases, soil C/N ratio and microbial biomass C/N ratio confirmed the high sensitivity of soil microbial populations to the tillage system applied. After three year studies, the direct sowing system enhanced the increase of labile fraction of organic matter content in soil. There were no significant changes in the labile fraction quantity observed in soil under conventional tillage. Similar response related to the tillage intensity was observed in particulate organic matter quantities expressed as a percentage of total organic matter in soil. A high correlation coefficients calculated between contents of soil microbial biomass C and N, particulate organic matter and potentially mineralizable N, and the obtained yields of winter wheat grown on experimental fields indicated on a high importance of biological quality of status of soil for agricultural crop production.

  16. Feasibility and effectiveness of the implementation of a primary prevention programme for type 2 diabetes in routine primary care practice: a phase IV cluster randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Sanchez Alvaro

    2012-11-01

    Full Text Available Abstract Background The objective of this study is to perform an independent evaluation of the feasibility and effectiveness of an educational programme for the primary prevention of type 2 diabetes (DM2 in high risk populations in primary care settings, implanted within the Basque Health Service - Osakidetza. Methods/design This is a prospective phase IV cluster clinical trial conducted under routine conditions in 14 primary health care centres of Osakidetza, randomly assigned to an intervention or control group. We will recruit a total sample of 1089 individuals, aged between 45 and 70 years old, without diabetes but at high risk of developing the condition (Finnish Diabetes Risk Score, FINDRISC ≥ 14 and follow them up for 2 years. Primary health care nursing teams of the intervention centres will implement DE-PLAN, a structured educational intervention program focused on changing healthy lifestyles (diet and physical activity; while the patients in the control centres will receive the usual care for the prevention and treatment of DM2 currently provided in Osakidetza. The effectiveness attributable to the programme will be assessed by comparing the changes observed in patients exposed to the intervention and those in the control group, with respect to the risk of developing DM2 and lifestyle habits. In terms of feasibility, we will assess indicators of population coverage and programme implementation. Discussion The aim of this study is to provide the scientific basis for disseminate the programme to the remaining primary health centres in Osakidetza, as a novel way of addressing prevention of DM2. The study design will enable us to gather information on the effectiveness of the intervention as well as the feasibility of implementing it in routine practice. Trial registration ClinicalTrials.gov NCT01365013

  17. Strip Tillage and Early-Season Broadleaf Weed Control in Seeded Onion (Allium cepa)

    OpenAIRE

    Sarah Gegner-Kazmierczak; Harlene Hatterman-Valenti

    2016-01-01

    Field experiments were conducted in 2007 and 2008 near Oakes, North Dakota (ND), USA, to evaluate if strip tillage could be incorporated into a production system of seeded onion (Allium cepa) to eliminate the standard use of a barley (Hordeum vulgare) companion crop with conventional, full width tillage, yet support common early-season weed control programs. A split-factor design was used with tillage (conventional and strip tillage) as the main plot and herbicide treatments (bromoxynil, DCPA...

  18. Implementation of Mandatory Nutritional Guidelines in South Australian Primary School Canteens: A Qualitative Study

    Science.gov (United States)

    Abery, Elizabeth; Drummond, Claire

    2014-01-01

    Primary schools are identified as being in a primary position to offer nutrition education. Moreover, primary schools can offer an environment which is conducive to the promotion of healthy eating while influencing eating behaviours of children to benefit their health, well-being and academic development and performance. School canteens are one…

  19. Implementation and evaluation of early gastroscopy for patients with dyspepsia and warning signs in Primary Care.

    Science.gov (United States)

    García-Alonso, Francisco Javier; Hernández Tejero, María; Rubio Benito, Elvira; Valer, Paz; Guerra, Iván; García Ceballos, Victoria Gema; Noguerol, Mar; Llinares, Victoria; Bermejo, Fernando

    2017-05-01

    Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC. We developed a pilot project establishing an early gastroscopy programme for patients with dyspepsia and warning signs in PC, subsequently extending it to the entire healthcare area. The aim was to evaluate the requirements, impact and opinion of this service at the PC level. Demographic, symptomatic and endoscopic variables on the patients referred to SC from the pilot centre were recorded. A satisfaction survey was conducted among the PC physicians. The one-year pilot study and the first year of implementation of the programme were evaluated. A total of 355 patients were included (median age 56.4 years; IQR 45.5-64.3); 61.2% (56.1-66.3%) were women. The waiting time for examination was 1.5 weeks (IQR 1.5-2.5). Gastroscopy was correctly indicated in 82.7% (78.4-86.3%) of patients. The median number of requests per month was 1.1 per 10,000 adults (range 0.8-1.6). Monthly referrals to SC clinics from the pilot centre fell by 11 subjects (95% CI 5.9-16) with respect to the previous median of 58 (IQR 48-64.5). Almost all those polled (98.4%) considered the programme useful in routine practice. The availability of an early gastroscopy programme in PC for patients with dyspepsia and warning signs reduced the number of referrals to SC. Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  20. Implementing managerial innovations in primary care: can we rank change drivers in complex adaptive organizations?

    Science.gov (United States)

    Longo, Francesco

    2007-01-01

    There has been much innovation in primary care in the past few decades. Although external and systemic constraints for health care organizations are relevant for their managerial evolution, there is also evidence that organizations operating under the same external pressures reach different levels of maturity. Which of the internal drivers available explain and foster change? Is it possible to rank change drivers by looking at their rate of efficacy in order to define a general change management path in the relationship between managers and physicians? The study is a hypothesis-generating work, designed to discuss a framework, consistent with the complex adaptive systems literature, for more effective internal change management approaches. We employed a qualitative approach to conduct a multiple case study in order to directly observe the evidence and to ask "key change players" for their perceptions. We studied different organizations all subject to the same external constraints in order to focus on the effects of internal change drivers. According to key players' opinions, the main drivers for managerial development are characteristics of the actors involved: their motivation, leadership, and commitment; the quality of relationships among the main actors; and how the resources dedicated to manage change are used. Given these criteria, any organizational strategy and goal seems to be achievable. This is consistent with the suggestions coming from the complex adaptive system literature. MANAGERIAL IMPLICATIONS: Managers have to consider the management of the relationship with professionals as the key success factor for implementing change. Managerial leadership has to be diffused in the organization both in the vertical and horizontal dimensions. Innovations need a medium or long-term perspective to become widely applied, and this requires a strong commitment which is related to managerial stability. Resources for innovation are to be considered a critical driver

  1. Historicizing Teaching in Awgni as a Mother Tongue Language at Primary Schools of Awi Nationality Administrative Zone: Challenges and Implementation

    Science.gov (United States)

    Engida, Alemayehu Erkihun

    2015-01-01

    This study examined the challenges facing the teaching as well as the implementation of Awgni as a mother tongue language in primary schools of Awi administrative zone. The need to teach through mother tongue in Ethiopia was widely discussed following the change of the politics in 1991. To this end, the government issued new education and training…

  2. Investigation of Problems of Implementing Curriculum in Primary Schools in Somalia. African Studies in Curriculum Development & Evaluation.

    Science.gov (United States)

    Mohamed, Ibrahim Jeylani

    The aim of this study was to investigate the implementation of modern mathematics in the primary schools of Somalia. In particular, three concerns were addressed: (1) teachers' confidence and ability in teaching mathematics; (2) students' interest in mathematics; and (3) students' examination performance in mathematics. Subjects were 30 teachers…

  3. Challenges to the Implementation of PLAP in Primary Schools: Perceptions of ZOU Bachelor of Educational Management Students

    Science.gov (United States)

    Mercy, Kurebwa; Mabhanda, Wilson

    2015-01-01

    The study explored the challenges that impact on the implementation of PLAP in the Primary schools. The research was conducted with teachers who study towards the BEd Management degree with Zimbabwe Open University (ZOU) in the Midlands Region. The study used a qualitative research approach and collected data through open ended questionnaires and…

  4. Losing connections and receiving support to reconnect: experiences of frail older people within care programmes implemented in primary care settings

    NARCIS (Netherlands)

    Bindels, J.; Cox, K.; De La Haye, J.; Mevissen, G.; Heijing, S.; van Schayck, O.C.P.; Widdershoven, G.; Abma, T.A.

    2015-01-01

    Aims and objectives: The objective of this study was to evaluate whether care provided in the care programmes matched the needs of older people. Background: Care programmes were implemented in primary-care settings in the Netherlands to identify frail older people and to prevent further

  5. The impacts of implementation of National Essential Medicines Policies on primary healthcare institutions: a cross-sectional study in China.

    Science.gov (United States)

    Guo, Zhigang; Guan, Xiaodong; Shi, Luwen

    2017-11-13

    In 2009, China implemented the National Essential Medicines Policies (NEMPs) as part of a new round of medical system reforms. This study aims to evaluate the impacts of the NEMPs on primary healthcare institutions and discuss the roles of the policies in the new healthcare reforms of China. The study selected a total of six representative provinces of China, generating a sample of 261 primary healthcare institutions from August to December in 2010. A questionnaire survey developed by the study team was distributed to all of the primary healthcare institutions. Nine indicators from three dimensions as the outcome variables were used and calculated to evaluate the impacts of implementation of policies. All of the outcome variables were tested using independent-samples T test between the treatment group (with the NEMPs implemented) and the control group (without the NEMPs implemented). The ratio of drug sales and institution revenues at primary healthcare institutions was 42.99% in the treatment group, which was significantly lower than the control group (53.90%, p financial subsidies of the treatment group was shown to be higher (30.78% VS 20.82%, p institutions, the improvement of the mechanisms for government investment, and the healthcare pricing system. Meanwhile, the gaps between urban and rural areas need to be addressed. In conclusion, the NEMPs of China are instrumental to the aim of providing basic healthcare services to every citizen.

  6. Implementation of the Social Decision-Making Skills Curriculum on Primary Students (Grades 1-3) in Lebanon

    Science.gov (United States)

    El Hassan, Karma; Mouganie, Zeina

    2014-01-01

    This study investigated the effect of the Social Decision-Making Skills Curriculum (SDSC) on the emotional intelligence and the prosocial behaviors of primary students in Grades 1-3, in a private school in Lebanon. Students were trained in social problem-solving and social decision-making skills through the implementation of the SDSC. Participants…

  7. Examining teachers’ views on the implementation of English as L3 into primary schools: A case of Kazakhstan

    Directory of Open Access Journals (Sweden)

    Bakhytgul A Zhetpisbayeva

    2016-06-01

    Full Text Available The Ministry of Education and Science of the Republic of Kazakhstan changed the State Educational Program for primary education and the curriculum for teaching English as a third language (L3 to grades 1-4in 2013. As with many changes in the curriculum, English language teaching has also been changed and the starting age for learning of English language has been lowered to 6-7 years of age (Grade 1. However, implementation of the curriculum requires readiness on the part of the teachers and teachers' views about teaching English in primary school is important for successful implementation of English language policy. Thus, this research aims to investigate the teachers’ views about the starting age for L3 learning, teachers' professional development, teaching materials and problems of implementation of a language policy in primary schools in Kazakhstan. The data for the study was gathered from 105 English teachers working in different primary schools. The study revealed that most have not yet made a transition to the organized system of teaching English languages in primary school.

  8. Grounded Theory of Barriers and Facilitators to Mandated Implementation of Mental Health Care in the Primary Care Setting

    Directory of Open Access Journals (Sweden)

    Justin K. Benzer

    2012-01-01

    Full Text Available Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups.

  9. Organizational correlates of implementation of colocation of mental health and primary care in the Veterans Health Administration.

    Science.gov (United States)

    Guerrero, Erick G; Heslin, Kevin C; Chang, Evelyn; Fenwick, Karissa; Yano, Elizabeth

    2015-07-01

    This study explored the role of organizational factors in the ability of Veterans Health Administration (VHA) clinics to implement colocated mental health care in primary care settings (PC-MH). The study used data from the VHA Clinical Practice Organizational Survey collected in 2007 from 225 clinic administrators across the United States. Clinic degree of implementation of PC-MH was the dependent variable, whereas independent variables included policies and procedures, organizational context, and leaders' perceptions of barriers to change. Pearson bivariate correlations and multivariable linear regression were used to test hypotheses. Results show that depression care training for primary care providers and clinics' flexibility and participation were both positively correlated with implementation of PC-MH. However, after accounting for other factors, regressions show that only training primary care providers in depression care was marginally associated with degree of implementation of PC-MH (p = 0.051). Given the importance of this topic for implementing integrated care as part of health care reform, these null findings underscore the need to improve theory and testing of more proximal measures of colocation in future work.

  10. Catch crop biomass production, nitrogen uptake and root development under different tillage systems

    DEFF Research Database (Denmark)

    Munkholm, Lars Juhl; Hansen, Elly Møller

    2012-01-01

    tinctoria L.), perennial ryegrass (RG) (Lolium perenne L.) and fodder radish (FR) (Raphanus sativus L.) under three tillage systems. For that, we used a tillage experiment established in 2002 on a Danish sandy loam. The tillage treatments were direct drilling (D), harrowing to 8–10 cm (H) and ploughing (P...

  11. Challenges with implementing malaria rapid diagnostic tests at primary care facilities in a Ghanaian district: a qualitative study.

    Science.gov (United States)

    Boadu, Nana Yaa; Amuasi, John; Ansong, Daniel; Einsiedel, Edna; Menon, Devidas; Yanow, Stephanie K

    2016-02-27

    Rapid diagnostic Tests (RDTs) for malaria enable diagnostic testing at primary care facilities in resource-limited settings, where weak infrastructure limits the use of microscopy. In 2010, Ghana adopted a test-before-treat guideline for malaria, with RDT use promoted to facilitate diagnosis. Yet healthcare practitioners still treat febrile patients without testing, or despite negative malaria test results. Few studies have explored RDT implementation beyond the notions of provider or patient acceptability. The aim of this study was to identify the factors directly influencing malaria RDT implementation at primary care facilities in a Ghanaian district. Qualitative interviews, focus groups and direct observations were conducted with 50 providers at six purposively selected primary care facilities in the Atwima-Nwabiagya district. Data were analysed thematically. RDT implementation was hampered by: (1) healthcare delivery constraints (weak supply chain, limited quality assurance and control, inadequate guideline emphasis, staffing limitations); (2) provider perceptions (entrenched case-management paradigms, limited preparedness for change); (3) social dynamics of care delivery (expected norms of provider-patient interaction, test affordability); and (4) limited provider engagement in policy processes leading to fragmented implementation of health sector reform. Limited health system capacity, socio-economic, political, and historical factors hampered malaria RDT implementation at primary care facilities in the study district. For effective RDT implementation providers must be: (1) adequately enabled through efficient allocation and management of essential healthcare commodities; (2) appropriately empowered with the requisite knowledge and skill through ongoing, effective professional development; and (3) actively engaged in policy dialogue to demystify socio-political misconceptions that hinder health sector reform policies from improving care delivery. Clear

  12. N-utilization in non-inversion tillage systems

    DEFF Research Database (Denmark)

    Hansen, Elly Møller; Munkholm, Lars Juhl; Olesen, Jørgen E

    2011-01-01

    When changing from ploughing to non-inversion tillage, N rates are of particular importance both for farmers and the environment. A tillage and fertilizer experiment was established in Denmark under temperate coastal climatic conditions to evaluate the N fertilizer responses on yields and N uptake......–30 kg N ha−1 of the total fertilizer N amount in autumn to autumn-sown crops (1.00NAut). In all the crop rotations, straw was chopped and retained after harvest. Different types of N fertilizer responses were observed in the six crops, but generally yields were lower with non-inversion tillage than...... with ploughing. On two occasions, yields in ploughed plots were significantly (p able to offset the growth reduction, which resulted from poor growth in patches probably caused...

  13. Weed seed germination in winter cereals under contrasting tillage systems

    DEFF Research Database (Denmark)

    Scherner, Ananda

    2015-01-01

    to accumulate in the top soil layer and timing of herbicide applications sometimes seems to target the emergence pattern of these weeds poorly. In contrast to the management of most diseases and pests, weed management should be considered in a time frame. The abilities to produce above and below ground...... of weeds. An important component in IWM is to understand and ultimately predict weed emergence patterns in relation to the cropping system and the tillage method applied. A better understanding of the cumulative emergence patterns of weed species in winter crops under different tillage regimes will help......Grass weeds and Gallium aparine are major weed problems in North European arable cropping systems with high proportions of winter crops, especially winter wheat (Clarke et al., 2000; Melander et al., 2008). Problems are accentuated where inverting tillage is omitted, as weed seeds tend...

  14. Residual nitrogen-15 recovery by corn as influenced by tillage and fertilization method

    International Nuclear Information System (INIS)

    Timmons, D.R.; Cruse, R.M.

    1991-01-01

    Tillage systems that create different surface residue conditions may also affect the recovery of residual fertilizer N during subsequent growing seasons. This study evaluated the recovery of residual labeled N fertilizer in the soil by corn (Zea mays L.) for two tillage systems and two fertilization methods. Five atom % 15 N-enriched 28% urea-ammonium nitrate solution (UAN) at 224 kg N ha -1 was either surface-applied in the fall before any primary tillage or banded (knifed in) just before planting in the spring. Continuous corn was grown with either fall moldboard-plow (MP) or ridge-till (RT) systems. After the initial growing season, the recovery of residual labeled N in the soil by corn was determined for three consecutive growing seasons, and the soil profile was sampled periodically to measure residual 15 N in the organic and inorganic pools. One year after labeled UAN application, from 16 to 27% of the initial 15 N applied was found in the organic N pool and only 1% as inorganic N[NH 4 +(NO 2 +NO 3 )-N]. After four seasons, residual 15 N in the organic N pool ranged from 13 to 24%. Less than 0.5% remained as inorganic N. Regression analyses indicated that about 5 kg 15 N ha -1 year -1 became available for both MP and RT systems with banded N, so the amounts were small. Total residual 15 N recovery by corn grain plus stover for three seasons ranged from 1.7 to 3.5%, and was greatest for spring-banded fertilizer. Because the amounts of residual 15 N utilized were too small to affect corn growth, this N source appears to be negligible when considering corn-N needs

  15. The Level of Implementation of the Strategic Management in Primary Schools

    Science.gov (United States)

    Yenipinar, Senyurt; Akgün, Nuri

    2017-01-01

    In this study, primary school principals and teachers apply determination of the degree to which the views of the primary institutions. The research was carried out in the scan; working population in Istanbul province, Turkey on the Asian side in the Atasehir, Kadiköy, Kartal, Maltepe and the townships of Sultanbeyli the academic year 2011-2012,…

  16. Effect of Tillage Technology on Species Composition of Weeds in Monoculture of Maize

    OpenAIRE

    S. Chovancova; F. Illek; J. Winkler

    2014-01-01

    The effect of tillage technology of maize on intensity of weed infestation and weed species composition was observed at experimental field. Maize is grown consecutively since 2001. The experimental site is situated at an altitude of 230 m above sea level in the Czech Republic. Variants of tillage technology are CT: plowing – conventional tillage 0.22 m, MT: loosening – disc tillage on the depth of 0.1 – 0.12 m, NT: direct sowing – without tillage. The evaluation of weed infestation was carrie...

  17. Experiences of primary health care nurses in implementing integrated management of childhood illnesses strategy at selected clinics of Limpopo Province.

    Science.gov (United States)

    Vhuromu, E N; Davhana-Maselesele, M

    2009-09-01

    Treatment of the under five years is a national priority as an attempt in curbing deaths and deformities affecting children. Primary health care was implemented in the clinics in order to help in the treatment of illnesses affecting the community, including children. As a result of childhood illnesses; the World Health Organization (WHO) and United Nation Children's Fund (UNICEF) came up with Integrated Management of Childhood illnesses (IMCI) strategy to enhance treatment of such illnesses in developing countries. Primary health care nurses (PHCNS) in Limpopo Province were also trained to implement the strategy. This study is intended to explore and describe the experiences of PHCNS in implementing the IMCI strategy at selected clinics in Vhembe District in the Limpopo Province. A qualitative, explorative, descriptive and contextual design was used. In-depth interviews were conducted with PHCNS who are IMCI trained and have implemented the strategy for a period of not less than two years. Data analysis was done through using Tesch 's method of open coding for qualitative analysis. Findings revealed that PHCNS had difficulty in rendering IMCI services due to lack of resources and poor working conditions. Recommendations address the difficulties experienced by PHCNS when implementing the IMCI strategy.

  18. [Implementing daily physical education in primary school - potentials and barriers from the involved actor's point of view].

    Science.gov (United States)

    Sterdt, E; Liersch, S; Henze, V; Röbl, M; Suermann, T; Krauth, C; Walter, U

    2015-04-01

    The objective was to determine to what extent daily physical education can be implemented in primary schools, what barriers exist and how to overcome the mentioned barriers. Moreover, it was analysed to what extent daily physical education is accepted by teachers, external trainers, parents and students. Semi-structured interviews with parents (n=7), teachers (n=5) and external trainers (n=6) of the intervention schools. The intervention students (n=44) were surveyed within focus groups. All surveyed groups appraised the implementation of daily school sports as successful. The cooperation between the schools and the sports club should be maintained during a comprehensive implementation of daily physical education. Besides an improved lessons quality teachers and external trainers reported an improved social behaviour of the children. Parents perceived positive effects on the child development. All groups believe that daily physical education increases the enjoyment of children in sports. As a certain barrier a lack of resources (e. g., facilities, equipment, financial resources) in the schools were mentioned. The cooperation between the schools and the sports club proved to be an applicable model to implement daily physical education. The combination of teachers and external trainers can contribute to a higher lesson quality. Considering the perceived potentials of daily physical education by all surveyed groups, a comprehensive implementation of systematic daily physical activity promotion in the primary school setting should be tapped more strongly in future. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Soil physical and X-ray computed tomographic measurements to investigate small-scale structural differences under strip tillage compared to mulch till and no-till

    Science.gov (United States)

    Pöhlitz, Julia; Rücknagel, Jan; Schlüter, Steffen; Vogel, Hans-Jörg

    2017-04-01

    . Mechanical precompression stress was significantly higher for STBS (141 kPa) than STWS (38 kPa). In addition, the CT image cross sections and the computed tomographic parameters confirmed the mechanically more stable soil structure observed under STBS with a higher initial average pore size but lower porosity and connectivity values compared to STWS. The reason for this is the lack of tillage. On the other hand, tillage at STWS created a loosened, porous and connective substrate. For all variants, the increasing load application led to progressive homogenization processes of the soil structure. At the same time, as stress application increased in all variants, the increase in dry bulk density led to a decrease in average pore size, porosity, and connectivity, while anisotropy increased. It was possible to confirm that strip tillage combines the advantages of no-till and a deeper conservation primary tillage, since on the one hand MT and STWS and on the other hand STBS and NT showed very similar soil structures. The computed tomographic parameters therefore provide valuable information about the impact of tillage on microscopic pore space attributes that improve our understanding about soil functional behavior at much larger scales.

  20. Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices.

    Science.gov (United States)

    Garbutt, Jane M; Dodd, Sherry; Walling, Emily; Lee, Amanda A; Kulka, Katharine; Lobb, Rebecca

    2018-03-13

    The national guideline for use of the vaccine targeting oncogenic strains of the human papillomavirus (HPV) is an evidence-based practice that is poorly implemented in primary care. Recommendations include completion of the vaccine series before the 13th birthday for girls and boys, giving the first dose at the 11- to 12-year-old check-up visit, concurrent with other recommended vaccines. Interventions to increase implementation of this guideline have had little impact, and opportunities to prevent cancer continue to be missed. We used a theory-informed approach to develop a pragmatic intervention for use in primary care settings to increase implementation of the HPV vaccine guideline recommendation. Using a concurrent mixed methods design in 10 primary care practices, we applied the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors strongly influencing vaccine use. We then used the Behavior Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to analyze provider behavior and identify behaviors to target for change and behavioral change strategies to include in the intervention. We identified facilitators and barriers to guideline use across the five CFIR domains: most distinguishing factors related to provider characteristics, their perception of the intervention, and their process to deliver the vaccine. Targeted behaviors were for the provider to recommend the HPV vaccine the same way and at the same time as the other adolescent vaccines, to answer parents' questions with confidence, and to implement a vaccine delivery system. To this end, the intervention targeted improving provider's capability (knowledge, communication skills) and motivation (action planning, belief about consequences, social influences) regarding implementing guideline recommendations, and increasing their opportunity to do so (vaccine delivery system). Behavior change strategies included providing information and

  1. Soil tillage conservation and its effect on erosion control, water management and carbon sequestration

    Science.gov (United States)

    Rusu, Dr.; Gus, Dr.; Bogdan, Dr.; Moraru, Dr.; Pop, Dr.; Clapa, Dr.; Pop, Drd.

    2009-04-01

    The energetic function of the soil expressed through the potential energy accumulated through humus, the biogeochemical function (the circuit of the nutrient elements) are significantly influenced by its hydrophysical function and especially by the state of the bedding- consolidation, soil capacity of retaining an optimal quantity of water, and then its gradual disponibility for plant consumption. The understanding of soil functions and management including nutrient production, stocking, filtering and transforming minerals, water , organic matter , gas circuit and furnishing breeding material, all make the basis of human activity, Earth's past, present and especially future. The minimum tillage soil systems - paraplow, chisel or rotary grape - are polyvalent alternatives for basic preparation, germination bed preparation and sowing, for fields and crops with moderate loose requirements being optimized technologies for: soil natural fertility activation and rationalization, reduction of erosion, increasing the accumulation capacity for water and realization of sowing in the optimal period. By continuously applying for 10 years the minimum tillage system in a crop rotation: corn - soy-bean - wheat - potato / rape, an improvement in physical, hydro-physical and biological properties of soil was observed, together with the rebuilt of structure and increase of water permeability of soil. The minimum tillage systems ensure an adequate aerial-hydrical regime for the biological activity intensity and for the nutrients solubility equilibrium. The vegetal material remaining at the soil surface or superficially incorporated has its contribution to intensifying the biological activity, being an important resource of organic matter. The minimum tillage systems rebuild the soil structure, improving the global drainage of soil which allows a rapid infiltration of water in soil. The result is a more productive soil, better protected against wind and water erosion and needing less

  2. The Effects of Different Tillage Methods on Available Soil Potassium Measured by Various Extractors in a Soil with High Specific Surface Area

    Directory of Open Access Journals (Sweden)

    M. Hosseini

    2016-02-01

    Full Text Available Introduction: The effects of any tillage method on soil properties, depends on location (soil, water and air and the number of (years their implementation. Soil compaction reduces yield through increased soil mechanical resistance against root growth and lower water and nutrient use efficiency (Gamda et al. 18 & Ishagh et al 23. Soil surface and sub surface compaction both reduce yield due to limited root growth and plant potassium uptake (Doulan et al. 14. Sabt et al. (50 reported that in the study area, which the lands are mostly illite clay (high specific surface area with sufficient nitrogen, soil potassium is the most important limiting factor for the growth of wheat.Considering the point that loess soils in Golestan Province have a high specific surface area,they can provide potassium for plants to produce crop, but for a higher production, potassium fertilizers should be used. Previous studies indicated that production of wheat is limited due to potassium deficiency (4, 49, 54 and 57. In these soils with a high specific surface area, the speed of movement of potassium from the soil solution is low, and doing solimits wheat yield.In loess soils containing high illite and high specific surface area (eg, soilsin the series of Rahmat Abad of Gorgan, ammonium acetate measured potassium on exchange and solution surfaces, which is highly correlated with grain yield (54 . There is a high correlation between grain yield with overload of potassium and Na TPB extraction (57. The aim of this study was to absorb potassium (limiting factor for plant growth with different tillage systemsat different depths. International recommendations towards reducing the depth and intensity of tillage (from minimum tillage to no-tillage in order to reduce erosion and oxidation of organic substances plays an important role in determining the amount of greenhouse gases. If potassium absorption does not reduceafter reducing tillage intensity,low or no-tillage methods

  3. Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care

    OpenAIRE

    Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora

    2016-01-01

    Background Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy ? systems consultation ?intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy ? translation of a clinical practice guideline into a checklist-based im...

  4. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

    OpenAIRE

    Bajorek, Beata; Lemay, Kate S.; Magin, Parker; Roberts, Christopher; Krass, Ines; Armour, Carol L.

    2016-01-01

    Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. C...

  5. Soil workability as a basis for advice on tillage activities

    NARCIS (Netherlands)

    Cadena Zapata, M.

    1999-01-01

    In the tropical area of Mexico, when and how to carry out tillage is a qualitative decision. There is no quantified information about the interaction between a chosen process of cultivation, soil type and weather, which dictate the tool and power requirements. Waste of energy and soil

  6. Tillage and Farmyard Manure Effects on Crusting and Compacting ...

    African Journals Online (AJOL)

    Seasonal rainwater losses through increased runoff volumes reduce soil moisture and hence result in agricultural drought. The objective of this study was to examine the hydrological effects of two tillage practices with and without farmyard manure on surface runoff and soil loss of crusting and compacting soils under field ...

  7. Effect of tillage and fumigation on Pasteuria penetrans

    Science.gov (United States)

    The endospore-forming bacterium Pasteuria penetrans (Pp) is a parasite of Meloidogyne spp. In this study, the effect of tillage and the fumigant 1,3-dichloropropene (1,3-D) on numbers of Pp and suppression of M. incognita (Mi) was evaluated from 2011-2013. A split-plot experiment was established i...

  8. Developments in conservation tillage in rainfed regions of North China

    NARCIS (Netherlands)

    Wang, X.B.; Cai, D.X.; Hoogmoed, W.B.; Oenema, O.; Perdok, U.D.

    2007-01-01

    Dryland regions in northern China account for over 50% of the nation's total area, where farming development is constrained by adverse weather, topography and water resource conditions, low fertility soils, and poor soil management. Conservation tillage research and application in dryland regions of

  9. Phosphorus Uptake and Partitioning in Maize as Affected by Tillage ...

    African Journals Online (AJOL)

    Higher phosphorus concentrations were found in the ears than in the shoots and leaves at physiological maturity. Tillage x phospho-rus interactions influenced phosphorus partitioning in the ears and the leaves on the Dystric Cam-bisol but not on the Ferric Acrisol. PUE in the plant parts were significantly higher under ...

  10. Tillage as a driver of change in weed communities

    NARCIS (Netherlands)

    Armengot, L.; Blanco-Moreno, J.M.; Bàrberi, P.; Bocci, G.; Carlesi, S.; Aendekerk, R.; Berner, A.; Celette, F.; Grosse, M.; Huiting, H.; Kranzler, A.; Luik, A.; Mäder, P.; Peigné, J.; Stoll, E.; Delfosse, P.; Sukkel, W.; Surböck, A.; Westaway, S.; Sans, F.X.

    2016-01-01

    The adoption of non-inversion tillage practices has been widely promoted due to their potential benefits in reducing energy consumption and greenhouse emissions as well as improving soil fertility. However, the lack of soil inversion usually increases weed infestations and changes the composition

  11. to Phosphorus Fertilization, Crop Sequence and Tillage Management

    Directory of Open Access Journals (Sweden)

    Xiaopeng Gao

    2012-01-01

    Full Text Available Field experiments were conducted at two locations in Manitoba, Canada, to determine the effect of crop rotation, phosphorus (P fertilization and tillage on grain yield and grain concentrations of Cd and Zn in durum wheat (Triticum durum L.. Compared to conventional tillage (CT, reduced tillage (RT management decreased grain Cd and increased grain yield and grain Zn in half of the site-years. The type of preceding crops of spring wheat-flax or canola-flax had little influence. Rate and timing of P application had little effect on grain Cd, but increasing P rate tended to decrease grain Zn. No interactive effect was detected among tested factors. Grain Zn was not related to grain Cd, but positively to other nutrients such as Fe, Mn, P, Ca, K, and Mg. Both grain Zn and Fe correlated positively with grain protein content, suggesting protein may represent a sink for micronutrients. The study suggested that the tillage management may have beneficial effects on both grain yield and quality. Phosphorus fertilizer can remain available for subsequent crops and high annual inputs in the crop sequence may decrease crop grain Zn. Understanding the environment is important in determining the impact of agricultural management on agronomic and nutrient traits.

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

    Science.gov (United States)

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

    2013-09-01

    Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before-after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians' monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Implementation of EMRs by primary care physicians did not result in decreased

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

    Science.gov (United States)

    Shultz, Susan E.; Tu, Karen

    2013-01-01

    Background Several barriers to the adoption of electronic medical records (EMRs) by family physicians have been discussed, including the costs of implementation, impact on work flow and loss of productivity. We examined billings and payments received before and after implementation of EMRs among primary care physicians in the province of Ontario. We also examined billings and payments before and after switching from a fee-for-service to a capitation payment model, because EMR implementation coincided with primary care reform in the province. Methods We used information from the Electronic Medical Record Administrative Data Linked Database (EMRALD) to conduct a retrospective before–after study. The EMRALD database includes EMR data extracted from 183 community-based family physicians in Ontario. We included EMRALD physicians who were eligible to bill the Ontario Health Insurance Plan at least 18 months before and after the date they started using EMRs and had completed a full 18-month period before Mar. 31, 2011, when the study stopped. The main outcome measures were physicians’ monthly billings and payments for office visits and total annual payments received from all government sources. Two index dates were examined: the date physicians started using EMRs and were in a stable payment model (n = 64) and the date physicians switched from a fee-for-service to a capitation payment model (n = 42). Results Monthly billings and payments for office visits did not decrease after the implementation of EMRs. The overall weighted mean annual payment from all government sources increased by 27.7% after the start of EMRs among EMRALD physicians; an increase was also observed among all other primary care physicians in Ontario, but it was not as great (14.4%). There was a decline in monthly billings and payments for office visits after physicians changed payment models, but an increase in their overall annual government payments. Interpretation Implementation of EMRs by

  14. The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care.

    Science.gov (United States)

    Carlfjord, S; Andersson, A; Nilsen, P; Bendtsen, P; Lindberg, M

    2010-12-01

    The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC. © 2010 Blackwell Publishing Ltd.

  15. Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

    Directory of Open Access Journals (Sweden)

    Carlfjord Siw

    2010-08-01

    Full Text Available Abstract Background Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC. The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden. Methods A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption. Results The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process. Conclusion When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the

  16. District nurses' experience of supervising nursing students in primary health care: A pre- and post-implementation questionnaire study.

    Science.gov (United States)

    Bos, Elisabeth; Löfmark, Anna; Törnkvist, Lena

    2009-11-01

    Nursing students go through clinical supervision in primary health care settings but district nurses' (DNs) circumstances when supervising them are only briefly described in the literature. The aim of this study was to investigate DNs experience of supervising nursing students before and after the implementation of a new supervision model. Ninety-eight (74%) DNs answered a questionnaire before and 84 (65%) after implementation of the new supervision model. The study showed that DNs in most cases felt that conditions for supervision in the workplace were adequate. But about 70% lacked training for the supervisory role and 20% had no specialist district nurse training. They also experienced difficulty in keeping up-to-date with changes in nurse education programmes, in receiving support from the university and from their clinic managers, and in setting aside time for supervision. Improvements after the implementation of a new model chiefly concerned organisation; more DNs stated that one person had primary responsibility for students' clinical practice, that information packages for supervisors and students were available at the health care centres, and that conditions were in place for increasing the number of students they supervised. DNs also stated that supervisors and students benefited from supervision by more than one supervisor. To conclude, implementation of a new supervision model resulted in some improvements.

  17. Ethnographic process evaluation in primary care: explaining the complexity of implementation.

    Science.gov (United States)

    Bunce, Arwen E; Gold, Rachel; Davis, James V; McMullen, Carmit K; Jaworski, Victoria; Mercer, MaryBeth; Nelson, Christine

    2014-12-05

    The recent growth of implementation research in care delivery systems has led to a renewed interest in methodological approaches that deliver not only intervention outcome data but also deep understanding of the complex dynamics underlying the implementation process. We suggest that an ethnographic approach to process evaluation, when informed by and integrated with quantitative data, can provide this nuanced insight into intervention outcomes. The specific methods used in such ethnographic process evaluations are rarely presented in detail; our objective is to stimulate a conversation around the successes and challenges of specific data collection methods in health care settings. We use the example of a translational clinical trial among 11 community clinics in Portland, OR that are implementing an evidence-based, health-information technology (HIT)-based intervention focused on patients with diabetes. Our ethnographic process evaluation employed weekly diaries by clinic-based study employees, observation, informal and formal interviews, document review, surveys, and group discussions to identify barriers and facilitators to implementation success, provide insight into the quantitative study outcomes, and uncover lessons potentially transferable to other implementation projects. These methods captured the depth and breadth of factors contributing to intervention uptake, while minimizing disruption to clinic work and supporting mid-stream shifts in implementation strategies. A major challenge is the amount of dedicated researcher time required. The deep understanding of the 'how' and 'why' behind intervention outcomes that can be gained through an ethnographic approach improves the credibility and transferability of study findings. We encourage others to share their own experiences with ethnography in implementation evaluation and health services research, and to consider adapting the methods and tools described here for their own research.

  18. ECONOMICS RESULTS OF WHEAT PRODUCTION BY DIFFERENT SOIL TILLAGE WAYS

    Directory of Open Access Journals (Sweden)

    J. Kanisek

    2001-06-01

    Full Text Available Wheat consumption in the world increases and its importers are some European countries too. The present price of wheat grain will make selling at the market difficult for manufactures from the Republic of Croatia. Conditions and results of four year organizational - economical investigations of conventional and four ways of reduced soil tillage at wheat production are displayed in this paper. Total of 9.35 hours/ha of machinery work and 114.3 l/ha of fuel are consumed at conventional soil tillage. Total costs are 1660 DM/ha. Price of grain is 276.71 DM/t and profit amounts to 187.83 DM/ha. If the soil tillage is done by a disk harrow costs of the machinery work reduce to 471.36 DM/ha and profitability amounts to 16.5%. When soil tillage is done by multitiller with classical sowing, a yield of 5.65 t/ha st price of 273.37 DM/t and investment profitability 12.7% are obtained. Direct sowing by a Rotosem, without previous tillage, requires 11.66 hours/ha of human work and 7.18 hours/ha of machinery work. to meet the total costs 4.9 t/ha of grains need. In order to get equipment, 98 t of grains from land of 17.5 ha should be given annually during the period of 8 years. Plughing and sowing by Rotosem give 5.9 t/ha grains at price of 279.36 DM/t. Total energy cost at conventional production is 30085 and at reduced one it is 27972 MJ/ha.

  19. Infiltration of surface mined land reclaimed by deep tillage treatments

    International Nuclear Information System (INIS)

    Chong, S.K.; Cowsert, P.

    1994-01-01

    Surface mining of coal leads to the drastic disturbance of soils. Compaction of replaced subsoil and topsoil resulting from hauling, grading, and leveling procedures produces a poor rooting medium for crop growth. Soil compaction results in high bulk density, low macroporosity, poor water infiltration capacity, and reduced elongation of plant roots. In the United States, Public Law 95-87 mandates that the rooting medium of mined soils have specific textural characteristics and be graded and shaped to a topography similar to premining conditions. Also, crop productivity levels equivalent to those prior to mining must be achieved, especially for prime farmland. Alleviation of compaction has been the major focus of reclamation, and recently new techniques to augment the rooting zone with deep-ripping and loosening equipment have come to the forefront. Several surface mine operators in the Illinois coal basin are using deep tillage equipment that is capable of loosening soils to greater depths than is possible with conventional farm tillage equipment. Information on the beneficial effects of these loosening procedures on soil hydrological properties, such as infiltration, runoff potential, erosion, and water retention, is extremely important for future mined land management. However, such information is lacking. In view of the current yield demonstration regulation for prime farmland and other unmined soils, it is important that as much information as possible be obtained concerning the effect of deep tillage on soil hydrologic properties. The objectives of this study are: (1) to compare infiltration rates and related soil physical properties of mined soils reclaimed by various deep tillage treatments and (2) to study the temporal variability of infiltration and related physical properties of the reclaimed mined soil after deep tillage treatment

  20. Soil organic carbon sequestration and tillage systems in Mediterranean environments

    Science.gov (United States)

    Francaviglia, Rosa; Di Bene, Claudia; Marchetti, Alessandro; Farina, Roberta

    2016-04-01

    Soil carbon sequestration is of special interest in Mediterranean areas, where rainfed cropping systems are prevalent, inputs of organic matter to soils are low and mostly rely on crop residues, while losses are high due to climatic and anthropic factors such as intensive and non-conservative farming practices. The adoption of reduced or no tillage systems, characterized by a lower soil disturbance in comparison with conventional tillage, has proved to be positively effective on soil organic carbon (SOC) conservation and other physical and chemical processes, parameters or functions, e.g. erosion, compaction, ion retention and exchange, buffering capacity, water retention and aggregate stability. Moreover, soil biological and biochemical processes are usually improved by the reduction of tillage intensity. The work deals with some results available in the scientific literature, and related to field experiment on arable crops performed in Italy, Greece, Morocco and Spain. Data were organized in a dataset containing the main environmental parameters (altitude, temperature, rainfall), soil tillage system information (conventional, minimum and no-tillage), soil parameters (bulk density, pH, particle size distribution and texture), crop type, rotation, management and length of the experiment in years, initial SOCi and final SOCf stocks. Sampling sites are located between 33° 00' and 43° 32' latitude N, 2-860 m a.s.l., with mean annual temperature and rainfall in the range 10.9-19.6° C and 355-900 mm. SOC data, expressed in t C ha-1, have been evaluated both in terms of Carbon Sequestration Rate, given by [(SOCf-SOCi)/length in years], and as percentage change in comparison with the initial value [(SOCf-SOCi)/SOCi*100]. Data variability due to the different environmental, soil and crop management conditions that influence SOC sequestration and losses will be examined.

  1. Potential for improved radiation thermometry measurement uncertainty through implementing a primary scale in an industrial laboratory

    Science.gov (United States)

    Willmott, Jon R.; Lowe, David; Broughton, Mick; White, Ben S.; Machin, Graham

    2016-09-01

    A primary temperature scale requires realising a unit in terms of its definition. For high temperature radiation thermometry in terms of the International Temperature Scale of 1990 this means extrapolating from the signal measured at the freezing temperature of gold, silver or copper using Planck’s radiation law. The difficulty in doing this means that primary scales above 1000 °C require specialist equipment and careful characterisation in order to achieve the extrapolation with sufficient accuracy. As such, maintenance of the scale at high temperatures is usually only practicable for National Metrology Institutes, and calibration laboratories have to rely on a scale calibrated against transfer standards. At lower temperatures it is practicable for an industrial calibration laboratory to have its own primary temperature scale, which reduces the number of steps between the primary scale and end user. Proposed changes to the SI that will introduce internationally accepted high temperature reference standards might make it practicable to have a primary high temperature scale in a calibration laboratory. In this study such a scale was established by calibrating radiation thermometers directly to high temperature reference standards. The possible reduction in uncertainty to an end user as a result of the reduced calibration chain was evaluated.

  2. Primary Physical Education (PE): School Leader Perceptions about Classroom Teacher Quality Implementation

    Science.gov (United States)

    Lynch, Timothy; Soukup, Gregory J., Sr.

    2017-01-01

    Quality physical education (QPE) in primary school optimises children's well-being. However, international research indicates that the preparation of classroom teachers is impeded by systemic barriers, resulting in low-classroom teacher confidence, competence and subsequent interest. This empirical research investigates school principal…

  3. Implementing Free Primary Education Policy in Malawi and Ghana: Equity and Efficiency Analysis

    Science.gov (United States)

    Inoue, Kazuma; Oketch, Moses

    2008-01-01

    Malawi and Ghana are among the numerous Sub-Saharan Africa countries that have in recent years introduced Free Primary Education (FPE) policy as a means to realizing the 2015 Education for All and Millennium Development Goals international targets. The introduction of FPE policy is, however, a huge challenge for any national government that has…

  4. Excluding deep vein thrombosis in primary care: validation, updating, and implementation of a diagnostic rule.

    NARCIS (Netherlands)

    Toll, D.B.

    2008-01-01

    In primary care patients suspected of deep vein thrombosis (DVT), it is a challenge to discriminate the patients with DVT from those without DVT. The risk of missing the diagnosis (which may result in a potentially lethal pulmonary embolism) and the risk of unnecessary referral and treatment with a

  5. Implementing Open Source Platform for Education Quality Enhancement in Primary Education: Indonesia Experience

    Science.gov (United States)

    Kisworo, Marsudi Wahyu

    2016-01-01

    Information and Communication Technology (ICT)-supported learning using free and open source platform draws little attention as open source initiatives were focused in secondary or tertiary educations. This study investigates possibilities of ICT-supported learning using open source platform for primary educations. The data of this study is taken…

  6. 3D Structure of Tillage Soils

    Science.gov (United States)

    González-Torre, Iván; Losada, Juan Carlos; Falconer, Ruth; Hapca, Simona; Tarquis, Ana M.

    2015-04-01

    Soil structure may be defined as the spatial arrangement of soil particles, aggregates and pores. The geometry of each one of these elements, as well as their spatial arrangement, has a great influence on the transport of fluids and solutes through the soil. Fractal/Multifractal methods have been increasingly applied to quantify soil structure thanks to the advances in computer technology (Tarquis et al., 2003). There is no doubt that computed tomography (CT) has provided an alternative for observing intact soil structure. These CT techniques reduce the physical impact to sampling, providing three-dimensional (3D) information and allowing rapid scanning to study sample dynamics in near real-time (Houston et al., 2013a). However, several authors have dedicated attention to the appropriate pore-solid CT threshold (Elliot and Heck, 2007; Houston et al., 2013b) and the better method to estimate the multifractal parameters (Grau et al., 2006; Tarquis et al., 2009). The aim of the present study is to evaluate the effect of the algorithm applied in the multifractal method (box counting and box gliding) and the cube size on the calculation of generalized fractal dimensions (Dq) in grey images without applying any threshold. To this end, soil samples were extracted from different areas plowed with three tools (moldboard, chissel and plow). Soil samples for each of the tillage treatment were packed into polypropylene cylinders of 8 cm diameter and 10 cm high. These were imaged using an mSIMCT at 155keV and 25 mA. An aluminium filter (0.25 mm) was applied to reduce beam hardening and later several corrections where applied during reconstruction. References Elliot, T.R. and Heck, R.J. 2007. A comparison of 2D and 3D thresholding of CT imagery. Can. J. Soil Sci., 87(4), 405-412. Grau, J, Médez, V.; Tarquis, A.M., Saa, A. and Díaz, M.C.. 2006. Comparison of gliding box and box-counting methods in soil image analysis. Geoderma, 134, 349-359. González-Torres, Iván. Theory and

  7. Community participation in primary care in Ireland: the need for implementation research.

    LENUS (Irish Health Repository)

    McEvoy, Rachel

    2012-04-30

    There are now several decades of history of community participation in health, with significant international evidence to suggest that there is much to be gained by primary health services and disadvantaged communities working in partnership.In this paper we provide an overview of community participation in primary care, establishing the policy context in which a recent \\'Joint Initiative on Community Participation in Primary Health Care\\' was developed in Ireland. This Initiative was designed to support the involvement of disadvantaged communities and groups in the development of primary health care services at local level.An independent formative evaluation of the Joint Initiative took place between September 2009 and April 2010. We present a summary of key findings from this evaluation. We pay particular attention to the issue of sustaining community participation in newly developed Primary Care Teams (PCTs) in the current and changing economic climate, an issue considered crucial if the documented positive impacts of the Joint Initiative are to be maintained and the potential for health gains in the longer term are to be realised.We then argue that the Joint Initiative referred to in this paper clearly provides a strong prototype for community participation in PCTs in Ireland. We also ask whether it can be replicated across all PCTs in the country and embedded as a core part of thinking and everyday health care. We highlight the need for research to build knowledge about the ways in which innovations such as this can be embedded into ongoing, routine healthcare practice. This research agenda will have relevance for policy makers, practitioners and evaluators in Ireland and other healthcare jurisdictions.

  8. [Effects of Tillage on Soil Respiration and Root Respiration Under Rain-Fed Summer Corn Field].

    Science.gov (United States)

    Lu, Xing-li; Liao, Yun-cheng

    2015-06-01

    To explore the effects of different tillage systems on soil respiration and root respiration under rain-fed condition. Based on a short-term experiment, this paper investigated soil respiration in summer corn growth season under four tillage treatments including subsoiling tillage (ST), no tillage (NT), rotary tillage (RT) and moldboard plow tillage (CT). The contribution of root respiration using root exclusion method was also discussed. The results showed that soil respiration rate presented a single peak trend under four tillage methods during the summer corn growing season, and the maximum value was recorded at the heading stage. The trends of soil respiration were as follows: heading stage > flowering stage > grain filling stage > maturity stage > jointing stage > seedling stage. The trends of soil respiration under different tillage systems were as follows: CT > ST > RT > NT. There was a significant correlation between soil respiration rate and soil temperatures (P soil respiration using exponential function equation. However, there was no significant correlation between soil respiration rate and soil moisture. Root respiration accounted for 45.13%-56.86% of the proportion of soil respiratio n with the mean value 51.72% during the summer corn growing season under different tillage systems. Therefore, root exclusion method could be used to study the contribution of crop growth to carbon emission, to compare effects of different tillage systems on the contribution of root respiration provides the bases for selecting the measures to slow down the decomposition of soil carbon.

  9. Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care:

    DEFF Research Database (Denmark)

    Smith-Nielsen, Johanne; Lønfeldt, Nicole Nadine; Guedeney, Antoine

    2018-01-01

    the health visitors' digital filing system, and qualitative coding of answers to open-ended questions) was undertaken. SETTING AND PARTICIPANTS: Health visitors in three of five districts of the City of Copenhagen, Denmark (N=79). METHODS: We describe and evaluate the implementation process from the date...

  10. Strip Tillage and Early-Season Broadleaf Weed Control in Seeded Onion (Allium cepa

    Directory of Open Access Journals (Sweden)

    Sarah Gegner-Kazmierczak

    2016-03-01

    Full Text Available Field experiments were conducted in 2007 and 2008 near Oakes, North Dakota (ND, USA, to evaluate if strip tillage could be incorporated into a production system of seeded onion (Allium cepa to eliminate the standard use of a barley (Hordeum vulgare companion crop with conventional, full width tillage, yet support common early-season weed control programs. A split-factor design was used with tillage (conventional and strip tillage as the main plot and herbicide treatments (bromoxynil, DCPA, oxyfluorfen, and pendimethalin as sub-plots. Neither tillage nor herbicide treatments affected onion stand counts. Common lambsquarters (Chenopodium album densities were lower in strip tillage compared to conventional tillage up to three weeks after the post-emergence applied herbicides. In general, micro-rate post-emergence herbicide treatments provided greater early-season broadleaf weed control than pre-emergence herbicide treatments. Onion yield and grade did not differ among herbicide treatments because the mid-season herbicide application provided sufficient control/suppression of the early-season weed escapes that these initial weed escapes did not impact onion yield or bulb diameter. In 2007, onion in the strip tillage treatment were larger in diameter resulting in greater total and marketable yields compared to conventional tillage. Marketable onion yield was 82.1 Mg ha−1 in strip tillage and 64.9 Mg ha−1 in conventional tillage. Results indicate that strip tillage use in direct-seeded onion production was beneficial, especially when growing conditions were conducive to higher yields and that the use of strip tillage in onion may provide an alternative to using a companion crop as it did not interfere with either early-season weed management system.

  11. Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study.

    Science.gov (United States)

    Teunissen, E; Gravenhorst, K; Dowrick, C; Van Weel-Baumgarten, E; Van den Driessen Mareeuw, F; de Brún, T; Burns, N; Lionis, C; Mair, F S; O'Donnell, C; O'Reilly-de Brún, M; Papadakaki, M; Saridaki, A; Spiegel, W; Van Weel, C; Van den Muijsenbergh, M; MacFarlane, A

    2017-02-10

    Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice. We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers' fieldwork reports, were coded and thematically analysed by each team using NPT. In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants' needs. Implementation of interpreter services was difficult mainly because of financial and other

  12. Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation.

    Science.gov (United States)

    Manca, Donna Patricia; Aubrey-Bassler, Kris; Kandola, Kami; Aguilar, Carolina; Campbell-Scherer, Denise; Sopcak, Nicolette; O'Brien, Mary Ann; Meaney, Christopher; Faria, Vee; Baxter, Julia; Moineddin, Rahim; Salvalaggio, Ginetta; Green, Lee; Cave, Andrew; Grunfeld, Eva

    2014-10-08

    The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care. The BETTER 2 program aims to expand the implementation of the intervention used in the original BETTER trial into communities across Canada (Alberta, Ontario, Newfoundland and Labrador, the Northwest Territories and Nova Scotia). This proactive approach provides at-risk patients with an intervention from the prevention practitioner, a health-care professional. Using the BETTER toolkit, the prevention practitioner determines which CDPS actions the patient is eligible to receive, and through shared decision-making and motivational interviewing, develops a unique and individualized 'prevention prescription' with the patient. This intervention is 1) personalized; 2) addressing multiple conditions; 3) integrated through linkages to local, regional, or national resources; and 4) longitudinal by assessing patients over time. The BETTER 2 program brings together primary care providers, policy/decision makers and researchers to work towards improving CDPS in primary care. The target patient population is adults aged 40-65. The reach, effectiveness, adoption, implementation, maintain (RE-AIM) framework will inform the evaluation of the program through qualitative and quantitative methods. A composite index will be used to quantitatively assess the effectiveness of the prevention practitioner intervention. The CDPS actions

  13. Implementation of a diabetes self-management education program in primary care for adults using shared medical appointments.

    Science.gov (United States)

    Sanchez, Iris

    2011-01-01

    The purpose of this study was to implement diabetes self-management education in primary care using the Chronic Care Model and shared medical appointments (SMA) to provide evidence-based interventions to improve process and measure outcomes. A quality improvement project using the Plan-Do-Check-Act cycle was implemented in a primary care setting in South Texas to provide diabetes self-management education for adults. Biological measures were evaluated in 70 patients at initiation of the project and thereafter based on current practice guidelines. The results of the project were consistent with the literature regarding the benefits, sustainability, and viability of SMA. As compared with that in studies presented in the literature, the patient population who participated in SMA had similar outcomes regarding improvement in A1C, self-management skills, and satisfaction. SMA are an innovative system redesign concept with the potential to provide comprehensive and coordinated care for patients with multiple and chronic health conditions while still being an efficient, effective, financially viable, and sustainable program. As the incidence and prevalence of diabetes increase, innovative models of care can meet the growing demand for access and utilization of diabetes self-management education programs. Programs focusing on chronic conditions to improve outcomes can be replicated by health care providers in primary care settings. SMA can increase revenue and productivity, improve disease management, and increase provider and patient satisfaction.

  14. The feasibility of implementing food-based dietary guidelines in the South African primary-school curriculum.

    Science.gov (United States)

    Nguyen, Kim A; de Villiers, Anniza; Fourie, Jean M; Bourne, Lesley T; Hendricks, Michael K

    2015-01-01

    To explore the perceptions of educators from the Western Cape Province about the feasibility of implementing South African food-based dietary guidelines (FBDG) in the national curriculum of primary schools. Combined quantitative and qualitative methods. We report on the quantitative component. Twelve public primary schools of different socio-economic status in three education districts of the Western Cape: Metro Central, Metro East and Cape Winelands. Educators (n 256) participated in the self-completed questionnaire survey. Educators assessed that FBDG were appropriate to South African schoolchildren (94%), could be used as an education tool (97%) and fill gaps in the current curriculum about healthy dietary habits (91%). Besides Life Orientation, FBDG could be taught in other learning areas from grades 3 to 7 (9-13 years old). Important barriers to implementing FBDG in the curriculum were educators' workload (61%), insufficient time (46%), learners' disadvantaged background (43%) and educators' lack of knowledge (33%). Other approaches to teach children about FBDG included linking these to the National School Nutrition Programme (82%), school tuck shops (79%), parent meetings (75%), school nutrition policy (73%) and school assembly (57%). Educators in high-income schools perceived that learners' lifestyle was significantly worse (P school assembly were the best means to teach pupils about FBDG (P school curriculum is seen as important together with optimizing the school physical environment. Key factors required for successful implementation in the curriculum are sufficient educational materials, adequate time allocation and appropriate educator training.

  15. A Case Study of Crestwood Primary School: Organizational Routines Implemented For Data-Driven Decison Making

    OpenAIRE

    Williams, Kimberly Graybeal

    2014-01-01

    The research study investigated how organizational routines influenced classroom and intervention instruction in a primary school. Educators have used student data for decades but they continue to struggle with the best way to use data to influence instruction. The historical overview of the research highlighted the context of data use from the Effective Schools movement through the No Child Left Behind Act noting the progression of emphasis placed on student data results. While numerous rese...

  16. Improving Interdisciplinary Relationships in Primary Care with the Implementation of TeamSTEPPS

    Directory of Open Access Journals (Sweden)

    Nicole Siddons

    2016-03-01

    Full Text Available A major challenge in healthcare is lack of interdisciplinary collaboration (O’Daniel & Rosenstein, 2008. The Institute of Medicine report, To Err is Human: Building a Safer Health System (1999, shows that errors often occur due to lapses in partnership and communication. This article describes the implementation of TeamSTEPPS, an evidence-based tool for optimizing staff relationships and partnership, in a clinic in which a change in the care model had affected interprofessional collaboration and teamwork, threatening healthcare outcomes and staff engagement. The implementation of TeamSTEPPS, customized using elements of IDEO’s (2015 Human-Centered Design, shifted the culture of the clinic towards partnership, resulting in improved staff perceptions of teamwork and statistically significant improvements in the quality of patient care.

  17. From intervention to innovation: applying a formal implementation strategy in community primary care.

    Science.gov (United States)

    Wallace, Andrea S; Sussman, Andrew L; Anthoney, Mark; Parker, Edith A

    2013-01-01

    Objective. To describe a comprehensive strategy for implementing an effective diabetes self-management support intervention incorporating goal-setting and followup support in community health clinics (CHCs) serving vulnerable patients. Methods. The Replicating Effective Programs (REP) framework was applied to develop an intervention strategy. In order to create a strategy consistent with the REP framework, four CHCs engaged in an iterative process involving key-informant interviews with clinic staff, ongoing involvement of clinic staff facilitating translational efforts, feedback from national experts, and an instructional designer. Results. Moving through the REP process resulted in an implementation strategy that aims to facilitate commitment, communication, and change at the clinic level, as well as means of providing interactive, time-limited education about patient behavior change and support to health care providers. Conclusion. The REP offered a useful framework for providing guidance toward the development of a strategy to implement a diabetes self-management intervention in CHCs serving medically underserved and underrepresented patient populations.

  18. From Intervention to Innovation: Applying a Formal Implementation Strategy in Community Primary Care

    Directory of Open Access Journals (Sweden)

    Andrea S. Wallace

    2013-01-01

    Full Text Available Objective. To describe a comprehensive strategy for implementing an effective diabetes self-management support intervention incorporating goal-setting and followup support in community health clinics (CHCs serving vulnerable patients. Methods. The Replicating Effective Programs (REP framework was applied to develop an intervention strategy. In order to create a strategy consistent with the REP framework, four CHCs engaged in an iterative process involving key-informant interviews with clinic staff, ongoing involvement of clinic staff facilitating translational efforts, feedback from national experts, and an instructional designer. Results. Moving through the REP process resulted in an implementation strategy that aims to facilitate commitment, communication, and change at the clinic level, as well as means of providing interactive, time-limited education about patient behavior change and support to health care providers. Conclusion. The REP offered a useful framework for providing guidance toward the development of a strategy to implement a diabetes self-management intervention in CHCs serving medically underserved and underrepresented patient populations.

  19. PROBLEMS OF FORMING FUTURE PRIMARY SCHOOL TEACHERS’ HEALTH-PRESERVING TECHNOLOGIES AND IMPLEMENTING THEM INTO THE EDUCATIONAL PROCESS

    Directory of Open Access Journals (Sweden)

    Liudmyla Horobets

    2017-04-01

    Full Text Available The issues of forming future primary school teachers’ health-preserving technologies and implementing them into the educational process are discussed in the article. Motivational, information and knowledgeable, and operational and instrumental components are singled out as main ones in teachers’ training. Filling the components takes place during the theoretical training while teaching natural, psychological, pedagogical and methodological disciplines, as well as during practical pedagogical training. One of the main tasks of practical pedagogical training is students’ independent work in school hygiene. Methodological recommendations to the independent work are made by the authors; the list of tasks is given. Doing tasks in school hygiene, students assess hygienic conditions for pupils’ work: determine the air-thermal regime, lighting, room equipment, analyze the working mode of a school and a timetable. Unfavorable social and economic problems in contemporary Ukraine, the difficult ecological situation, overloads of information and intensification of educational process cause the tendencies to schoolchildren’s health impairment. Primary school teacher plays an especially important part in organization of preserving and strengthening children’s health that is caused by young learners’ age peculiarities. Primary school teacher, as a main organizer of the educational process, should systematically and effectively influence his/her pupils’ healthy development. Nowadays the problem of preserving pupils’ health is studied by R. Aizman, H. Zaitsev, V. Kabanov, O. Yazlovetska; the ways of preserving and strengthening pupils’ health through implementing health-preserving technologies are disclosed by A. Akhutina, V. Kovalko, V.Lozynskyi, M. Smirnov; the approaches to organizing the holistic educational process as the basis of forming, preserving and incipiency of pupils’ health are developed by M. Bezrukikh, P. Bohdan, V

  20. Effect of implementing the 5As of obesity management framework on provider-patient interactions in primary care.

    Science.gov (United States)

    Rueda-Clausen, C F; Benterud, E; Bond, T; Olszowka, R; Vallis, M T; Sharma, A M

    2014-02-01

    Obesity counselling in primary care is positively associated with self-reported behaviour change in patients with obesity. Obesity counselling is rare, and when it does occur, it is often of low quality because of poor training and/or competency of providers' obesity management, lack of time and economical disincentives, and negative attitude towards obesity and obesity management. 5As frameworks are routinely used for behaviour-change counselling and addiction management (e.g. smoking cessation), but few studies have examined its efficacy for weight management. This study presents pilot data from the implementation and evaluation of an obesity management tool (5As of Obesity Management developed by the Canadian Obesity Network) in a primary care setting. Results show that the tool facilitates weight management in primary care by promoting physician-patient communications, medical assessments for obesity and plans for follow-up care. Obesity remains poorly managed in primary care. The 5As of Obesity Management is a theory-driven, evidence-based minimal intervention designed to facilitate obesity counselling and management by primary care practitioners. This project tested the impact of implementing this tool in primary care clinics. Electronic self-administered surveys were completed by pre-screened obese subjects at the end of their appointments in four primary care clinics (over 25 healthcare providers [HCPs]). These measurements were performed before (baseline, n = 51) and 1 month after implementing the 5As of Obesity Management (post-intervention, n = 51). Intervention consisted of one online training session (90 min) and distribution of the 5As toolkit to HCPs of participating clinics. Subjects completing the survey before and after the intervention were comparable in terms of age, sex, body mass index, comorbidities, satisfaction and self-reported health status (P > 0.2). Implementing the 5As of Obesity Management resulted in a twofold increase

  1. Physical activity interventions in Danish primary schools – how do we attain sufficient implementation?

    DEFF Research Database (Denmark)

    Johansen, Danielle Louise Nørager

    Aim: Physical activity (PA) holds important health benefits for children and youth on reducing the risk of obesity, non-communicable diseases such as cardiovascular diseases and type-II-diabetes, and on increasing children’s well-being, academic achievement, cognition etc. In August 2014 a reform...... as the overall methodical approach. Various factors for implementation of physical activity interventions in a school setting were identified using a scoping review of the scientific literature and by exploring grey literature. Using a snowball sampling method, a group of experts (organizations, municipalities...

  2. Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol

    Directory of Open Access Journals (Sweden)

    Giguere Anik

    2012-08-01

    Full Text Available Abstract Background Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1 the Decision Boxes themselves, (2 the primary healthcare team (PHT, and (3 the primary care practice environment. Methods/design A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians’ intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control. Web-log data will be used to monitor clinicians’ access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs. Conclusions This project will allow tailoring of Decision Boxes and their delivery to overcome the

  3. Impact of the implementation of an online network support tool among clinicians of primary health care and specialists: ECOPIH Project.

    Science.gov (United States)

    Lacasta Tintorer, David; Flayeh Beneyto, Souhel; Alzaga Reig, Xavier; Mundet Tuduri, Xavier; De la Fuente, Josep Anton; Manresa, Josep Maria; Torán Monserrat, Pere; Saigí Rubió, Francesc

    2013-10-03

    There has been created an online communication tool with the objective to improve the communication among different levels of care, between Primary Care clinicians and Specialists. This tool is web 2.0 based technology (ECOPIH project). It allows to review clinical cases and to share knowledge. Our study will evaluate its impact in terms of reduction on the number of referrals to three specialties two years after the use of this tool. Open, multicenter, controlled, non random intervention study over 24 months. Study population includes 131 Primary Care Physicians assigned to nine health centers. The study will compare the clinicians that use the ECOPIH with the ones that do not use the tool. Also, professionals that start to use the tool during the period time of the study will be included.The number of annual referrals during the first and second year will be analyzed and retrospectively compared with the previous year to the implementation of the tool. Moreover, it will be assessed the level of satisfaction of the professionals with the tool and to what extend the tool responds to their needs. The implementation of ECOPIH in the field of Primary Health Care can decrease the number of referrals from primary care to specialist care.It is expected that the reduction will be more noticeable in the group of professionals that use more intensively the tool. Furthermore, we believe that it can be also observed with the professionals that read the contributions of the others.We anticipate high degree of customer satisfaction as it is a very helpful resource never used before in our environment.

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

    Science.gov (United States)

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

    2011-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Tello-Bernabé Eugenia

    2011-12-01

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

  6. Tillage System and Cover Crop Effects on Soil Quality

    DEFF Research Database (Denmark)

    Abdollahi, Lotfollah; Munkholm, Lars Juhl

    2014-01-01

    ), and moldboard plowing (MP) with and without a cover crop were evaluated in a long-term experiment on a sandy loam soil in Denmark. Chemical, physical, and biological soil properties were measured in the spring of 2012. The field measurements included mean weight diameter (MWD) after the drop-shatter test......, penetration resistance, and visual evaluation of soil structure (VESS). In the laboratory, aggregate strength, water-stable aggregates (WSA), and clay dispersibility were measured. The analyzed chemical and biological properties included soil organic C (SOC), total N, microbial biomass C, labile P and K......Optimal use of management systems including tillage and winter cover crops is recommended to improve soil quality and sustain agricultural production. The effects on soil properties of three tillage systems (as main plot) including direct drilling (D), harrowing to a depth of 8 to 10 cm (H...

  7. Tillage and residue burning affects weed populations and seed banks.

    Science.gov (United States)

    Narwal, S; Sindel, B M; Jessop, R S

    2006-01-01

    An integrated weed management approach requires alternative management practices to herbicide use such as tillage, crop rotations and cultural controls to reduce soil weed seed banks. The objective of this study was to examine the value of different tillage practices and stubble burning to exhaust the seed bank of common weeds from the northern grain region of Australia. Five tillage and burning treatments were incorporated in a field experiment, at Armidale (30 degrees 30'S, 151 degrees 40'E), New South Wales, Australia in July 2004 in a randomized block design replicated four times. The trial was continued and treatments repeated in July 2005 with all the mature plants from the first year being allowed to shed seed in their respective treatment plots. The treatments were (i) no tillage (NT), (ii) chisel ploughing (CP), (iii) mould board ploughing (MBP), (iv) wheat straw burning with no tillage (SBNT) and (v) wheat straw burning with chisel ploughing (SBC). Soil samples were collected before applying treatments and before the weeds flowered to establish the seed bank status of the various weeds in the soil. Wheat was sown after the tillage treatments. Burning treatments were only initiated in the second year, one month prior to tillage treatments. The major weeds present in the seed bank before initiating the trial were Polygonum aviculare, Sonchus oleraceus and Avena fatua. Tillage promoted the germination of other weeds like Hibiscus trionum, Medicago sativa, Vicia sp. and Phalaris paradoxa later in the season in 2004 and Convolvulus erubescens emerged as a new weed in 2005. The MBP treatment in 2004 reduced the weed biomass to a significantly lower level of 55 g/m2 than the other treatments of CP (118 g/m2) and NT plots (196 g/m2) (P < 0.05). However, in 2005 SBC and MBP treatments were similar in reducing the weed biomass. In 2004, the grain yield trend of wheat was significantly different between CP and NT, and MBP and NT (P < 0.05) with maximum yield of 5898

  8. Planning soil tillage using quality function deployment (QFD

    Directory of Open Access Journals (Sweden)

    Milan Marcos

    2003-01-01

    Full Text Available The Brazilian forest sector represents about 4% of gross domestic product (GDP which is correspondent to US$ 21.0 billion. The natural forest area is approximately 4.8 million hectares and for the near future there will be a need to increase the planted area. To avoid or minimize the impact of mechanized practices on forest soils, the reduced tillage has been developed. The aim of this work is to define the technical priorities of the reduced tillage for eucalyptus seedlings, using quality function deployment (QDF. The design requirements classified as the most important to attend seedling demands were the furrow width and depth, and clod sizes. QFD has the potential to be applied to agro-forestry systems to translate plant demands into technical requirements.

  9. Implementing primary health care-based PMTCT interventions: operational perspectives from Muhima cohort analysis (Rwanda)

    Science.gov (United States)

    Bucagu, Maurice; Muganda, John

    2014-01-01

    Introduction In countries with high burden of HIV, major programmatic challenges have been identified to preventing new infections among children and scaling up of treatment for pregnant mothers. We initiated this study to examine operational approaches that were used to enhance implementation of PMTCT interventions in Muhima health Centre (Kigali/Rwanda) from 2007 to 2010. Methods The prospective cohort study was conducted at Muhima health centre. A sample size of 656 was the minimum number required for the study. The main outcome was cumulative incidence of mother - to - child transmission of HIV-1 measured at 6 weeks of life among live born children. Results Among the 679 live born babies and followed up in this study, the overall cumulative rate of HIV-1 mother - to - child transmission observed was 3.2% at 6 weeks of age after birth. Disclosure of HIV status to partner was significantly associated with HIV-1 status of infants at 6 weeks of age (non-disclosure of HIV status adjusted odds ratio [AOR] 4.68, CI 1.39 to 15.77, p. Conclusion The Muhima type of decentralized health facility offered an appropriate platform for implementation of PMTCT interventions, with the following operational features: family - centered approach; integrated service delivery for PMTCT/MCH interventions, task shifting; subsidized membership fees for people living with HIV, allowing for access to the community-based health insurance benefits. PMID:26113893

  10. Effects of Conventional and Conservation Tillage on Soil Hydraulic Properties of a Silty-loamy Soil

    DEFF Research Database (Denmark)

    Wahl, Niels Arne; Bens, O.; Buczko, U.

    2004-01-01

    Infiltration into soils is strongly correlated with macroporosity. Under agricultural land use, the properties of the macropore network are governed by the applied management and tillage system. On an experimental site with a silt loam soil partly under conventional and conservation tillage, the ......, conservation tillage could possibly offer a means to reduce surface runoff and flood generation in agricultural landscapes dominated by silty-loamy soils. d 2...

  11. Tillage practices in the conterminous United States, 1989-2004-Datasets Aggregated by Watershed

    Science.gov (United States)

    Baker, Nancy T.

    2011-01-01

    This report documents the methods used to aggregate county-level tillage practices to the 8-digit hydrologic unit (HU) watershed. The original county-level data were collected by the Conservation Technology Information Center (CTIC). The CTIC collects tillage data by conducting surveys about tillage systems for all counties in the United States. Tillage systems include three types of conservation tillage (no-till, ridge-till, and mulch-till), reduced tillage, and intensive tillage. Total planted acreage for each tillage practice for each crop grown is reported to the CTIC. The dataset includes total planted acreage by tillage type for selected crops (corn, cotton, grain sorghum, soybeans, fallow, forage, newly established permanent pasture, spring and fall seeded small grains, and 'other' crops) for 1989-2004. Two tabular datasets, based on the 1992 enhanced and 2001 National Land Cover Data (NLCD), are provided as part of this report and include the land-cover area-weighted interpolation and aggregation of acreage for each tillage practice in each 8-digit HU watershed in the conterminous United States for each crop. Watershed aggregations were done by overlying the 8-digit HU polygons with a raster of county boundaries and a raster of either the enhanced 1992 or the 2001 NLCD for cultivated land to derive a county/land-cover area weighting factor. The weighting factor then was applied to the county-level tillage data for the counties within each 8-digit HU and summed to yield the total acreage of each tillage type within each 8-digit HU watershed.

  12. Effects of no tillage on the abundance and diversity of soil and olive tree canopy arthropods.

    OpenAIRE

    Lousão, C.; Bento, Albino; Campos, M.; Ruano, F.; Pereira, J.A.

    2007-01-01

    Soil tillage is a traditional practice in the olive groves of Trás-os-Montes region (Northeast of Portugal) where the soil is maintained without any vegetal cover. However, this agronomic practice may have dangerous environmental effects of several orders. In this way, with the present work we aimed to contribute for the knowledge about the effect of two soil management practices in the olive grove (traditional tillage in comparison to no tillage) on the arthropods abundance an...

  13. Assessment of tillage systems in organic farming: influence of soil structure on microbial biomass. First results

    OpenAIRE

    Vian, Jean François; Peigné, Joséphine; Chaussod, Rémi; Roger-Estrade, Jean

    2007-01-01

    Soil tillage modifies environmental conditions of soil microorganisms and their ability to release nitrogen. We compare the influence of reduced tillage (RT) and mouldboard ploughing (MP) on the soil microbial functioning in organic farming. In order to connect soil structure generated by these tillage systems on the soil microbial biomass we adopt a particular sampling scheme based on the morphological characterisation of the soil structure by the description of the soil profile. This method...

  14. Reduced tillage and green manures for sustainable cropping systems - Overview of the TILMAN-ORG project

    OpenAIRE

    Mäder, Paul

    2013-01-01

    Reduced tillage and green manures are environmentally friendly practices that increase levels of soil organic matter and biological activity, improve soil stability, and reduce fuel consumption and may mitigate the climate impact of crop production. The avoidance of deep ploughing is successfully practiced as no-tillage agriculture in conventional farming systems. However, these no-tillage systems rely on herbicides for weed control and mineral fertilisers for plant nutrients. As these inputs...

  15. Infiltration in reclaimed mined land ameliorated with deep tillage treatments

    International Nuclear Information System (INIS)

    Chong, S.K.; Cowsert, P.T.

    1997-01-01

    Reclamation of mined land with heavy machinery can result in soil compaction, which increases soil bulk density and reduces porosity, water infiltrability, root elongation and crop productivity. This paper examines the effect on infiltration in reclaimed surface mined land of a deep tillage treatment, and the subsequent changes in infiltration after the amelioration. The experiment was conducted at the Horse Creek Mine near Conant, Ferry County, IL, USA

  16. Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative.

    Science.gov (United States)

    Thomas, Kristin; Krevers, Barbro; Bendtsen, Preben

    2015-01-22

    Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care. A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively. Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff. Intervention centres did not show higher rates than control centres on reach of patients

  17. Effect of Interplanting with Zero Tillage and Straw Manure on Rice Growth and Rice Quality

    Directory of Open Access Journals (Sweden)

    Shi-ping LIU

    2007-09-01

    Full Text Available The interplanting with zero-tillage of rice, i.e. direct sowing rice 10–20 days before wheat harvesting, and remaining about 30-cm high stubble after cutting wheat or rice with no tillage, is a new cultivation technology in wheat-rice rotation system. To study the effects of interplanting with zero tillage and straw manure on rice growth and quality, an experiment was conducted in a wheat-rotation rotation system. Four treatments, i.e. ZIS (Zero-tillage, straw manure and rice interplanting, ZI (Zero-tillage, no straw manure and rice interplanting, PTS (Plowing tillage, straw manure and rice transplanting, and PT (Plowing tillage, no straw manure and rice transplanting, were used. ZIS reduced plant height, leaf area per plant and the biomass of rice plants, but the biomass accumulation of rice at the late stage was quicker than that under conventional transplanting cultivation. In the first year (2002, there was no significant difference in rice yield among the four treatments. However, rice yield decreased in interplanting with zero-tillage in the second year (2003. Compared with the transplanting treatments, the number of filled grains per panicle decreased but 1000-grain weight increased in interplanting with zero-tillage, which were the main factors resulting in higher yield. Interplanting with zero-tillage improved the milling and appearance qualities of rice. The rates of milled and head rice increased while chalky rice rate and chalkiness decreased in interplanting with zero-tillage. Zero-tillage and interplanting also affected rice nutritional and cooking qualities. In 2002, ZIS showed raised protein content, decreased amylose content, softer gel consistency, resulting in improved rice quality. In 2003, zero-tillage and interplanting decreased protein content and showed similar amylose content as compared with transplanting treatments. Moreover, protein content in PTS was obviously increased in comparison with the other three treatments

  18. Economic and energy assessment of minimalized soil tillage methods in maize cultivation

    OpenAIRE

    Piotr Szulc; Andrzej Dubas

    2014-01-01

    Grain yield of maize cultivated in the years 1997-2009 in monoculture and with annual tillage simplifications was assessed in energy and economy terms. Effects of no-tillage system and direct sowing (D) with cultivation with autumn deep (A) and shallow (B) ploughing and cultivation with spring pre-sowing ploughing (C) were compared. It was demonstrated that the 13-year maize grain yield in no-tillage system and direct sowing was lower by 10.4% than the yield obtained in conventional tillage s...

  19. Evaluating energy efficiency of site-specific tillage in maize in NE Italy.

    Science.gov (United States)

    Bertocco, M; Basso, B; Sartori, L; Martin, E C

    2008-10-01

    This paper examine the efficiency of energy use of three conservation tillage practices (SST - sub-soil tillage; MT - minimum tillage; and NT - no tillage) performed within two management zones, previously identified in a field according to the stability of yield variability. Experiments were carried out in 2003 in NE Italy, on a farm near Rovigo, on a 8-ha field with clay soil, in maize (Zea mays, L.). The purpose of the paper is (i) to investigate the energy variability due to these tillage practices performed spatially within two management zones and (ii) to analyze the long-term energetic efficiency for each tillage practice. The energy balance was highest for SST with respect to MT and NT, due to labor and fuel consumption rates. The energy balance was influenced by the spatial pattern of yield, with appreciable differences between practices in terms of both the conversion index of energy for tillage (9.0, 12.6 and 22.8GJha(-1) for SST, MT and NT, respectively) and the energy use efficiency for tillage (8.0, 11.6, 21.8GJha(-1) for SST, MT and NT, respectively). Based on the simulated data and the calibration results, SALUS model proved to be a good tool for analyzing long-term effects of tillage practices on yield. The NT treatment showed the best efficiency over years, due to the low inputs in comparison with the output level.

  20. Tillage methods and mulch on water saving and yield of spring maize in Chitwan

    Directory of Open Access Journals (Sweden)

    Ishwari Prasad Upadhyay

    2016-12-01

    Full Text Available Tillage methods and mulch influences the productivity and water requirement of spring maize hence a field experiment was conducted at the National Maize Research Program, Rampur in spring seasons of 2011 and 2012 with the objectives to evaluate different tillage methods with and without mulch on water requirement and grain yield of spring maize. The experiment was laid out in two factors factorial randomized complete design with three replications. The treatments consisted of tillage methods (Permanent bed, Zero tillage and Conventional tillage and mulch (with and without. Irrigation timing was fixed as knee high stage, tasseling stage and milking/dough stage. Data on number of plants, number of ears, thousand grain weight and grain yield were recorded and analysed using GenStat. Two years combined result showed that the effect of tillage methods and mulch significant influenced grain yield and water requirement of spring maize. The maize grain yield was the highest in permanent beds with mulch (4626 kg ha-1 followed by zero tillage with mulch (3838 kg ha-1. Whereas total water applied calculated during the crop period were the highest in conventional tillage without mulch followed by conventional tillage with mulch. The permanent bed with mulch increased the yield and reduced the water requirement of spring maize in Chitwan.

  1. The Role of Government Policies in the Adoption of Conservation Tillage in China: A Theoretical Model

    Science.gov (United States)

    Ding, Ya

    2018-01-01

    In recent years, many areas of China have been facing increasing problems of soil erosion and land degradation. Conservation tillage, with both economic and ecological benefits, provides a good avenue for Chinese farmers to conserve land as well as secure food production. However, the adoption rate of conservation tillage systems is very low in China. In this paper, the author constructs a theoretical model to explain a farmer’s adoption decision of conservation tillage. The goal is to investigate potential reasons behind the low adoption rate and explores alternative policy tools that can help improve a farmer’s incentive to adopt conservation tillage in China.

  2. Implementing international osteoarthritis treatment guidelines in primary health care: study protocol for the SAMBA stepped wedge cluster randomized controlled trial.

    Science.gov (United States)

    Østerås, Nina; van Bodegom-Vos, Leti; Dziedzic, Krysia; Moseng, Tuva; Aas, Eline; Andreassen, Øyvor; Mdala, Ibrahim; Natvig, Bård; Røtterud, Jan Harald; Schjervheim, Unni-Berit; Vlieland, Thea Vliet; Hagen, Kåre Birger

    2015-12-02

    Previous research indicates that people with osteoarthritis (OA) are not receiving the recommended and optimal treatment. Based on international treatment recommendations for hip and knee OA and previous research, the SAMBA model for integrated OA care in Norwegian primary health care has been developed. The model includes physiotherapist (PT) led patient OA education sessions and an exercise programme lasting 8-12 weeks. This study aims to assess the effectiveness, feasibility, and costs of a tailored strategy to implement the SAMBA model. A cluster randomized controlled trial with stepped wedge design including an effect, process, and cost evaluation will be conducted in six municipalities (clusters) in Norway. The municipalities will be randomized for time of crossover from current usual care to the implementation of the SAMBA model by a tailored strategy. The tailored strategy includes interactive workshops for general practitioners (GPs) and PTs in primary care covering the SAMBA model for integrated OA care, educational material, educational outreach visits, feedback, and reminder material. Outcomes will be measured at the patient, GP, and PT levels using self-report, semi-structured interviews, and register based data. The primary outcome measure is patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire) at 6-month follow-up. Secondary outcomes include referrals to PT, imaging, and referrals to the orthopaedic surgeon as well as participants' treatment satisfaction, symptoms, physical activity level, body weight, and self-reported and measured lower limb function. The actual exposure to the tailor made implementation strategy and user experiences will be measured in a process evaluation. In the economic evaluation, the difference in costs of usual OA care and the SAMBA model for integrated OA care will be compared with the difference in health outcomes and reported by the incremental cost-effectiveness ratio (ICER). The results

  3. What is required to facilitate implementation of Swedish physical activity on prescription? - interview study with primary healthcare staff and management.

    Science.gov (United States)

    Gustavsson, Catharina; Nordqvist, Maria; Bröms, Kristina; Jerdén, Lars; Kallings, Lena V; Wallin, Lars

    2018-03-21

    The method, Swedish Physical Activity on Prescription (SPAP), has been launched in Swedish healthcare to promote physical activity for prevention and treatment of lifestyle related health disorders. Despite scientific support for the method, and education campaigns, it is used to a limited extent by health professionals. The aim of the study was to describe the views of health professionals on perceived facilitators, barriers and requirements for successful implementation of SPAP in primary healthcare. Eighteen semi-structured interviews with stakeholders in SPAP, i.e. ten people working in local or central management and eight primary healthcare professionals in two regional healthcare organisations, were analysed using qualitative content analysis. We identified an overarching theme regarding requirements for successful implementation of SPAP: Need for knowledge and organisational support, comprising four main categories: Need for increased knowledge and affirmative attitude among health professionals; Need for clear and supportive management; Need for central supporting structures; Need for local supporting structures. Knowledge of the SPAP method content and core components was limited. Confidence in the method varied among health professionals. There was a discrepancy between the central organisation policy documents declaring that disease preventive methods were prioritised and a mandatory assignment, while the health professionals asked for increased interest, support and resources from management, primarily time and supporting structures. There were somewhat conflicting views between primary healthcare professionals and managers concerning perceived barriers and requirements. In contrast to some of the management's beliefs, all primary healthcare professionals undisputedly acknowledged the importance of promoting physical activity, but they lacked time, written routines and in some cases competence for SPAP counselling. The study provides knowledge

  4. 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

  5. Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production.

    Science.gov (United States)

    Farr, Michelle; Banks, Jonathan; Edwards, Hannah B; Northstone, Kate; Bernard, Elly; Salisbury, Chris; Horwood, Jeremy

    2018-03-19

    To examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved. Mixed-method evaluation of a primary care e-consultation system. Primary care practices in South West England. Qualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients' records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients' and staff touchpoints. We found different expectations between patients and staff on how to use e-consultations 'appropriately'. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation. Where both patients and staff interact with technology, it is in effect 'co-implemented'. How patients used e-consultations impacted on practice staff's experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved

  6. Impact of implementation and conduct of the HEALTHY primary prevention trial on student performance.

    Science.gov (United States)

    Hernandez, Arthur E; Marcus, Marsha D; Hirst, Kathryn; Faith, Myles S; Goldberg, Linn; Treviño, Roberto P

    2014-01-01

    To determine whether a school-wide intervention program to reduce risk factors for type 2 diabetes (T2D) affected student achievement, rates of disciplinary actions, and attendance rates. The HEALTHY primary prevention trial was designed to evaluate a comprehensive school-based intervention to reduce factors for T2D, especially overweight and obesity. Students were followed up from beginning of sixth grade (Fall 2006) through end of eighth grade (Spring 2009). Forty-two middle schools at seven U.S. sites. Schools were randomized in equal numbers at each site to intervention (21 schools, 2307 students) or control (21 schools, 2296 students). Intervention . An integrated school-wide program that focused on (1) foods and beverages, (2) physical education, (3) classroom-based behavior change and education, and (4) social marketing communication and promotional campaigns. Aggregate (grade- and school-wide) test performance (passing rate), attendance, and referrals for disciplinary actions. Descriptive statistics and tests of intervention versus control using mixed linear models methods to adjust for the clustering of students within schools. There were no differences between intervention and control schools in test performance for mathematics (p = .7835) or reading (p = .6387), attendance (p = .5819), or referrals for disciplinary action (p = .8671). The comprehensive HEALTHY intervention and associated research procedures did not negatively impact student achievement test scores, attendance, or referrals for disciplinary action.

  7. Implementation of a primary standard for a x-ray exposure

    International Nuclear Information System (INIS)

    peixoto, J.G.P.

    1991-04-01

    In the scientific program of the National Laboratory for Ionizing Radiation Metrology of the Instituto de Radioprotecao e Dosimetria, which belongs to the Comissao Nacional de Energia Nuclear, a free-air ionization chamber should be established as an exposure primary standard for X-rays of 100 K V to 250 K V of potential range. Preliminary results showed that the available free-air ionization chamber was suitable to be used. The absolute measurement of the radiation quantity exposure, is performed with a free-air ionization chamber. Its geometrical volume, which allows the determination of the air mass, is defined by the effective aperture area and by the length of the region where an electrical field is applied. Most of the ions produced in such volume are collected as an ionization current. Parameters related to the measurement of the quantity exposure were evaluated, such as: air absorption, scattering inside the ionization chamber, saturation, beam homogeneity, influence of beam size and influences of temperature, humidity and atmospheric pressure. Preliminary determination of correction factors has showed good results with 99.9% of repeatability and has demonstrated the reliability of the checked chamber as a standard instrument. (author)

  8. Evaluation of Low-Cost Mitigation Measures Implemented to Improve Air Quality in Nursery and Primary Schools

    Directory of Open Access Journals (Sweden)

    Juliana P. Sá

    2017-05-01

    Full Text Available Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO2, CO, NO2, O3, CH2O, total volatile organic compounds (VOC, PM1, PM2.5, PM10, Total Suspended Particles (TSP and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO were found for PM2.5, PM10, CO2 and CH2O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE. In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO2. However, mitigation measures were not always sufficient to decrease the pollutants’ concentrations till values considered safe to protect human health.

  9. Evaluation of Low-Cost Mitigation Measures Implemented to Improve Air Quality in Nursery and Primary Schools.

    Science.gov (United States)

    Sá, Juliana P; Branco, Pedro T B S; Alvim-Ferraz, Maria C M; Martins, Fernando G; Sousa, Sofia I V

    2017-05-31

    Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO₂, CO, NO₂, O₃, CH₂O, total volatile organic compounds (VOC), PM₁, PM 2.5 , PM 10 , Total Suspended Particles (TSP) and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO) were found for PM 2.5 , PM 10 , CO₂ and CH₂O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO₂. However, mitigation measures were not always sufficient to decrease the pollutants' concentrations till values considered safe to protect human health.

  10. Climate, duration, and N placement determine N2 O emissions in reduced tillage systems: a meta-analysis.

    Science.gov (United States)

    van Kessel, Chris; Venterea, Rodney; Six, Johan; Adviento-Borbe, Maria Arlene; Linquist, Bruce; van Groenigen, Kees Jan

    2013-01-01

    No-tillage and reduced tillage (NT/RT) management practices are being promoted in agroecosystems to reduce erosion, sequester additional soil C and reduce production costs. The impact of NT/RT on N2 O emissions, however, has been variable with both increases and decreases in emissions reported. Herein, we quantitatively synthesize studies on the short- and long-term impact of NT/RT on N2 O emissions in humid and dry climatic zones with emissions expressed on both an area- and crop yield-scaled basis. A meta-analysis was conducted on 239 direct comparisons between conventional tillage (CT) and NT/RT. In contrast to earlier studies, averaged across all comparisons, NT/RT did not alter N2 O emissions compared with CT. However, NT/RT significantly reduced N2 O emissions in experiments >10 years, especially in dry climates. No significant correlation was found between soil texture and the effect of NT/RT on N2 O emissions. When fertilizer-N was placed at ≥5 cm depth, NT/RT significantly reduced area-scaled N2 O emissions, in particular under humid climatic conditions. Compared to CT under dry climatic conditions, yield-scaled N2 O increased significantly (57%) when NT/RT was implemented <10 years, but decreased significantly (27%) after ≥10 years of NT/RT. There was a significant decrease in yield-scaled N2 O emissions in humid climates when fertilizer-N was placed at ≥5 cm depth. Therefore, in humid climates, deep placement of fertilizer-N is recommended when implementing NT/RT. In addition, NT/RT practices need to be sustained for a prolonged time, particularly in dry climates, to become an effective mitigation strategy for reducing N2 O emissions. © 2012 Blackwell Publishing Ltd.

  11. Implementation of a high-resolution workstation for primary diagnosis of projection radiography images

    Science.gov (United States)

    Good, Walter F.; Herron, John M.; Maitz, Glenn S.; Gur, David; Miller, Stephen L.; Straub, William H.; Fuhrman, Carl R.

    1990-08-01

    We designed and implemented a high-resolution video workstation as the central hardware component in a comprehensive multi-project program comparing the use of digital and film modalities. The workstation utilizes a 1.8 GByte real-time disk (RCI) capable of storing 400 full-resolution images and two Tektronix (GMA251) display controllers with 19" monitors (GMA2O2). The display is configured in a portrait format with a resolution of 1536 x 2048 x 8 bit, and operates at 75 Hz in a noninterlaced mode. Transmission of data through a 12 to 8 bit lookup table into the display controllers occurs at 20 MBytes/second (.35 seconds per image). The workstation allows easy use of brightness (level) and contrast (window) to be manipulated with a trackball, and various processing options can be selected using push buttons. Display of any of the 400 images is also performed at 20MBytes/sec (.35 sec/image). A separate text display provides for the automatic display of patient history data and for a scoring form through which readers can interact with the system by means of a computer mouse. In addition, the workstation provides for the randomization of cases and for the immediate entry of diagnostic responses into a master database. Over the past year this workstation has been used for over 10,000 readings in diagnostic studies related to 1) image resolution; 2) film vs. soft display; 3) incorporation of patient history data into the reading process; and 4) usefulness of image processing.

  12. EFFECT OF SOIL TILLAGE AND PLANT RESIDUE ON SURFACE ROUGHNESS OF AN OXISOL UNDER SIMULATED RAIN

    Directory of Open Access Journals (Sweden)

    Elói Panachuki

    2015-02-01

    Full Text Available Surface roughness of the soil is formed by mechanical tillage and is also influenced by the kind and amount of plant residue, among other factors. Its persistence over time mainly depends on the fundamental characteristics of rain and soil type. However, few studies have been developed to evaluate these factors in Latossolos (Oxisols. In this study, we evaluated the effect of soil tillage and of amounts of plant residue on surface roughness of an Oxisol under simulated rain. Treatments consisted of the combination of the tillage systems of no-tillage (NT, conventional tillage (CT, and minimum tillage (MT with rates of plant residue of 0, 1, and 2 Mg ha-1 of oats (Avena strigosa Schreb and 0, 3, and 6 Mg ha-1 of maize (Zea mays L.. Seven simulated rains were applied on each experimental plot, with intensity of 60±2 mm h-1 and duration of 1 h at weekly intervals. The values of the random roughness index ranged from 2.94 to 17.71 mm in oats, and from 5.91 to 20.37 mm in maize, showing that CT and MT are effective in increasing soil surface roughness. It was seen that soil tillage operations carried out with the chisel plow and the leveling disk harrow are more effective in increasing soil roughness than those carried out with the heavy disk harrow and leveling disk harrow. The roughness index of the soil surface decreases exponentially with the increase in the rainfall volume applied under conditions of no tillage without soil cover, conventional tillage, and minimum tillage. The oat and maize crop residue present on the soil surface is effective in maintaining the roughness of the soil surface under no-tillage.

  13. Uncertainties in assessing tillage erosion - How appropriate are our measuring techniques?

    Science.gov (United States)

    Fiener, P.; Wilken, F.; Aldana-Jague, E.; Deumlich, D.; Gómez, J. A.; Guzmán, G.; Hardy, R. A.; Quinton, J. N.; Sommer, M.; Van Oost, K.; Wexler, R.

    2018-03-01

    Tillage erosion on arable land is a very important process leading to a net downslope movement of soil and soil constitutes. Tillage erosion rates are commonly in the same order of magnitude as water erosion rates and can be even higher, especially under highly mechanized agricultural soil management. Despite its prevalence and magnitude, tillage erosion is still understudied compared to water erosion. The goal of this study was to bring together experts using different techniques to determine tillage erosion and use the different results to discuss and quantify uncertainties associated with tillage erosion measurements. The study was performed in northeastern Germany on a 10 m by 50 m plot with a mean slope of 8%. Tillage erosion was determined after two sequences of seven tillage operations. Two different micro-tracers (magnetic iron oxide mixed with soil and fluorescent sand) and one macro-tracer (passive radio-frequency identification transponders (RFIDs), size: 4 × 22 mm) were used to directly determine soil fluxes. Moreover, tillage induced changes in topography were measured for the entire plot with two different terrestrial laser scanners and an unmanned aerial system for structure from motion topography analysis. Based on these elevation differences, corresponding soil fluxes were calculated. The mean translocation distance of all techniques was 0.57 m per tillage pass, with a relatively wide range of mean soil translocation distances ranging from 0.39 to 0.72 m per pass. A benchmark technique could not be identified as all used techniques have individual error sources, which could not be quantified. However, the translocation distances of the macro-tracers used were consistently smaller than the translocation distances of the micro-tracers (mean difference = - 26 ± 12%), which questions the widely used assumption of non-selective soil transport via tillage operations. This study points out that tillage erosion measurements, carried out under almost

  14. Implementing the Comprehensive Unit-Based Safety Program (CUSP) to Improve Patient Safety in an Academic Primary Care Practice.

    Science.gov (United States)

    Pitts, Samantha I; Maruthur, Nisa M; Luu, Ngoc-Phuong; Curreri, Kimberly; Grimes, Renee; Nigrin, Candace; Sateia, Heather F; Sawyer, Melinda D; Pronovost, Peter J; Clark, Jeanne M; Peairs, Kimberly S

    2017-11-01

    While there is growing awareness of the risk of harm in ambulatory health care, most patient safety efforts have focused on the inpatient setting. The Comprehensive Unit-based Safety Program (CUSP) has been an integral part of highly successful safety efforts in inpatient settings. In 2014 CUSP was implemented in an academic primary care practice. As part of CUSP implementation, staff and clinicians underwent training on the science of safety and completed a two-question safety assessment survey to identify safety concerns in the practice. The concerns identified by team members were used to select two initial safety priorities. The impact of CUSP on safety climate and teamwork was assessed through a pre-post comparison of results on the validated Safety Attitudes Questionnaire. Ninety-six percent of staff completed science of safety training as part of CUSP implementation, and 100% of staff completed the two-question safety assessment. The most frequently identified safety concerns were related to medications (n = 11, 28.2), diagnostic testing (n = 9, 25), and communication (n = 5, 14). The CUSP team initially prioritized communication and infection control, which led to standardization of work flows within the practice. Six months following CUSP implementation, large but nonstatistically significant increases were found for the percentage of survey respondents who reported knowledge of the proper channels for questions about patient safety, felt encouraged to report safety concerns, and believed that the work setting made it easy to learn from the errors of others. CUSP is a promising tool to improve safety climate and to identify and address safety concerns within ambulatory health care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  15. Community led active schools programme (CLASP) exploring the implementation of health interventions in primary schools: headteachers' perspectives.

    Science.gov (United States)

    Christian, Danielle; Todd, Charlotte; Davies, Helen; Rance, Jaynie; Stratton, Gareth; Rapport, Frances; Brophy, Sinead

    2015-03-13

    Schools are repeatedly utilised as a key setting for health interventions. However, the translation of effective research findings to the school setting can be problematic. In order to improve effective translation of future interventions, it is imperative key challenges and facilitators of implementing health interventions be understood from a school's perspective. Nineteen semi-structured interviews were conducted in primary schools (headteachers n = 16, deputy headteacher n = 1, healthy school co-ordinator n = 2). Interviews were transcribed verbatim and analysed using thematic analysis. The main challenges for schools in implementing health interventions were; government-led academic priorities, initiative overload, low autonomy for schools, lack of staff support, lack of facilities and resources, litigation risk and parental engagement. Recommendations to increase the application of interventions into the school setting included; better planning and organisation, greater collaboration with schools and external partners and elements addressing sustainability. Child-centred and cross-curricular approaches, inclusive whole school approaches and assurances to be supportive of the school ethos were also favoured for consideration. This work explores schools' perspectives regarding the implementation of health interventions and utilises these thoughts to create guidelines for developing future school-based interventions. Recommendations include the need to account for variability between school environments, staff and pupils. Interventions with an element of adaptability were preferred over the delivery of blanket fixed interventions. Involving schools in the developmental stage would add useful insights to ensure the interventions can be tailored to best suit each individual schools' needs and improve implementation.

  16. The Role of Practitioner Self-Efficacy, Training, Program and Workplace Factors on the Implementation of an Evidence-Based Parenting Intervention in Primary Care

    Science.gov (United States)

    Turner, Karen M. T.; Nicholson, Jan M.; Sanders, Matthew R.

    2011-01-01

    This study examines factors affecting the implementation by primary care practitioners (nursing, education, allied health, and medical) of a brief parenting and family support intervention (the Primary Care Triple P--Positive Parenting Program) following professional training. It assesses the impact of prior experience, self-efficacy, program…

  17. Urease activity and its relation to soil organic matter, microbial biomass nitrogen and urea-nitrogen assimilation by maize in a Brazilian oxisol under no-tillage and tillage systems

    NARCIS (Netherlands)

    Roscoe, R.; Vasconcellos, C.A.; Furtini Neto, A.E.; Guedes, G.A.A.; Fernandes, L.A.

    2000-01-01

    We studied the relationship between urease activity (UA) and soil organic matter (SOM), microbial biomass N (Nbiom) content, and urea-N fertilizer assimilation by maize in a Dark Red Latosol (Typic Haplustox) cultivated for 9 years under no-tillage (NT), tillage with a disc plough (DP), and tillage

  18. What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care.

    Science.gov (United States)

    Philips, Hilde; Remmen, Roy; Van Royen, Paul; Teblick, Marc; Geudens, Leo; Bronckaers, Marc; Meeuwis, Herman

    2010-07-30

    Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice. We used a prospective before/after interventional study design. The intervention was the implementation of a GPC. One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836). One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.

  19. Water Use Efficiency under Different Tillage and Irrigation Systems for Tomato Farming in Southeastern Brazil

    Science.gov (United States)

    Bhering, S. B.; Fernandes, N. F.; Macedo, J. R.

    2009-04-01

    study did no suggest significant modifications on soil physical properties among the three systems. The no-tillage system (NT-D) presented the lower values for average soil temperature and amplitude and supplied more water to the plants, favoring groundwater recharge on the long-term, while preventing runoff, leaching or evaporation of water from the soil. On the other hand, conventional (CT-H) and minimum tillage (MT-H) systems generated water stress conditions, especially during fruiting, maturation and harvest periods. Besides, 75% of the root system is concentrated on the first 30cm of the soil profile while in the no-tillage system with drip irrigation (NT-D) is observed an increase of water availability in the effective root zone (60 cm). The results obtained here also suggest a 50% increase in the production of tomato for the no-tillage system with drip irrigation (NT-D) when compared to the conventional system. Therefore, the results attest that the implementation of simple soil and water conservation practices play an important role toward an improvement of the environmental sustainability of the tomato farming in this area.

  20. Weed Population Dynamics, Water Productivity and Grain Yield of Durum Wheat (Triticum durum L. in No-Tillage and Conventional Tillage Systems

    Directory of Open Access Journals (Sweden)

    Mehdi Mojab

    2016-09-01

    Full Text Available Introduction: Elimination or reduction of tillage in conservation agricultural systems has led to wide variations in germination, emergence, and growth of weeds and has caused variations in the density and diversity of weeds under such systems. Maintaining crop residues on the soil surface has many potential benefits in agricultural production systems; such as reducing water and wind erosions, increasing the soil organic matter content, improving the soil structure and sowing conditions, as well as a better weed management through allelopathy or physical interference provided by the crop residues. Crop residue and tillage system cause potential changes in the soil temperature and water content, which influence soil density, structure, moisture, as well as soil temperature and nutrients. Crop residues act as mulches and can effect on weed seed germination and seedling emergence. Therefore, the objectives of current study were to evaluate the effects of no-tillage systems on: (i narrow- and broadleaved weed densities, (ii crop yield and (iii water productivity (WP. Materials and Methods: A two-year field study based on a split plot experiment in a randomized complete block design with four replications was carried out in Zahedshahr, Fars province, Iran (latitude 28˚44΄N, longitude 53˚48΄E, 1180 m altitude during 2009-10 and 2010-11 growing seasons. The planting practices including moldboard plow, disk and leveler were practiced in conventional tillage plots and crop planting was performed using a drill seeder (made by Kohorasan Co., Iran. The no-tillage plots were directly planted without any soil disturbance and removing wheat residues of the last year using a direct planter machine (model Berteni, Argentina. Furrow irrigation was used at both systems and a water counter (model WD, size DN100 was applied to measure the amount of used water based on m3 ha-1. 1 x 1 m quadrates that were installed at the center of each plot. Crop density, narrow

  1. Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care: a focus on methods.

    Science.gov (United States)

    Lionis, Christos; Petelos, Elena; Mechili, Enkeleint-Aggelos; Sifaki-Pistolla, Dimitra; Chatzea, Vasiliki-Eirini; Angelaki, Agapi; Rurik, Imre; Pavlic, Danica Rotar; Dowrick, Christopher; Dückers, Michel; Ajdukovic, Dean; Bakic, Helena; Jirovsky, Elena; Mayrhuber, Elisabeth Sophie; van den Muijsenbergh, Maria; Hoffmann, Kathryn

    2018-02-08

    The current political crisis, conflicts and riots in many Middle Eastern and African countries have led to massive migration waves towards Europe. European countries, receiving these migratory waves as first port of entry (POE) over the past few years, were confronted with several challenges as a result of the sheer volume of newly arriving refugees. This humanitarian refugee crisis represents the biggest displacement crisis of a generation. Although the refugee crisis created significant challenges for all national healthcare systems across Europe, limited attention has been given to the role of primary health care (PHC) to facilitate an integrated delivery of care by enhancing care provision to refugees upon arrival, on transit or even for longer periods. Evidence-based interventions, encompassing elements of patient-centredness, shared decision-making and compassionate care, could contribute to the assessment of refugee healthcare needs and to the development and the implementation of training programmes for rapid capacity-building for the needs of these vulnerable groups and in the context of integrated PHC care. This article reports on methods used for enhancing PHC for refugees through rapid capacity-building actions in the context of a structured European project under the auspices of the European Commission and funded under the 3rd Health Programme by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). The methods include the assessment of the health needs of all the people reaching Europe during the study period, and the identification, development, and testing of educational tools. The developed tools were evaluated following implementation in selected European primary care settings.

  2. Implementation of brief alcohol interventions by nurses in primary care: do non-clinical factors influence practice?

    Science.gov (United States)

    Lock, Catherine A; Kaner, Eileen F S

    2004-06-01

    In the UK, GPs and practice nurses selectively provide brief alcohol interventions to risk drinkers. GPs' provision of a brief alcohol intervention can be predicted by patient characteristics, practitioner characteristics and structural factors such as the features of the practice and how it is organized. However, much less is known about possible modifiers of nurse practice. Our aim was to investigate if patient characteristics, nurse characteristics and practice factors influence provision of a brief alcohol intervention by practice nurses in primary health care. One hundred and twenty-eight practice nurses who had implemented a brief alcohol intervention programme in a previous trial based in the North of England were requested to screen adults presenting to their surgery and follow a structured protocol to give a brief intervention (5 min of advice plus an information booklet) to all 'risk' drinkers. Anonymized carbon copies of 5541 completed Alcohol Use Disorders Identification Test (AUDIT) screening questionnaires were collected after a 3-month implementation period and analysed by logistic regression analysis. Although AUDIT identified 1500 'risk' drinkers, only 926 (62%) received a brief intervention. Logistic regression modelling showed that patients' risk status as measured by AUDIT score was the most influential predictor of a brief intervention by practice nurses. However, risk drinkers who were most likely to receive a brief intervention were male. Patients' age or social class did not independently predict a brief intervention. The multilevel model was unable to identify any independent nurse characteristics that could predict a brief intervention, but indicated significant variation between nurses in their tendency to offer the intervention to patients. No structural factors were found to be positively associated with selective provision. Patient and nurse factors contributed to the selective provision of a brief intervention in primary care. If

  3. Comparison of runoff and soil loss in different tillage systems in the Mollisol region of Northeast China

    Science.gov (United States)

    Longitudinal ridge tillage is the conventional tillage method in the cold, Mollisol region of Northeast China in which furrows are oriented up and down the slope. Soil erosion is a serious problem in this region in part due to the use of this tillage system with long slope lengths. It is unclear wha...

  4. Tillage and residue effects on rainfed wheat and corn production in the Semi-Arid Regions of Northern China

    NARCIS (Netherlands)

    Wang, X.B.; Hoogmoed, W.B.; Perdok, U.D.; Cai, D.X.

    2003-01-01

    Field studies on tillage and residue management for spring corn were conducted at two sites, in Tunliu (1987-1990), and Shouyang (1992-1995) counties of Shanxi province in the semihumid arid regions of northern China. This paper discusses the effects of different fall tillage (winter fallow tillage)

  5. influence of tillage practices on physical properties of a sandy loam

    African Journals Online (AJOL)

    DR. AMINU

    many regions of the world if the mechanics of tillage effects on soil physical properties is to be well understood. Thus, the ... tillage systems on water storage of a sandy loam soil after 22 years of ..... Soil infiltration ... and processes. Academy ...

  6. Effects of Tillage Model on Healthy Plough Layer Structure and Its Development Trends

    Directory of Open Access Journals (Sweden)

    HU Jun-ming

    2018-02-01

    Full Text Available Soil cultivation is closely related to land productivity. Nutrient in plough layer is the key factor affecting the absorption and utilization of crop nutrients. Good plough layer structure is beneficial to the coordination of water, fertilizer, gas and heat. The depth of arable layer is related to tillage methods. Constructing good plough layer structure is conducive to crop growth and distribution. This paper reviewed both domestic and foreign researches regarding tillage models, which included conventional tillage, protective cultivation, rotary tillage, deep tillage, and so on. Based on the above research results, the effects of tillage models on the healthy soil layer construction were discussed from the soil bulk density, soil porosity, soil aggregates, infiltration of soil, soil heavy metals, soil respiration and the characters of root system. The deficiencies of current research were pointed out from several aspects such as tillage system, system positioning, tillage efficiency, suitable crop. In order to maximize the comprehensive production capacity of cultivated land resources and solve the contradiction between human being and land, this paper forecasted the development trend of ideal plough layer structure from four aspects:Cultivate patterns according to local conditions, the establishment of complex farming models, accelerating the research and application of new agricultural machinery, conducting systematic research of farmland microclimate environment. This will provide the theoretical basis and technical support for the optimal farming mode in agricultural production.

  7. European Perspectives on the Adoption of Nonchemical Weed Management in Reduced -Tillage Systems for Arable Crops

    DEFF Research Database (Denmark)

    Melander, Bo; Munier-Jolain, Nicolas; Charles, Raphaël

    2013-01-01

    Non-inversion tillage with tine or disc based cultivations prior to crop establishment is the most common way of reducing tillage for arable cropping systems with small grain cereals, oilseed rape and maize in Europe. However, new regulations on pesticide use may hinder further expansion of reduc...

  8. Soil nitrogen dynamics and leaching under conservation tillage in the Atlantic Coastal Plain, Georgia, USA

    Science.gov (United States)

    Conservation tillage (CsT) involves management that reduces soil erosion by maintaining crop residue cover on farm fields. Typically, both infiltration and soil organic matter increase over time with CsT practices. We compared the impact of a commonly used CsT practice, strip tillage (ST), to conven...

  9. Fertilizer placement and tillage effects on phosphorus leaching in fine-textured soils

    Science.gov (United States)

    Adoption of no-tillage in agricultural watersheds has resulted in substantial reductions in sediment and particulate phosphorus (P) delivery to surface waters. No-tillage, however, may result in increased losses of dissolved P in tile-drained landscapes due to the accumulation of P in surface soil l...

  10. Tillage and Water Deficit Stress Effects on Corn (Zea mays, L.) Root Distribution

    Science.gov (United States)

    One goal of soil management is to provide optimum conditions for root growth. Corn root distributions were measured in 2004 from a crop rotation – tillage experiment that was started in 2000. Corn was grown either following corn or following sunflower with either no till or deep chisel tillage. Wate...

  11. Soil water retention as affected by tillage and residue management in semiarid Spain

    NARCIS (Netherlands)

    Bescansa, P.; Imaz, M.J.; Virto, I.; Enrique, A.; Hoogmoed, W.B.

    2006-01-01

    Conservation tillage preserves soil water and this has been the main reason for its rapid dissemination in rainfed agriculture in semiarid climates. We determined the effects of conservation versus conventional tillage on available soil water capacity (AWC) and related properties at the end of 5

  12. Pesticide Interactions with N source and Tillage: Effects on soil biota and ecosystem services

    DEFF Research Database (Denmark)

    Jensen, John; Petersen, Søren O; Elsgaard, Lars

    . This study was planned to evaluate interactions between pesticide use and other soil management factors. The study was carried out within a long-term tillage experiment using two tillage practices (no-till (NT) and mouldboard ploughing (MP), two contrasting N sources (manure and mineral fertiliser), and two...

  13. Carbon dioxide emissions after application of different tillage systems for loam in northern China

    Science.gov (United States)

    Hongwen, Li; Lifeng, Hu; Fub, Chen; Xuemin, Zhang

    2010-05-01

    Tillage operations influence soil physical properties and crop growth, and thus both directly and indirectly the cropland CO2 exchange with the atmosphere. In this study, the results of CO2 flux measurements on cropland, under different tillage practices in northern China, are presented. CO2 flux on croplands with a winter wheat (Triticum aestivum L.) and maize (Zea may L.) rotation was monitored on plots with conventional tillage (CT), rotary tillage (RT) and no tillage (NT). Soil CO2 flux was generally greater in CT than in NT, and the RT CO2 flux was only slightly smaller than the CT. Daily soil CO2 emissions for CT, RT, and NT averaged 11.30g m-2, 9.63 g m-2 and 7.99 g m-2, respectively, during the growing period. Analysis of variance shows that these differences are significant for the three tillage treatments. Peak CO2 emissions were recorded on the CT and RT croplands after tillage operations. At the same time, no obviously increased emission of CO2 occurred on the NT plot. These differences demonstrate that tillage results in a rapid physical release of CO2.

  14. Effect of tillage on earthworms over short- and medium-term in conventional and organic farming

    NARCIS (Netherlands)

    Crittenden, S.; Eswaramurthy, T.; Goede, de R.G.M.; Brussaard, L.; Pulleman, M.M.

    2014-01-01

    Earthworms play an important role in many soil functions and are affected by soil tillage in agricultural soils. However, effects of tillage on earthworms are often studied without considering species and their interactions with soil properties. Furthermore, many field studies are based on one-time

  15. Simulation of Tillage Systems Impact on Soil Biophysical Properties Using the SALUS Model

    Directory of Open Access Journals (Sweden)

    Luigi Sartori

    2011-02-01

    Full Text Available A sustainable land management has been defined as the management system that allows for production, while minimizing risk, maintaining quality of soil and water. Tillage systems can significantly decrease soil carbon storage and influence the soil environment of a crop. Crop growth models can be useful tools in evaluating the impact of different tillage systems on soil biophysical properties and on the growth and final yield of the crops. The objectives of this paper were i to illustrate the SALUS model and its tillage component; ii to evaluate the effects of different tillage systems on water infiltration and time to ponding, iii to simulate the effect of tillage systems on some soil biophysical properties. The SALUS (System Approach to Land Use Sustainability model is designed to simulate continuous crop, soil, water and nutrient conditions under different tillage and crop residues management strategies for multiple years. Predictions of changes in surface residue, bulk density, runoff, drainage and evaporation were consistent with expected behaviours of these parameters as described in the literature. The experiment to estimate the time to ponding curve under different tillage system confirmed the theory and showed the beneficial effects of the residue on soil surface with respect to water infiltration. It also showed that the no-tillage system is a more appropriate system to adopt in areas characterized by high intensity rainfall.

  16. Tillage and NPK Effect on growth and yield of spring maize in islamabad, pakistan

    International Nuclear Information System (INIS)

    Memon, S.Q.; Mughal, A.Q.; Amjad, N.; Javed, H.I.

    2013-01-01

    Tillage is a very important crop production practice which affect crop performance. An experiment was conducted during the spring crop season 2009 to compare the effect of three different tillage regimes i.e. deep, conventional and zero and four fertilizer levels viz., control 100-50-50, 150-75-75 and 200-100-100 NPK kg ha. The randomized complete block design was used with three replications. There was significant differences in maize emergence percentage, plant height, grains cob, 1000-grain weight and grain yield due to tillage practices and various fertilizer levels, between tillage practices. However, the NPK at the rate 200-100-100 kg ha and deep tillage produced the highest emergence percentage, plant height, grains per cob, 1000-grain weight and grain yield followed by other fertilizer levels and conventional tillage. The zero tillage plots produced the low emergence percentage, plant height, grains cob, 1000-grain weight and grain yield. Therefore, considering the environ-mental conditions, the deep tillage with recommended dose of NPK performed best and provided more vegetative growth and grain yield in maize. However, poor-resource farmers can use the medium level of NPK at the rate 150-75-75 kg ha for getting an economical and successful maize crop. (author)

  17. Nitrous oxide emissions and controls as influenced by tillage and crop residue management strategy

    DEFF Research Database (Denmark)

    Mutegi, James; Munkholm, Lars Juhl; Petersen, Bjørn Molt

    2010-01-01

    (RT) or conventional tillage (CT). Each of these tillage treatments further varied in respect to whether the resulting plot crop residues were retained (+Res) or removed (-Res). Sampling took place from autumn 2007 to the end of spring 2008. Overall N2O emissions were 27 and 26% lower in DD and RT...

  18. Effects of over-winter green cover on soil solution nitrate concentrations beneath tillage land.

    Science.gov (United States)

    Premrov, Alina; Coxon, Catherine E; Hackett, Richard; Kirwan, Laura; Richards, Karl G

    2014-02-01

    There is a growing need to reduce nitrogen losses from agricultural systems to increase food production while reducing negative environmental impacts. The efficacy of vegetation cover for reducing nitrate leaching in tillage systems during fallow periods has been widely investigated. Nitrate leaching reductions by natural regeneration (i.e. growth of weeds and crop volunteers) have been investigated to a lesser extent than reductions by planted cover crops. This study compares the efficacy of natural regeneration and a sown cover crop (mustard) relative to no vegetative cover under both a reduced tillage system and conventional plough-based system as potential mitigation measures for reducing over-winter soil solution nitrate concentrations. The study was conducted over three winter fallow seasons on well drained soil, highly susceptible to leaching, under temperate maritime climatic conditions. Mustard cover crop under both reduced tillage and conventional ploughing was observed to be an effective measure for significantly reducing nitrate concentrations. Natural regeneration under reduced tillage was found to significantly reduce the soil solution nitrate concentrations. This was not the case for the natural regeneration under conventional ploughing. The improved efficacy of natural regeneration under reduced tillage could be a consequence of potential stimulation of seedling germination by the autumn reduced tillage practices and improved over-winter plant growth. There was no significant effect of tillage practices on nitrate concentrations. This study shows that over winter covers of mustard and natural regeneration, under reduced tillage, are effective measures for reducing nitrate concentrations in free draining temperate soils. © 2013.

  19. Simulation of Tillage Systems Impact on Soil Biophysical Properties Using the SALUS Model

    Directory of Open Access Journals (Sweden)

    Bruno Basso

    2006-12-01

    Full Text Available A sustainable land management has been defined as the management system that allows for production, while minimizing risk, maintaining quality of soil and water. Tillage systems can significantly decrease soil carbon storage and influence the soil environment of a crop. Crop growth models can be useful tools in evaluating the impact of different tillage systems on soil biophysical properties and on the growth and final yield of the crops. The objectives of this paper were i to illustrate the SALUS model and its tillage component; ii to evaluate the effects of different tillage systems on water infiltration and time to ponding, iii to simulate the effect of tillage systems on some soil biophysical properties. The SALUS (System Approach to Land Use Sustainability model is designed to simulate continuous crop, soil, water and nutrient conditions under different tillage and crop residues management strategies for multiple years. Predictions of changes in surface residue, bulk density, runoff, drainage and evaporation were consistent with expected behaviours of these parameters as described in the literature. The experiment to estimate the time to ponding curve under different tillage system confirmed the theory and showed the beneficial effects of the residue on soil surface with respect to water infiltration. It also showed that the no-tillage system is a more appropriate system to adopt in areas characterized by high intensity rainfall.

  20. Simulated soil organic carbon response to tillage, yield, and climate change in the southeastern Coastal Plains

    Science.gov (United States)

    Intensive tillage, low-residue crops, and a warm, humid climate have contributed to soil organic carbon (SOC) loss in the southeastern Coastal Plains region. Conservation (CnT) tillage and winter cover cropping are current management practices to rebuild SOC; however, there is sparse long-term field...

  1. Root growth conditions in the topsoil as affected by tillage intensity

    DEFF Research Database (Denmark)

    Kadziene, Grazina; Munkholm, Lars Juhl; Mutegi, James

    2011-01-01

    in the topsoil. Samples were taken from a 7-year tillage experiment on a Danish sandy loam at Foulum, Denmark (56°30′ N, 9°35′ E) in 2008. The main crop was spring barley followed by either dyer's woad (Isatis tinctoria L.) or fodder radish (Raphanus sativus L.) cover crops as subtreatment. The tillage...

  2. Sustainable semiarid dryland production in relation to tillage effects on Hydrology: 1983-2013

    Science.gov (United States)

    Semiarid dryland crop yields with no-till, NT, residue management are often greater than stubble-mulch tillage, SM, as a result of improved soil conditions or water conservation, but knowledge of long-term tillage effects on the comprehensive field hydrology and sustained crop production is needed. ...

  3. An assessment of implementation of Community Oriented Primary Care in Kenyan family medicine postgraduate medical education programmes

    Directory of Open Access Journals (Sweden)

    Ian J. Nelligan

    2016-12-01

    Full Text Available Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results: Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1 making a community diagnosis, (2 understanding social determinants of health and (3 training in participatory research. Three community-based enablers for sustainability of COPC were (1 partnerships with community health workers, (2 community empowerment and engagement and (3 institutional financial support. Conclusions: Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.

  4. The effect of tillage intensity on soil structure and winter wheat root/shoot growth

    DEFF Research Database (Denmark)

    Munkholm, Lars Juhl; Hansen, Elly Møller; Olesen, Jørgen E

    2008-01-01

    was followed during the growing seasons using spectral reflectance and mini-rhizotron measurements, respectively. A range of soil physical properties were measured. We found decreased early season shoot and root growth with decreasing tillage intensity. Differences diminished later in the growing season...... of this study was to investigate the effect of tillage intensity on crop growth dynamics and soil structure. A tillage experiment was established in autumn 2002 on two Danish sandy loams (Foulum and Flakkebjerg) in a cereal-based crop rotation. The tillage systems included in this study were direct drilling (D...... with decreasing tillage intensity for the first year winter wheat at Foulum. In general ploughing resulted in the highest grain yields. This study highlights the important interaction between soil structure and crop growth dynamics....

  5. Repeated soil application of organic waste amendments reduces draught force and fuel consumption for soil tillage

    DEFF Research Database (Denmark)

    Peltrea, Clément; Nyord, Tavs; Bruun, Sander

    2015-01-01

    Abstract Soil application of organic waste products (OWP) can maintain or increase soil organic carbon (SOC) content, which in turn could lead to increased porosity and potentially to reduced energy use for soil tillage. Only a few studies have addressed the effect of SOC content on draught force...... for soil tillage, and this still needs to be addressed for fields that receive diverse types of organic waste of urban, agricultural and agro-industrial origin. The objective of this study was to determine the effect of changes in SOC induced by repeated soil application of OWP on draught force for soil...... tillage and tractor fuel consumption. Draught force was measured for tillage with conventional spring tillage tines, as well as bulk density, soil texture and SOC content in the CRUCIAL field experiment, Denmark in which diverse types of OWP had been applied annually for 11 years. The OWP included...

  6. Effects of ridge tillage on photosynthesis and root characters of rice

    Directory of Open Access Journals (Sweden)

    Yao Yuan-zhi

    2015-03-01

    Full Text Available Rice (Oryza sativa L. is an important crop and breeding has not been able to improve yield. Root characteristics of hybrid rice 'Zhuliangyou 02' under conventional tillage and ridge tillage were studied in a Calcisols in Huaihua, China, from 2011 to 2013 to find better tillage methods to resolve massive water consumption, improve yield, and enhance productivity of agricultural labor for rice cultivation. Results showed ridge tillage increased photosynthetic parameters such as photosynthetic rate (P N, stomatal conductance (g s, and water use efficiency (WUE. It also significantly enhanced rice root number, root activity, and antioxidant enzyme activities; it also increased effective panicle number and actual yield by 22.12% and 15.18%, respectively, and enhanced aerenchymae during the early growth stage. Overall, ridge tillage could promote hybrid rice yields by enhancing root absorption, gas exchange, and reducing water consumption. It could be widely used in rice cultivation.

  7. Understanding the implementation and adoption of a technological intervention to improve medication safety in primary care: a realist evaluation.

    Science.gov (United States)

    Jeffries, Mark; Phipps, Denham L; Howard, Rachel L; Avery, Anthony J; Rodgers, Sarah; Ashcroft, Darren M

    2017-03-14

    Monitoring for potentially hazardous prescribing is increasingly important to improve medication safety. Healthcare information technology can be used to achieve this aim, for example by providing access to prescribing data through surveillance of patients' electronic health records. The aim of our study was to examine the implementation and adoption of an electronic medicines optimisation system that was intended to facilitate clinical audit in primary care by identifying patients at risk of an adverse drug event. We adopted a sociotechnical approach that focuses on how complex social, organisational and institutional factors may impact upon the use of technology within work settings. We undertook a qualitative realist evaluation of the use of an electronic medicines optimisation system in one Clinical Commissioning Group in England. Five semi-structured interviews, four focus groups and one observation were conducted with a range of stakeholders. Consistent with a realist evaluation methodology, the analysis focused on exploring the links between context, mechanism and outcome to explain the ways the intervention might work, for whom and in what circumstances. Using the electronic medicines optimisation system could lead to a number of improved patient safety outcomes including pre-emptively reviewing patients at risk of adverse drug events. The effective use of the system depended upon engagement with the system, the flow of information between different health professionals centrally placed at the Clinical Commissioning Group and those locally placed at individual general practices, and upon variably adapting work practices to facilitate the use of the system. The use of the system was undermined by perceptions of ownership, lack of access, and lack of knowledge and awareness. The use of an electronic medicines optimisation system may improve medication safety in primary care settings by identifying those patients at risk of an adverse drug event. To fully

  8. Initial Experience of a Primary Urgent Care Clinic Curriculum and Subspecialty Lectureship Series Implementation in a Los Angeles County Hospital.

    Science.gov (United States)

    Agrawal, Harsh; Martinez, Anna; Volkmann, Elizabeth R; Melamed, Oleg; Wali, Soma

    2017-05-01

    Urgent care clinics are extremely busy in the University of California-Los Angeles (UCLA) County hospital system. We determined that residents and medical students in the internal medicine residency program who are rotating through these clinics did not receive enough teaching during their rotation. We decided to create and implement an urgent care curriculum and lectures to help achieve structure for the rotation. The goal of this series was to educate and assist residents in the primary care setting to comfortably manage subspecialty conditions, help reduce the already-overwhelmed county subspecialty referral system, and promote learning. The Olive View-UCLA Medical Center internal medicine residency program has a total of 74 residents, which includes postgraduate year-1 (PGY-1) to PGY-4, with PGY-4 being combined internal medicine-pediatrics or emergency medicine-internal medicine residents. We used core curriculum topics as provided by the Accreditation Council for Graduate Medical Education to design the curriculum. We sent e-mails to the stakeholders whom we identified as the residents and the attending physicians working in urgent care, inquiring after topics they wanted to discuss during the rotation. Using these responses we compiled a list of all of the topics that could be discussed and reviewed during the rotation. These topics were broken down into short 10- to 15-minute-long lectures. During the lectures, we provided a retrospective post- then prequestionnaire to the residents for evaluation of the program and the lectures. A benefit of the post-then-pre design is that participants answer the postquestions and the prequestions together after the lecture, thereby reducing the possibility of response shift bias. Of the 74 residents in the program, 25 responded; the response rate was approximately 33%. Regarding content, 92% (23) said it was appropriate, 4% (1) said it was too low a level, and 4% (1) did not respond. Overall, 36% (9) said the lecture was

  9. Effects of land clearing techniques and tillage systems on runoff and soil erosion in a tropical rain forest in Nigeria.

    Science.gov (United States)

    Ehigiator, O A; Anyata, B U

    2011-11-01

    This work reports runoff and soil loss from each of 14 sub-watersheds in a secondary rain forest in south-western Nigeria. The impact of methods of land clearing and post-clearing management on runoff and soil erosion under the secondary forest is evaluated. These data were acquired eighteen years after the deforestation of primary vegetation during the ' West bank' project of the International Institute for Tropical Agriculture (IITA). These data are presented separately for each season; however, statistical analyses for replicates were not conducted due to differences in their past management. Soil erosion was affected by land clearing and tillage methods. The maximum soil erosion was observed on sub-watersheds that were mechanically cleared with tree-pusher/root-rake attachments and tilled conventionally. A high rate of erosion was observed even when graded-channel terraces were constructed to minimize soil erosion. In general there was much less soil erosion on manually cleared than on mechanically cleared sub-watersheds (2.5 t ha(-1) yr(-1) versus 13.8 t ha(-1) yr(-1)) and from the application of no-tillage methods than from conventionally plowed areas (6.5 t ha(-1) yr(-1) versus 12.1 t ha(-1) yr(-1)). The data indicate that tillage methods and appropriate management of soils and crops play an important role in soil and water conservation and in decreasing the rate of decline of soil quality. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. 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

  11. On-farm tillage trials for rice-wheat cropping system in Indo-Gangetic plains of Eastern India

    International Nuclear Information System (INIS)

    Khan, A.R.; Singh, S.S.; Prasad, L.K.; Prasad, S.S.; Bhupendra Singh; Singh, S.R.; Gaunt, J.L.

    2002-05-01

    Demonstration plots of deep summer ploughing (DSP) with rice followed by wheat and other winter crops and fields of zero tilled wheat have been established and monitored at head, middle and tail sections of RP distributory Channel - 5 of Patna Canal during kharif (wet) and rabi (winter) seasons of 2001 and 2002, respectively at four different villages. The DSP plots were large (6 acres, 2.42 ha) in each village enabling farmers and researchers to see and assess a new practice at a farming scale. Zero tillage of wheat has involved a total of 181 farmers and total area of 50.4 ha. The plots were not only monitored but also information from farmers on how they view the ploughing/tillage practices was gathered. This information indicates that farmers are assessing the practices from a range of view points relative to their usual practices including land preparation and sowing costs, quality of crop establishment, weed growth and species composition, pest and disease incidence. Main findings are that DSP does not significantly only alter the yield of rice, wheat, lentil and gram and but also reduces the weed burden. Participatory budgeting indicated cost savings for land preparation and crop management costs. Over 60 percent of farmers in a total sample of 86 farmers had a positive reaction to practice during wet season. Similarly farmers recognized cost savings and potential yield gains (due to early and good crop establishment) in zero tilled wheat. After the harvest of winter crops like wheat, lentil and gram in May 2002, farmers dropped their reservation about DSP and there was a change in their attitude from reluctance to partial agreement and now they are ready for tillage operations on self-payment. For both practices, there are some limitations in respect of availability of implements and suitable tractor couplings. Findings indicate that if tractor owners perceive a demand, they would take steps to offer these new practices as land preparation services. (author)

  12. Fungal Communities in Rhizosphere Soil under Conservation Tillage Shift in Response to Plant Growth

    Directory of Open Access Journals (Sweden)

    Ziting Wang

    2017-07-01

    Full Text Available Conservation tillage is an extensively used agricultural practice in northern China that alters soil texture and nutrient conditions, causing changes in the soil microbial community. However, how conservation tillage affects rhizosphere and bulk soil fungal communities during plant growth remains unclear. The present study investigated the effect of long-term (6 years conservation (chisel plow, zero and conventional (plow tillage during wheat growth on the rhizosphere fungal community, using high-throughput sequencing of the internal transcribed spacer (ITS gene and quantitative PCR. During tillering, fungal alpha diversity in both rhizosphere and bulk soil were significantly higher under zero tillage compared to other methods. Although tillage had no significant effect during the flowering stage, fungal alpha diversity at this stage was significantly different between rhizosphere and bulk soils, with bulk soil presenting the highest diversity. This was also reflected in the phylogenetic structure of the communities, as rhizosphere soil communities underwent a greater shift from tillering to flowering compared to bulk soil communities. In general, less variation in community structure was observed under zero tillage compared to plow and chisel plow treatments. Changes in the relative abundance of the fungal orders Capnodiales, Pleosporales, and Xylariales contributed the highest to the dissimilarities observed. Structural equation models revealed that the soil fungal communities under the three tillage regimes were likely influenced by the changes in soil properties associated with plant growth. This study suggested that: (1 differences in nutrient resources between rhizosphere and bulk soils can select for different types of fungi thereby increasing community variation during plant growth; (2 tillage can alter fungal communities' variability, with zero tillage promoting more stable communities. This work suggests that long-term changes in

  13. Conservation tillage versus conventional tillage on carbon stock in a Mediterranean dehesa (southern Spain)

    Science.gov (United States)

    Parras-Alcántara, Luis; Lozano-García, Beatriz

    2014-05-01

    Understanding soil dynamics is essential for making appropriate land management decisions, as soils can affect the carbon content from the atmosphere, emitting large quantities of CO2 or storing carbon. This property is essential for climate change mitigation strategies as agriculture and forestry soil management can affect the carbon cycle. The dehesa is a Mediterranean silvopastoral system formed by grasslands with scattered oaks (Quercus ilex or Q. suber). The dehesa is a pasture where the herbaceous layer is comprised of either cultivated cereals such as oat, barley and wheat or native vegetation dominated by annual species, which are used as grazing resources. In addition, the dehesa is a practice dedicated to the combined production of Iberian swine, sheep, fuel wood, coal and cork, as well as hunting. The dehesa is characterized by the preservation of forest oaks. In this work, we compared two management practices such as organic farming (OF) and conventional tillage (CT) on soil organic carbon stocks (SOC-S) in Cambisols (CM) and Leptosols (LP), and we analyzed the quality of these soils based on stratification ratio (SR) in a Mediterranean dehesa. MATERIAL AND METHODS An analysis of 85 soil profiles was performed in 2009 in Los Pedroches Valley (Cordoba, southern Spain). Two soil management practices were selected: OF (isolated trees of variable densities —15-25— trees ha-1, mostly holm and cork oaks, and patches of shrubs — cistaceae, fabaceae and lamiaceae— with a herbaceous pasture layer mostly composed of therophytic species and livestock are introduced to provide organic fertilizer to the soil, without ploughing and animal manure from the farms may be incorporated) for 20 years and CT (similar to OF, with ploughing —annual passes with a disc harrow and/or cultivator— is aimed at growing grain for livestock or at clearing the encroaching shrubs) in CM and LP. The dehesas studied were silvopastoral systems without cropping. Soil properties

  14. Extrapolating effects of conservation tillage on yield, soil moisture and dry spell mitigation using simulation modelling

    Science.gov (United States)

    Mkoga, Z. J.; Tumbo, S. D.; Kihupi, N.; Semoka, J.

    There is big effort to disseminate conservation tillage practices in Tanzania. Despite wide spread field demonstrations there has been some field experiments meant to assess and verify suitability of the tillage options in local areas. Much of the experiments are short lived and thus long term effects of the tillage options are unknown. Experiments to study long term effects of the tillage options are lacking because they are expensive and cannot be easily managed. Crop simulation models have the ability to use long term weather data and the local soil parameters to assess long term effects of the tillage practices. The Agricultural Production Systems Simulator (APSIM) crop simulation model; was used to simulate long term production series of soil moisture and grain yield based on the soil and weather conditions in Mkoji sub-catchment of the great Ruaha river basin in Tanzania. A 24 year simulated maize yield series based on conventional tillage with ox-plough, without surface crop residues (CT) treatment was compared with similar yield series based on conservation tillage (ox-ripping, with surface crop residues (RR)). Results showed that predicted yield averages were significantly higher in conservation tillage than in conventional tillage ( P APSIM simulation model, showed that average soil moisture in the conservation tillage was significantly higher ( P < 0.05) (about 0.29 mm/mm) than in conventional tillage (0.22 mm/mm) treatment during the seasons which received rainfall between 468 and 770 mm. Similarly the conservation tillage treatment recorded significantly higher yields (4.4 t/ha) ( P < 0.01) than the conventional tillage (3.6 t/ha) treatment in the same range of seasonal rainfall. On the other hand there was no significant difference in soil moisture for the seasons which received rainfall above 770 mm. In these seasons grain yield in conservation tillage treatment was significantly lower (3.1 kg/ha) than in the conventional tillage treatment (4.8 kg

  15. The impact of different soil tillage on weed infestation of spring barley in conditions of dryer climatic areas Czech Republic

    OpenAIRE

    Jan Winkler

    2008-01-01

    The impact of soil tillage on weeds in spring barley was observed on the field trial. The field trial was established in very warm and dry climatic region (experimental field station in Žabčice, Mendel University of Agriculture and Forestry Brno, Czech Republic). In the experiment there was used 7-strip crop rotation and three variants of soil tillage: conventional tillage (CT), minimum tillage (MT), when soil is shallow loosened and no tillage (NT) what means direct sowing without any soil t...

  16. Defining the effect of sweep tillage tool cutting edge geometry on tillage forces using 3D discrete element modelling

    Directory of Open Access Journals (Sweden)

    Mustafa Ucgul

    2015-09-01

    Full Text Available The energy required for tillage processes accounts for a significant proportion of total energy used in crop production. In many tillage processes decreasing the draft and upward vertical forces is often desired for reduced fuel use and improved penetration, respectively. Recent studies have proved that the discrete element modelling (DEM can effectively be used to model the soil–tool interaction. In his study, Fielke (1994 [1] examined the effect of the various tool cutting edge geometries, namely; cutting edge height, length of underside rub, angle of underside clearance, on draft and vertical forces. In this paper the experimental parameters of Fielke (1994 [1] were simulated using 3D discrete element modelling techniques. In the simulations a hysteretic spring contact model integrated with a linear cohesion model that considers the plastic deformation behaviour of the soil hence provides better vertical force prediction was employed. DEM parameters were determined by comparing the experimental and simulation results of angle of repose and penetration tests. The results of the study showed that the simulation results of the soil-various tool cutting edge geometries agreed well with the experimental results of Fielke (1994 [1]. The modelling was then used to simulate a further range of cutting edge geometries to better define the effect of sweep tool cutting edge geometry parameters on tillage forces. The extra simulations were able to show that by using a sharper cutting edge with zero vertical cutting edge height the draft and upward vertical force were further reduced indicating there is benefit from having a really sharp cutting edge. The extra simulations also confirmed that the interpolated trends for angle of underside clearance as suggested by Fielke (1994 [1] where correct with a linear reduction in draft and upward vertical force for angle of underside clearance between the ranges of −25 and −5°, and between −5 and 0°. The

  17. Temporal Dynamics of Soil Microbial Communities below the Seedbed under Two Contrasting Tillage Regimes

    Directory of Open Access Journals (Sweden)

    Florine Degrune

    2017-06-01

    Full Text Available Agricultural productivity relies on a wide range of ecosystem services provided by the soil biota. Plowing is a fundamental component of conventional farming, but long-term detrimental effects such as soil erosion and loss of soil organic matter have been recognized. Moving towards more sustainable management practices such as reduced tillage or crop residue retention can reduce these detrimental effects, but will also influence structure and function of the soil microbiota with direct consequences for the associated ecosystem services. Although there is increasing evidence that different tillage regimes alter the soil microbiome, we have a limited understanding of the temporal dynamics of these effects. Here, we used high-throughput sequencing of bacterial and fungal ribosomal markers to explore changes in soil microbial community structure under two contrasting tillage regimes (conventional and reduced tillage either with or without crop residue retention. Soil samples were collected over the growing season of two crops (Vicia faba and Triticum aestivum below the seedbed (15–20 cm. Tillage, crop and growing stage were significant determinants of microbial community structure, but the impact of tillage showed only moderate temporal dependency. Whereas the tillage effect on soil bacteria showed some temporal dependency and became less strong at later growing stages, the tillage effect on soil fungi was more consistent over time. Crop residue retention had only a minor influence on the community. Six years after the conversion from conventional to reduced tillage, soil moisture contents and nutrient levels were significantly lower under reduced than under conventional tillage. These changes in edaphic properties were related to specific shifts in microbial community structure. Notably, bacterial groups featuring copiotrophic lifestyles or potentially carrying the ability to degrade more recalcitrant compounds were favored under conventional

  18. Temporal Dynamics of Soil Microbial Communities below the Seedbed under Two Contrasting Tillage Regimes.

    Science.gov (United States)

    Degrune, Florine; Theodorakopoulos, Nicolas; Colinet, Gilles; Hiel, Marie-Pierre; Bodson, Bernard; Taminiau, Bernard; Daube, Georges; Vandenbol, Micheline; Hartmann, Martin

    2017-01-01

    Agricultural productivity relies on a wide range of ecosystem services provided by the soil biota. Plowing is a fundamental component of conventional farming, but long-term detrimental effects such as soil erosion and loss of soil organic matter have been recognized. Moving towards more sustainable management practices such as reduced tillage or crop residue retention can reduce these detrimental effects, but will also influence structure and function of the soil microbiota with direct consequences for the associated ecosystem services. Although there is increasing evidence that different tillage regimes alter the soil microbiome, we have a limited understanding of the temporal dynamics of these effects. Here, we used high-throughput sequencing of bacterial and fungal ribosomal markers to explore changes in soil microbial community structure under two contrasting tillage regimes (conventional and reduced tillage) either with or without crop residue retention. Soil samples were collected over the growing season of two crops ( Vicia faba and Triticum aestivum ) below the seedbed (15-20 cm). Tillage, crop and growing stage were significant determinants of microbial community structure, but the impact of tillage showed only moderate temporal dependency. Whereas the tillage effect on soil bacteria showed some temporal dependency and became less strong at later growing stages, the tillage effect on soil fungi was more consistent over time. Crop residue retention had only a minor influence on the community. Six years after the conversion from conventional to reduced tillage, soil moisture contents and nutrient levels were significantly lower under reduced than under conventional tillage. These changes in edaphic properties were related to specific shifts in microbial community structure. Notably, bacterial groups featuring copiotrophic lifestyles or potentially carrying the ability to degrade more recalcitrant compounds were favored under conventional tillage, whereas

  19. Aerodynamic roughness length related to non-aggregated tillage ridges

    Directory of Open Access Journals (Sweden)

    M. Kardous

    2005-11-01

    Full Text Available Wind erosion in agricultural soils is dependent, in part, on the aerodynamic roughness length (z0 produced by tillage ridges. Although previous studies have related z0 to ridge characteristics (ridge height (RH and spacing (RS, these relationships have not been tested for tillage ridges observed in the North African agricultural fields. In these regions, due to climate and soil conditions, small plowing tools are largely used. Most of these tools produce non-aggregated and closely-spaced small ridges. Thus, experiments were conducted in a 7-m long wind tunnel to measure z0 for 11 ridge types covering the range of geometric characteristics frequently observed in south Tunisia. Experimental results suggest that RH2/RS is the first order parameter controlling z0. A strong relationship between z0 and RH2/RS is proposed for a wide range of ridge characteristics.

  20. Suitability of technical materials for machinery subsoilers for soil tillage

    Directory of Open Access Journals (Sweden)

    Radek Bednář

    2013-01-01

    Full Text Available Agricultural soil processing belongs to the basic elements in the process of crop production. Currently classic tillage method is decreasing and the only trend has stated as a shallow plowing. Suitable post harvest soil tillage greatly affects yields in the next cycle. The aim of the study is the analysis of abrasive wear of selected construction materials and their subsequent use for DXRV-HD cultivator. The performed tests are focused on monitoring the mechanical properties of the materials and their use for variable cutting tip of cultivator body. Tested materials are divided into four categories. These materials include tool steel (19436, carbon steel (12050, cast iron with globular graphite and welding material supplied as a functional complex on low carbon steel by the Abraweld company. These materials are tested together with the original part of share cultivator. The present experiment is focused on metallorgraphic, mechanical and abrasive analysis. Structural component of the material is identified by metallographic photos and then compared with the impact strength tested on Charpy hammer. Followed the abrasion resistance according to CSN 01 5084 and the total evaluation of the tested samples are done.

  1. Tillage System and Cover Crop Effects on Soil Quality

    DEFF Research Database (Denmark)

    Abdollahi, Lotfollah; Munkholm, Lars Juhl

    2014-01-01

    Information about the quantitative effect of conservation tillage combined with a cover crop on soil structure is still limited. This study examined the effect of these management practices on soil pore characteristics of a sandy loam soil in a long-term field trial. The tillage treatments (main...... plots) included direct drilling (D), harrowing to a depth of 8 to 10 cm (H), and moldboard plowing (MP). The cover crop treatments were subplot with cover crop (+CC) and without cover crop (−CC). Minimally disturbed soil cores were taken from the 4- to 8-, 12- to 16-, and 18- to 27-cm depth intervals...... in the spring of 2012 before cultivation. Soil water retention and air permeability were measured for matric potentials ranging from −1 to −30 kPa. Gas diffusivity was measured at −10 kPa. Computed tomography (CT) scanning was also used to characterize soil pore characteristics. At the 4- to 8- and 18- to 27-cm...

  2. The impact of different soil tillage on weed infestation of spring barley in conditions of dryer climatic areas Czech Republic

    Directory of Open Access Journals (Sweden)

    Jan Winkler

    2008-01-01

    Full Text Available The impact of soil tillage on weeds in spring barley was observed on the field trial. The field trial was established in very warm and dry climatic region (experimental field station in Žabčice, Mendel University of Agriculture and Forestry Brno, Czech Republic. In the experiment there was used 7-strip crop rotation and three variants of soil tillage: conventional tillage (CT, minimum tillage (MT, when soil is shallow loosened and no tillage (NT what means direct sowing without any soil tillage. The weed infestation was evaluated by counting method before herbicide application. Analysis of va­rian­ce (ANOVA and then LSD methods, DCA (Detrended Correspondence Analysis and CCA (Canonical Correspondence Analysis were used for evaluation of results. The obtained results showed, that different soil tillage did not statistically influenced weed infestation in spring barley. The number of weed species depended on the depth of soil tillage, the variant of minimum tillage had lower number of weed species. These species were more common on the variant of conventional tillage: Chenopodium album, Silene noctiflora, Sinapis arvensis, Veronica polita. The variant of minimum tillage was more suitable for these species: Cirsium arvense, Convolvulus arvensis, Amaranthus sp., Galium aparine. On the variant of direct so­wing there appeared mainly these species: Sonchus oleraceus, Lactuca serriola, Tripleurospermum inodorum.

  3. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges.

    Science.gov (United States)

    Bajorek, Beata; Lemay, Kate S; Magin, Parker; Roberts, Christopher; Krass, Ines; Armour, Carol L

    2016-01-01

    Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.

  4. Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

    Directory of Open Access Journals (Sweden)

    Bajorek B

    2016-06-01

    Full Text Available Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care, Group B (Intervention, or Group C (Short Intervention. Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively, improvement in medication adherence scores (P=0.01, and a slight improvement in quality of life (EQ-5D-3L Index scores (P=0.91. There were no significant changes in Group B (the full intervention, and no differences in comparison to Group A (usual care. Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.

  5. Do Tillage Methods Affect Germination and Species Similarity of Soil Weed Seeds Bank?

    Directory of Open Access Journals (Sweden)

    Shahgholi Hassan

    2015-12-01

    Full Text Available Cultural practices such as tillage used for crop production influence the composition of the weed seed bank in the soil. In order to investigate the effects of different tillage methods on seed bank properties, species diversity and similarity, two laboratory and greenhouse experiments were carried out as randomized complete block design with four replications in 2011. Treatments included: once tillage per year (T1, twice tillage per year (T2, more than twice tillage (T3 and no tillage (T4. Laboratory results showed that the T3 and T4 treatments had the highest and the lowest observed seeds numbers, respectively. Between the laboratory observed weed seeds, the maximum weed seed numbers were Echinochloa crus-galli and Amaranthus retroflexus in the T3 treatment, while Chenopodium album, Polygonum aviculare and Cuscuta campestris had the highest seed numbers in the T2 treatment. At the greenhouse study, Chenopodium album, Amaranthus retroflexus and Hordeum morinum in the T2 treatment were dominant species. The highest diversity was observed in the T2 treatment, and Chenopodium album and Echinochloa crus-galli were dominant species in the T2 and T3 treatments. Maximum species similarity index was achieved from the T1 and T3 treatments. Thereby this study concluded that increasing of tillage number could affect the similarity index of weed seeds and subsequently alters the weed community composition.

  6. [Conservation tillage systems in North America and their significance for China].

    Science.gov (United States)

    Yang, Xueming; Zhang, Xiaoping; Fang, Huajun; Liang, Aizhen; Qi, Xiaoning; Wang, Yang

    2004-02-01

    Soil degradation through erosion and desertification reduces soil productivity, and is a serious problem in agricultural production of China. To avert our arable land from further degradation, soil management must be shifted from degrading tillage to conservation practices. Over viewing the technology used in the 20th century for controlling soil degradation from erosion, conservation tillage developed in the United States and adopted in South America and Africa is one of the most successful measures to overcome soil degradation problems. This paper reviewed the historical development and the current situation of conservation tillage systems used in North and South America, with special reference to their effects on soil erosion control and soil quality. The increasing adoption of conservation tillage systems in North and South America and Africa followed an enhanced awareness of the increasing risk of soil erosion and the high cost of fuel associated with conventional tillage. Many crucial points for successfully adopting conservation tillage systems were emphasized, such as equipment/tool development and chemical weed control. Adopting conservation tillage could provide China with low-priced means of reducing soil degradation and improving soil and water quality.

  7. Effect of simulated tillage on microbial autotrophic CO2 fixation in paddy and upland soils

    Science.gov (United States)

    Ge, Tida; Wu, Xiaohong; Liu, Qiong; Zhu, Zhenke; Yuan, Hongzhao; Wang, Wei; Whiteley, A. S.; Wu, Jinshui

    2016-01-01

    Tillage is a common agricultural practice affecting soil structure and biogeochemistry. To evaluate how tillage affects soil microbial CO2 fixation, we incubated and continuously labelled samples from two paddy soils and two upland soils subjected to simulated conventional tillage (CT) and no-tillage (NT) treatments. Results showed that CO2 fixation (14C-SOC) in CT soils was significantly higher than in NT soils. We also observed a significant, soil type- and depth-dependent effect of tillage on the incorporation rates of labelled C to the labile carbon pool. Concentrations of labelled C in the carbon pool significantly decreased with soil depth, irrespective of tillage. Additionally, quantitative PCR assays revealed that for most soils, total bacteria and cbbL-carrying bacteria were less abundant in CT versus NT treatments, and tended to decrease in abundance with increasing depth. However, specific CO2 fixation activity was significantly higher in CT than in NT soils, suggesting that the abundance of cbbL-containing bacteria may not always reflect their functional activity. This study highlights the positive effect of tillage on soil microbial CO2 fixation, and the results can be readily applied to the development of sustainable agricultural management. PMID:26795428

  8. Effect of tillage systems and permanent groundcover intercropped with orange trees on soil enzyme activities

    Directory of Open Access Journals (Sweden)

    Elcio Liborio Balota

    2011-04-01

    Full Text Available The objective of this study was to evaluate the effect of different soil tillage systems and groundcover crops intercropped with orange trees on soil enzyme activities. The experiment was performed in an Ultisol soil in northwestern Paraná State. Two soil tillage systems were evaluated [conventional tillage (CT across the entire area and strip tillage (ST with a 2-m strip width] in combination with various groundcover vegetation management systems. Soil samples were collected after five years of experimental management at a depth of 0-15 cm under the tree canopy and in the inter-row space in the following treatments: (1 CT-Calopogonium mucunoides; (2 CT-Arachis pintoi; (3 CT-Bahiagrass; (4 CT-Brachiaria humidicola; and (5 ST-B. humidicola. The soil tillage systems and groundcover crops influenced the soil enzyme activities both under the tree canopy and in the inter-row space. The cultivation of B. humidicola provided higher amylase, arylsulfatase, acid phosphatase and alkaline phosphatase than other groundcover species. Strip tillage increased enzyme activities compared to the conventional tillage system.

  9. Engaging multilevel stakeholders in an implementation trial of evidence-based quality improvement in VA women's health primary care.

    Science.gov (United States)

    Hamilton, Alison B; Brunner, Julian; Cain, Cindy; Chuang, Emmeline; Luger, Tana M; Canelo, Ismelda; Rubenstein, Lisa; Yano, Elizabeth M

    2017-09-01

    The Veterans Health Administration (VHA) has undertaken primary care transformation based on patient-centered medical home (PCMH) tenets. VHA PCMH models are designed for the predominantly male Veteran population, and require tailoring to meet women Veterans' needs. We used evidence-based quality improvement (EBQI), a stakeholder-driven implementation strategy, in a cluster randomized controlled trial across 12 sites (eight EBQI, four control) that are members of a Practice-Based Research Network. EBQI involves engaging multilevel, inter-professional leaders and staff as stakeholders in reviewing evidence and setting QI priorities. The goal of this analysis was to examine processes of engaging stakeholders in early implementation of EBQI to tailor VHA's medical home for women. Four inter-professional regional stakeholder planning meetings were conducted; these meetings engaged stakeholders by providing regional data about gender disparities in Veterans' care experiences. Subsequent to each meeting, qualitative interviews were conducted with 87 key stakeholders (leaders and staff). Stakeholders were asked to describe QI efforts and the use of data to change aspects of care, including women's health care. Interview transcripts were summarized and coded using a hybrid deductive/inductive analytic approach. The presentation of regional-level data about gender disparities resulted in heightened awareness and stakeholder buy-in and decision-making related to women's health-focused QI. Interviews revealed that stakeholders were familiar with QI, with regional and facility leaders aware of inter-disciplinary committees and efforts to foster organizational change, including PCMH transformation. These efforts did not typically focus on women's health, though some informal efforts had been undertaken. Barriers to engaging in QI included lack of communication across clinical service lines, fluidity in staffing, and lack of protected time. Inter-professional, multilevel

  10. Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.

    Science.gov (United States)

    Mashamba-Thompson, Tivani P; Jama, Ngcwalisa A; Sartorius, Benn; Drain, Paul K; Thompson, Rowan M

    2017-01-08

    Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

  11. Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

    Directory of Open Access Journals (Sweden)

    Tivani P. Mashamba-Thompson

    2017-01-01

    Full Text Available Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

  12. Monoculture Maize (Zea mays L. Cropped Under Conventional Tillage, No-tillage and N Fertilization: (I Three Year Yield Performances

    Directory of Open Access Journals (Sweden)

    Vincenzo Tabaglio

    Full Text Available A three-year (2004-2006 field trial was carried out to compare two agricultural land management systems, in the Po Valley (Northern Italy. Conventional tillage and No-tillage (hereafter indicated as CT and NT, respectively were compared for maize treated with three levels of nitrogen. The soil was a fine-loamy, mixed, mesic Ultic Haplustalf, that had been under processing tomato in the previous year. Experimental design was a split-plot with four replicates, with the management system as the main factor and nitrogen fertilization (0, 250 and 300 kg N ha-1 year-1 as the secondary factor. Cumulative 3-yr yields of grain and total biomass of NT maize plants were 8% lower than those obtained under CT management, but not significantly different. No N starter was distributed in the first conversion year, causing 17% less grain yield in the NT plots compared with the CT plots. The N fertilizing with 250 and 300 kg N ha-1 year-1 determined statistically equal grain yields, demonstrating the waste of the extra 50 kg N at the N2 rate. Overall, the results for the three years indicate that on an Ultic Haplustalf conversion from a ploughed regime to mature NT conditions could be achieved over a relatively short period.

  13. ORGANIC MATTER FRACTIONS OF AN IRRIGATED OXISOL UNDER NO - TILL AND CONVENTIONAL TILLAGE IN THE BRAZILIAN SEMI - ARID REGION

    Directory of Open Access Journals (Sweden)

    RAFAEL PEREIRA SALES

    2017-01-01

    Full Text Available The replacement of natural vegetation by crop systems directly impacts the soil organic matter fractions. The objective of this study was to evaluate the total organic carbon (TOC and nitrogen (TN contents in different fractions of the soil organic matter (SOM of an Oxisol of the Brazilian semiarid region under different irrigated crops and different soil management systems. Seven treatments were evaluated, which consisted of two soil management systems (no - till and conventional tillage and three crops (maize, sunflower and sorghum, using as reference the soil under a native forest (NF. The summer crops preceded common bean crops in the autumn - winter. The total organic carbon content, total nitrogen, carbon content in humic substances and their constituents (fulvic acids, humic acids and humin and labile, non - labile and water - soluble carbon contents were evaluated two years and three months after the experiment implementation to determine the carbon lability (L lability index (LI, partitioning index (CPI and management index (CMI. The greatest carbon, nitrogen and organic matter contents in the soil surface layer (0.00 - 0.05 m were found in crops under no - till system (NTS, especially maize. The crops under NTS presented greater carbon content in humic substances than the conventional tillage system (CTS ones in the layer 0.05 - 0.10 m. The crops under NTS presented greater sustainability in the Brazilian semiarid region compared with those under CTS, as shown by their higher CMI in the soil surface layer.

  14. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    NARCIS (Netherlands)

    Odusola, A.O.; Stronks, K.; Hendriks, M.E.; Schultsz, C.; Akande, T.; Osibogun, A.; van Weert, H.; Haafkens, J.A.

    2016-01-01

    Background: Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective: We explored perspectives of primary care staff and health insurance managers on enablers and

  15. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    NARCIS (Netherlands)

    Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; Weert, Henk van; Haafkens, Joke A.

    2016-01-01

    Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and

  16. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol

    OpenAIRE

    Cohen, Deborah J.; Balasubramanian, Bijal A.; Gordon, Leah; Marino, Miguel; Ono, Sarah; Solberg, Leif I.; Crabtree, Benjamin F.; Stange, Kurt C.; Davis, Melinda; Miller, William L.; Damschroder, Laura J.; McConnell, K. John; Creswell, John

    2016-01-01

    Background The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to...

  17. Variations in thematic mapper spectra of soil related to tillage and crop residue management - Initial evaluation

    Science.gov (United States)

    Seeley, M. W.; Ruschy, D. L.; Linden, D. R.

    1983-01-01

    A cooperative research project was initiated in 1982 to study differences in thematic mapper spectral characteristics caused by variable tillage and crop residue practices. Initial evaluations of radiometric data suggest that spectral separability of variably tilled soils can be confounded by moisture and weathering effects. Separability of bare tilled soils from those with significant amounts of corn residue is enhanced by wet conditions, but still possible under dry conditions when recent tillage operations have occurred. In addition, thematic mapper data may provide an alternative method to study the radiant energy balance at the soil surface in conjunction with variable tillage systems.

  18. Effects of Tillage Practices on Soil Organic Carbon and Soil Respiration

    Science.gov (United States)

    Rusu, Teodor; Ioana Moraru, Paula; Bogdan, Ileana; Ioan Pop, Adrian

    2016-04-01

    Soil tillage system and its intensity modify by direct and indirect action soil temperature, moisture, bulk density, porosity, penetration resistance and soil structural condition. Minimum tillage and no-tillage application reduce or completely eliminate the soil mobilization, due to this, soil is compacted in the first years of application. The degree of compaction is directly related to soil type and its state of degradation. All this physicochemical changes affect soil biology and soil respiration. Soil respiration leads to CO2 emissions from soil to the atmosphere, in significant amounts for the global carbon cycle. Soil respiration is one measure of biological activity and decomposition. Soil capacity to produce CO2 varies depending on soil, season, intensity and quality of agrotechnical tillage, soil water, cultivated plant and fertilizer. Our research follows the effects of the three tillage systems: conventional system, minimum tillage and no-tillage on soil respiration and finally on soil organic carbon on rotation soybean - wheat - maize, obtained on an Argic Faeoziom from the Somes Plateau, Romania. To quantify the change in soil respiration under different tillage practices, determinations were made for each crop in four vegetative stages (spring, 5-6 leaves, bean forming, harvest). Soil monitoring system of CO2 and O2 included gradient method, made by using a new generation of sensors capable of measuring CO2 concentration in-situ and quasi-instantaneous in gaseous phase. At surface soil respiration is made by using ACE Automated Soil CO2 Exchange System. These areas were was our research presents a medium multi annual temperature of 8.20C medium of multi annual rain drowns: 613 mm. The experimental variants chosen were: i). Conventional system: reversible plough (22-25 cm) + rotary grape (8-10 cm); ii). Minimum tillage system: paraplow (18-22 cm) + rotary grape (8-10 cm); iii). No-tillage. The experimental design was a split-plot design with three

  19. Losing connections and receiving support to reconnect: experiences of frail older people within care programmes implemented in primary care settings.

    Science.gov (United States)

    Bindels, Jill; Cox, Karen; De La Haye, Jean; Mevissen, Ger; Heijing, Servé; van Schayck, Onno C P; Widdershoven, Guy; Abma, Tineke A

    2015-09-01

    The objective of this study was to evaluate whether care provided in the care programmes matched the needs of older people. Care programmes were implemented in primary-care settings in the Netherlands to identify frail older people and to prevent further deterioration of health. In total, 23 older people participated in in-depth interviews. Within this study, three older people participated as co-researchers; they gathered and analysed the data together with the academic researchers. Content analysis was used to analyse the data. Two categories emerged from the data: 'Losing connections' and 'Receiving support to reconnect.' 'Losing connections' reflects the needs of older people and 'Receiving support to reconnect' reflects their experience and the appreciated aspects of the provided care. A relationship of trust with the practice nurse (PN) appeared to be an important aspect of care, as it fostered the sharing of feelings and issues other than physical or medical problems that could not be shared with the general practitioner. The PNs are experienced as connectors, who help to restore feelings of connectedness and older peoples' access to resources in the community. The relationship with the PN was experienced as valuable because of the feelings of 'connectedness' it created. Through this connectedness, older people could discuss feelings of loneliness, depression and frustration in receiving and acquiring the appropriate resources and services with the PNs. Furthermore, the relationship with the PN helped the older people to gain access to other health professionals and services. The results imply that care for frail older people should include an awareness of the importance of the trusting relationship. Nurses can play a vital role in creating a trusting relationship and are able to bridge the gap between older people and other professionals and services. © 2014 John Wiley & Sons Ltd.

  20. Development of a Curriculum Management Process by Applying Lean Concept for Waste Elimination to Enhance Curriculum Implementation of Primary School Teacher

    Science.gov (United States)

    Chitrangsan, Nadrudee; Sawekngam, Wichai; Thongthew, Sumlee

    2015-01-01

    This research aims to study and develop a curriculum management process by applying Lean concept for waste elimination to enhance curriculum implementation of primary school teacher. This study was conducted with a focus on qualitative data collection by dividing into 2 phases, including (1) analyze and synthesize relevant notions, theories,…

  1. Differences in Readiness between Rural Hospitals and Primary Care Providers for Telemedicine Adoption and Implementation: Findings from a Statewide Telemedicine Survey

    Science.gov (United States)

    Martin, Amy Brock; Probst, Janice C.; Shah, Kyle; Chen, Zhimin; Garr, David

    2012-01-01

    Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation…

  2. Implementation of an electronic medical record system in previously computer-naïve primary care centres: a pilot study from Cyprus.

    Science.gov (United States)

    Samoutis, George; Soteriades, Elpidoforos S; Kounalakis, Dimitris K; Zachariadou, Theodora; Philalithis, Anastasios; Lionis, Christos

    2007-01-01

    The computer-based electronic medical record (EMR) is an essential new technology in health care, contributing to high-quality patient care and efficient patient management. The majority of southern European countries, however, have not yet implemented universal EMR systems and many efforts are still ongoing. We describe the development of an EMR system and its pilot implementation and evaluation in two previously computer-naïve public primary care centres in Cyprus. One urban and one rural primary care centre along with their personnel (physicians and nurses) were selected to participate. Both qualitative and quantitative evaluation tools were used during the implementation phase. Qualitative data analysis was based on the framework approach, whereas quantitative assessment was based on a nine-item questionnaire and EMR usage parameters. Two public primary care centres participated, and a total often health professionals served as EMR system evaluators. Physicians and nurses rated EMR relatively highly, while patients were the most enthusiastic supporters for the new information system. Major implementation impediments were the physicians' perceptions that EMR usage negatively affected their workflow, physicians' legal concerns, lack of incentives, system breakdowns, software design problems, transition difficulties and lack of familiarity with electronic equipment. The importance of combining qualitative and quantitative evaluation tools is highlighted. More efforts are needed for the universal adoption and routine use of EMR in the primary care system of Cyprus as several barriers to adoption exist; however, none is insurmountable. Computerised systems could improve efficiency and quality of care in Cyprus, benefiting the entire population.

  3. Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study.

    Science.gov (United States)

    Wolk, Courtney Benjamin; Jager-Hyman, Shari; Marcus, Steven C; Ahmedani, Brian K; Zeber, John E; Fein, Joel A; Brown, Gregory K; Lieberman, Adina; Beidas, Rinad S

    2017-06-24

    The promotion of safe firearm practices, or firearms means restriction, is a promising but infrequently used suicide prevention strategy in the USA. Safety Check is an evidence-based practice for improving parental firearm safety behaviour in paediatric primary care. However, providers rarely discuss firearm safety during visits, suggesting the need to better understand barriers and facilitators to promoting this approach. This study, Adolescent Suicide Prevention In Routine clinical Encounters, aims to engender a better understanding of how to implement the three firearm components of Safety Check as a suicide prevention strategy in paediatric primary care. The National Institute of Mental Health-funded Mental Health Research Network (MHRN), a consortium of 13 healthcare systems across the USA, affords a unique opportunity to better understand how to implement a firearm safety intervention in paediatric primary care from a system-level perspective. We will collaboratively develop implementation strategies in partnership with MHRN stakeholders. First, we will survey leadership of 82 primary care practices (ie, practices serving children, adolescents and young adults) within two MHRN systems to understand acceptability and use of the three firearm components of Safety Check (ie, screening, brief counselling around firearm safety and provision of firearm locks). Then, in collaboration with MHRN stakeholders, we will use intervention mapping and the Consolidated Framework for Implementation Research to systematically develop and evaluate a multilevel menu of implementation strategies for promoting firearm safety as a suicide prevention strategy in paediatric primary care. Study procedures have been approved by the University of Pennsylvania. Henry Ford Health System and Baylor Scott & White institutional review boards (IRBs) have ceded IRB review to the University of Pennsylvania IRB. Results will be submitted for publication in peer-reviewed journals. © Article

  4. Spatial Distribution of Soil Fauna In Long Term No Tillage

    Science.gov (United States)

    Corbo, J. Z. F.; Vieira, S. R.; Siqueira, G. M.

    2012-04-01

    The soil is a complex system constituted by living beings, organic and mineral particles, whose components define their physical, chemical and biological properties. Soil fauna plays an important role in soil and may reflect and interfere in its functionality. These organisms' populations may be influenced by management practices, fertilization, liming and porosity, among others. Such changes may reduce the composition and distribution of soil fauna community. Thus, this study aimed to determine the spatial variability of soil fauna in consolidated no-tillage system. The experimental area is located at Instituto Agronômico in Campinas (São Paulo, Brazil). The sampling was conducted in a Rhodic Eutrudox, under no tillage system and 302 points distributed in a 3.2 hectare area in a regular grid of 10.00 m x 10.00 m were sampled. The soil fauna was sampled with "Pitfall Traps" method and traps remained in the area for seven days. Data were analyzed using descriptive statistics to determine the main statistical moments (mean variance, coefficient of variation, standard deviation, skewness and kurtosis). Geostatistical tools were used to determine the spatial variability of the attributes using the experimental semivariogram. For the biodiversity analysis, Shannon and Pielou indexes and richness were calculated for each sample. Geostatistics has proven to be a great tool for mapping the spatial variability of groups from the soil epigeal fauna. The family Formicidae proved to be the most abundant and dominant in the study area. The parameters of descriptive statistics showed that all attributes studied showed lognormal frequency distribution for groups from the epigeal soil fauna. The exponential model was the most suited for the obtained data, for both groups of epigeal soil fauna (Acari, Araneae, Coleoptera, Formicidae and Coleoptera larva), and the other biodiversity indexes. The sampling scheme (10.00 m x 10.00 m) was not sufficient to detect the spatial

  5. Effects of soil tillage on the energy budget of soybean (Glycine max (L.) Merr.)

    International Nuclear Information System (INIS)

    Casa, R.; Cascio, B. lo

    1997-01-01

    The different terms of the energy budget were measured by the Bowen ratio method on soybean (Glycine max (L.) Merr.) grown on a conventional tillage and a direct drilling system. The differences found in the energy budgets varied according to the degree of fractional ground cover and of soil water availability. Soil heat flux was greater for the direct drilling treatment, although soil heating was slower as compared to the conventional tillage. Comparisons for well watered and dry conditions revealed that the conventional tillage system used as latent heat a fraction of net radiation greater than the direct drilling treatment only in well watered conditions. In dry conditions the differences in latent heat fluxes and canopy resistances between the two tillage systems were smaller [it

  6. Nitrate Leaching From Grain Maize After Different Tillage Methods and Long/Short Term Cover Cropping

    DEFF Research Database (Denmark)

    Hansen, Elly Møller

    trial initiated in 1968 on a coarse sandy soil. The previous trial included spring sown crops undersown (with or without) perennial ryegrass (Lolium perenne L.) as cover crop, two N-rates (90 and 120 kg N ha-1) and different tillage methods (shallow tillage and ploughing autumn or spring). With maize......) previous history of long-term cover cropping, ii) soil tillage methods, iii) N rates and iv) present short-term use of cover cropping in maize. Preliminary results from 2009 – 2011 suggest that leaching after a history of cover cropping tended to be higher than after no history of cover cropping......, but the effect was insignificant. The effect of tillage and previous N rates were also insignificant but the present use of cover crops had a small but significant decreasing effect on leaching compared to no cover cropping. The cover crop was well established in both years but grew less vigorously during autumn...

  7. Responses of reniform nematode and browntop millet to tillage, cover crop, and herbicides in cotton

    Science.gov (United States)

    Cropping practices that reduce competition from reniform nematode (Rotylenchulus reniformis) and browntop millet (Urochlora ramosum) may help minimize losses in cotton (Gossypium hirsutum). The impacts of tillage, rye cover crop, and preemergence and postemergence herbicides on cotton yields, renifo...

  8. Effect of Soil Tillage Practices on Dynamic of Bacterial Communities in Soil

    OpenAIRE

    Mirna Mrkonjić Fuka; Mihaela Blažinkov; Viviane Radl; Danijel Jug; Nataša Hulak; Sulejman Redžepović; Michael Schloter

    2016-01-01

    Several studies have indicated that intensive tillage has notable effect on properties of the soil microbiota that may influence numerous important soils functions, e.g. mobilization of nutrients or change of the overall emission rates of greenhouse gases. Therefore, the aim of our study was to investigate dynamic of microbial communities in soil planted with soybean under different tillage systems. Moreover, abundance of populations harboring the nitrous- oxide reductase gene (nosZ) a...

  9. Effect of subsoil tillage depth on nutrient accumulation, root distribution, and grain yield in spring maize

    Directory of Open Access Journals (Sweden)

    Hongguang Cai

    2014-10-01

    Full Text Available A four-year field experiment was conducted to investigate the effect of subsoiling depth on root morphology, nitrogen (N, phosphorus (P, and potassium (K uptake, and grain yield of spring maize. The results indicated that subsoil tillage promoted root development, increased nutrient accumulation, and increased yield. Compared with conventional soil management (CK, root length, root surface area, and root dry weight at 0–80 cm soil depth under subsoil tillage to 30 cm (T1 and subsoil tillage to 50 cm (T2 were significantly increased, especially the proportions of roots in deeper soil. Root length, surface area, and dry weight differed significantly among three treatments in the order of T2 > T1 > CK at the 12-leaf and early filling stages. The range of variation of root diameter in different soil layers in T2 treatment was the smallest, suggesting that roots were more likely to grow downwards with deeper subsoil tillage in soil. The accumulation of N, P, and K in subsoil tillage treatment was significantly increased, but the proportions of kernel and straw were different. In a comparison of T1 with T2, the grain accumulated more N and P, while K accumulation in kernel and straw varied in different years. Grain yield and biomass were increased by 12.8% and 14.6% on average in subsoil tillage treatments compared to conventional soil treatment. Although no significant differences between different subsoil tillage depths were observed for nutrient accumulation and grain yield, lodging resistance of plants was significantly improved in subsoil tillage to 50 cm, a characteristic that favors a high and stable yield under extreme environments.

  10. Soil carbon and nitrogen mineralization under different tillage systems and Permanent Groundcover cultivation between Orange trees

    Directory of Open Access Journals (Sweden)

    Elcio Liborio Balota

    2011-06-01

    Full Text Available The objective of this work was to evaluate the alterations in carbon and nitrogen mineralization due to different soil tillage systems and groundcover species for intercropped orange trees. The experiment was established in an Ultisol soil (Typic Paleudults originated from Caiuá sandstone in northwestern of the state of Paraná, Brazil, in an area previously cultivated with pasture (Brachiaria humidicola. Two soil tillage systems were evaluated: conventional tillage (CT in the entire area and strip tillage (ST with a 2-m width, each with different groundcover vegetation management systems. The citrus cultivar utilized was the 'Pera' orange (Citrus sinensis grafted onto a 'Rangpur' lime rootstock. The soil samples were collected at a 0-15-cm depth after five years of experiment development. Samples were collected from under the tree canopy and from the inter-row space after the following treatments: (1 CT and annual cover crop with the leguminous Calopogonium mucunoides; (2 CT and perennial cover crop with the leguminous peanut Arachis pintoi; (3 CT and evergreen cover crop with Bahiagrass Paspalum notatum; (4 CT and cover crop with spontaneous B. humidicola grass vegetation; and (5 ST and maintenance of the remaining grass (pasture of B. humidicola. The soil tillage systems and different groundcover vegetation influenced the C and N mineralization, both under the tree canopy and in the inter-row space. The cultivation of B. humidicola under strip tillage provided higher potential mineralization than the other treatments in the inter-row space. Strip tillage increased the C and N mineralization compared to conventional tillage. The grass cultivation increased the C and N mineralization when compared to the others treatments cultivated in the inter-row space.

  11. Methodology proposal for the development of Tillage Models - (Part II) Indexes of physical-mechanic characterization of the soil and development of a tillage model

    International Nuclear Information System (INIS)

    Lozano Osorno Fernando; Castillo Herran, Bernardo

    1999-01-01

    A proposal was presented for the elaboration of tillage models that allows making decisions on systems of soil preparation (including the option of zero tillage) starting with measurements of the condition of these. After following a plan of sampling of diverse physical-mechanics parameters of the soil and of a statistical process of correlation, they were chosen as representative variables: the apparent density, the cone index, the content of humidity and the cohesion (torsion box, proves in situ); not only such parameters are very related to each other, but rather they also make possible to estimate other variables of interest like the total porosity appropriately, the macro-porosity, the hydraulic conductivity and in general the soil resistance, which makes viable to choose methods of removal of the soil in function of the initial state of the same one. In the proven case it could verify the possibility to establish systems of tillage reduction

  12. [Effects of different tillage patterns on soil properties, maize yield and water use efficiency in Weibei Highland, China.

    Science.gov (United States)

    Liu, Dan; Zhang, Xia; Li, Jun; Wang, Xu-Dong

    2018-02-01

    An eight-year field experiment of straw returning was conducted on dark loessial soil in Weibei Highland to investigate the effects of tillage patterns on soil aggregate, soil organic carbon (SOC), corn yield and soil water use efficiency (WUE). There were six tillage patterns, including conventional tillage (CT/CT), no-tillage (NT/NT), subsoiling tillage (ST/ST), no-tillage/subsoiling tillage (NT/ST), conventional tillage/no-tillage (CT/NT) and conventional tillage/subsoiling tillage (CT/ST). The results showed that compared with CT/CT, the patterns of NT/NT, ST/ST and the rotational tillage patterns (NT/ST, CT/NT and CT/ST) decreased the mean mass diameter of soil mechanical stable aggregate. The patterns of NT/NT, ST/ST and NT/ST increased the content of soil water-stable aggregate with the particle size >0.25 mm (WR 0.25 ) and their mean mass diameter, especially in the depth of 20-50 cm. These patterns reduced the proportion of aggregate destruction (PAD). Compared with CT/CT, the patterns of NT/ST, CT/NT, NT/NT and ST/ST increased the content of SOC in 0-10 cm soil layer. The content of SOC decreased as the increases of soil depth for all tillage patterns, but the decrease in SOC of three single tillage patterns (ST/ST, NT/NT and CT/CT) was larger than that of three rotational tillage patterns. Compared with CT/CT, the other five tillage patterns increased soil water storage in 0-200 cm soil profile, crop yield and WUE in maize. The yield and WUE in NT/ST pattern were significantly increased by 15.1% and 27.5%, respectively. Both corn yield and WUE were significantly and positively correlated with soil water storage in 0-200 cm soil profile in field during the cropping and fallow periods. Moreover, soil water storage during the cropping period was positively correlated with WR 0.25 , but negatively correlated with PAD in 0-50 cm soil layer. Particularly, maize yield, WUE and soil water storage during the cropping period were closely related to WR 0.25 in 20

  13. Tillage effects on N2O emissions as influenced by a winter cover crop

    DEFF Research Database (Denmark)

    Petersen, Søren O; Mutegi, James; Hansen, Elly Møller

    2011-01-01

    emissions may be more important than the effect on soil C. This study monitored emissions of N2O between September 2008 and May 2009 in three tillage treatments, i.e., conventional tillage (CT), reduced tillage (RT) and direct drilling (DD), all with (+CC) or without (−CC) fodder radish as a winter cover...... application by direct injection N2O emissions were stimulated in all tillage treatments, reaching 250–400 μg N m−2 h−1 except in the CT + CC treatment, where emissions peaked at 900 μg N m−2 h−1. Accumulated emissions ranged from 1.6 to 3.9 kg N2O ha−1. A strong positive interaction between cover crop......Conservation tillage practices are widely used to protect against soil erosion and soil C losses, whereas winter cover crops are used mainly to protect against N losses during autumn and winter. For the greenhouse gas balance of a cropping system the effect of reduced tillage and cover crops on N2O...

  14. Carbon fractions and soil fertility affected by tillage and sugarcane residue management an Xanthic Udult

    Directory of Open Access Journals (Sweden)

    Iara Maria Lopes

    2017-10-01

    Full Text Available The gradual change in management practices in sugarcane (Saccharum spp. production from burning straw to a green harvesting system, as well as the use of minimum soil tillage during field renovation, may affect soil fertility and soil organic matter (SOM contents. The objectives of this work were to investigate the influence of sugar cane production systems on: (1 soil fertility parameters; (2 on physical carbon fractions; (3 and on humic substance fractions, in a long-term experiment, comparing two soil tillage and two residue management systems an Xanthic Udult, in the coastal tableland region of Espírito Santo State, Brazil. The treatments consisted of plots (conventional tillage (CT or minimum tillage (MT and subplots (residue burned or unburned at harvesting, with five replicates The highest values of Ca2+ + Mg2+ and total organic carbon (TOC were observed in the MT system in all soil layers, while high values of K+ were observed in the 0.1-0.2 m layer. The CT associated with the burned residue management negatively influenced the TOC values, especially in the 0.1-0.2 and 0.2-0.4 m layers. The carbon in the humin fraction and organic matter associated with minerals were significantly different among the tillage systems; the MT showed higher values than the CT. However, there were no significant differences between the sugarcane residue management treatments. Overall, fractioning the SOM allowed for a better understanding of tillage and residue management systems effects on the soil properties.

  15. The tillage effect on the soil acid and alkaline phosphatase activity

    Directory of Open Access Journals (Sweden)

    Lacramioara Oprica

    2011-12-01

    Full Text Available Phosphatases (acid and alkaline are important in soils because these extracellular enzymes catalyze the hydrolysis of organic phosphate esters to orthophosphate; thus they form an important link between biologically unavailable and mineral phosphorous. Phosphatase activity is sensitive to environmental perturbations such as organic amendments, tillage, waterlogging, compaction, fertilizer additions and thus it is often used as an environmental indicator of soil quality in riparian ecosystems. The aim of the study was to assess the effect of tillage systems on phosphatases activity in a field experiment carried out in Ezăreni farm. The phosphatase activitiy were determined at two depths (7-10 cm and 15-25cm layers of a chernozem soil submitted to conventional tillage (CT in a fertilised and unfertilised experiment. Monitoring soil alkaline phosphatase activity showed, generally, the same in fertilized soil profiles collected from both depths; the values being extremely close. In unfertilized soils, alkaline phosphatase activity is different only in soils that were exposed to unconventional work using disc harrows and 30cm tillage. Both works type (no tillage and conventional tillage cause an intense alkaline phosphatase activity in 7-10 cm soil profile. Acid phosphatase activity is highly fluctuating in both fertilized as well unfertilized soil, this enzyme being influenced by the performed works.

  16. Effect of various tillage practices on soil properties and maize growth

    International Nuclear Information System (INIS)

    Leghari, N.

    2016-01-01

    Appropriate tillage practices are vital for good tilth that is pre-requisite for aggregate formation, soil aeration, better root development and plant growth. A field experiment of maize was carried out at the experimental site of Sindh Agriculture University Tandojam during two consecutive growing seasons 2009 and 2010. A randomized complete block design with three treatment conventional tillage (CT), reduced tillage (RT) and no tillage (NT) was used in the study. Significant differences between tillage treatments were observed in the soil properties, growth and root development of plants. The NT treatment retained higher soil water contents (15.8 and 16.0%) measured at 0-20 cm depth during 2009 and 2010, respectively. Likewise, the soil bulk density (1.4 and 1.4 cm-3) was higher at this depth consequently; it resulted in greater soil strength (81 N m-2 and 79 N m-2) during 2009 and 2010, respectively. The negative and significant correlations were recorded between root dry weight and soil strengths. On the other hand, positive and significant relationship of root dry weight with mean total dry matter production and LAI was observed. Moreover, the root development related observations were significantly enhanced under CT as compared to RT and NT treatments. The results indicate that conventional tillage improve maize growth and root development by improving soil properties. (author)

  17. Long-term Differences in Tillage and Land Use Affect Intra-aggregate Pore Heterogeneity

    International Nuclear Information System (INIS)

    Kravchenko, A.N.; Wang, A.N.W.; Smucker, A.J.M.; Rivers, M.L.

    2011-01-01

    Recent advances in computed tomography provide measurement tools to study internal structures of soil aggregates at micrometer resolutions and to improve our understanding of specific mechanisms of various soil processes. Fractal analysis is one of the data analysis tools that can be helpful in evaluating heterogeneity of the intra-aggregate internal structures. The goal of this study was to examine how long-term tillage and land use differences affect intra-aggregate pore heterogeneity. The specific objectives were: (i) to develop an approach to enhance utility of box-counting fractal dimension in characterizing intra-aggregate pore heterogeneity; (ii) to examine intra-aggregate pores in macro-aggregates (4-6 mm in size) using the computed tomography scanning and fractal analysis, and (iii) to compare heterogeneity of intra-aggregate pore space in aggregates from loamy Alfisol soil subjected to 20 yr of contrasting management practices, namely, conventional tillage (chisel plow) (CT), no-till (NT), and native succession vegetation (NS). Three-dimensional images of the intact aggregates were obtained with a resolution of 14.6 (micro)m at the Advanced Photon Source, Argonne National Laboratory, Argonne, IL. Proposed box-counting fractal dimension normalization was successfully implemented to estimate heterogeneity of pore voxel distributions without bias associated with different porosities in soil aggregates. The aggregates from all three studied treatments had higher porosity associated with large (>100 (micro)m) pores present in their centers than in their exteriors. Pores 15 to 60 (micro)m were equally abundant throughout entire aggregates but their distributions were more heterogeneous in aggregate interiors. The CT aggregates had greater numbers of pores 15 to 60 (micro)m than NT and NS. Distribution of pore voxels belonging to large pores was most heterogeneous in the aggregates from NS, followed by NT and by CT. This result was consistent with presence of

  18. Learning from doing: the case for combining normalisation process theory and participatory learning and action research methodology for primary healthcare implementation research.

    Science.gov (United States)

    de Brún, Tomas; O'Reilly-de Brún, Mary; O'Donnell, Catherine A; MacFarlane, Anne

    2016-08-03

    The implementation of research findings is not a straightforward matter. There are substantive and recognised gaps in the process of translating research findings into practice and policy. In order to overcome some of these translational difficulties, a number of strategies have been proposed for researchers. These include greater use of theoretical approaches in research focused on implementation, and use of a wider range of research methods appropriate to policy questions and the wider social context in which they are placed. However, questions remain about how to combine theory and method in implementation research. In this paper, we respond to these proposals. Focussing on a contemporary social theory, Normalisation Process Theory, and a participatory research methodology, Participatory Learning and Action, we discuss the potential of their combined use for implementation research. We note ways in which Normalisation Process Theory and Participatory Learning and Action are congruent and may therefore be used as heuristic devices to explore, better understand and support implementation. We also provide examples of their use in our own research programme about community involvement in primary healthcare. Normalisation Process Theory alone has, to date, offered useful explanations for the success or otherwise of implementation projects post-implementation. We argue that Normalisation Process Theory can also be used to prospectively support implementation journeys. Furthermore, Normalisation Process Theory and Participatory Learning and Action can be used together so that interventions to support implementation work are devised and enacted with the expertise of key stakeholders. We propose that the specific combination of this theory and methodology possesses the potential, because of their combined heuristic force, to offer a more effective means of supporting implementation projects than either one might do on its own, and of providing deeper understandings of

  19. Primary social and emotional aspects of learning (SEAL small group interventions: a qualitative study of factors affecting implementation and the role of Local Authority support

    Directory of Open Access Journals (Sweden)

    Neil Humphrey

    2009-11-01

    Full Text Available The aims of the current study were to examine the factors affecting implementation of social and emotional aspects of learning (SEAL small group interventions in primary schools and to explore the role of support from Local Authorities (LAs in the implementation process. Telephone interviews were conducted with lead SEAL staff in 12 LAs across England as part of a larger national evaluation of this educational initiative. Data were transcribed and subjected to qualitative content analysis. Subsequently, a tentative model was developed to document the relationship between the nature of support provided by LAs (e.g. training events, developing/providing additional materials, factors affecting implementation at school level (e.g. school readiness, the profile of SEAL and perceived barriers to success (e.g. misconceptions about the purpose of small group interventions. These findings are discussed in relation to the existing literature on the implementation of social-emotional initiatives and interventions in education.

  20. Re-plant problems in long-term no-tillage cropping systems : causal analysis and mitigation strategies

    OpenAIRE

    Afzal

    2016-01-01

    No-tillage is considered as a promising alternative for tillage-based conventional farming, by saving energy-input and time, reducing groundwater pollution and counteracting soil erosion and losses of the soil-organic matter. However, in the recent past, no-tillage farmers in Southwest Germany repeatedly reported problems particularly in winter wheat production, characterized by stunted plant growth in early spring, chlorosis, impaired fine root development and increased disease susceptibilit...

  1. Long term effects of different tillage systems influencing yield and energy efficiency in maize (Zea mays L.)

    OpenAIRE

    Momirović, Nebojša; Dolijanović, Željko; Oljača, Mićo V.; Videnović, Živorad

    2011-01-01

    Adoption and improvement of different tillage systems toward agricultural sustainability has a great social, economical and environmental impact. The base of sustainability is a system productivity as ratio of output to input in a given system, measured in the same units, commonly as energy requirements. The objective of this study was to evaluate the aspect of energy requirements in the different soil tillage systems regarding total energy consumption under conventional tillage. The appropri...

  2. Phosphorus fractions in an agricultural chronosequence under tillage regimes in the Cerrado area in Goiás, Brazil

    Directory of Open Access Journals (Sweden)

    Roni Fernandes Guareschi

    2016-04-01

    Full Text Available The increase in the amount and quantity of soil organic matter (SOM, as well as the use of phosphorus-based fertilizers in the superficial soil layer in areas under tillage regimes (TR, may affect phosphorus (P dynamics in the soil. Therefore, the aims of the present work were as follows: to evaluate the inorganic and organic fractions of P and its lability levels (labile, moderately labile, and moderately resistant in a Distroferric Red Latosol under tillage regimes (TR 3, 15, and 20 years after implementation, and to compare them with those of areas of native Cerrado and pastures. We also focus on analyzing the correlations of the P fractions in these areas with other soil attributes, such as total carbon and nitrogen levels, light organic matter (LOM, chemical and physical granulometric fractions of the SOM, maximum phosphate adsorption capacity (MPAC, and the remaining phosphorus (Prem. In each of these areas, samples were collected from the 0.0-0.05 and 0.05-0.10 m soil layers. An entirely randomized experimental design was used. After TR implementation, the constant use of phosphorus-based fertilizers as well as the incremental addition of SOM resulted in an increase in the levels of labile, moderate labile, and moderately resistant organic and inorganic P, with a tendency for total P accumulation to be mostly in the inorganic, moderately labile form. The native Cerrado soil presented high levels of labile and moderately labile inorganic P. Pasture areas presented the lowest levels of labile organic and inorganic P, as well as moderately labile and moderately resistant organic P. By principal component analysis (PCA, it was possible to observe alterations in all soil attributes and P levels of the fractions analyzed.

  3. Implementation of innovative attitudes and behaviour in primary health care by means of strategic communication: a 7-year follow-up.

    Science.gov (United States)

    Morténius, Helena; Marklund, Bertil; Palm, Lars; Björkelund, Cecilia; Baigi, Amir

    2012-06-01

    To bridge the gap between theory and practice, methods are needed that promote a positive attitude to change among health care professionals and facilitate the incorporation of new research findings. In this context, communication plays a significant role. The aim of this study was to analyse primary care staff members' readiness to adopt new ways of thinking and willingness to change their work practices by means of strategic communication. An evaluative design was used to study a primary care staff cohort for 7 years. The study population comprised all primary care staff in a region of Sweden (n = 1206). The strategic communication encompassed managerial impact, planning and implementation of reflexive communication processes, in addition to activities in three established communication channels (oral, written and digital). A questionnaire was used, and bivariate and multivariate statistical analyses were performed. A total of 846 individuals participated in the evaluation (70%). Strategic communication had a significant effect on staff members' new way of thinking (61%) and willingness to change daily work practices (33%). The communication channels had a significant synergy effect on the adoption of new ideas and willingness to change attitudes. Oral and digital communication had a significant impact on staff members' readiness to change. Strategic communication plays an important role in the process of creating innovative attitudes and behaviour among primary care professionals. The willingness to change attitudes enhances primary care staff's readiness to change everyday practices, thus facilitating the implementation of evidence-based care. © 2011 Blackwell Publishing Ltd.

  4. Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project).

    Science.gov (United States)

    Aragonès, Enric; Palao, Diego; López-Cortacans, Germán; Caballero, Antonia; Cardoner, Narcís; Casaus, Pilar; Cavero, Myriam; Monreal, José Antonio; Pérez-Sola, Víctor; Cirera, Miquel; Loren, Maite; Bellerino, Eva; Tomé-Pires, Catarina; Palacios, Laura

    2017-12-13

    Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. This project tests the transferability of a healthcare intervention

  5. Conservation tillage, optimal water and organic nutrient supply enhance soil microbial activities during wheat (Triticum Aestivum L.) cultivation

    Science.gov (United States)

    Sharma, Pankaj; Singh, Geeta; Singh, Rana P.

    2011-01-01

    The field experiments were conducted on sandy loam soil at New Delhi, during 2007 and 2008 to investigate the effect of conservation tillage, irrigation regimes (sub-optimal, optimal and supra-optimal water regimes), and integrated nutrient management (INM) practices on soil biological parameters in wheat cultivation. The conservation tillage soils has shown significant (pbiofertilizer+25% Green Manure) has been used in combination with the conservation tillage and the optimum water supply. Study demonstrated that microbial activity could be regulated by tillage, water and nitrogen management in the soil in a sustainable manner. PMID:24031665

  6. The Effect of Conservation Tillage and Cover Crop Residue on Beneficial Arthropods and Weed Seed Predation in Acorn Squash.

    Science.gov (United States)

    Quinn, N F; Brainard, D C; Szendrei, Z

    2016-12-01

    Conservation tillage combined with cover crops or mulching may enhance natural enemy activity in agroecosystems by reducing soil disturbance and increasing habitat structural complexity. In particular, weed seed predation can increase with vegetation cover and reduced tillage, indicating that mulches may improve the quality of the habitat for weed seed foraging. The purpose of this study was to quantify the effects of tillage and mulching for conservation biological control in cucurbit fields. The effects of mulch and reduced tillage on arthropods and rates of weed seed loss from arenas were examined in field trials on sandy soils in 2014 and 2015. Experimental factors included tillage and cover crop, each with two levels: strip-tillage or full-tillage, and cover crop mulch (rye residue) or no cover crop mulch (unmulched). Arthropod abundance on the crop foliage was not affected by tillage or cover crops. Contrary to expectations, epigeal natural enemies of insects and rates of weed seed removal either did not respond to treatments or were greater in full-tilled plots and plots without mulch. Our study demonstrates the potential importance of weed seed predators in reducing weed seedbanks in vegetable agroecosystems, and suggests that early-season tillage may not be detrimental to epigeal predator assemblages. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.

    Science.gov (United States)

    Cohen, Deborah J; Balasubramanian, Bijal A; Gordon, Leah; Marino, Miguel; Ono, Sarah; Solberg, Leif I; Crabtree, Benjamin F; Stange, Kurt C; Davis, Melinda; Miller, William L; Damschroder, Laura J; McConnell, K John; Creswell, John

    2016-06-29

    The Agency for Healthcare Research and Quality (AHRQ) launched the EvidenceNOW Initiative to rapidly disseminate and implement evidence-based cardiovascular disease (CVD) preventive care in smaller primary care practices. AHRQ funded eight grantees (seven regional Cooperatives and one independent national evaluation) to participate in EvidenceNOW. The national evaluation examines quality improvement efforts and outcomes for more than 1500 small primary care practices (restricted to those with fewer than ten physicians per clinic). Examples of external support include practice facilitation, expert consultation, performance feedback, and educational materials and activities. This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). This prospective observational study will examine the portfolio of EvidenceNOW Cooperatives using both qualitative and quantitative data. Qualitative data include: online implementation diaries, observation and interviews at Cooperatives and practices, and systematic assessment of context from the perspective of Cooperative team members. Quantitative data include: practice-level performance on clinical quality measures (aspirin prescribing, blood pressure and cholesterol control, and smoking cessation; ABCS) collected by Cooperatives from electronic health records (EHRs); practice and practice member surveys to assess practice capacity and other organizational and structural characteristics; and systematic tracking of intervention delivery. Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness. ESCALATES is

  8. Effect of Tillage Practices on Soil Properties and Crop Productivity in Wheat-Mungbean-Rice Cropping System under Subtropical Climatic Conditions

    Science.gov (United States)

    Islam, Md. Monirul; Hasanuzzaman, Mirza

    2014-01-01

    This study was conducted to know cropping cycles required to improve OM status in soil and to investigate the effects of medium-term tillage practices on soil properties and crop yields in Grey Terrace soil of Bangladesh under wheat-mungbean-T. aman cropping system. Four different tillage practices, namely, zero tillage (ZT), minimum tillage (MT), conventional tillage (CT), and deep tillage (DT), were studied in a randomized complete block (RCB) design with four replications. Tillage practices showed positive effects on soil properties and crop yields. After four cropping cycles, the highest OM accumulation, the maximum root mass density (0–15 cm soil depth), and the improved physical and chemical properties were recorded in the conservational tillage practices. Bulk and particle densities were decreased due to tillage practices, having the highest reduction of these properties and the highest increase of porosity and field capacity in zero tillage. The highest total N, P, K, and S in their available forms were recorded in zero tillage. All tillage practices showed similar yield after four years of cropping cycles. Therefore, we conclude that zero tillage with 20% residue retention was found to be suitable for soil health and achieving optimum yield under the cropping system in Grey Terrace soil (Aeric Albaquept). PMID:25197702

  9. Yield and tillering response of super hybrid rice Liangyoupeijiu to tillage and establishment methods

    Directory of Open Access Journals (Sweden)

    M.A. Badshah

    2014-02-01

    Full Text Available Tillering is an important agronomic trait for rice grain production. To evaluate yield and tillering response, Liangyoupeijiu (super hybrid rice was grown in Hunan, China during 2011–2012 under different methods of tillage (conventional and no-tillage system and crop establishment methods (transplanting at a spacing of 20 cm × 20 cm with one seedling per hill and direct seeding at a seeding rate of 22.5 kg ha− 1. Our results revealed that, at maximum tillering (Max. and at maturity (MA stages, direct seeding (DS resulted in 22% more tillers than transplanting (TP irrespective of tillage system. Tiller mortality reached a peak between panicle initiation (PI and booting (BT stages, and was 16% higher under conventional tillage (CT than under no-tillage (NT. Transplanting required 29% more time for the completion of tillering and less for DS. Tillering rate was 43% higher in DS than TP under either CT or NT. There was a positive correlation between panicle number per m2 and maximum tiller number per m2, but not panicle-bearing tiller rate. The panicle bearing tiller rate was higher under DS than TP and higher under NT than CT. Tiller dry weight gradually increased up to heading (HD stage, and was 14% higher under TP than DS. Leaf area (cm2 tiller− 1 gradually increased from Max. to HD stage and then decreased by 34% in conventional tillage transplanting (CTTP and 45% in no-tillage transplanting (NTTP from 12DAH–24DAH (days after heading, but was similar (35% under DS under either CT or NT. Grain yield was higher under CTTP owing to the larger sink size (heavier panicle, more spikelets in per cm length of panicle than under DS.

  10. Dust-associated microbiomes from dryland wheat fields differ with tillage practice and biosolids application

    Science.gov (United States)

    Schlatter, Daniel C.; Schillinger, William F.; Bary, Andy I.; Sharratt, Brenton; Paulitz, Timothy C.

    2018-07-01

    Wind erosion is a significant threat to the productivity and sustainability of agricultural soils. In the dryland winter wheat (Triticum aestivum L.)-fallow region of Inland Pacific Northwest of the USA (PNW), farmers increasingly use conservation tillage practices to control wind erosion. In addition, some farmers in this dry region apply municipal biosolids to soils as fertilizer and a source of stable organic matter. The impacts of soil management practices on emissions of dust microbiota to the atmosphere are understudied. We used high-throughput DNA sequencing to examine the impacts of conservation tillage and biosolids amendments on the transport of dust-associated fungal and bacterial communities during simulated high-wind events over two years at Lind, WA. The fungal and bacterial communities contained in windblown dust differed significantly with tillage (conservation vs. conventional) and fertilizer (synthetic vs. biosolids) treatments. However, the richness and diversity of fungal and bacterial communities of dust did not vary significantly with tillage or fertilizer treatments. Taxa enriched in dust from fields under conservation tillage represented many plant-associated taxa that likely grow on residue left on the soil surface, whereas taxa that were more abundant with conventional tillage were those that likely grow on buried plant residue. Dust from biosolids-amended fields harbored greater abundances of taxa that likely feed on introduced carbon. Most human-associated taxa that may pose a health risk were not present in dust after biosolids amendment, although members of Clostridiaceae were enriched with this treatment. Results show that tillage and fertilizer management practices impact the composition of bioaerosols emitted during high-wind events and have potential implications for plant and human health.

  11. Effects of Different Soil Tillage Intensity on Yields of Spring Barley

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    Alena Pernicová

    2014-01-01

    Full Text Available Within the period 1990–2012, effects of different soil tillage intensity on yields of spring barley were studied in a field experiment in the sugar-beet producing region (Ivanovice na Hané, Czech Republic. The forecrop of the spring barley was always sugar beet; following in three different crop rotations, after maize for silage, winter wheat and spring barley. Four variants of tillage were evaluated: Variant 1 – ploughing to the depth of 0.22 m; Variant 2 – shallow ploughing to the depth of 0.15 m; Variant 3 – no tillage; Variant 4 – shallow loosening soil to the depth of 0.10 m.Effect of different tillage on yields of spring barley was statistically insignificant. In all three crop rotations, the highest and the lowest average yields were obtained in Variant 2 (ploughing to the depth of 0.15 m and Variant 1 (ploughing to the depth of 0.22 m, respectively. Average yields in variants of soil tillage were these: variant 1 – 6.42 t.ha−1; variant 2 – 6.57 t.ha−1, variant 3 – 6.53 t.ha−1, variant 4 – 6.50 t.ha−1. The obtained results indicate that in these pedo-climatic conditions reduction of intensity soil tillage represented a very suitable alternative in case of growing spring barley after sugar beet as compared with the conventional method of tillage by ploughing to the depth of 0.22 m.

  12. Spatial targeting of conservation tillage to improve water quality and carbon retention benefits

    International Nuclear Information System (INIS)

    Yang, W.; Sheng, C.; Voroney, P.

    2005-01-01

    Conservation tillage reduces soil erosion and improves water quality in agricultural watersheds. However, the benefits of conservation tillage in carbon sequestration are the subject of controversy. Public funds are provided to farms to encourage the adoption of conservation tillage. Given the economic costs, the targeting of areas likely to achieve the greatest environmental benefits has become an important policy-making issue. A geographic information system (GIS) based modelling framework which integrated hydrologic, soil organic matter, and farm models to evaluate the spatial targeting of conservation tillage was presented. A case study applying the framework in the Fairchild Creek watershed in Ontario indicated that targeting conservation tillage based on sediment abatement goals can achieve comparable carbon retention benefits in terms of the percentage reduction of base carbon losses. Targeted subcatchments for conservation tillage varied across the watershed based on benefit to cost ratios. Conservation tillage patterns based on carbon retention goals showed similar results to sediment abatement goals but slight differences were observed because of different carbon content in the soils. The results indicated that sediment abatement may be used as an indicator in setting up program goals. The impacts of conservation programs can then be evaluated based on calibrated and validated hydrologic models in conjunction with monitoring data. Results also showed that setting carbon retention may lead to higher costs in order to achieve corresponding sediment abatement benefits. Carbon retention may not be suitable for setting as a stand-alone environmental goal for conservation programs because of the difficulties in verifying the impacts and the discrepancies between carbon and sediment benefits. It was concluded that the modelling results have important policy implications for the design of conservation stewardship programs that aim to achieve environmental

  13. Factors influencing the adoption, implementation, and continuation of physical activity interventions in primary health care: A Delphi study

    NARCIS (Netherlands)

    Huijg, J.M.; Crone, M.R.; Verheijden, M.W.; Zouwe, N. van der; Middelkoop, B.J.; Gebhardt, W.A.

    2013-01-01

    Background: The introduction of efficacious physical activity interventions in primary health care is a complex process. Understanding factors influencing the process can enhance the development of effective introduction strategies. This Delphi study aimed to identify factors most relevant for the

  14. Effectiveness of a multi-strategy intervention in increasing the implementation of vegetable and fruit breaks by Australian primary schools: a non-randomized controlled trial.

    Science.gov (United States)

    Nathan, Nicole; Wolfenden, Luke; Bell, Andrew C; Wyse, Rebecca; Morgan, Philip J; Butler, Michelle; Sutherland, Rachel; Milat, Andrew J; Hector, Debra; Wiggers, John

    2012-08-13

    Limited evidence exists describing the effectiveness of strategies in facilitating the implementation of vegetable and fruit programs by schools on a population wide basis. The aim of this study was to examine the effectiveness of a multi-strategy intervention in increasing the population-wide implementation of vegetable and fruit breaks by primary schools and to determine if intervention effectiveness varied by school characteristics. A quasi-experimental study was conducted in primary schools in the state of New South Wales, Australia. All primary schools in one region of the state (n = 422) received a multi-strategy intervention. A random sample of schools (n = 406) in the remainder of the state served as comparison schools. The multi-strategy intervention to increase vegetable and fruit breaks involved the development and provision of: program consensus and leadership; staff training; program materials; incentives; follow-up support; and implementation feedback. Comparison schools had access to routine information-based Government support. Data to assess the prevalence of vegetable and fruit breaks were collected by telephone from Principals of the intervention and comparison schools at baseline (2006-2007) and 11 to 15 months following the commencement of the intervention (2009-2010). GEE analysis was used to examine the change in the prevalence of vegetable and fruit breaks in intervention schools compared to comparison schools. At follow-up, prevalence of vegetable and fruit breaks increased significantly in both intervention (50.3% to 82.0%, p strategy intervention can significantly increase the implementation of vegetable and fruit breaks by a large number of Australian primary schools.

  15. Evaluating the Implementation and Feasibility of a Web-Based Tool to Support Timely Identification and Care for the Frail Population in Primary Healthcare Settings

    Directory of Open Access Journals (Sweden)

    Beverley Lawson

    2017-07-01

    Full Text Available Background Understanding and addressing the needs of frail persons is an emerging health priority for Nova Scotia and internationally. Primary healthcare (PHC providers regularly encounter frail persons in their daily clinical work. However, routine identification and measurement of frailty is not standard practice and, in general, there is a lack of awareness about how to identify and respond to frailty. A web-based tool called the Frailty Portal was developed to aid in identifying, screening, and providing care for frail patients in PHC settings. In this study, we will assess the implementation feasibility and impact of the Frailty Portal to: (1 support increased awareness of frailty among providers and patients, (2 identify the degree of frailty within individual patients, and (3 develop and deliver actions to respond to frailtyl in community PHC practice. Methods This study will be approached using a convergent mixed method design where quantitative and qualitative data are collected concurrently, in this case, over a 9-month period, analyzed separately, and then merged to summarize, interpret and produce a more comprehensive understanding of the initiative’s feasibility and scalability. Methods will be informed by the ‘Implementing the Frailty Portal in Community Primary Care Practice’ logic model and questions will be guided by domains and constructs from an implementation science framework, the Consolidated Framework for Implementation Research (CFIR. Discussion The ‘Frailty Portal’ aims to improve access to, and coordination of, primary care services for persons experiencing frailty. It also aims to increase primary care providers’ ability to care for patients in the context of their frailty. Our goal is to help optimize care in the community by helping community providers gain the knowledge they may lack about frailty both in general and in their practice, support improved identification of frailty with the use of screening

  16. Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment

    Science.gov (United States)

    Ludwick, D. A.; Doucette, John

    2009-01-01

    Our aging population has exacerbated strong and divergent trends between health human resource supply and demand. One way to mitigate future inequities is through the adoption of health information technology (HIT). Our previous research showed a number of risks and mitigating factors which affected HIT implementation success. We confirmed these findings through semistructured interviews with nine Alberta clinics. Sociotechnical factors significantly affected physicians' implementation success. Physicians reported that the time constraints limited their willingness to investigate, procure, and implement an EMR. The combination of antiquated exam room design, complex HIT user interfaces, insufficient physician computer skills, and the urgency in patient encounters precipitated by a fee-for-service remuneration model and long waitlists compromised the quantity, if not the quality, of the information exchange. Alternative remuneration and access to services plans might be considered to drive prudent behavior during physician office system implementation. PMID:19081787

  17. Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment

    Directory of Open Access Journals (Sweden)

    D. A. Ludwick

    2009-01-01

    Full Text Available Our aging population has exacerbated strong and divergent trends between health human resource supply and demand. One way to mitigate future inequities is through the adoption of health information technology (HIT. Our previous research showed a number of risks and mitigating factors which affected HIT implementation success. We confirmed these findings through semistructured interviews with nine Alberta clinics. Sociotechnical factors significantly affected physicians' implementation success. Physicians reported that the time constraints limited their willingness to investigate, procure, and implement an EMR. The combination of antiquated exam room design, complex HIT user interfaces, insufficient physician computer skills, and the urgency in patient encounters precipitated by a fee-for-service remuneration model and long waitlists compromised the quantity, if not the quality, of the information exchange. Alternative remuneration and access to services plans might be considered to drive prudent behavior during physician office system implementation.

  18. Effects of tillage on the Fe oxides activation in soil

    Science.gov (United States)

    Chi, Guangyu; Chen, Xin; Shi, Yi; Wang, Jun; Zheng, Taihui

    2009-07-01

    Since mid-1950s, the wetland ecosystems in Sanjiang Plain of Northeast China have been experiencing greater changes in land use, which had negative effects on the soil environments. This study assessed the effects of soil tillage on the activation of soil Fe in the region. The test ecosystems included natural wetland, paddy field and upland field converted from wetland. Soil samples at the depths of 0-10 cm, 10-20 cm, 20-30 cm, 30-40 cm, 40-60 cm, 60-90 cm and 90-120 cm were collected from each of the ecosystems for the analysis of vertical distribution of soil pH, organic carbon, chelate Fe oxides and Fe(II). The results showed that the conversion of wetland into paddy field and upland field induced a decrease of organic carbon content in 0-10 cm soil layer by 61.8% (P carbon showed that chelate Fe oxides and Fe(II) was correlated positively with soil organic carbon and chelate ratio had a more positive relationship with organic carbon than chelate Fe oxides and Fe(II). The results of chelate Fe oxides, Fe(II) and chelate ratio of Fe suggested that reclamation could prevent the Fe activation and organic matter is credited for having an important influence on the process of Fe activation.

  19. Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

    Science.gov (United States)

    Abdelaziz, Adel; Hany, Mohamed; Atwa, Hani; Talaat, Wagdy; Hosny, Somaya

    2016-01-01

    In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

  20. MAIZE YIELD AND ITS STABILITY AS AFFECTED BY TILLAGE AND CROP RESIDUE MANAGEMENT IN THE EASTERN ROMANIAN DANUBE PLAIN

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    Alexandru COCIU

    2015-10-01

    Full Text Available Rainfed crop management systems need to be optimized to provide more resilient options in order to cope with projected climatic scenarios which are forecasting a decrease in mean precipitation and more frequent extreme drought periods in the Eastern Romanian Danube Plain. This research, carried out in the period of 2011-2014, had as main purpose the determination of influence of tillage practices and residue management on rainfall use efficiency, maize yield and its stability, in order to evaluate the advantages of conservation agriculture (CA in the time of stabilization of direct seeding effects, in comparison with traditional chisel tillage. The maize grain yields are presented for each crop management practices, as follows: (1 chisel tillage, retained crop residues being chopped and incorporated (ciz; (2 zero tillage, retained crop residue chopped and kept on the field in short flat condition (rvt; (3 zero tillage, crop residues kept on the field in short root-anchored condition (1/2rva, and (4 zero tillage, crop residues kept on the field in tall root-anchored condition (1/1rva. In 2012, a year with prolonged drought during vegetative growth, yield differences between zero tillage with short root-anchored residue retention (1/2rva and chisel tillage with residue incorporation (ciz were positive, up to 840 kg ha-1. In average over 2011-2014, conservation agriculture (CA practices had a yield advantage over traditional chisel tillage practice. Zero tillage with residue retention used rainfall more efficiently so suggesting that it is a more resilient agronomic system than traditional (conventional practices involving chisel tillage with residue incorporation.

  1. Perceived Barriers to Implementing Individual Choosing Wisely® Recommendations in Two National Surveys of Primary Care Providers.

    Science.gov (United States)

    Zikmund-Fisher, Brian J; Kullgren, Jeffrey T; Fagerlin, Angela; Klamerus, Mandi L; Bernstein, Steven J; Kerr, Eve A

    2017-02-01

    While some research has examined general attitudes about efforts to reduce overutilization of services, such as the Choosing Wisely ® (CW) initiative, little data exists regarding primary care providers' attitudes regarding individual recommendations. We sought to identify whether particular CW recommendations were perceived by primary care providers as difficult to follow, difficult for patients to accept, or both. Two national surveys, one by mail to a random sample of 2000 U.S. primary care physicians in November 2013, and the second electronically to a random sample of 2500 VA primary care providers (PCPs) in October-December 2014. A total of 603 U.S. primary care physicians and 1173 VA primary care providers. Response rates were 34 and 48 %, respectively. PCP ratings of whether 12 CW recommendations for screening, testing and treatments applicable to adult primary care were difficult to follow and difficult for patients to accept; and ratings of potential barriers to reducing overutilization. For four recommendations regarding not screening or testing in asymptomatic patients, less than 20 % of PCPs found the CW recommendations difficult to accept (range 7.2-16.6 %) or difficult for patients to follow (12.2-19.3 %). For five recommendations regarding testing or treatment for symptomatic conditions, however, there was both variation in reported difficulty to follow (9.8-32 %) and a high level of reported difficulty for patients to accept (35.7-87.1 %). The most frequently reported barriers to reducing overuse included malpractice concern, patient requests for services, lack of time for shared decision making, and the number of tests recommended by specialists. While PCPs found many CW recommendations easy to follow, they felt that some, especially those for symptomatic conditions, would be difficult for patients to accept. Overcoming PCPs' perceptions of patient acceptability will require approaches beyond routine physician education, feedback and

  2. Satisfaction of health professionals after implementation of a primary care hospital emergency centre in Switzerland: A prospective before-after study.

    Science.gov (United States)

    Hess, Sascha; Sidler, Patrick; Chmiel, Corinne; Bögli, Karin; Senn, Oliver; Eichler, Klaus

    2015-10-01

    The increasing number of patients requiring emergency care is a challenge and leads to decreased satisfaction of health professionals at emergency departments (EDs). Thus, a Swiss hospital implemented a hospital-associated primary care centre at the ED. The study aim was to investigate changes in job satisfaction of ED staff before and after the implementation of this new service model and to measure hospital GPs' (HGPs) satisfaction at the hospital-associated primary care centre. This study was embedded in a large prospective before-after study over two years. We examined changes in job satisfaction with a questionnaire followed by selected interviews approaching all of the involved 25 ED staff members and 38 HGPs. The new emergency care model increased job satisfaction of ED staff and HGPs in all measured dimensions. The overall job satisfaction of ED employees improved from 76.5 to 83.9 points (visual analogue scale 0-100; difference 7.4 points [95% CI: 1.3 to 13.5, p = 0.02]). 86% of 29 HGPs preferred to provide their out-of-hours service at the new hospital-associated primary care centre. The hospital-associated primary care centre is a promising option to improve job satisfaction of different health professionals in emergency care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. 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/

  4. REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings (RESTORE: study protocol

    Directory of Open Access Journals (Sweden)

    MacFarlane Anne

    2012-11-01

    Full Text Available Abstract Background The implementation of guidelines and training initiatives to support communication in cross-cultural primary care consultations is ad hoc across a range of international settings with negative consequences particularly for migrants. This situation reflects a well-documented translational gap between evidence and practice and is part of the wider problem of implementing guidelines and the broader range of professional educational and quality interventions in routine practice. In this paper, we describe our use of a contemporary social theory, Normalization Process Theory and participatory research methodology—Participatory Learning and Action—to investigate and support implementation of such guidelines and training initiatives in routine practice. Methods This is a qualitative case study, using multiple primary care sites across Europe. Purposive and maximum variation sampling approaches will be used to identify and recruit stakeholders—migrant service users, general practitioners, primary care nurses, practice managers and administrative staff, interpreters, cultural mediators, service planners, and policy makers. We are conducting a mapping exercise to identify relevant guidelines and training initiatives. We will then initiate a PLA-brokered dialogue with stakeholders around Normalization Process Theory’s four constructs—coherence, cognitive participation, collective action, and reflexive monitoring. Through this, we will enable stakeholders in each setting to select a single guideline or training initiative for implementation in their local setting. We will prospectively investigate and support the implementation journeys for the five selected interventions. Data will be generated using a Participatory Learning and Action approach to interviews and focus groups. Data analysis will follow the principles of thematic analysis, will occur in iterative cycles throughout the project and will involve participatory co

  5. REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings (RESTORE): study protocol.

    Science.gov (United States)

    MacFarlane, Anne; O'Donnell, Catherine; Mair, Frances; O'Reilly-de Brún, Mary; de Brún, Tomas; Spiegel, Wolfgang; van den Muijsenbergh, Maria; van Weel-Baumgarten, Evelyn; Lionis, Christos; Burns, Nicola; Gravenhorst, Katja; Princz, Christine; Teunissen, Erik; van den Driessen Mareeuw, Francine; Saridaki, Aristoula; Papadakaki, Maria; Vlahadi, Maria; Dowrick, Christopher

    2012-11-20

    The implementation of guidelines and training initiatives to support communication in cross-cultural primary care consultations is ad hoc across a range of international settings with negative consequences particularly for migrants. This situation reflects a well-documented translational gap between evidence and practice and is part of the wider problem of implementing guidelines and the broader range of professional educational and quality interventions in routine practice. In this paper, we describe our use of a contemporary social theory, Normalization Process Theory and participatory research methodology--Participatory Learning and Action--to investigate and support implementation of such guidelines and training initiatives in routine practice. This is a qualitative case study, using multiple primary care sites across Europe. Purposive and maximum variation sampling approaches will be used to identify and recruit stakeholders-migrant service users, general practitioners, primary care nurses, practice managers and administrative staff, interpreters, cultural mediators, service planners, and policy makers. We are conducting a mapping exercise to identify relevant guidelines and training initiatives. We will then initiate a PLA-brokered dialogue with stakeholders around Normalization Process Theory's four constructs--coherence, cognitive participation, collective action, and reflexive monitoring. Through this, we will enable stakeholders in each setting to select a single guideline or training initiative for implementation in their local setting. We will prospectively investigate and support the implementation journeys for the five selected interventions. Data will be generated using a Participatory Learning and Action approach to interviews and focus groups. Data analysis will follow the principles of thematic analysis, will occur in iterative cycles throughout the project and will involve participatory co-analysis with key stakeholders to enhance the

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

    Science.gov (United States)

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

    2018-01-25

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

  7. Creating a Learning Environment to Promote Food Sustainability Issues in Primary Schools? Staff Perceptions of Implementing the Food for Life Partnership Programme

    Directory of Open Access Journals (Sweden)

    Judy Orme

    2013-03-01

    Full Text Available There is increasing interest in the role that schools can play in promoting education for sustainable development (ESD, and evidence is emerging that schools can be influential in the emerging agenda around the ecological, ethical and social aspects of food, diet and nutrition. With regard to such food sustainability issues, this paper analyses the role of the Food for Life Partnership national programme in supporting garden and farm-based learning activities in 55 primary schools in England, UK. Using a mixed methods approach, the study examined the programme’s implementation through staff perceptions and a range of school change indicators. The study found that the programme delivery was associated with widespread institutional reforms. According to staff, implementation of the programme provided a range of opportunities for pupils to learn about food production and sustainability, but addressing these issues was challenging for teachers and raised a number of questions concerned with effective, equitable and on-going implementation. At a pedagogical level, teachers also reflected on conceptually challenging aspects of food sustainability as a topic for primary school education. The study identified ways that ESD programmes could support schools to think about and implement learning opportunities as well as identifying significant barriers related to resourcing such programmes.

  8. An Investigation into Implementation of ICT in Primary Schools, in Kenya, in the Light of Free Laptops at Primary One: A Case Study of Teachers Implementing ICT into Their Teaching Practice

    Science.gov (United States)

    Tonui, Betty; Kerich, E.; Koross, R.

    2016-01-01

    Information and communication technologies (ICTs) have been touted as being potentially powerful tools that can be used to facilitate the implied educational change and reform. Implementation of ICT in higher education learning environments is a complex task. Teachers and students, but also management, administration and ICT support are affected…

  9. Soil Tillage Conservation and its Effect on Soil Properties Bioremediation and Sustained Production of Crops

    Science.gov (United States)

    Rusu, Teodor; Ioana Moraru, Paula; Muresan, Liliana; Andriuca, Valentina; Cojocaru, Olesea

    2017-04-01

    Soil Tillage Conservation (STC) is considered major components of agricultural technology for soil conservation strategies and part of Sustainable Agriculture (SA). Human action upon soil by tillage determines important morphological, physical-chemical and biological changes, with different intensities and evaluative directions. Nowadays, internationally is unanimous accepted the fact that global climatic changes are the results of human intervention in the bio-geo-chemical water and material cycle, and the sequestration of carbon in soil is considered an important intervention to limit these changes. STC involves reducing the number of tillage's (minimum tillage) to direct sowing (no-tillage) and plant debris remains at the soil surface in the ratio of at least 30%. Plant debris left on the soil surface or superficial incorporated contributes to increased biological activity and is an important source of carbon sequestration. STC restore soil structure and improve overall soil drainage, allowing more rapid infiltration of water into soil. The result is a soil bioremediation, more productive, better protected against wind and water erosion and requires less fuel for preparing the germinative bed. Carbon sequestration in soil is net advantageous, improving the productivity and sustainability. We present the influence of conventional plough tillage system on soil, water and organic matter conservation in comparison with an alternative minimum tillage (paraplow, chisel plow and rotary harrow) and no-tillage system. The application of STC increased the organic matter content 0.8 to 22.1% and water stabile aggregate content from 1.3 to 13.6%, in the 0-30 cm depth, as compared to the conventional system. For the organic matter content and the wet aggregate stability, the statistical analysis of the data showed, increasing positive significance of STC. While the soil fertility and the wet aggregate stability were initially low, the effect of conservation practices on the

  10. Energy balance, costs and CO2 analysis of tillage technologies in maize cultivation

    International Nuclear Information System (INIS)

    Šarauskis, Egidijus; Buragienė, Sidona; Masilionytė, Laura; Romaneckas, Kęstutis; Avižienytė, Dovile; Sakalauskas, Antanas

    2014-01-01

    To achieve energy independence, Lithuania and other Baltic countries are searching for new ways to produce energy. Maize is a crop that is suitable for both food and forage, as well as for the production of bioenergy. The objective of this work was to assess the energy efficiency of maize cultivation technologies in different systems of reduced tillage. The experimental research and energy assessment was carried out for five different tillage systems: DP (deep ploughing), SP (), DC (deep cultivation), SC (shallow cultivation) and NT (no tillage). The assessment of the fuel inputs for these systems revealed that the greatest amount of diesel fuel (67.2 l ha −1 ) was used in the traditional DP system. The reduced tillage systems required 12–58% less fuel. Lower fuel consumption reduces the costs of technological operations and reduces CO 2 emissions, which are associated with the greenhouse effect. The agricultural machinery used in reduced tillage technologies emits 107–223 kg ha −1 of CO 2 gas into the environment, whereas DP emits 253 kg ha −1 of CO 2 . The energy analysis conducted in this study showed that the greatest total energy input (approximately 18.1 GJ ha −1 ) was associated with the conventional deep-ploughing tillage technology. The energy inputs associated with the reduced-tillage technologies, namely SP, DC and SC, ranged from 17.1 to 17.6 GJ ha −1 . The lowest energy input (16.2 GJ ha −1 ) was associated with the NT technology. Energy efficiency ratios for the various technologies were calculated as a function of the yield of maize grain and biomass. The best energy balance and the highest energy efficiency ratio (14.0) in maize cultivation was achieved with the NT technology. The energy efficiency ratios for DP, SP, DC and SC were 12.4, 13.4, 11.3 and 12.0, respectively. - Highlights: • Energetical and economic analysis of maize cultivation was done. • Reduced tillage technology reduces working time, fuel consumption

  11. Sanitary state and yielding of spring barley as dependent on soil tillage method

    Directory of Open Access Journals (Sweden)

    Tomasz P. Kurowski

    2012-12-01

    Full Text Available The effects of traditional tillage cultivation (control treatment, no tillage (instead of tillage the soil was loosened with scruff, and direct sowing (with a special drill into unploughed soil on the health of spring barley cultivar. Klimek were compared in three-field crop rotation (field bean, winter wheat, spring barley in an experiment performed in the years 1997-1999 on the soil of a good wheat complex. The results of phytopathological observations carried out over the vegetation season are presented in the form of an injury index. The following diseases were recorded on spring barley: net blotch (Drechslera teres - net type and spot type, powdery mildew (Blumeria graminis, leaf blotch (Rhynchosporium secalis, eyespot (Tapesia yallundae and foot rot (fungal complex. Tillage system had no a significant influence on the occurrence of both types of net blotch. The intensity of powdery mildew and leaf blotch was the highest in the case of traditional tillage cultivation, and the lowest - in that of no tillage. Direct sowing was conductive to the development of eyespot, and no tillage - to foot rot. Fungi of the genus Fusarium, mainly F. culmorum, and the species Bipolaris sorokiniana, were isolated most frequently from infested stem bases. The weather conditions differed during spring barley grown in the three years analyzed. Mean air temperature in 1997 and 1998 was similar to the many-year average for the city of Olsztyn and its surroundings (13.8°C. In the vegetation season 1999 mean air temperature reached 14.6°C, and was considerably higher than the many-year average. Taking into account total precipitation and distribution in the three-year experimental cycle, 1997 and 1998 can be considered average, and 1999 - wet.The weather conditions had a significant effect on the intensity of all diseases observed on spring barley. The highest yield grain was obtained in the case of traditional tillage cultivation (on average 3.06 t·ha-1 for the

  12. A multiple soil ecosystem services approach to evaluate the sustainability of reduced tillage systems

    Science.gov (United States)

    Pérès, Guénola; Menasseri, Safya; Hallaire, Vincent; Cluzeau, Daniel; Heddadj, Djilali; Cotinet, Patrice; Manceau, Olivier; Pulleman, Mirjam

    2017-04-01

    In the current context of soil degradation, reduced tillage systems (including reduced soil disturbance, use of cover crops and crop rotation, and improved organic matter management) are expected to be good alternatives to conventional system which have led to a decrease of soil multi-functionality. Many studies worldwide have analysed the impact of tillage systems on different soil functions, but overran integrated view of the impact of these systems is still lacking. The SUSTAIN project (European SNOWMAN programme), performed in France and the Netherlands, proposes an interdisciplinary collaboration. The goals of SUSTAIN are to assess the multi-functionality of soil and to study how reduced-tillage systems impact on multiple ecosystem services such as soil biodiversity regulation (earthworms, nematodes, microorganisms), soil structure maintenance (aggregate stability, compaction, soil erosion), water regulation (run-off, transfer of pesticides) and food production. Moreover, a socio-economic study on farmer networks has been carried out to identify the drivers of adoption of reduced-tillage systems. Data have been collected in long-term experimental fields (5 - 13 years), representing conventional and organic farming strategies, and were complemented with data from farmer networks. The impact of different reduced tillage systems (direct seeding, minimum tillage, non-inverse tillage, superficial ploughing) were analysed and compared to conventional ploughing. Measurements (biological, chemical, physical, agronomical, water and element transfer) have been done at several dates which allow an overview of the evolution of the soil properties according to climate variation and crop rotation. A sociological approach was performed on several farms covering different production types, different courses (engagement in reduced tillage systems) and different geographical locations. Focusing on French trials, this multiple ecosystem services approach clearly showed that

  13. Multi-faceted implementation strategy to increase use of a clinical guideline for the diagnosis of deep venous thrombosis in primary care.

    Science.gov (United States)

    Kingma, Anna E C; van Stel, Henk F; Oudega, Ruud; Moons, Karel G M; Geersing, Geert-Jan

    2017-08-01

    A clinical decision rule (CDR), combined with a negative D-dimer test, can safely rule out deep venous thrombosis (DVT) in primary care. This strategy is recommended by guidelines, yet uptake by GPs is low. To evaluate a multi-faceted implementation strategy aimed at increased use of the guideline recommended CDR plus D-dimer test in primary care patients with suspected DVT. This multi-faceted implementation strategy consisted of educational outreach visits, financial reimbursements and periodical newsletters. 217 Dutch GPs (implementation group) received this strategy and included patients. Effectiveness was measured through the following patient-level outcomes: (i) proportion of non-referred patients, (ii) proportion of missed DVT cases within this group and (iii) the proportion of patients in whom the guideline was applied incorrectly. Implementation outcomes ('acceptability', 'feasibility', 'fidelity' and 'sustainability') were assessed with an online questionnaire. Patient-level outcomes were compared with those of patients included by 450 GPs, uninformed about the study's purposes providing information about usual care. 336 (54%) of 619 analyzable implementation group patients were not referred, missing 6 [1.8% (95% confidence interval 0.7% to 3.9%)] DVT cases. Incorrect guideline use was observed in 199 patients (32%). Self-reported acceptability, feasibility and expected sustainability were high. Guideline use increased from 42% to an expected continuation of use of 91%. Only 32 usual care GPs included 62 patients, making formal comparison unreliable. This multi-faceted implementation strategy safely reduced patient referral to secondary care, despite frequently incorrect application of the guideline and resulted in high acceptability, feasibility and expected sustainability. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. The development and adoption of conservation tillage systems on the Canadian Prairies

    Directory of Open Access Journals (Sweden)

    L. Awada

    2014-03-01

    Full Text Available One of the major agricultural innovations on the Canadian Prairies over the last 40 years has been the introduction of conservation tillage (CT. Conservation tillage-a system that includes minimum and zero tillage (ZT -was introduced as an alternative to traditional (conventional tillage (TT to control soil degradation and to promote agricultural sustainability. The development and adoption of CT systems involved pioneer farmers, engineers, scientists, and farmer associations. By the end of the 1970s, CT started to take shape on the Prairies, but for a number of economic, technical, political and social reasons, the adoption of CT did not occur on any major scale before the 1990s. Today, more than 75% of the Prairie's cropland is under some form of CT with more than 50% under ZT. In this paper, the factors behind the development and adoption of conservation tillage technology on the Prairies in the period between 1930 and 2011 are reviewed. Then, some of the benefits of the adoption of CT on the Prairies are highlighted. The data show that CT and ZT became profitable for the majority of farmers during and after the 1990s, and that the increased use of CT contributed to the dramatic decrease in the area under summerfallow and to the increase in the area sown to canola and pulse crops. These changes contributed to the reduction of all forms of land degradation and to decreases in agricultural greenhouse gas (GHG emissions.

  15. Cowpea production as affected by dry spells in no-tillage and conventional crop systems

    Directory of Open Access Journals (Sweden)

    Rômulo Magno Oliveira de Freitas

    2013-12-01

    Full Text Available The objective of this study was to evaluate the effect of different periods of water shortage in no-tillage and conventional crop systems on cowpea yield components and grain yield in the Mossoró-RN region. For this, an experiment was conducted using two tillage systems (conventional and no-tillage subjected to periods of irrigation suspension (2; 6; 10; 14; 18 end 22 days, started at flowering (34 days after sowing. Plants were harvested 70 days after sowing, and the studied variables were: Pods length (CV, number of grains per pod (NGV, number of pods per plant (NPP, the hundred grains weight (PCG and grain yield (kg ha-1. The no-tillage system is more productive than the conventional under both irrigation and water stress treatments. The water stress length affected grain yield and all yield components studied in a negative way, except for the hundred grains weight. Among the systems studied, the no-tillage provides higher values for the yield components, except the hundred grains weight.

  16. Response of wheat to tillage and nitrogen fertilization in rice-wheat system

    International Nuclear Information System (INIS)

    Qamar, R.; Ehsanullah, A.; Ahmad, R.; Iqbal, M.

    2012-01-01

    In a rice-wheat system, rice stubbles remaining in the field often delay early planting of winter wheat to utilize residual soil moisture and reduce operating costs. A randomized complete block design in a split plot arrangement was conducted with four seasonal tillage methods [conventional tillage, CT; deep tillage, DT; zero tillage with zone disk tiller, ZDT; and happy seeder, HS] as main plots and five N levels [0, 75, 100, 125, and 150 kg ha/sup -1/] as subplots during 2009 to 2010 and 2010 to 2011 wheat growing seasons. Results showed that DT significantly decreased soil bulk density, penetration resistance, and volumetric moisture content compared with CT, ZDT and HS. However, wheat growth and yield parameter such as fertile tillers, plant height, root length, spike length, grain yields, and water and nutrient-use efficiency was significantly higher in DT compared with other tillage treatments. Wheat growth and yield was more increased by N fertilization at 125 kg ha/sup -1/ than other N rates. However, when the wheat plant productivity index was plotted over N rates, the non-linear relationship showed that N fertilization at 80 kg N ha-1 accounted for 85% of the variability in the plant productivity under DT and HS while ZDT had the same productivity at 120 kg N ha/sup -1/. (author)

  17. Effect of tillage system on yield and weed populations of soybean ( Glycin Max L.).

    Science.gov (United States)

    Hosseini, Seyed Z; Firouzi, Saeed; Aminpanah, Hashem; Sadeghnejhad, Hamid R

    2016-03-01

    Field experiment was conducted at Agricultural and Natural Resources Research Center of Golestan Province, Iran, to determine the effects of tillage system and weed management regime on yield and weed populations in soybean ( Glycin max L.). The experimental design was a split plot where the whole plot portion was a randomized complete block with three replicates. Main plots were tillage system: 1- No-till row crop seeding, 2- No-till seed drilling, 3- Tillage with disc harrow and drill planting, 4- Tillage with chisel packer and drill planting. The subplots were weed management regimes: 1-Weed control with herbicide application, 2- Hand weeding, 3- Herbicide application plus hand weeding, and 4- Non-weeding. Results indicated that the main effects of tillage system and weed management regime were significant for seed yield, pod number per plant, seed number per pod, weed density and biomass, while their interaction were significant only for weed density, weed biomass, and seed number per pod. The highest grain yields (3838 kg ha-1) were recorded for No-till row crop seeding. The highest seed yield (3877 kg ha-1) also was recorded for weed control with herbicide and hand weeding treatment, followed by hand weeding (3379 kg ha-1).

  18. The effect of different tillage and cover crops on soil quality

    DEFF Research Database (Denmark)

    Abdollahi, Lotfollah; Munkholm, Lars Juhl

    This paper examines the effect of different tillage treatments and cover crop on soil physical, chemical and biological properties of a sandy loam soil in a long-term field trial set up in 2007 at Foulum, Denmark. The experimental design is a split plot design with different tillage practices (di...... that P improved soil quality compared to H and D, especially when combined with cover crop. We also conclude that D may benefit from cover crop to yield better soil friability and hence soil quality.......This paper examines the effect of different tillage treatments and cover crop on soil physical, chemical and biological properties of a sandy loam soil in a long-term field trial set up in 2007 at Foulum, Denmark. The experimental design is a split plot design with different tillage practices...... (direct drilling (D), harrowing (H) to a depth of 8 cm and ploughing to a depth of 20 cm (P)) as main plot. The soil was cropped with cover crop (+CC) or left without cover crop (-CC) as split plot treatments in the main plots with different tillage treatments. We assessed topsoil structural quality...

  19. Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project.

    Science.gov (United States)

    Zgierska, Aleksandra E; Vidaver, Regina M; Smith, Paul; Ales, Mary W; Nisbet, Kate; Boss, Deanne; Tuan, Wen-Jan; Hahn, David L

    2018-06-05

    Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project. A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention. Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of

  20. To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis.

    Science.gov (United States)

    Glidewell, Liz; Willis, Thomas A; Petty, Duncan; Lawton, Rebecca; McEachan, Rosemary R C; Ingleson, Emma; Heudtlass, Peter; Davies, Andrew; Jamieson, Tony; Hunter, Cheryl; Hartley, Suzanne; Gray-Burrows, Kara; Clamp, Susan; Carder, Paul; Alderson, Sarah; Farrin, Amanda J; Foy, Robbie

    2018-02-17

    Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages. We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms-mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators. Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. 'graded tasks' and 'problem solving' for educational outreach). BCTs addressing the determinants 'environmental context' and 'social and professional roles' (e.g. 'restructuring the social and 'physical environment' and 'adding objects to the environment') were indicator specific. We found it challenging to operationalise BCTs targeting 'environmental context

  1. Protocol for implementation of family health history collection and decision support into primary care using a computerized family health history system

    Directory of Open Access Journals (Sweden)

    Agbaje Astrid B

    2011-10-01

    Full Text Available Abstract Background The CDC's Family History Public Health Initiative encourages adoption and increase awareness of family health history. To meet these goals and develop a personalized medicine implementation science research agenda, the Genomedical Connection is using an implementation research (T3 research framework to develop and integrate a self-administered computerized family history system with built-in decision support into 2 primary care clinics in North Carolina. Methods/Design The family health history system collects a three generation family history on 48 conditions and provides decision support (pedigree and tabular family history, provider recommendation report and patient summary report for 4 pilot conditions: breast cancer, ovarian cancer, colon cancer, and thrombosis. All adult English-speaking, non-adopted, patients scheduled for well-visits are invited to complete the family health system prior to their appointment. Decision support documents are entered into the medical record and available to provider's prior to the appointment. In order to optimize integration, components were piloted by stakeholders prior to and during implementation. Primary outcomes are change in appropriate testing for hereditary thrombophilia and screening for breast cancer, colon cancer, and ovarian cancer one year after study enrollment. Secondary outcomes include implementation measures related to the benefits and burdens of the family health system and its impact on clinic workflow, patients' risk perception, and intention to change health related behaviors. Outcomes are assessed through chart review, patient surveys at baseline and follow-up, and provider surveys. Clinical validity of the decision support is calculated by comparing its recommendations to those made by a genetic counselor reviewing the same pedigree; and clinical utility is demonstrated through reclassification rates and changes in appropriate screening (the primary outcome

  2. Why Organization May Be the Primary Limitation to Implementing Sustainability at the Local Level: Examples from Swedish Case Studies

    Directory of Open Access Journals (Sweden)

    E. Carina H. Keskitalo

    2017-03-01

    Full Text Available Much of the effort to address environmental issues at the local level has focused on defining principles and aims rather than addressing the operational difficulties of implementation. Drawing upon insights from sustainability scholarship, this study reviews two cases: the development of a Swedish standard for implementing sustainable development at municipality, county council, and regional levels, and attempts by a small rural municipality to establish a process towards implementing the Aalborg Commitments. The research illustrates the specific organizational and managerial complexity of these case study experiences. It concludes that an organizational focus on integration and mainstreaming deserves particular attention to achieve broader sustainability, or related environmental or adaptation goals. The results, in particular, highlight the role that integrated management systems can play for sustainability work at the local level.

  3. Improved delivery of cardiovascular care (IDOCC through outreach facilitation: study protocol and implementation details of a cluster randomized controlled trial in primary care

    Directory of Open Access Journals (Sweden)

    Akbari Ayub

    2011-09-01

    Full Text Available Abstract Background There is a need to find innovative approaches for translating best practices for chronic disease care into daily primary care practice routines. Primary care plays a crucial role in the prevention and management of cardiovascular disease. There is, however, a substantive care gap, and many challenges exist in implementing evidence-based care. The Improved Delivery of Cardiovascular Care (IDOCC project is a pragmatic trial designed to improve the delivery of evidence-based care for the prevention and management of cardiovascular disease in primary care practices using practice outreach facilitation. Methods The IDOCC project is a stepped-wedge cluster randomized control trial in which Practice Outreach Facilitators work with primary care practices to improve cardiovascular disease prevention and management for patients at highest risk. Primary care practices in a large health region in Eastern Ontario, Canada, were eligible to participate. The intervention consists of regular monthly meetings with the Practice Outreach Facilitator over a one- to two-year period. Starting with audit and feedback, consensus building, and goal setting, the practices are supported in changing practice behavior by incorporating chronic care model elements. These elements include (a evidence-based decision support for providers, (b delivery system redesign for practices, (c enhanced self-management support tools provided to practices to help them engage patients, and (d increased community resource linkages for practices to enhance referral of patients. The primary outcome is a composite score measured at the level of the patient to represent each practice's adherence to evidence-based guidelines for cardiovascular care. Qualitative analysis of the Practice Outreach Facilitators' written narratives of their ongoing practice interactions will be done. These textual analyses will add further insight into understanding critical factors impacting

  4. Understanding the implementation of 'sick day guidance' to prevent acute kidney injury across a primary care setting in England: a qualitative evaluation.

    Science.gov (United States)

    Martindale, Anne-Marie; Elvey, Rebecca; Howard, Susan J; McCorkindale, Sheila; Sinha, Smeeta; Blakeman, Tom

    2017-11-08

    The study sought to examine the implementation of sick day guidance cards designed to prevent acute kidney injury (AKI), in primary care settings. Qualitative semistructured interviews were conducted and comparative analysis informed by normalisation process theory was undertaken to understand sense-making, implementation and appraisal of the cards and associated guidance. A single primary care health setting in the North of England. 29 participants took part in the qualitative evaluation: seven general practitioners, five practice nurses, five community pharmacists, four practice pharmacists, two administrators, one healthcare assistant and five patients. The sick day guidance intervention was rolled out (2015-2016) in general practices (n=48) and community pharmacies (n=60). The materials consisted of a 'medicine sick day guidance' card, provided to patients who were taking the listed drugs. The card provided advice about medicines management during episodes of acute illness. An information leaflet was provided to healthcare practitioners and administrators suggesting how to use and give the cards. Implementation of sick day guidance cards to prevent AKI entailed a new set of working practises across primary care. A tension existed between ensuring reach in administration of the cards to at risk populations while being confident to ensure patient understanding of their purpose and use. Communicating the concept of temporary cessation of medicines was a particular challenge and limited their administration to patient populations at higher risk of AKI, particularly those with less capacity to self-manage. Sick day guidance cards that focus solely on medicines management may be of limited patient benefit without adequate resourcing or if delivered as a standalone intervention. Development and evaluation of primary care interventions is urgently warranted to tackle the harm associated with AKI. © Article author(s) (or their employer(s) unless otherwise stated in the

  5. Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings.

    Science.gov (United States)

    Tanner, C; Gans, D; White, J; Nath, R; Pohl, J

    2015-01-01

    The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.

  6. Indigenous Sky Stories: Reframing How We Introduce Primary School Students to Astronomy--A Type II Case Study of Implementation

    Science.gov (United States)

    Ruddell, Nicholas; Danaia, Lena; McKinnon, David

    2016-01-01

    The Indigenous Sky Stories Program may have the potential to deliver significant and long-lasting changes to the way science is taught to Year 5 and 6 primary school students. The context for this article is informed by research that shows that educational outcomes can be strengthened when Indigenous knowledge is given the space to co-exist with…

  7. How to Support Primary Teachers' Implementation of Inquiry: Teachers' Reflections on Teaching Cooperative Inquiry-Based Science

    Science.gov (United States)

    Gillies, Robyn M.; Nichols, Kim

    2015-01-01

    Many primary teachers face challenges in teaching inquiry science, often because they believe that they do not have the content knowledge or pedagogical skills to do so. This is a concern given the emphasis attached to teaching science through inquiry where students do not simply learn about science but also do science. This study reports on the…

  8. Diagnosing pneumonia in primary care : implementation of C-reactive protein point-of-care testing in daily practice

    NARCIS (Netherlands)

    Minnaard, M.C.

    2016-01-01

    Cough is a very common symptom in the community, and lower respiratory tract infections (LRTIs) occur very frequently in all seasons. The primary goal in the diagnostic work-up of LRTI is to differentiate serious conditions like community acquired pneumonia (CAP) from self-limiting conditions and to

  9. Examining Teachers' Views on the Implementation of English as L3 into Primary Schools: A Case of Kazakhstan

    Science.gov (United States)

    Zhetpisbayeva, Bakhytgul A.; Shelestova, Tatyana Y.; Abildina, Saltanat K.

    2016-01-01

    The Ministry of Education and Science of the Republic of Kazakhstan changed the State Educational Program for primary education and the curriculum for teaching English as a third language (L3) to grades 1-4 in 2013. As with many changes in the curriculum, English language teaching has also been changed and the starting age for learning of English…

  10. The use of the international classification of functioning, disability and health in primary care: Findings of exploratory implementation throughout life

    NARCIS (Netherlands)

    I. Debrouwere (Inge); J. Lebeer (Jo); P.J. Prinzie (Peter)

    2016-01-01

    markdownabstract__Purpose:__ The International Classification of Functioning (ICF) has found widespread acceptance since it was launched in 2001. Yet, little is known about its use in Primary Care. This paper aims to contribute to the dialogue about the practical use of the ICF by exploring how this

  11. Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study

    NARCIS (Netherlands)

    Teunissen, E.; Gravenhorst, K.; Dowrick, C.; Weel-Baumgarten, E.M. van; Driessen Mareeuw, F.A. van den; Brun, T. de; Burns, N.; Lionis, C.; Mair, F.S.; O'Donnell, C.; O'Reilly-de Brún, M.P.; Papadakaki, M.; Saridaki, A.; Spiegel, W.; Weel, C. van; Muijsenbergh, M.E.T.C. van den; Macfarlane, A.

    2017-01-01

    BACKGROUND: Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this

  12. English Language Teaching in Public Primary Schools in Mexico: The Practices and Challenges of Implementing a National Language Education Program

    Science.gov (United States)

    Ramírez Romero, José Luis; Sayer, Peter; Pamplón Irigoyen, Elva Nora

    2014-01-01

    Over the past 15?years, many state governments in Mexico have initiated local programs to introduce English at the primary school level. In 2009, the Mexican Ministry of Education formalized the "Programa Nacional de Inglés en Educación Básica" (PNIEB) as part of the national curriculum, based on the argument that increasing the number…

  13. Implementing Self-Assessment in Singapore Primary Schools: Effects on Students' Perceptions of Self-Assessment

    Science.gov (United States)

    Wong, Hwei Ming

    2017-01-01

    Student academic self-assessment engages the students in deliberate reflection about what they are learning and how they are learning it. This intervention study investigated the effects of self-assessment training on students' perceptions towards self-assessment in two Singaporean primary schools. The study, which used a pretest-posttest design,…

  14. Evaluation of a tailored implementation strategy to improve the management of patients with chronic obstructive pulmonary disease in primary care: a study protocol of a cluster randomized trial.

    Science.gov (United States)

    Godycki-Cwirko, Maciek; Zakowska, Izabela; Kosiek, Katarzyna; Wensing, Michel; Krawczyk, Jaroslaw; Kowalczyk, Anna

    2014-04-04

    Chronic obstructive pulmonary disease (COPD) remains a major health problem, strongly related to smoking. Despite the publication of practice guidelines on prevention and treatment, not all patients with the disease receive the recommended healthcare, particularly with regard to smoking cessation advice where applicable. We have developed a tailored implementation strategy for enhancing general practitioners' adherence to the disease management guidelines. The primary aim of the study is to evaluate the effects of this tailored implementation intervention on general practitioners' adherence to guidelines. A pragmatic two-arm cluster randomized trial has been planned to compare care following the implementation of tailored interventions of four recommendations in COPD patients against usual care. The study will involve 18 general practices (9 in the intervention group and 9 in the control group) in Poland, each with at least 80 identified (at the baseline) patients with diagnosed COPD. The nine control practices will provide usual care without any interventions. Tailored interventions to implement four recommendations will be delivered in the remaining nine practices. At follow-up after nine months, data will be collected for all 18 general practices. The primary outcome measure is physicians' adherence to all four recommendations: brief anti-smoking advice, dyspnea assessment, care checklist utilization and demonstration to patients of correct inhaler use. This measurement will be based on data extracted from identified patients' records. Additionally, we will survey and interview patients with chronic obstructive pulmonary disease about the process of care. The results of this trial will be directly applicable to primary care in Poland and add to the growing body of evidence on interventions to improve chronic illness care. This trial has been registered with Clinical Trials Protocol Registration System. NCT01893476.

  15. Barriers to implementing the "2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis" in primary healthcare practice.

    Science.gov (United States)

    Loyola-Sanchez, Adalberto; Richardson, Julie; Pelaez-Ballestas, Ingris; Sánchez, José Guadalupe; González, Martha Alicia; Sánchez-Cruz, Juan; Jiménez-Baez, María Valeria; Nolasco-Alonso, Nancy; Alvarado, Idolina; Rodríguez-Amado, Jacqueline; Alvarez-Nemegyei, José; Wilson, Mike G

    2014-01-01

    To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  16. European Perspectives on the Adoption of Nonchemical Weed Management in Reduced-Tillage Systems for Arable Crops

    NARCIS (Netherlands)

    Melander, B.; Munier-Jolain, N.M.; Charles, R.; Wirth, J.; Schwarz, J.; Weide, van der R.Y.; Bonin, L.; Jensen, P.K.; Kudsk, P.K.

    2013-01-01

    Noninversion tillage with tine- or disc-based cultivations prior to crop establishment is the most common way of reducing tillage for arable cropping systems with small grain cereals, oilseed rape, and maize in Europe. However, new regulations on pesticide use might hinder further expansion of

  17. [Effects of conservation tillage on soil CO2 and N2O emission during the following winter-wheat season].

    Science.gov (United States)

    Pan, Ying; Hu, Zheng-Hu; Wu, Yang-Zhou; Sun, Yin-Yin; Sheng, Lu; Chen, Shu-Tao; Xiao, Qi-Tao

    2014-07-01

    In order to study the effect of conservation tillage on soil CO2 and N2O emissions in the following crop-growing season, field experiments were conducted in the winter wheat-growing season. Four treatments were conventional tillage (T), no-tillage with no straw cover (NT), no-tillage with straw cover (NTS), and conventional tillage with straw incorporation (TS), respectively. The CO2 and N2O fluxes were measured using a static chamber-gas chromatograph technique. The results showed that in the following winter wheat-growing season, conservation tillage did not change the seasonal pattern of CO2 and N2O emission fluxes from soil, and had no significant effect on crop biomass. Conservation tillage significantly reduced the accumulative amount of CO2 and N2O. Compared with the T treatment, the accumulative amount of CO2 under TS, NT, and NTS treatments were reduced by 5.95% (P = 0.132), 12.94% (P = 0.007), and 13.91% (P = 0.004), respectively, and the accumulative amount of N2O were significantly reduced by 31.23% (P = 0.000), 61.29% (P = 0.000), and 33.08% (P = 0.000), respectively. Our findings suggest that conservation tillage significantly reduced CO2 and N2O emission from soil in the following winter wheat-growing season.

  18. Long-term conventional and no-tillage effects on field hydrology and yields of a dryland crop rotation

    Science.gov (United States)

    Semiarid dryland crop yields with no-till, NT, residue management are often greater than stubble-mulch, SM, tillage as a result of improved soil conditions and water conservation, but information on long-term tillage effects on field hydrology and sustained crop production are needed. Our objective ...

  19. Are we ready for the challenge of implementing risk-based breast cancer screening and primary prevention?

    NARCIS (Netherlands)

    Rainey, L.; Waal, D. van der; Jervaeus, A.; Wengstrom, Y.; Evans, D.G.; Donnelly, L.S.; Broeders, M.J.M.

    2018-01-01

    BACKGROUND: Increased knowledge of breast cancer risk factors provides opportunities to shift from a one-size-fits-all screening programme to a personalised approach, where screening and prevention is based on a woman's risk of developing breast cancer. However, potential implementation of this new

  20. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

    Directory of Open Access Journals (Sweden)

    Sylvie Provost

    2017-04-01

    Full Text Available Introduction: Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. Methods: We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. Results: A total of 1689 patients took part in the study (60.1% participation rate. Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992, we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. Conclusion: Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.

  1. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

    Science.gov (United States)

    Provost, Sylvie; Pineault, Raynald; Grimard, Dominique; Pérez, José; Fournier, Michel; Lévesque, Yves; Desforges, Johanne; Tousignant, Pierre; Borgès Da Silva, Roxane

    2017-04-01

    Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics, to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. A total of 1689 patients took part in the study (60.1% participation rate). Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992), we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.

  2. Experimental analysis of CO2 emissions from agricultural soils subjected to five different tillage systems in Lithuania

    International Nuclear Information System (INIS)

    Buragienė, Sidona; Šarauskis, Egidijus; Romaneckas, Kęstutis; Sasnauskienė, Jurgita; Masilionytė, Laura; Kriaučiūnienė, Zita

    2015-01-01

    Intensive agricultural production strongly influences the global processes that determine climate change. Thus, tillage can play a very important role in climate change. The intensity of soil carbon dioxide (CO 2 ) emissions, which contribute to the greenhouse effect, can vary depending on the following factors: the tillage system used, meteorological conditions (which vary in different regions of the world), soil properties, plant residue characteristics and other factors. The main purpose of this research was to analyse and assess the effects of autumn tillage systems with different intensities on CO 2 emissions from soils during different seasons and under the climatic conditions of Central Lithuania. The research was conducted at the Experimental Station of Aleksandras Stulginskis University from 2009 to2012; and in 2014. The soils at the experimental site were classified as Eutric Endogleyic Planosol (Drainic). The investigations were conducted using five tillage systems with different intensities, typical of the Baltic Region. Deep conventional ploughing was performed at a depth of 230–250 mm, shallow ploughing was conducted at a depth of 120–150 mm, deep loosening was conducted at depths of 250–270 mm, and shallow loosening was conducted at depths of 120–150 mm. The fifth system was a no-tillage system. Overall, autumn tillage resulted in greater CO 2 emissions from the soil over both short- and long-term periods under the climatic conditions of Central Lithuania, regardless of the tillage system applied. The highest soil CO 2 emissions were observed for the conventional deep ploughing tillage system, and the lowest emissions were observed for the no-tillage system. The meteorological conditions greatly influenced the CO 2 emissions from the soil during the spring. Soil CO 2 emissions were enhanced as precipitation and the air and soil temperatures increased. Long-term investigations regarding the dynamics of CO 2 emissions from soils during the

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

    Science.gov (United States)

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

    2018-01-01

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

  4. Long-term rotation and tillage effects on soil structure and crop yield

    DEFF Research Database (Denmark)

    Munkholm, Lars Juhl; Heck, R; Deen, B

    2013-01-01

    long-term rotation and tillage treatment experiment on a Canadian silt loam soil. Topsoil measurements were carried out for three different rotations: R1, (C–C–C–C) continuous corn (Zea mays L.), R6, (C–C–O(RC), B(RC)) corn, corn, oats (Avena fatua L.) and spring barley (Hordeum vulgare L.) and R8, (C......–C–S–S) corn, corn, soybean (Glycine max L.), soybean. A red clover (Trifolium pretense L.) cover crop was under seeded in oats and spring barley in R6. In 2010, first year corn was grown in R6 and R8. The tillage treatments included no tillage, NT and mouldboard ploughing, MP. Topsoil structural quality...

  5. RESEARCHES REGARDING TO CONTROL SPECIES CONVOLVULUS ARVENSIS L. ON RELATION WITH SOIL TILLAGE SYSTEMS

    Directory of Open Access Journals (Sweden)

    Teodor RUSU

    2007-07-01

    Full Text Available The research paper presents the results obtained in the pedoclimatic conditions of Cluj-Napoca, Romania, concerning the control of Convolvulus arvensis L species. To determine or accomplish the relation with soil tillage systems and herbicides applied on soy-bean, wheat and maize crop. Minimum tillage systems determine an increasing percentage of Convolvulus arvensis species at weeding, different depending on experimental variant and on crop: 11.2-39.1% at soy-bean, 0.9-4.2% at wheat and 11.9-24.4% at maize crop. The number of Convolvulus arvensis seeds increases with 169% at tillage variant with disk + rotary harrow, 77% of these being located in the first 10 cm soil depth.

  6. Assessing Tillage Effects on Soil Hydraulic Properties via Inverse Parameter Estimation using Tension Infiltrometry

    Science.gov (United States)

    Schwen, Andreas; Bodner, Gernot; Loiskandl, Willibald

    2010-05-01

    Hydraulic properties are key factors controlling water and solute movement in soils. While several recent studies have focused on the assessment of the spatial variability of hydraulic properties, the temporal dynamics are commonly not taken into account, primarily because its measurement is costly and time-consuming. However, there is extensive empirical evidence that these properties are subject to temporal changes, particularly in the near-saturated range where soil structure strongly influences water flow. One main source of temporal variability is soil tillage. It can improve macroporosity by loosening the soil and thereby changing the pore-size distribution. Since these modifications are quite unstable over time, the pore space partially collapses after tillage. This effect should be largest for conventional tillage (CT), where the soil is ploughed after harvest every year. Assessing the effect of different tillage treatments on the temporal variability of hydraulic properties requires adequate measurement techniques. Tension infiltrometry has become a popular and convenient method providing not only the hydraulic conductivity function but also the soil rentention properties. The inverse estimation of parameters from infiltration measurements remains challenging, despite some progress since the first approach of Šimůnek et al. (1998). Measured data like the cumulative infiltration, the initial and final volumetric water content, as well as independently measured retention data from soil core analysis with laboratory methods, have to be considered to find an optimum solution describing the soil's pore space. In the present study we analysed tension infiltration measurements obtained several times between August 2008 and December 2009 on an arable field in the Moravian Basin, Lower Austria. The tillage treatments were conventional tillage including ploughing (CT), reduced tillage with chisel only (RT), and no-tillage treatment using a direct seeding

  7. A simplified modelling approach for quantifying tillage effects on soil carbon stocks

    DEFF Research Database (Denmark)

    Chatskikh, Dmitri; Hansen, Søren; Olesen, Jørgen E.

    2009-01-01

    Soil tillage has been shown to affect long-term changes in soil organic carbon (SOC) content in a number of field experiments. This paper presents a simplified approach for including effects of tillage in models of soil C turnover in the tilled-soil layer. We used an existing soil organic matter...... (SOM) model (CN-SIM) with standard SOC data for a homogeneous tilled layer from four long-term field experiments with conventionally tilled (CT) and no-till (NT) treatments. The SOM model was tested on data from long-term (>10 years) field trials differing in climatic conditions, soil properties......, residue management and crop rotations in Australia, Brazil, the USA and Switzerland. The C input for the treatments was estimated using data on crop rotation and residue management. The SOM model was applied for both CT and NT trials without recalibration, but incorporated a 'tillage factor' (TF) to scale...

  8. Relating soil microbial activity to water content and tillage-induced differences in soil structure

    DEFF Research Database (Denmark)

    Schjønning, Per; Thomsen, Ingrid Kaag; Petersen, Søren O

    2011-01-01

    Several studies have identified optima in soil water content for aerobic microbial activity, and this has been ascribed to a balance between gas and solute diffusivity as limiting processes. We investigated the role of soil structure, as created by different tillage practices (moldboard ploughing......, MP, or shallow tillage, ST), in regulating net nitrification, applied here as an index of aerobic microbial activity. Intact soil cores were collected at 0–4 and 14–18 cm depth from a fine sandy (SAND) and a loamy (LOAM) soil. The cores were drained to one of seven matric potentials ranging from − 15...... content to a maximum and then decreased. This relationship was modelled with a second order polynomium. Model parameters did not show any tillage effect on the optimum water content, but the optimum coincided with a lower matric potential in ST (SAND: − 140 to –197 hPa; LOAM: − 37 to − 65 hPa) than in MP...

  9. Effects of different tillage and transplanting methods on rice rooting ability

    International Nuclear Information System (INIS)

    Ren Wanjun; Yang Wenyu; Fan Gaoqiong; Wu Jinxiu; Wang Lihong

    2007-01-01

    Effects of different tillage and transplanting methods on rice rooting ability were studied with the methods of water culture and 3 H labeling. The results showed that the dynamic curve of rooting ability had single peak during growth period, and the peak of root length per plant, root number and root dry weight appeared at booting. With conventional tillage and transplanting method, the rice plant had the strongest rooting ability, under non-tillage treatment (BCSNT), the rooting ability was the lowest during elongating to heading. After 10d of heading, the dry weight and 3 H specific activity of BCSNT was higher than other treatments, at the same time, the percentage of 3 H assimilate at new root was the highest. Dry weight was positively correlated with percentage of 3 H assimilate of new root, while negatively with percentage of 3 H assimilate of panicle. (authors)

  10. Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory.

    Science.gov (United States)

    Bamford, Claire; Poole, Marie; Brittain, Katie; Chew-Graham, Carolyn; Fox, Chris; Iliffe, Steve; Manthorpe, Jill; Robinson, Louise

    2014-11-08

    Case management has been suggested as a way of improving the quality and cost-effectiveness of support for people with dementia. In this study we adapted and implemented a successful United States' model of case management in primary care in England. The results are reported elsewhere, but a key finding was that little case management took place. This paper reports the findings of the process evaluation which used Normalization Process Theory to understand the barriers to implementation. Ethnographic methods were used to explore the views and experiences of case management. Interviews with 49 stakeholders (patients, carers, case managers, health and social care professionals) were supplemented with observation of case managers during meetings and initial assessments with patients. Transcripts and field notes were analysed initially using the constant comparative approach and emerging themes were then mapped onto the framework of Normalization Process Theory. The primary focus during implementation was on the case managers as isolated individuals, with little attention being paid to the social or organizational context within which they worked. Barriers relating to each of the four main constructs of Normalization Process Theory were identified, with a lack of clarity over the scope and boundaries of the intervention (coherence); variable investment in the intervention (cognitive participation); a lack of resources, skills and training to deliver case management (collective action); and limited reflection and feedback on the case manager role (reflexive monitoring). Despite the intuitive appeal of case management to all stakeholders, there were multiple barriers to implementation in primary care in England including: difficulties in embedding case managers within existing well-established community networks; the challenges of protecting time for case management; and case managers' inability to identify, and act on, emerging patient and carer needs (an essential, but

  11. Barriers and facilitators to HPV vaccination in primary care practices: a mixed methods study using the Consolidated Framework for Implementation Research.

    Science.gov (United States)

    Garbutt, Jane M; Dodd, Sherry; Walling, Emily; Lee, Amanda A; Kulka, Katharine; Lobb, Rebecca

    2018-05-07

    In the United States, the effective, safe huma papilloma virus (HPV) vaccine is underused and opportunities to prevent cancer continue to be missed. National guidelines recommend completing the 2-3 dose HPV vaccine series by age 13, well before exposure to the sexually transmitted virus. Accurate characterization of the facilitators and barriers to full implementation of HPV vaccine recommendations in the primary care setting could inform effective implementation strategies. We used the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors that influence HPV vaccine use in 10 primary care practices (16 providers) using a concurrent mixed methods design. The CFIR was used to guide collection and analysis of qualitative data collected through in-person semi-structured interviews with the primary care providers. We analyzed HPV vaccine use with data abstracted from medical charts. Constructs that most strongly influenced vaccine use were identified by integrating the qualitative and quantitative data. Of the 72 CFIR constructs assessed, seven strongly distinguished and seven weakly distinguished between providers with higher versus lower HPV vaccine coverage. The majority of strongly distinguishing constructs were facilitators and were related to characteristics of the providers (knowledge and beliefs; self-efficacy; readiness for change), their perception of the intervention (relative advantage of vaccinating younger vs. older adolescents), and their process to deliver the vaccine (executing). Additional weakly distinguishing constructs that were facilitators were from outer setting (peer pressure; financial incentives), inner setting (networks and communications and readiness for implementation) and process (planning; engaging, and reflecting and evaluating). Two strongly distinguishing constructs were barriers to use, one from the intervention (adaptability of the age of initiation) and the other from outer

  12. Intensity-modulated arc therapy with simultaneous integrated boost in the treatment of primary irresectable cervical cancer. Treatment planning, quality control, and clinical implementation

    Energy Technology Data Exchange (ETDEWEB)

    Vandecasteele, Katrien; De Neve, Wilfried; De Gersem, Werner; Paelinck, Leen; Fonteyne, Valerie; De Wagter, Carlos; De Meerleer, Gert [Dept. of Radiotherapy, Ghent Univ. Hospital (Belgium); Delrue, Louke; Villeirs, Geert [Dept. of Radiology, Ghent Univ. Hospital (Belgium); Makar, Amin [Dept. of Gynecology, Ghent Univ. Hospital (Belgium)

    2009-12-15

    Purpose: to report on the planning procedure, quality control, and clinical implementation of intensity-modulated arc therapy (IMAT) delivering a simultaneous integrated boost (SIB) in patients with primary irresectable cervix carcinoma. Patients and methods: six patients underwent PET-CT (positron emission tomography-computed tomography) and MRI (magnetic resonance imaging) before treatment planning. Prescription (25 fractions) was (1) a median dose (D{sub 50}) of 62, 58 and 56 Gy to the primary tumor (GTVcervix), primary clinical target volume (CTVcervix) and its planning target volume (PTVcervix), respectively; (2) a D{sub 50} of 60 Gy to the PET-positive lymph nodes (GTVnodes); (3) a minimal dose (D{sub 98}) of 45 Gy to the planning target volume of the elective lymph nodes (PTVnodes). IMAT plans were generated using an anatomy-based exclusion tool with the aid of weight and leaf position optimization. The dosimetric delivery of IMAT was validated preclinically using radiochromic film dosimetry. Results: five to nine arcs were needed to create valid IMAT plans. Dose constraints on D{sub 50} were not met in two patients (both GTVcervix: 1 Gy and 3 Gy less). D{sub 98} for PTVnodes was not met in three patients (1 Gy each). Film dosimetry showed excellent gamma evaluation. There were no treatment interruptions. Conclusion: IMAT allows delivering an SIB to the macroscopic tumor without compromising the dose to the elective lymph nodes or the organs at risk. The clinical implementation is feasible. (orig.)

  13. Effect of different tillage intensity on yields and yield-forming factors in winter wheat

    Directory of Open Access Journals (Sweden)

    Martin Houšť

    2012-01-01

    Full Text Available The paper presents results of a study on application of minimum tillage technologies when growing winter wheat. Experiments were performed in the sugar-beet-growing region with loamy chernozem within the period of 2005–2009. Aanalysed and evaluated were effects of different methods of soil processing on yield-forming factors in stands of winter wheat grown after three different preceding crops (i.e. alfalfa, maize for silage and pea. Evaluated were the following four variants of tillage: (1 conventional ploughing to the depth of 0.22 m (Variant 1; (2 ploughing to the depth of 0.15 m (Variant 2; (3 direct sowing into the untilled soil (Variant 3, and (4 shallow tillage to the depth of 0.10 m (Variant 4.The effect of different tillage intensity on winter wheat yields was statistically non-significant after all forecrops. After alfalfa, the highest and the lowest average yields were recorded in Variant 2 (i.e. with ploughing to the depth of 0.15 m and Variant 3 (direct sowing into the untilled soil, respectively. After maize grown for silage, higher yields were obtained in Variant 2 and Variant 1 (conventional ploughing while in Variants 4 and 3 the obtained yields were lower. When growing winter wheat after pea as a preceding crop, the highest and the lowest average yields were recorded after direct sowing (Variant 3 and in Variant 1 (i.e. ploughing to the depth of 0.22 m, respectively. Results of studies on effect of different tillage technologies on yields of winter wheat crops indicate that under the given pedological and climatic conditions it is possible to apply methods of reduced tillage intensity. However, the choice of the corresponding technology must be performed with regard to the type of preceding crop.

  14. Impact of tillage, plant population and mulches on phenological characters of maize

    International Nuclear Information System (INIS)

    Gul, B.; Khan, M.A.; Khan, H.

    2014-01-01

    Field experiments were conducted during 2006 and 2007 in Peshawar, using open pollinated maize variety Azam in RCB design having 3 factors viz., tillage, maize populations and mulches with split-split plot arrangements. Tillage levels (zero and conventional) were assigned to the main plots, populations (90000, 60000 and 30000 plants ha/sup -1/) to sub-plots and four types of mulches (weeds mulch, black plastic mulch, white plastic mulch and mungbean as living mulch), a hand weeding and a weedy check were allotted to sub-sub plots, respectively. Data were recorded on days to tasseling, days to silking, days to maturity, leaf area of maize plant-1 (cm/sub 2/) and plant height (cm). Tillage affected leaf area of maize, where zero tillage resulted lower leaf area of 4094 cm/sub 2/ compared to conventional tillage (4722 cm/sub 2/). Different levels of plant populations affected all the physiological parameters. Days to tasseling, silking and maturity were more in higher plant population as compared to medium and lower plant population. Similarly, minimum leaf area plant-1 was recorded in higher plant population (3894 cm/sub 2/) than medium and lower plant population of 4398 and 4932 cm/sub 2/, respectively. Maximum plant height was recorded in hand weeding treatment (173 cm). However, it was statistically at par with black plastic mulch (171 cm), followed by weeds mulch (162 cm) and white plastic mulch (161 cm) as compared to weedy check (152 cm). Based on two years study it is suggested that even if tillage options and plant populations are a part of the weed management program, it should not be used as a sole management tool, as both have a negative impact on the phenological parameters of maize which subsequently affected the final yield and must be integrated and supplemented with other control methods. (author)

  15. Using the diffusion of innovations theory to assess socio-technical factors in planning the implementation of an electronic health record alert across multiple primary care clinics.

    Science.gov (United States)

    Lin, Ching-Pin; Guirguis-Blake, Janelle; Keppel, Gina A; Dobie, Sharon; Osborn, Justin; Cole, Allison M; Baldwin, Laura-Mae

    2016-04-15

    Adverse drug events (ADEs) are a leading cause of death in the United States. Patients with stage 3 and 4 chronic kidney disease (CKD) are at particular risk because many medications are cleared by the kidneys. Alerts in the electronic health record (EHR) about drug appropriateness and dosing at the time of prescription have been shown to reduce ADEs for patients with stage 3 and 4 CKD in inpatient settings, but more research is needed about the implementation and effectiveness of such alerts in outpatient settings.  To explore factors that might inform the implementation of an electronic drug-disease alert for patients with CKD in primary care clinics, using Rogers' diffusion of innovations theory as an analytic framework. Interviews were conducted with key informants in four diverse clinics using various EHR systems. Interviews were audio recorded and transcribed. results Although all clinics had a current method for calculating glomerular filtration rate (GFR), clinics were heterogeneous with regard to current electronic decision support practices, quality improvement resources, and organizational culture and structure. Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.

  16. The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Oyun Chimeddamba

    2016-04-01

    Full Text Available (1 Background: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2 Methods: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3 Results: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4 Conclusions: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines.

  17. Effects of different tillage and straw return on soil organic carbon in a rice-wheat rotation system.

    Directory of Open Access Journals (Sweden)

    Liqun Zhu

    Full Text Available Soil management practices, such as tillage method or straw return, could alter soil organic carbon (C contents. However, the effects of tillage method or straw return on soil organic C (SOC have showed inconsistent results in different soil/climate/cropping systems. The Yangtze River Delta of China is the main production region of rice and wheat, and rice-wheat rotation is the most important cropping system in this region. However, few studies in this region have been conducted to assess the effects of different tillage methods combined with straw return on soil labile C fractions in the rice-wheat rotation system. In this study, a field experiment was used to evaluate the effects of different tillage methods, straw return and their interaction on soil total organic C (TOC and labile organic C fractions at three soil depths (0-7, 7-14 and 14-21 cm for a rice-wheat rotation in Yangzhong of the Yangtze River Delta of China. Soil TOC, easily oxidizable C (EOC, dissolved organic C (DOC and microbial biomass C (MBC contents were measured in this study. Soil TOC and labile organic C fractions contents were significantly affected by straw returns, and were higher under straw return treatments than non-straw return at three depths. At 0-7 cm depth, soil MBC was significantly higher under plowing tillage than rotary tillage, but EOC was just opposite. Rotary tillage had significantly higher soil TOC than plowing tillage at 7-14 cm depth. However, at 14-21 cm depth, TOC, DOC and MBC were significantly higher under plowing tillage than rotary tillage except for EOC. Consequently, under short-term condition, rice and wheat straw both return in rice-wheat rotation system could increase SOC content and improve soil quality in the Yangtze River Delta.

  18. Effects of Tillage on Yield and Economic Returns of Maize and Cowpea in Semi-Arid Eastern Kenya

    International Nuclear Information System (INIS)

    Miriti, M.J; Kironchi, G; Gachene, K.K.C; Esilaba, O.A.; Mwangi, M.D; Nyamwaro, S.O; Heng, K.L

    2014-01-01

    Crop yields and financial returns are important criteria for adoption of conservation tillage by farmers. A study was conducted between 2007-2010 to compare the financial returns of subsoiling-ripping and tied-ridge tillage with the conventional ox-plough tillage in the production of maize (Zea mays L.) and cowpea (Vigna unguiculata L.) under semi-arid subsistence farming conditions in lower eastern Kenya. Four cropping systems namely maize sole crop, cowpea sole crop, maize/cowpea intercrop and maize sole crop with manure were evaluated in a split-plot treatments arrangement with tillage practices as the main plots and cropping systems as the sub-plots. The grain yields of maize and cowpea, prevailing market prices for cowpea and maize grains, labour, inputs applied and other relevant socio-economic data were collected every season, to enable estimation of economic returns and acceptability of the technologies. The results showed that average grain yield for maize sole crop, cowpea sole crop, maize/cowpea intercrop and maize sole crop with manure cropping systems under tied-ridge were 5, 9, 97 and 27% greater than the yields under oxplough tillage, respectively. Crop yields produced under subsoiling-ripping and ox-plough tillage were generally similar. However, land preparation and weeding labour expenses (KES 4240 / ha) for ox-plough tillage were 34% greater than those for subsoiling-ripping tillage but 40% lower than those for tied-ridge tillage. When averaged across seasons and tillage systems, the highest gross margins (KES 8567 / ha) were obtained in sole cowpea cropping system, followed by sole maize with manure (KES 4070 / ha), intercrop (KES 864 / ha) and least (loss of KES 1330 / ha) in sole maize without manure cropping system. (author)

  19. Private primary care physicians' perspectives on factors affecting the adoption of electronic medical records: a qualitative pre-implementation study.

    Science.gov (United States)

    Or, Calvin; Wong, Katie; Tong, Ellen; Sek, Antonio

    2014-01-01

    Use of electronic medical records (EMR) has the potential to offer quality and safety benefits, but without the adoption of the technology, the benefits will not be realized. This study aimed to identify the factors perceived as relevant by private physicians when considering EMR adoption. A qualitative pre-implementation study was conducted using semi-structured, face to face interviews to explore the perspectives of physicians (n=16) operating in private clinics on the factors affecting their adoption of EMR. A multilevel, work system approach and the immersion/crystallization data analysis technique guided the researchers in examining the data, identifying patterns and key themes, and extracting representative quotes to illustrate these themes. The major factors associated with EMR adoption, which relate to the five categories of a work system, were system usefulness; user interface design; technical support; cost; system reliability; the privacy, confidentiality, and security of patient information; physical space in the clinic; data migration process; adverse work-related factors; and the computer and systems skills of physicians. Pre-implementation identification of factors important to adoption can allow system developers to focus proactively on these factors when developing the system and its implementation strategies, to maximize the likelihood of successful introduction.

  20. Sediment yield control in vineyards covered with cereal. Effect of tillage

    International Nuclear Information System (INIS)

    Ruiz-Colmenero, M.; Bienes, R.; Marques, M. J.

    2009-01-01

    A study has been carried out about the use of plant cover treatment to avoid land degradation in a hillside rainfed vineyard in Madrid under Mediterranean semiarid climate. Three treatments were tested: traditional tillage (lab) soil covered by Brachypodium distrachyon (bra) with self-sowing, soil covered by Scale cereale (sec) mown in Spring. Three erosion plots per treatment were placed in the middle of the strips and 2 simulated rainfalls were carried out at each plot in autumn, before and after the tillage. (Author) 7 refs.

  1. Potential and economic efficiency of using reduced tillage to mitigate climate effects in Danish agriculture

    DEFF Research Database (Denmark)

    Zandersen, Marianne; Jørgensen, Sisse Liv; Nainggolan, Doan

    2016-01-01

    , research also suggests that soil carbon stocks are declining. The scope of Payment for Ecosystem Service (PES) approaches to effectively and efficiently address climate regulation will depend on the spatial distribution of the carbon assimilation capacity, current land use, the value of avoided emissions...... and compare these to the marginal abatement costs curve used in Danish climate policy. The cost effectiveness of reduced tillage as a climate mitigation PES scheme critically depends on the current debate on the net effects of carbon sequestration in reduced tillage practices. Based on existing IPCC...

  2. Reducing tillage intensity affects the cumulative emergence dynamics of annual grass weeds in winter cereals

    DEFF Research Database (Denmark)

    Scherner, A; Melander, B; Jensen, P K

    2017-01-01

    Annual grass weeds such as Apera spica-venti and Vulpia myuros are promoted in non-inversion tillage systems and winter cereal-based crop rotations. Unsatisfactory weed control in these conditions is often associated with a poor understanding of the emergence pattern of these weed species. The aim...... with a higher total emergence seen under direct drilling, followed by pre-sowing tine cultivation and ploughing. The emergence patterns of all species were differently influenced by the tillage systems, suggesting that under direct drilling, in which these species occur simultaneously, management interventions...

  3. Atributos físicos do solo em sistemas de manejo de solo e de rotação de culturas Soil tillage and crop rotation systems on the soil physical attributes

    Directory of Open Access Journals (Sweden)

    Silvio Tulio Spera

    2009-01-01

    attributes were assessed after twenty years of implementation (1985 to 2005 on a typical Dystrophic Red Latosol (Rodic Hapludox located in Passo Fundo, Rio Grande do Sul State, Brazil. Four soil tillage systems were evaluated: 1 no-tillage; 2 minimum tillage; 3 conventional tillage using a disk plow plus disk harrow, and 4 conventional tillage using a moldboard plow plus disk harrow. Three crop rotation systems were evaluated: I (wheat/soybean, II (wheat/soybean and common vetch/corn or sorghum, and III (wheat/soybean, common vetch/corn or sorghum and white oats/soybean. A randomized complete block design, with split-plots and three replicates, was used. The main plots were formed by the soil tillage systems, while split-plots were composed by crop rotation systems. As control, soil samples were collected in a subtropical forest fragment adjacent to the experiment. Soil tillage systems and crop rotation systems influenced soil physical parameters when compared to the samples collected in a fragment of subtropical forest. During four years (2001 to 2005 the physical attributes were altered among different soil tillage management. The no-tillage system (PD presented higher soil bulk density and microporosity in comparison to the other systems, mainly in 0.10 to 0.15 m layer, characterizing high soil compaction levels. Crop systems did not promote favorable changes in physical attributes independent of the type of soil management.

  4. Problems and Guidelines of Strategy Implementation in Basic Educational Institutions under the Supervision of KhonKaen Primary Educational Service Area Office 4

    Directory of Open Access Journals (Sweden)

    Sasiwan Tonkanya

    2016-09-01

    Full Text Available The research aimed to 1 study problems of strategy implementation in basic educational institutions under Khonkaen Primary Educational Service Area Office 4 ; and 2 propose the guidelines for strategy implementation in basic educational institutions under Khonkaen Primary Educational Service Area Office 4. The study was carried out in 2 phases. In phase 1, it focused on the study and analysis of the strategic implementation problems and phase 2 studied the best practice schools. The informants for the interview in phase 1 comprised 6 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized schools. They were selected by the use of purposive sampling technique. The population in the study of the strategic implementation problems in basic educational institutions in phase 1 consisted of 543 school administrators and teachers who were involved in strategy implementation from 181 schools under Khonkaen Primary Educational Service Area Office 4 in academic year 2014. The study samples were 217 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized schools under Khonkaen Primary Educational Service Area Office 4. The samples were selected by the use of stratified sampling technique. The informants of the phase 2 study were 6 school administrators and teachers who were involved in strategy implementation from small-sized, medium-sized, and large-sized best practice schools obtained from purposive sampling technique. The research instruments used for data collection consisted of 2 sets of questionnaires. The Set 1 questionnaire was the 5-point Likert scale on the levels of the problems in implementation with item discrimination at 0.60 – 1.00 and reliability of the whole questionnaire at .9359. The questionnaire contained 3 parts with 65 items. The Set 2 questionnaire comprised 2 parts with 10 items regarding

  5. IMPaCT Back study protocol. Implementation of subgrouping for targeted treatment systems for low back pain patients in primary care: a prospective population-based sequential comparison

    Directory of Open Access Journals (Sweden)

    Foster Nadine E

    2010-08-01

    Full Text Available Abstract Background Prognostic assessment tools to identify subgroups of patients at risk of persistent low back pain who may benefit from targeted treatments have been developed and validated in primary care. The IMPaCT Back study is investigating the effects of introducing and supporting a subgrouping for targeted treatment system in primary care. Methods/Design A prospective, population-based, quality improvement study in one Primary Care Trust in England with a before and after design. Phases 1 and 3 collect data on current practice, attitudes and behaviour of health care practitioners, patients' outcomes and health care costs. Phase 2 introduces and supports the subgrouping for targeted treatment system, via a multi-component, quality improvement intervention that includes educational courses and outreach visits led by opinion leaders, audit/feedback, mentoring and organisational support to embed the subgrouping tools within IT and clinical management systems. We aim to recruit 1000 low back pain patients aged 18 years and over consulting 7 GP practices within one Primary Care Trust in England, UK. The study includes GPs in participating practices and physiotherapists in associated services. The primary objective is to determine the effect of the subgrouping for targeted treatment system on back pain related disability and catastrophising at 2 and 6 months, comparing data from phase 1 with phase 3. Key secondary objectives are to determine the impact on: a GPs' and physiotherapists' attitudes and behaviour regarding low back pain; b The process of care that patients receive; c The cost-effectiveness and sustainability of the new clinical system. Discussion This paper details the rationale, design, methods, planned analysis and operational aspects of the IMPaCT Back study. We aim to determine whether the new subgrouping for targeted treatment system is implemented and sustained in primary care, and evaluate its impact on clinical decision

  6. A randomised controlled trial of an intervention to increase the implementation of a healthy canteen policy in Australian primary schools: study protocol.

    Science.gov (United States)

    Wolfenden, Luke; Nathan, Nicole; Williams, Christopher M; Delaney, Tessa; Reilly, Kathryn L; Freund, Megan; Gillham, Karen; Sutherland, Rachel; Bell, Andrew C; Campbell, Libby; Yoong, Serene; Wyse, Rebecca; Janssen, Lisa M; Preece, Sarah; Asmar, Melanie; Wiggers, John

    2014-10-11

    The implementation of healthy school canteen policies has been recommended as a strategy to help prevent unhealthy eating and excessive weight gain. Internationally, research suggests that schools often fail to implement practices consistent with healthy school canteen policies. Without a population wide implementation, the potential benefits of these policies will not be realised. The aim of this trial is to assess the effectiveness of an implementation intervention in increasing school canteen practices consistent with a healthy canteen policy of the New South Wales (NSW), Australia, government known as the 'Fresh Tastes @ School NSW Healthy School Canteen Strategy'. The parallel randomised trial will be conducted in 70 primary schools located in the Hunter region of New South Wales, Australia. Schools will be eligible to participate if they are not currently meeting key components of the healthy canteen policy. Schools will be randomly allocated after baseline data collection in a 1:1 ratio to either an intervention or control group using a computerised random number function in Microsoft Excel. Thirty-five schools will be selected to receive a multi-component intervention including implementation support from research staff, staff training, resources, recognition and incentives, consensus and leadership strategies, follow-up support and implementation feedback. The 35 schools allocated to the control group will not receive any intervention support as part of the research trial. The primary outcome measures will be i) the proportion of schools with a canteen menu that does not contain foods or beverages restricted from regular sale ('red' and 'banned' items) and ii) the proportion of schools where healthy canteen items ('green' items) represent the majority (>50%) of products listed on the menu. Outcome data will be collected via a comprehensive menu audit, conducted by dietitians blind to group allocation. Intervention effectiveness will be assessed using

  7. Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study.

    Science.gov (United States)

    Keurhorst, M; Heinen, M; Colom, J; Linderoth, C; Müssener, U; Okulicz-Kozaryn, K; Palacio-Vieira, J; Segura, L; Silfversparre, F; Słodownik, L; Sorribes, E; Laurant, M; Wensing, M

    2016-06-07

    Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important T&S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information

  8. Lasting impact of an implemented self-management programme for people with type 2 diabetes referred from primary care: a one-group, before-after design.

    Science.gov (United States)

    Fløde, Mari; Iversen, Marjolein M; Aarflot, Morten; Haltbakk, Johannes

    2017-12-01

    Research interventions in uniform clinical settings and in patients fulfilling well-defined inclusion criteria might show a more pronounced effect than implementing the same intervention in existing practice. Diabetes Self-Management Education (DSME) is complex, and should be assessed in existing practice as it is an intervention widely implemented. To examine the impact of an established group-based DSME in unselected people with type 2 diabetes referred from primary care. A one-group, before-after design was used for assessments before, immediately after, and 3 months after participation in a group-based DSME programme conducted at two Learning and Mastering Centres in Norway between November 2013 and June 2014. Participants completed a questionnaire before (n = 115), immediately after (n = 95) and 3 months after (n = 42) the DSME programme. Primary outcome measure was diabetes knowledge (Michigan Diabetes Knowledge Test). Also patient activation (Patient Activation Measure [PAM]) and self-efficacy (General Self-Efficacy scale [GSE]) were measured. Changes in outcome measures were analysed using paired t-tests for normally distributed data and Wilcoxon signed-rank test for skewed data. Mean knowledge improved significantly from baseline (p < 0.001). Changes persisted at the 3-month assessment. Mean PAM scores improved significantly from baseline (p < 0.001), and changes persisted for 3 months. Mean GSE scores improved from baseline (p = 0.022) and persisted for 3 months. However, when results were stratified for participants who responded at all three time points, GSE showed no change during the study period. The complexity self-management in the individual is challenging to reflect in DSME. This implemented DSME programme for people with type 2 diabetes improved levels of diabetes knowledge and patient activation, persisting for at least 3 months. Hence, the DSME programme appears to be robust beyond standardised research settings, in educating unselected

  9. Genetically Guided Statin Therapy on Statin Perceptions, Adherence, and Cholesterol Lowering: A Pilot Implementation Study in Primary Care Patients

    Directory of Open Access Journals (Sweden)

    Josephine H. Li

    2014-03-01

    Full Text Available Statin adherence is often limited by side effects. The SLCO1B1*5 variant is a risk factor for statin side effects and exhibits statin-specific effects: highest with simvastatin/atorvastatin and lowest with pravastatin/rosuvastatin. The effects of SLCO1B1*5 genotype guided statin therapy (GGST are unknown. Primary care patients (n = 58 who were nonadherent to statins and their providers received SLCO1B1*5 genotyping and guided recommendations via the electronic medical record (EMR. The primary outcome was the change in Beliefs about Medications Questionnaire, which measured patients’ perceived needs for statins and concerns about adverse effects, measured before and after SLCO1B1*5 results. Concurrent controls (n = 59 were identified through the EMR to compare secondary outcomes: new statin prescriptions, statin utilization, and change in LDL-cholesterol (LDL-c. GGST patients had trends (p = 0.2 towards improved statin necessity and concerns. The largest changes were the “need for statin to prevent sickness” (p < 0.001 and “concern for statin to disrupt life” (p = 0.006. GGST patients had more statin prescriptions (p < 0.001, higher statin use (p < 0.001, and greater decrease in LDL-c (p = 0.059 during follow-up. EMR delivery of SLCO1B1*5 results and recommendations is feasible in the primary care setting. This novel intervention may improve patients’ perceptions of statins and physician behaviors that promote higher statin adherence and lower LDL-c.

  10. Implementing core NICE guidelines for osteoarthritis in primary care with a model consultation (MOSAICS): a cluster randomised controlled trial.

    Science.gov (United States)

    Dziedzic, K S; Healey, E L; Porcheret, M; Afolabi, E K; Lewis, M; Morden, A; Jinks, C; McHugh, G A; Ryan, S; Finney, A; Main, C; Edwards, J J; Paskins, Z; Pushpa-Rajah, A; Hay, E M

    2018-01-01

    To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice. Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England. 525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differences in quality indicator outcomes were assessed using logistic regression. 525 eligible participants were enrolled (mean age 67.3 years, SD 10.5; 59.6% female): 288 from intervention and 237 from control practices. There were no statistically significant differences in SF-12 PCS: mean difference at the 6-month primary endpoint was -0.37 (95% CI -2.32, 1.57). Uptake of core NICE recommendations by 6 months was statistically significantly higher in the intervention arm compared with control: e.g., increased written exercise information, 20.5% (7.9, 28.3). Whilst uptake of core NICE recommendations was increased, there was no evidence of benefit of this intervention, as delivered in this pragmatic randomised trial, on the primary outcome of physical functioning at 6 months. ISRCTN06984617. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Which Clinical Guidelines Should Be Implemented for Management of Osteopenia in Primary Care? A Clin-IQ

    Directory of Open Access Journals (Sweden)

    Turia Hollingsworth

    2014-11-01

    Full Text Available Literature review was conducted to determine clinical guidelines for osteopenia management of immunocompetent patients in the primary care setting. It was concluded that pharmacological treatment should be offered to patients with osteopenia if they are considered high risk, which can be determined by utilizing the World Health Organization Fracture Risk Assessment Tool (FRAX® to evaluate 10-year risk. Patients with a calculated hip fracture probability of at least 3% or those with probability of 20% or more for all osteoporotic fractures may be offered bisphosphonate therapy.

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

    Science.gov (United States)

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

    2012-04-15

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

  13. Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers.

    Science.gov (United States)

    Hermes, Eric; Burrone, Laura; Perez, Elliottnell; Martino, Steve; Rowe, Michael

    2018-05-18

    Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop

  14. Implementation of a anti-coincidence system of 4πNaI(Tl)-Cl and primary standardization of 57Co, 124Sb and 241Am

    International Nuclear Information System (INIS)

    Silva, Carlos Jose da; Iwahara, Akira; Poledna, Roberto; Oliveira, Estela Maria de; Prinzio, Maria Antonieta de; Lopes, Ricardo Tadeu

    2009-01-01

    The Radionuclide Metrology Laboratory of the IRD-Brazil, implemented a primary standardization system which utilizes the anti-coincidence technique with live time keeping. For testing the performance of these system it was made the standardization of the 57 Co, 124 Sb and 241 Am. Encourages results were obtained not only the standardization of 241 Am but also of the 124 Sb whose reference value obtained by the LNMRI was utilized for the key comparison organized by the IAEA and EURAMET. The standard uncertainties were of 0.28%, 0.22% and 0.13% for the 57 Co, 124 Sb and 241 Am, respectively

  15. 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...

  16. Extent of Parent-Teacher Association Involvement in the Implementation of Universal Basic Education Program in Primary Schools in Northern Senatorial District of Ondo State, Nigeria

    Directory of Open Access Journals (Sweden)

    Chidi Nnebedum

    2018-05-01

    Full Text Available Pupil’ absenteeism and lateness to school, dilapidated and shortage of relevant facilities in primary schools in the Northern Senatorial District of Ondo State seems to suggest lapses in parent-teacher association involvement in school affairs. This prompted the researchers to ascertain the extent of parent-teacher association (PTA involvement in the implementation of universal basic education program in primary schools in the Northern Senatorial District of Ondo State. Three research questions guided the study and three null hypotheses were tested. The descriptive survey research design was adopted for the study. The population of the study was comprised of all 250 head teachers and all PTA members at all 250 primary schools in the Northern Senatorial District. Multiple stage sampling technique was used to sample 205 respondents made up of 75 head teachers and 130 PTA members. The researchers developed an instrument titled “Parent-Teacher Association Involvement in School Questionnaire (PTAISQ” which was used for data collection. The instrument was validated by three experts. The reliability of the instrument was ascertained using Cronbach alpha and it yielded an overall reliability coefficient value of .76. Mean and standard deviation were used to answer the research questions, while t-test was used to test the null hypotheses at .05 level of significance. The findings of the study revealed among others that the extent of PTA involvement in maintenance of facilities in the implementation of universal basic education program in primary schools in the Northern Senatorial District of Ondo State was high. Based on the findings, recommendations were made and conclusions were drawn.

  17. Teachers’ Experiences of the Implementation of the Curriculum and Assessment Policy Statement (CAPS in Three Primary Schools in KwaZulu Natal

    Directory of Open Access Journals (Sweden)

    Lokesh R. Maharajh

    2016-12-01

    Full Text Available This article examined on teachers’ experiences on the implementation of CAPS, using three primary schools in KwaZulu-Natal. This article employed the curriculum theory as an analytical framework. The aim of this article is to examine teacher’s experiences of the implementation of the Curriculum and Assessment Policy Statement (CAPS. The article employed a qualitative research design to gather data. The data gathered through the use of semi-structured face to face interviews with teachers. The findings of the article reveal that there are many dynamics and possibilities relating to curriculum change in South Africa. The findings of the article further reveal that despite the challenges facing CAPS, South Africa’s education system as a whole is plagued by challenges. The challenges are attributed to lack of resources and poorly trained teachers. The article concludes that understanding these dynamics depend, to a large extent, on paying attention to constraints and challenges influencing curriculum change. This article fills the knowledge-gap with reference to teacher’s first-hand knowledge of CAPS and the challenges associated with it. The article thus recommends that appropriate resources should be made available in order to ensure efficient and effective implementation of curriculum implementation. It also recommends that a teacher: learner ratio of 1:30 should be practiced to ensure that teachers give special attention to each learner.

  18. Understanding the implementation and adoption of an information technology intervention to support medicine optimisation in primary care: qualitative study using strong structuration theory.

    Science.gov (United States)

    Jeffries, Mark; Phipps, Denham; Howard, Rachel L; Avery, Anthony; Rodgers, Sarah; Ashcroft, Darren

    2017-05-10

    Using strong structuration theory, we aimed to understand the adoption and implementation of an electronic clinical audit and feedback tool to support medicine optimisation for patients in primary care. This is a qualitative study informed by strong structuration theory. The analysis was thematic, using a template approach. An a priori set of thematic codes, based on strong structuration theory, was developed from the literature and applied to the transcripts. The coding template was then modified through successive readings of the data. Clinical commissioning group in the south of England. Four focus groups and five semi-structured interviews were conducted with 18 participants purposively sampled from a range of stakeholder groups (general practitioners, pharmacists, patients and commissioners). Using the system could lead to improved medication safety, but use was determined by broad institutional contexts; by the perceptions, dispositions and skills of users; and by the structures embedded within the technology. These included perceptions of the system as new and requiring technical competence and skill; the adoption of the system for information gathering; and interactions and relationships that involved individual, shared or collective use. The dynamics between these external, internal and technological structures affected the adoption and implementation of the system. Successful implementation of information technology interventions for medicine optimisation will depend on a combination of the infrastructure within primary care, social structures embedded in the technology and the conventions, norms and dispositions of those utilising it. Future interventions, using electronic audit and feedback tools to improve medication safety, should consider the complexity of the social and organisational contexts and how internal and external structures can affect the use of the technology in order to support effective implementation. © Article author(s) (or their

  19. Effect of tillage and planting date on seasonal abundance and diversity of predacious ground beetles in cotton.

    Science.gov (United States)

    Shrestha, R B; Parajulee, M N

    2010-01-01

    A 2-year field study was conducted in the southern High Plains region of Texas to evaluate the effect of tillage system and cotton planting date window on seasonal abundance and activity patterns of predacious ground beetles. The experiment was deployed in a split-plot randomized block design with tillage as the main-plot factor and planting date as the subplot factor. There were two levels for each factor. The two tillage systems were conservation tillage (30% or more of the soil surface is covered with crop residue) and conventional tillage. The two cotton planting date window treatments were early May (normal planting) and early June (late planting). Five prevailing predacious ground beetles, Cicindela sexguttata F., Calosoma scrutator Drees, Pasimachus spp., Pterostichus spp., and Megacephala Carolina L. (Coleoptera: Carabidae), were monitored using pitfall traps at 2-week intervals from June 2002 to October 2003. The highest total number of ground beetles (6/trap) was observed on 9 July 2003. Cicindela sexguttata was the dominant ground dwelling predacious beetle among the five species. A significant difference between the two tillage systems was observed in the abundances of Pterostichus spp. and C. sexguttata. In 2002. significantly more Pterostichus spp. were recorded from conventional plots (0.27/trap) than were recorded from conservation tillage plots (0.05/trap). Significantly more C. sexguttata were recorded in 2003 from conservation plots (3.77/trap) than were recorded from conventional tillage plots (1.04/trap). There was a significant interaction between year and tillage treatments. However, there was no significant difference in the abundances of M. Carolina and Pasimachus spp. between the two tillage practices in either of the two years. M. Carolina numbers were significantly higher in late-planted cotton compared with those observed in normal-planted cotton. However, planting date window had no significant influence on the activity patterns of the

  20. Implementation and evaluation of the 5As framework of obesity management in primary care: design of the 5As Team (5AsT) randomized control trial.

    Science.gov (United States)

    Campbell-Scherer, Denise L; Asselin, Jodie; Osunlana, Adedayo M; Fielding, Sheri; Anderson, Robin; Rueda-Clausen, Christian F; Johnson, Jeffrey A; Ogunleye, Ayodele A; Cave, Andrew; Manca, Donna; Sharma, Arya M

    2014-06-19

    Obesity is a pressing public health concern, which frequently presents in primary care. With the explosive obesity epidemic, there is an urgent need to maximize effective management in primary care. The 5As of Obesity Management™ (5As) are a collection of knowledge tools developed by the Canadian Obesity Network. Low rates of obesity management visits in primary care suggest provider behaviour may be an important variable. The goal of the present study is to increase frequency and quality of obesity management in primary care using the 5As Team (5AsT) intervention to change provider behaviour. The 5AsT trial is a theoretically informed, pragmatic randomized controlled trial with mixed methods evaluation. Clinic-based multidisciplinary teams (RN/NP, mental health, dietitians) will be randomized to control or the 5AsT intervention group, to participate in biweekly learning collaborative sessions supported by internal and external practice facilitation. The learning collaborative content addresses provider-identified barriers to effective obesity management in primary care. Evidence-based shared decision making tools will be co-developed and iteratively tested by practitioners. Evaluation will be informed by the RE-AIM framework. The primary outcome measure, to which participants are blinded, is number of weight management visits/full-time equivalent (FTE) position. Patient-level outcomes will also be assessed, through a longitudinal cohort study of patients from randomized practices. Patient outcomes include clinical (e.g., body mass index [BMI], blood pressure), health-related quality of life (SF-12, EQ5D), and satisfaction with care. Qualitative data collected from providers and patients will be evaluated using thematic analysis to understand the context, implementation and effectiveness of the 5AsT program. The 5AsT trial will provide a wide range of insights into current practices, knowledge gaps and barriers that limit obesity management in primary practice

  1. A Practical Risk Stratification Approach for Implementing a Primary Care Chronic Disease Management Program in an Underserved Community.

    Science.gov (United States)

    Xu, Junjun; Williams-Livingston, Arletha; Gaglioti, Anne; McAllister, Calvin; Rust, George

    2018-01-01

    The use of value metrics is often dependent on payer-initiated health care management incentives. There is a need for practices to define and manage their own patient panels regardless of payer to participate effectively in population health management. A key step is to define a panel of primary care patients with high comorbidity profiles. Our sample included all patients seen in an urban academic family medicine clinic over a two-year period. The simplified risk stratification was built using internal electronic health record and billing system data based on ICD-9 codes. There were 347 patients classified as high-risk out of the 5,364 patient panel. Average age was 59 years (SD 15). Hypertension (90%), hyperlipidemia (62%), and depression (55%) were the most common conditions among high-risk patients. Simplified risk stratification provides a feasible option for our team to understand and respond to the nuances of population health in our underserved community.

  2. Chances and Limitations of Implementing Measures of Differentiation for Gifted Children in Primary Schools: The Teachers’ Part

    Directory of Open Access Journals (Sweden)

    Martina Endepohls-Ulpe

    2014-06-01

    Full Text Available The presented study analyzes German primary school teachers’ attitudes towards several measures of internal differentiation with re-spect to the anticipated benefit for gifted pupils and the anticipated work load for teachers. Be-sides, correlations of these attitudes with teach-ers’ statements on the frequency of adopting the measures in their own classes were inspected. One-hundred thirty-seven teachers and teacher students were interviewed with a questionnaire on the assessed consequences and the fre-quency of the usage of several methods of dif-ferentiation. Data analysis was done by anal-yses of variance and calculation of Pearson cor-relation coefficients. Results show that teachers, as well as teacher students, mostly assessed the listed measures of internal differentiation to be appropriate for the promotion of gifted pupils, but for teachers there were significant negative correlations between assessed work load and frequency of usage in their own classes.

  3. Implementation and Evaluation of Two Educational Strategies to Improve Screening for Eating Disorders in Pediatric Primary Care.

    Science.gov (United States)

    Gooding, Holly C; Cheever, Elizabeth; Forman, Sara F; Hatoun, Jonathan; Jooma, Farah; Touloumtzis, Currie; Vernacchio, Louis

    2017-05-01

    Routine screening for disordered eating or body image concerns is recommended by the American Academy of Pediatrics. We evaluated the ability of two educational interventions to increase screening for eating disorders in pediatric primary care practice, predicting that the "active-learning" group would have an increase in documented screening after intervention. We studied 303 practitioners in a large independent practice association located in the northeastern United States. We used a quasi-experimental design to test the effect of printed educational materials ("print-learning" group, n = 280 participants) compared with in-person shared learning followed by on-line spaced education ("active-learning" group, n = 23 participants) on documented screening of adolescents for eating disorder symptoms during preventive care visits. A subset of 88 participants completed additional surveys regarding knowledge of eating disorders, comfort screening for, diagnosing, and treating eating disorders, and satisfaction with their training regarding eating disorders. During the preintervention period, 4.5% of patients seen by practitioners in both the print-learning and active-learning groups had chart documentation of screening for eating disorder symptoms or body image concerns. This increased to 22% in the active-learning group and 5.7% in the print-learning group in the postintervention period, a statistically significant result. Compared with print-learning participants, active-learning group participants had greater eating disorder knowledge scores, increases in comfort diagnosing eating disorders, and satisfaction with their training in this area. In-person shared learning followed by on-line spaced education is more effective than print educational materials for increasing provider documentation of screening for eating disorders in primary care. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  4. Implementation of the program of preventive examinations at primary health care in the city of Zagreb 2009-2013.

    Science.gov (United States)

    Bajs, Maja Marić; Štimac, Danijela; Marić, Nikolina

    2014-12-01

    The program covered all persons who had not been in contact with a physician for two years or had failed to notice symptoms themselves or to timely respond to the symptoms observed. The aim of the present study was to analyze the results of the program and try to draw conclusions regarding the necessity further implementation. This paper analyzes data on a cohort of 1375 subjects aged 45+, collected on preventive examinations by family physicians during the 2009-2013 period. Results show 24.4% smokers and 15.5% former smokers. Up to three alcoholic drinks per week consumed 18.5% respondents (27.8% male and 11.2% female). Overweight (body mass index 25-30) was recorded in 50.6% and 38.6%, obesity (body mass index >30) in 30.1% and 29.4%, hypertension in 14.6% and 11.8%, isolated systolic hypertension in 20.5% and 17.4%, and isolated diastolic hypertension in 3.3% and 3.0% of male and female subjects, respectively. Suspicion of one or more newly diagnosed disease was recorded in 52.9% (95% CI 50.2-55.5) of study subjects. Fifty-four subjects (7.4%; 95% CI 5.5-9.3) were suspected to have neoplasm and they were immediately referred for further diagnostic evaluation. Timely manner suspicion of malignant disease is of crucial influence on the course of treatment and outcome of the disease. The study results confirm the importance of continuing the implementation of prevention programs.

  5. [Diversity of soil fauna in corn fields in Huang-Huai-Hai Plain of China under effects of conservation tillage].

    Science.gov (United States)

    Zhu, Qiang-Gen; Zhu, An-Ning; Zhang, Jia-Bao; Zhang, Huan-Chao; Huang, Ping; Zhang, Cong-Zhi

    2009-10-01

    An investigation was made on the abundance and diversity of soil fauna in the corn fields under conventional and conservation tillage in Huang-Huai-Hai Plain of China. The abundance and diversity of soil fauna were higher at corn maturing (September) than at its jointing stage (July), and higher at jointing stage under conservation tillage than under conventional tillage. Soil fauna mainly distributed in surface soil layer (0-10 cm), but still had a larger number in 10-20 cm layer under conservation tillage. The individuals of acari, diptera, diplura, and microdrile oligochaetes, especially those of acari, were higher under conservation tillage than under conventional tillage. At maturing stage, an obvious effect of straw-returning under conservation tillage was observed, i. e., the more the straw returned, the higher the abundance of soil fauna, among which, the individuals of collembola, acari, coleopteran, and psocoptera, especially those of collembolan, increased significantly. The abundance of collembola at both jointing and maturing stages was significantly positively correlated with the quantity of straw returned, suggesting that collembola played an important role in straw decomposition and nutrient cycling.

  6. Effects of tillage on the activity density and biological diversity of carabid beetles in spring and winter crops.

    Science.gov (United States)

    Hatten, Timothy D; Bosque-Pérez, Nilsa A; Labonte, James R; Guy, Stephen O; Eigenbrode, Sanford D

    2007-04-01

    The effects of tillage regimen (conventional [CT] and no-tillage [NT]) on the activity density and diversity of carabid beetles (Coleoptera: Carabidae) was studied by pitfall trapping within a rain-fed cropping system in northwestern Idaho, 2000-2002. The cropping rotation consisted of a spring cereal (barley, Hordeum vulgare L., in 2000 and 2001; and wheat, Triticum aestivum L., in 2002), spring dry pea (Pisum sativum L.) 2000-2002, and wheat (T. aestivum), spring in 2000 and 2001, and winter in 2002. A total of 14,480 beetles comprised of 30 species was captured, with five numerically dominant species [Poecilus scitulus L., Poecilus lucublandus Say, Microlestes linearis L., Pterostichus melanarius Ill., and Calosoma cancellatum (Eschscholtz)], accounting for 98% of all captures. All species including the dominants responded idiosyncratically to tillage regimen. Adjusting for trapping biases did not significantly change seasonal activity density of Poecilus spp. or Pt. melanarius to tillage. More beetles were captured in CT than in NT crops because of the dominance of P. scitulus in CT, whereas species richness and biological diversity were generally higher in NT crops. Observed patterns suggest that direct effects of tillage affected some species, whereas indirect effects related to habitat characteristics affected others. CT may provide habitat preferable to xerophilic spring breeders. A relationship was found between beetle species size and tillage regimen in pea and to a lesser extent across all spring crops, with large species (>14 mm) conserved more commonly in NT, small species (tillage systems.

  7. Yield and water use efficiencies of maize and cowpea as affected by tillage and cropping systems in semi-arid Eastern Kenya

    International Nuclear Information System (INIS)

    Miriti, M.J; Kironchi, G; Gachene, K.K.C; Esilaba, O.A.; Mwangi, M.D; Heng, K.L

    2012-01-01

    Soil water conservation through tillage is widely accepted as one of the ways of improving crop yields in rainfed agriculture. Field experiments were conducted between 2007 and 2009 to evaluate the effects of conservation tillage on the yields and crop water use efficiency of maize (Zea mays L.) and cowpea (Vigna unguiculata L.) in eastern Kenya. Experimental treatments were a combination of three tillage practices and four cropping systems. Tillage practices were tied-ridges, subsoiling-ripping and ox-ploughing. The cropping systems were single crop maize, single crop cowpea, intercropped maize.cowpea and single crop maize with manure. The treatments were arranged in split plots with tillage practices as the main plots and cropping systems as the sub-plots in a Randomized Complete Block Design (RCBD). The results showed that tied-ridge tillage had the greatest plant available water content while subsoiling-ripping tillage had the least in all seasons. Averaged across seasons and cropping season, tillage did not have a significant effects on maize grain yield but it did have a significant effect on crop grain and dry matter water use efficiency (WUE). Nevertheless, maize grain yields and WUE values were generally greater under tied-ridge tillage than under subsoiling-ripping and ox-plough tillages. The yields and WUE of cowpea under subsoiling-ripping tillage were less than those of ox-plough tillage. When averaged across the seasons and tillage systems, the cropping system with the manure treatment increased (P.0.05) maize grain yield, grain WUE and dry matter WUE by 36%, 30%, 26% respectively, compared to treatments without manure. Maize and cowpea when intercropped under ox-plough and ripping tillage systems did not have any yield advantage over the single crop

  8. Effects of tillage operations and plant density on leaf spot disease ...

    African Journals Online (AJOL)

    Two seasons experiments conducted in 2002 and 2003 revealed that Tillage operations significantly influenced leafspot disease severity; Percentage lodging 3.14; 2.08 and Grain yield 3.02; 3.84 in 2002 and 2003 respectively. Plant density also had significant difference on leafspot disease severity; Percentage lodging ...

  9. Sediment and PM10 flux from no-tillage cropping systems in the Pacific Northwest

    Science.gov (United States)

    Wind erosion is a concern in the Inland Pacific Northwest (PNW) United States where the emission of fine particulates from winter wheat – summer fallow (WW/SF) dryland cropping systems during high winds degrade air quality. Although no-tillage cropping systems are not yet economically viable, these ...

  10. Did tillage erosion play a role in millennial scale landscape development?

    NARCIS (Netherlands)

    Baartman, J.E.M.; Temme, A.J.A.M.; Schoorl, J.M.; Braakhekke, M.H.A.; Veldkamp, A.

    2012-01-01

    Landscape evolution models (LEMs) quantitatively simulate processes of sedimentation and erosion on millennial timescales. An important aspect of human impact on erosion is sediment redistribution due to agriculture, referred to herein as tillage erosion. In this study we aim to analyse the

  11. Tillage effects on soil quality after three years of irrigation in Northern Spain

    Science.gov (United States)

    Irrigation is being initiated on large areas of traditionally rainfed land to meet increasing global demand for food, feed, fiber, and fuel. However, the consequences of this transition on soil quality (SQ) have scarcely been studied. Therefore, after previously identifying the most tillage-sensitiv...

  12. Soil and water conservation in the Pacific Northwest through no-tillage and intensified crop rotations

    Science.gov (United States)

    The winter wheat (Triticum aestivum L.) summer fallow rotation typically practiced in the intermediate precipitation zone [300-450 mm (12-18 in)] of the inland Pacific Northwest has proven to be economically stable for producers in this region. However multiple tillage operations are used to control...

  13. Reducing CO2 flux by decreasing tillage in Ohio: overcoming conjecture with data

    Science.gov (United States)

    Soil could become an important sink for atmospheric carbon dioxide (CO2) as global agricultural greenhouse gas emissions continue to grow, but data to support this conjecture are few. Sequestering soil carbon (C) depends upon many factors including soil type, climate, crop, tillage, nitrogen fertili...

  14. Effect of inoculum density and soil tillage on the development and severity of rhizoctonia root rot.

    Science.gov (United States)

    Schroeder, K L; Paulitz, T C

    2008-03-01

    Rhizoctonia spp. cause substantial yield losses in direct-seeded cereal crops compared with conventional tillage. To investigate the mechanisms behind this increased disease, soils from tilled or direct-seeded fields were inoculated with Rhizoctonia spp. at population densities from 0.8 to 250 propagules per gram and planted with barley (Hordeum vulgare). The incidence and severity of disease did not differ between soils with different tillage histories. Both R. solani AG-8 and R. oryzae stunted plants at high inoculum densities, with the latter causing pre-emergence damping-off. High inoculum densities of both species stimulated early production of crown roots in barley seedlings. Intact soil cores from these same tilled and direct-seeded fields were used to evaluate the growth of Rhizoctonia spp. from colonized oat seeds. Growth of R. oryzae was not affected by previous tillage history. However, R. solani AG-8 grew more rapidly through soil from a long-term direct-seeded field compared to tilled soils. The differential response between these two experiments (mixed, homogenized soil versus intact soil) suggests that soil structure plays a major role in the proliferation of R. solani AG-8 through soils with different tillage histories.

  15. Differential responses of nitrate reducer community size, structure, and activity to tillage systems.

    Science.gov (United States)

    Chèneby, D; Brauman, A; Rabary, B; Philippot, L

    2009-05-01

    The main objective of this study was to determine how the size, structure, and activity of the nitrate reducer community were affected by adoption of a conservative tillage system as an alternative to conventional tillage. The experimental field, established in Madagascar in 1991, consists of plots subjected to conventional tillage or direct-seeding mulch-based cropping systems (DM), both amended with three different fertilization regimes. Comparisons of size, structure, and activity of the nitrate reducer community in samples collected from the top layer in 2005 and 2006 revealed that all characteristics of this functional community were affected by the tillage system, with increased nitrate reduction activity and numbers of nitrate reducers under DM. Nitrate reduction activity was also stimulated by combined organic and mineral fertilization but not by organic fertilization alone. In contrast, both negative and positive effects of combined organic and mineral fertilization on the size of the nitrate reducer community were observed. The size of the nitrate reducer community was a significant predictor of the nitrate reduction rates except in one treatment, which highlighted the inherent complexities in understanding the relationships the between size, diversity, and structure of functional microbial communities along environmental gradients.

  16. Integrating soil physical and biological properties in contrasting tillage