WorldWideScience

Sample records for rationale process outcome

  1. Interprofessional education and the basic sciences: Rationale and outcomes.

    Science.gov (United States)

    Thistlethwaite, Jill E

    2015-01-01

    Interprofessional education (IPE) aims to improve patient outcomes and the quality of care. Interprofessional learning outcomes and interprofessional competencies are now included in many countries' health and social care professions' accreditation standards. While IPE may take place at any time in health professions curricula it tends to focus on professionalism and clinical topics rather than basic science activities. However generic interprofessional competencies could be included in basic science courses that are offered to at least two different professional groups. In developing interprofessional activities at the preclinical level, it is important to define explicit interprofessional learning outcomes plus the content and process of the learning. Interprofessional education must involve interactive learning processes and integration of theory and practice. This paper provides examples of IPE in anatomy and makes recommendations for course development and evaluation. © 2015 American Association of Anatomists.

  2. Rationale for Using Social Media to Collect Patient-Reported Outcomes in Patients with Celiac Disease.

    Science.gov (United States)

    Park, Kt; Harris, Merissa; Khavari, Nasim; Khosla, Chaitan

    2014-02-01

    Patients with celiac disease (CD) are increasingly interconnected through social media, exchanging patient experiences and health-tracking information between individuals through various web-based platforms. Social media represents potentially unique communication interface between gastroenterologists and active social media users - especially young adults and adolescents with celiac disease-regarding adherence to the strict gluten-free diet, gastrointestinal symptoms, and meaningful discussion about disease management. Yet, various social media platforms may be underutilized for research purposes to collect patient-reported outcomes data. In this commentary, we summarize the scientific rationale and potential for future growth of social media in patient-reported outcomes research, focusing on college freshmen with celiac disease as a case study and provide overview of the methodological approach. Finally, we discuss how social media may impact patient care in the future through increasing mobile technology use.

  3. Development of a Publicly Available, Comprehensive Database of Fiber and Health Outcomes: Rationale and Methods.

    Directory of Open Access Journals (Sweden)

    Kara A Livingston

    Full Text Available Dietary fiber is a broad category of compounds historically defined as partially or completely indigestible plant-based carbohydrates and lignin with, more recently, the additional criteria that fibers incorporated into foods as additives should demonstrate functional human health outcomes to receive a fiber classification. Thousands of research studies have been published examining fibers and health outcomes.(1 Develop a database listing studies testing fiber and physiological health outcomes identified by experts at the Ninth Vahouny Conference; (2 Use evidence mapping methodology to summarize this body of literature. This paper summarizes the rationale, methodology, and resulting database. The database will help both scientists and policy-makers to evaluate evidence linking specific fibers with physiological health outcomes, and identify missing information.To build this database, we conducted a systematic literature search for human intervention studies published in English from 1946 to May 2015. Our search strategy included a broad definition of fiber search terms, as well as search terms for nine physiological health outcomes identified at the Ninth Vahouny Fiber Symposium. Abstracts were screened using a priori defined eligibility criteria and a low threshold for inclusion to minimize the likelihood of rejecting articles of interest. Publications then were reviewed in full text, applying additional a priori defined exclusion criteria. The database was built and published on the Systematic Review Data Repository (SRDR™, a web-based, publicly available application.A fiber database was created. This resource will reduce the unnecessary replication of effort in conducting systematic reviews by serving as both a central database archiving PICO (population, intervention, comparator, outcome data on published studies and as a searchable tool through which this data can be extracted and updated.

  4. Pedagogical and didactical rationale of phonemic stimulation process in pre-school age children

    Directory of Open Access Journals (Sweden)

    López, Yudenia

    2010-01-01

    Full Text Available The paper describes the main results of a regional research problem dealing with education in pre-school age. It examines the effectiveness of the didactic conception of the process of phonemic stimulation in children from 3 to 5 years old. The pedagogical and didactic rationale of the process, viewed from the evolutionary, ontogeny, systemic perspective is explained. Likewise, possible scaffolding is illustrated. The suggested procedures focus the provision of support on a systematic and purposely practice which involve first the discrimination of non-verbal sounds and the discrimi-nation of verbal sound later, aiming to the creation of a phonological consciousness.

  5. Comparative analysis of rationale used by dentists and patient for final esthetic outcome of dental treatment.

    Science.gov (United States)

    Reddy, S Varalakshmi; Madineni, Praveen Kumar; Sudheer, A; Gujjarlapudi, Manmohan Choudary; Sreedevi, B; Reddy, Patelu Sunil Kumar

    2013-05-01

    To compare and evaluate the perceptions of esthetics among dentists and patients regarding the final esthetic outcome of a dental treatment. Esthetics is a matter of perception and is associated with the way different people look at an object. What constitutes esthetic for a particular person may not be acceptable for another. Hence it is subjective in nature. This becomes more obvious during the post-treatment evaluation of esthetics by dentist and the concerned patient. Opinion seldom matches. Hence, the study is a necessary part of the process of understanding the mind of dentist and patient regarding what constitutes esthetics. A survey has been conducted by means of a questionnaire consisting of 10 questions, on two groups of people. First group consists of 100 dentists picked at random in Kanyakumari district of Tamil Nadu, India. Second group consisted of 100 patients who required complete denture prosthesis. The second group was divided into two subgroups A and B. Subgroup A consisting of 50 men and subgroup B consisting of 50 women. In each subgroup 25 patients were selected in age group of 40 to 50 and 25 patients were selected in the age group of 50 to 60. The questionnaire was given to both the groups and asked to fill up, which was then statistically analyzed to look for patterns of thought process among them. Results were subjected to statistical analysis by Student's t-test. Perceptions of esthetics differs from dentist who is educated regarding esthetic principles of treatment and a patient who is not subjected to such education. Since, the questions were formulated such that patients could better understand the underlying problem, the final outcome of survey is a proof that dentists need to take into account what the patient regards as esthetics in order to provide a satisfactory treatment. CLINICAL AND ACADEMIC SIGNIFICANCE: The current study helps the dentist to better educate the patient regarding esthetics so that patient appreciates the final

  6. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study : rationale and methods

    NARCIS (Netherlands)

    Kaplan, Bonnie J.; Giesbrecht, Gerald F.; Leung, Brenda M. Y.; Field, Catherine J.; Dewey, Deborah; Bell, Rhonda C.; Manca, Donna P.; O'Beirne, Maeve; Johnston, David W.; Pop, Victor J.; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P.; Eliasziw, Misha; McCargar, Linda J.; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M.; Letourneau, Nicole; Martin, Jonathan W.

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their

  7. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study : Rationale and methods

    NARCIS (Netherlands)

    Kaplan, B.J.; Giesbrecht, G.F.; Leung, B.M.; Field, C.J.; Dewey, D.; Bell, R.C.; Manca, D.P.; O'Beirne, M.; Johnston, D.W.; Pop, V.J.M.; Singhal, N.; Gagnon, L.; Bernier, F.P.; Eliasziw, M.; McCargar, L.J.; Kooistra, L.; Farmer, A.; Cantell, M.; Goonewardene, L.; Casey, L.M.; Letourneau, N.; Martin, J.W.

    2014-01-01

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their

  8. Placentophagy among women planning community births in the United States: Frequency, rationale, and associated neonatal outcomes.

    Science.gov (United States)

    Benyshek, Daniel C; Cheyney, Melissa; Brown, Jennifer; Bovbjerg, Marit L

    2018-05-02

    Limited systematic research on maternal placentophagy is available to maternity care providers whose clients/patients may be considering this increasingly popular practice. Our purpose was to characterize the practice of placentophagy and its attendant neonatal outcomes among a large sample of women in the United States. We used a medical records-based data set (n = 23 242) containing pregnancy, birth, and postpartum information for women who planned community births. We used logistic regression to determine demographic and clinical predictors of placentophagy. Finally, we compared neonatal outcomes (hospitalization, neonatal intensive unit admission, or neonatal death in the first 6 weeks) between placenta consumers and nonconsumers, and participants who consumed placenta raw vs cooked. Nearly one-third (31.2%) of women consumed their placenta. Consumers were more likely to have reported pregravid anxiety or depression compared with nonconsumers. Most (85.7%) placentophagic mothers consumed their placentas in encapsulated form, and nearly half (49.1%) consumed capsules containing dehydrated, uncooked placenta. Placentophagy was not associated with any adverse neonatal outcomes. Women with home births were more likely to engage in placentophagy than women with birth center births. The most common reason given (58.6%) for engaging in placentophagy was to prevent postpartum depression. The majority of women consumed their placentas in uncooked/encapsulated form and hoping to avoid postpartum depression, although no evidence currently exists to support this strategy. Preparation technique (cooked vs uncooked) did not influence adverse neonatal outcomes. Maternity care providers should discuss the range of options available to prevent/treat postpartum depression, in addition to current evidence with respect to the safety of placentophagy. © 2018 Wiley Periodicals, Inc.

  9. The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods.

    Science.gov (United States)

    Kaplan, Bonnie J; Giesbrecht, Gerald F; Leung, Brenda M Y; Field, Catherine J; Dewey, Deborah; Bell, Rhonda C; Manca, Donna P; O'Beirne, Maeve; Johnston, David W; Pop, Victor J; Singhal, Nalini; Gagnon, Lisa; Bernier, Francois P; Eliasziw, Misha; McCargar, Linda J; Kooistra, Libbe; Farmer, Anna; Cantell, Marja; Goonewardene, Laki; Casey, Linda M; Letourneau, Nicole; Martin, Jonathan W

    2014-01-01

    The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration. © 2012 John Wiley & Sons Ltd.

  10. The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives.

    Science.gov (United States)

    Audigé, Laurent; Cornelius, Carl-Peter; Di Ieva, Antonio; Prein, Joachim

    2014-12-01

    Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal.

  11. Cognitive rehabilitation: the role of theoretical rationales and respect for the maturational process needed for our evidence.

    Science.gov (United States)

    Gonzalez-Rothi, Leslie J

    2006-01-01

    The challenge to presenters at the Galveston Brain Injury Conference held in April 2005 was to discuss examples of the use of theory to motivate the design of treatments for cognitive deficits resulting from traumatic brain injury. This article considers the role of theoretical rationales as well as the new optimism embracing neurorehabilitation today. However, caution to respect the maturational process needed to adequately prepare treatment evidence for clinical application is affected.

  12. Rationale and early outcomes for the management of thymoma with proton therapy.

    Science.gov (United States)

    Zhu, He J; Hoppe, Bradford S; Flampouri, Stella; Louis, Debbie; Pirris, John; Nichols, R Charles; Henderson, Randal H; Mercado, Catherine E

    2018-04-01

    Radiotherapy for thymic malignancies is technically challenging due to their close proximity to the heart, lungs, esophagus, and breasts, raising concerns about significant acute and late toxicities from conventional photon radiotherapy. Proton therapy (PT) may reduce the radiation dose to these vital organs, leading to less toxicity. We reviewed the dosimetry and outcomes among patients treated with PT for thymic malignancies at our institution. From January 2008 to March 2017, six patients with de novo Masaoka stages II-III thymic malignancies were treated with PT on an IRB-approved outcomes tracking protocol. Patients were evaluated weekly during treatment, then every 3 months for 2 years, then every 6 months for 3 more years, and then annually for CTCAE vs. four toxicities and disease recurrence. Comparison intensity-modulated radiotherapy (IMRT) plans were developed for each patient. Mean doses to the heart, esophagus, bilateral breasts, lungs, and V20 of bilateral lungs were evaluated for the two treatment plans. At last follow-up (median follow-up, 2.6 years), there were two patients with recurrences, including metastatic disease in the patient treated definitively with chemotherapy and PT without surgery and a local-regional recurrence in the lung outside the proton field in one of the post-operative cases. No patients with de novo disease experienced grade ≥3 toxicities after PT. The mean dose to the heart, lung, and esophagus was reduced on average by 36.5%, 33.5%, and 60%, respectively, using PT compared with IMRT (P<0.05 for each dose parameter). PT achieved superior dose sparing to the heart, lung, and esophagus compared to IMRT for thymic malignancies. Patients treated with PT had few radiation-induced toxicities and similar survival compared to historic proton data.

  13. Rationale, Design, and Methods for Process Evaluation in the Childhood Obesity Research Demonstration Project.

    Science.gov (United States)

    Joseph, Sitara; Stevens, Andria M; Ledoux, Tracey; O'Connor, Teresia M; O'Connor, Daniel P; Thompson, Debbe

    2015-01-01

    The cross-site process evaluation plan for the Childhood Obesity Research Demonstration (CORD) project is described here. The CORD project comprises 3 unique demonstration projects designed to integrate multi-level, multi-setting health care and public health interventions over a 4-year funding period. Three different communities in California, Massachusetts, and Texas. All CORD demonstration projects targeted 2-12-year-old children whose families are eligible for benefits under Title XXI (CHIP) or Title XIX (Medicaid). The CORD projects were developed independently and consisted of evidence-based interventions that aim to prevent childhood obesity. The interventions promote healthy behaviors in children by applying strategies in 4 key settings (primary care clinics, early care and education centers, public schools, and community institutions). The CORD process evaluation outlined 3 main outcome measures: reach, dose, and fidelity, on 2 levels (researcher to provider, and provider to participant). The plan described here provides insight into the complex nature of process evaluation for consortia of independently designed multi-level, multi-setting intervention studies. The process evaluation results will provide contextual information about intervention implementation and delivery with which to interpret other aspects of the program. Copyright © 2015 Society for Nutrition Education and Behavior. All rights reserved.

  14. Using Automated Processes to Generate Test Items And Their Associated Solutions and Rationales to Support Formative Feedback

    Directory of Open Access Journals (Sweden)

    Mark Gierl

    2015-08-01

    Full Text Available Automatic item generation is the process of using item models to produce assessment tasks using computer technology. An item model is similar to a template that highlights the elements in the task that must be manipulated to produce new items. The purpose of our study is to describe an innovative method for generating large numbers of diverse and heterogeneous items along with their solutions and associated rationales to support formative feedback. We demonstrate the method by generating items in two diverse content areas, mathematics and nonverbal reasoning

  15. Integration of behavioral medicine competencies into physiotherapy curriculum in an exemplary Swedish program: rationale, process, and review.

    Science.gov (United States)

    Sandborgh, Maria; Dean, Elizabeth; Denison, Eva; Elvén, Maria; Fritz, Johanna; Wågert, Petra von Heideken; Moberg, Johan; Overmeer, Thomas; Snöljung, Åsa; Johansson, Ann-Christin; Söderlund, Anne

    2018-06-21

    In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicine content and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.

  16. High-temperature industrial process heat: technology assessment and introduction rationale

    Energy Technology Data Exchange (ETDEWEB)

    1978-03-03

    Three specific topics of interest to DOE are addressed: to establish the significance and identify the role of high-temperature process heat in the nation's energy economy; to identify the role of solar thermal power in these high-temperature industrial applications in terms of possible markets and economic potential; and to recommend programmatic approaches for these solar thermal high-temperature process heat activities, including proposed content for initial Request for Proposals (RFPs) to accomplish such activities. The scope of the work required to accomplish these three purposes included the following: review of US industrial energy requirements, survey of current DOE low-temperature Agricultural and Industrial Process Heat Program, examination of high-temperature solar thermal electric systems already developed or under development by DOE and industry, and coordination with the high-energy user segments of industry (i.e., cement, chemical and petroleum) to find additional markets for some or all of the systems or components being developed in the DOE solar thermal electric program. Statistical data are presented identifying energy allocations to process heat and defining DOE's involvement. Three current fossil fuel process heat system examples are provided and the corresponding solar potential is identified.

  17. Rationale for Spiritually Oriented Cognitive Processing Therapy for Moral Injury in Active Duty Military and Veterans With Posttraumatic Stress Disorder.

    Science.gov (United States)

    Koenig, Harold G; Boucher, Nathan A; Oliver, Rev John P; Youssef, Nagy; Mooney, Scott R; Currier, Joseph M; Pearce, Michelle

    2017-02-01

    Wartime experiences have long been known to cause ethical conflict, guilt, self-condemnation, difficulty forgiving, loss of trust, lack of meaning and purpose, and spiritual struggles. "Moral injury" (MI) (also sometimes called "inner conflict") is the term used to capture this emotional, cognitive, and behavioral state. In this article, we provide rationale for developing and testing Spiritually Oriented Cognitive Processing Therapy, a version of standard cognitive processing therapy for the treatment of MI in active duty and veteran service members (SMs) with posttraumatic stress disorder symptoms who are spiritual or religious (S/R). Many SMs have S/R beliefs that could increase vulnerability to MI. Because the injury is to deeply held moral standards and ethical values and often adversely affects spiritual beliefs and worldview, we believe that those who are S/R will respond more favorably to a therapy that directly targets this injury from a spiritually oriented perspective. An evidence-based treatment for MI in posttraumatic stress disorder that not only respects but also utilizes SMs' spiritual beliefs/behaviors may open the door to treatment for many S/R military personnel.

  18. The WHO evidence-informed guideline development process and implications for vitamin and mineral research priorities: symposium rationale and summary.

    Science.gov (United States)

    Neufeld, Lynnette M; Jalal, Chowdhury S B; Peña-Rosas, Juan Pablo; Tovey, David; Lutter, Chessa K; Stoltzfus, Rebecca J; Habicht, Jean-Pierre

    2013-09-01

    The WHO evidence-informed guidelines provide recommendations to Member States and their partners on interventions with vitamins and minerals. Evidence gathered and synthesized through systematic reviews contributes to the development of these guidelines, a process that is dependent on the availability and quality of evidence. Although the guideline development process is stringently governed and supervised to maintain clarity and transparency, the lack of adequacy and specificity of available evidence poses limitations to the formulation of recommendations that can be easily applied for policy and program decision making in diverse contexts. The symposium created a space for dialogue among scientists and public health practitioners to improve the understanding of how evidence fulfills the needs and reflect on mechanisms by which policy and program guidance and priorities for research could be better informed by policy and program needs. Ultimately, programmatic success depends not only on identifying efficacious agents but ensuring effective delivery to those with the potential to respond. To do this, we must understand the rationale for recommending interventions, the biological pathways by which interventions work, delivery systems required to make efficacious interventions work, and other contextual factors that might limit or facilitate successful implementation.

  19. Controlled air incinerator for radioactive waste. Volume I. Rationale, process, equipment, performance, and recommendations

    International Nuclear Information System (INIS)

    Neuls, A.S.; Draper, W.E.; Koenig, R.A.; Newmyer, J.M.; Warner, C.L.

    1982-11-01

    This two-volume report is a detailed design and operating documentation of the Los Alamos National Laboratory Controlled Air Incinerator (CAI) and is an aid to technology transfer to other Department of Energy contractor sites and the commercial sector. Volume I describes the CAI process, equipment, and performance, and it recommends modifications based on Los Alamos experience. It provides the necessary information for conceptual design and feasibility studies. Volume II provides descriptive engineering information such as drawings specifications, calculations, and costs. It aids duplication of the process at other facilities

  20. Los Alamos Controlled Air Incinerator for radioactive waste. Volume I. Rationale, process, equipment, performance, and recommendations

    International Nuclear Information System (INIS)

    Neuls, A.S.; Draper, W.E.; Koenig, R.A.; Newmyer, J.M.; Warner, C.L.

    1982-08-01

    This two-volume report is a detailed design and operating documentation of the Los Alamos National Laboratory Controlled Air Incinerator (CAI) and is an aid to technology transfer to other Department of Energy contractor sites and the commercial sector. Volume I describes the CAI process, equipment, and performance, and it recommends modifications based on Los Alamos experience. It provides the necessary information for conceptual design and feasibility studies. Volume II provides descriptive engineering information such as drawing, specifications, calculations, and costs. It aids duplication of the process at other facilities

  1. Los Alamos Controlled Air Incinerator for radioactive waste. Volume I. Rationale, process, equipment, performance, and recommendations

    Energy Technology Data Exchange (ETDEWEB)

    Neuls, A.S.; Draper, W.E.; Koenig, R.A.; Newmyer, J.M.; Warner, C.L.

    1982-08-01

    This two-volume report is a detailed design and operating documentation of the Los Alamos National Laboratory Controlled Air Incinerator (CAI) and is an aid to technology transfer to other Department of Energy contractor sites and the commercial sector. Volume I describes the CAI process, equipment, and performance, and it recommends modifications based on Los Alamos experience. It provides the necessary information for conceptual design and feasibility studies. Volume II provides descriptive engineering information such as drawing, specifications, calculations, and costs. It aids duplication of the process at other facilities.

  2. Leadership Development as a Dialogic Process: The Rationale and Concept of an International Leadership Institute

    Science.gov (United States)

    Kedian, Jeremy; Giles, David; Morrison, Michele; Fletcher, Murray

    2016-01-01

    Rapidly changing educational contexts demand deft leadership responses. In this fluid environment, it is imperative that leadership learning models sound educational praxis. Such praxis necessitates the inclusion of participant voices within relational and dialogic processes that enable authentic, creative and collaborative thinking. This paper…

  3. Processes and outcomes in school health promotion

    DEFF Research Database (Denmark)

    Simovska, Venka

    2012-01-01

    This is the second special issue of Health Education which features research, theory and practice based perspectives on what counts as desirable outcomes of health promotion in schools in terms of health as well as education, and the effective processes in schools which lead to these outcomes....... The focus in the first special issue was on highlighting the argument that the question about the outcomes of the health-promoting schools should not be limited to narrowly defined health outcomes but needs to be closely linked with the core tasks and values of the school. Building further on this argument......, the papers in this issue feature a number of research issues of relevance for the effectiveness of the health-promoting schools approach, as well as a variety of research and evaluation methodologies contributing to the debate about what counts as reliable evidence within the health-promoting schools...

  4. Prediction of processing tomato peeling outcomes

    Science.gov (United States)

    Peeling outcomes of processing tomatoes were predicted using multivariate analysis of Magnetic Resonance (MR) images. Tomatoes were obtained from a whole-peel production line. Each fruit was imaged using a 7 Tesla MR system, and a multivariate data set was created from 28 different images. After ...

  5. China's fuel economy standards for passenger vehicles. Rationale, policy process, and impacts

    International Nuclear Information System (INIS)

    Oliver, Hongyan H.; Gallagher, Kelly Sims; Tian, Donglian; Zhang, Jinhua

    2009-01-01

    China issued its first Fuel Economy Standards (FES) for light-duty passenger vehicles (LDPV) in September 2004, and the first and second phases of the FES took effective in July 2005 and January 2008, respectively. The stringency of the Chinese FES ranks third globally, following the Japanese and European standards. In this paper, we first review the policy-making background, including the motivations, key players, and the process; and then explain the content and the features of the FES and why there was no compliance flexibility built into it. Next, we assess the various aspects of the standard's impact, including fuel economy improvement, technology changes, shift of market composition, and overall fuel savings. Lastly, we comment on the prospect of tightening the existing FES and summarize the complementary policies that have been adopted or may be considered by the Chinese government for further promoting efficient vehicles and reducing transport energy consumption. The Chinese experience is highly relevant for countries that are also experiencing or anticipating rapid growth in personal vehicles, those wishing to moderate an increase in oil demand, or those desirous of vehicle technology upgrades. (author)

  6. The design, rationale, and baseline characteristics of a nationwide cohort registry in China: blood pressure and clinical outcome in TIA or ischemic stroke.

    Science.gov (United States)

    Xu, Jie; Liu, Yi; Tao, Yongli; Xie, Xuewei; Gu, Hongqiu; Pan, Yuesong; Zhao, Xingquan; Wang, Yongjun; Yan, Aoshuang; Wang, Yilong

    2016-01-01

    The relationship between poststroke blood pressure (BP) and clinical outcomes in ischemic stroke (IS) is still controversial. However, there is no large BP database for IS or transient ischemic attack (TIA) in China. This study aims to describe the rationale, study design, and baseline characteristics of a nationwide BP database in IS or TIA patients in China. The BOSS (blood pressure and clinical outcome in TIA or ischemic stroke) study was a hospital-based, prospective cohort study aiming to assess BP parameters and clinical outcome in IS/TIA patients. BP parameters were based on office BP, ambulatory BP, and home BP. Clinical outcomes included stroke recurrence, combined vascular events, and disability. Electronic case-report forms were used to record baseline and follow-up data. The patients were followed up for clinical outcomes at 3 months through face-to-face interview and at 12 months by telephone. Between October 2012 and February 2014, the BOSS registry recruited 2,608 patients from 61 hospitals, with a mean age of 62.5 years, 32.4% of whom were female, 88.9% with an entry diagnosis of IS, and 86% diagnosed with hypertension. The rates of patients lost-to-follow-up were 3.1% at 3 months and 5.1% at 1 year; 93% of patients completed ambulatory BP monitoring during hospitalization and 94.7% finished a 3-month BP diary. The BOSS registry will provide important evidence about BP management in the acute phase and secondary prevention for IS/TIA patients.

  7. Randomized comparison of the clinical outcome of single versus multiple arterial grafts: the ROMA trial-rationale and study protocol.

    Science.gov (United States)

    Gaudino, Mario; Alexander, John H; Bakaeen, Faisal G; Ballman, Karla; Barili, Fabio; Calafiore, Antonio Maria; Davierwala, Piroze; Goldman, Steven; Kappetein, Peter; Lorusso, Roberto; Mylotte, Darren; Pagano, Domenico; Ruel, Marc; Schwann, Thomas; Suma, Hisayoshi; Taggart, David P; Tranbaugh, Robert F; Fremes, Stephen

    2017-12-01

    The primary hypothesis of the ROMA trial is that in patients undergoing primary isolated non-emergent coronary artery bypass grafting, the use of 2 or more arterial grafts compared with a single arterial graft (SAG) is associated with a reduction in the composite outcome of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary hypothesis is that in these patients, the use of 2 or more arterial grafts compared with a SAG is associated with improved survival. The ROMA trial is a prospective, unblinded, randomized event-driven multicentre trial comprising at least 4300 subjects. Patients younger than 70 years with left main and/or multivessel disease will be randomized to a SAG or multiple arterial grafts to the left coronary system in a 1:1 fashion. Permuted block randomization stratified by the centre and the type of second arterial graft will be used. The primary outcome will be a composite of death from any cause, any stroke, post-discharge myocardial infarction and/or repeat revascularization. The secondary outcome will be all-cause mortality. The primary safety outcome will be a composite of death from any cause, any stroke and any myocardial infarction. In all patients, 1 internal thoracic artery will be anastomosed to the left anterior descending coronary artery. For patients randomized to the SAG group, saphenous vein grafts will be used for all non-left anterior descending target vessels. For patients randomized to the multiple arterial graft group, the main target vessel of the lateral wall will be grafted with either a radial artery or a second internal thoracic artery. Additional grafts for the multiple arterial graft group can be saphenous veins or supplemental arterial conduits. To detect a 20% relative reduction in the primary outcome, with 90% power at 5% alpha and assuming a time-to-event analysis, the sample size must include 845 events (and 3650 patients). To detect a 20% relative

  8. Emotional Processing, Interaction Process, and Outcome in Clarification-Oriented Psychotherapy for Personality Disorders: A Process-Outcome Analysis.

    Science.gov (United States)

    Kramer, Ueli; Pascual-Leone, Antonio; Rohde, Kristina B; Sachse, Rainer

    2016-06-01

    It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional processing and by additionally taking into account a therapist's appropriate responsiveness to a patient's presentation in clarification-oriented psychotherapy (COP), a humanistic-experiential form of therapy. The present study involved 39 patients with a range of PDs undergoing COP. Session 25 was assessed as part of the working phase of each therapy by external raters in terms of emotional processing using the Classification of Affective-Meaning States (CAMS) and in terms of the overall quality of therapist-patient interaction using the Process-Content-Relationship Scale (BIBS). Treatment outcome was assessed pre- and post-therapy using the Global Severity Index (GSI) of the SCL-90-R and the BDI. Results indicate that the good outcome cases showed more self-compassion, more rejecting anger, and a higher quality of therapist-patient interaction compared to poorer outcome cases. For good outcome cases, emotional processing predicted 18% of symptom change at the end of treatment, which was not found for poor outcome cases. These results are discussed within the framework of an integrative understanding of emotional processing as an underlying mechanism of change in COP, and perhaps in other effective therapy approaches for PDs.

  9. Effect of genetic testing for risk of type 2 diabetes mellitus on health behaviors and outcomes: study rationale, development and design

    Directory of Open Access Journals (Sweden)

    Cho Alex H

    2012-01-01

    Full Text Available Abstract Background Type 2 diabetes is a prevalent chronic condition globally that results in extensive morbidity, decreased quality of life, and increased health services utilization. Lifestyle changes can prevent the development of diabetes, but require patient engagement. Genetic risk testing might represent a new tool to increase patients' motivation for lifestyle changes. Here we describe the rationale, development, and design of a randomized controlled trial (RCT assessing the clinical and personal utility of incorporating type 2 diabetes genetic risk testing into comprehensive diabetes risk assessments performed in a primary care setting. Methods/Design Patients are recruited in the laboratory waiting areas of two primary care clinics and enrolled into one of three study arms. Those interested in genetic risk testing are randomized to receive either a standard risk assessment (SRA for type 2 diabetes incorporating conventional risk factors plus upfront disclosure of the results of genetic risk testing ("SRA+G" arm, or the SRA alone ("SRA" arm. Participants not interested in genetic risk testing will not receive the test, but will receive SRA (forming a third, "no-test" arm. Risk counseling is provided by clinic staff (not study staff external to the clinic. Fasting plasma glucose, insulin levels, body mass index (BMI, and waist circumference are measured at baseline and 12 months, as are patients' self-reported behavioral and emotional responses to diabetes risk information. Primary outcomes are changes in insulin resistance and BMI after 12 months; secondary outcomes include changes in diet patterns, physical activity, waist circumference, and perceived risk of developing diabetes. Discussion The utility, feasibility, and efficacy of providing patients with genetic risk information for common chronic diseases in primary care remain unknown. The study described here will help to establish whether providing type 2 diabetes genetic risk

  10. Mineralized Collagen: Rationale, Current Status, and Clinical Applications

    Directory of Open Access Journals (Sweden)

    Zhi-Ye Qiu

    2015-07-01

    Full Text Available This paper presents a review of the rationale for the in vitro mineralization process, preparation methods, and clinical applications of mineralized collagen. The rationale for natural mineralized collagen and the related mineralization process has been investigated for decades. Based on the understanding of natural mineralized collagen and its formation process, many attempts have been made to prepare biomimetic materials that resemble natural mineralized collagen in both composition and structure. To date, a number of bone substitute materials have been developed based on the principles of mineralized collagen, and some of them have been commercialized and approved by regulatory agencies. The clinical outcomes of mineralized collagen are of significance to advance the evaluation and improvement of related medical device products. Some representative clinical cases have been reported, and there are more clinical applications and long-term follow-ups that currently being performed by many research groups.

  11. Pricing scheme choice: how process affects outcome

    Czech Academy of Sciences Publication Activity Database

    Shestakova, Natalia

    2010-01-01

    Roč. 20, č. 2 (2010), s. 99-129 ISSN 1211-3298 R&D Projects: GA MŠk(CZ) LC542 Institutional research plan: CEZ:MSM0021620846 Keywords : choice process * heuristics * price discrimination Subject RIV: AH - Economics http://www.cerge-ei.cz/pdf/wp/Wp411.pdf

  12. Evaluation of alternative school feeding models on nutrition, education, agriculture and other social outcomes in Ghana: rationale, randomised design and baseline data.

    Science.gov (United States)

    Gelli, Aulo; Masset, Edoardo; Folson, Gloria; Kusi, Anthoni; Arhinful, Daniel K; Asante, Felix; Ayi, Irene; Bosompem, Kwabena M; Watkins, Kristie; Abdul-Rahman, Lutuf; Agble, Rosanna; Ananse-Baden, Getrude; Mumuni, Daniel; Aurino, Elisabetta; Fernandes, Meena; Drake, Lesley

    2016-01-20

    , per capita food consumption and intake, school attendance, and anthropometric status in the 2-5 and 5-15 years age groups. In addition, approximately 19 % of children in the target age group received some form of free school meals at baseline. Designing and implementing the evaluation of complex interventions is in itself a complex undertaking, involving a multi-disciplinary research team working in close collaboration with programme- and policy-level stakeholders. Managing the complexity from an analytical and operational perspective is an important challenge. The analysis of the baseline data indicates that the random allocation process did not achieve statistically comparable treatment groups. Differences in outcomes and control variables across groups will be controlled for when estimating treatment effects. ISRCTN66918874 (registered on 5 March 2015).

  13. Branding Your Post-School Outcomes Data Collection Process

    Science.gov (United States)

    National Post-School Outcomes Center, 2013

    2013-01-01

    The purpose of "Branding your Post-School Outcomes Data Collection Process" is to help state education agencies create brand recognition with youths, families, and school personnel for the post-school outcomes survey. Recognition--paired with information about the survey purpose, who is conducting the interview, and how the information…

  14. Patient-Reported Outcome (PRO) Consortium translation process: consensus development of updated best practices.

    Science.gov (United States)

    Eremenco, Sonya; Pease, Sheryl; Mann, Sarah; Berry, Pamela

    2017-01-01

    This paper describes the rationale and goals of the Patient-Reported Outcome (PRO) Consortium's instrument translation process. The PRO Consortium has developed a number of novel PRO measures which are in the process of qualification by the U.S. Food and Drug Administration (FDA) for use in clinical trials where endpoints based on these measures would support product labeling claims. Given the importance of FDA qualification of these measures, the PRO Consortium's Process Subcommittee determined that a detailed linguistic validation (LV) process was necessary to ensure that all translations of Consortium-developed PRO measures are performed using a standardized approach with the rigor required to meet regulatory and pharmaceutical industry expectations, as well as having a clearly defined instrument translation process that the translation industry can support. The consensus process involved gathering information about current best practices from 13 translation companies with expertise in LV, consolidating the findings to generate a proposed process, and obtaining iterative feedback from the translation companies and PRO Consortium member firms on the proposed process in two rounds of review in order to update existing principles of good practice in LV and to provide sufficient detail for the translation process to ensure consistency across PRO Consortium measures, sponsors, and translation companies. The consensus development resulted in a 12-step process that outlines universal and country-specific new translation approaches, as well as country-specific adaptations of existing translations. The PRO Consortium translation process will play an important role in maintaining the validity of the data generated through these measures by ensuring that they are translated by qualified linguists following a standardized and rigorous process that reflects best practice.

  15. Therapeutic Process and Outcome: The Interplay of Research

    Science.gov (United States)

    Campbel, Holly

    2008-01-01

    From Freud through to modern times researchers have aimed to develop a clearer understanding of therapeutic processes and outcomes. Despite this continued interest in the field, the representation of psychotherapy processes and the applicability of research findings and recommendations to the therapeutic field continue to prove difficult.…

  16. Rationale for using integrated enzymatic preparation for receiving food fibers from secondary resources of vegetable material processing

    Directory of Open Access Journals (Sweden)

    Alimov A. V.

    2016-09-01

    presence of enzyme medicine is рН equal to 6.0. The received results allow set the rational modes of enzyme medicine effect (temperature and рН necessary for carrying out enzymatic hydrolysis of secondary resources of aubergines, vegetable marrows and onion processing.

  17. Evaluation oF FactORs ImpacTing CLinical Outcome and Cost EffectiveneSS of the S-ICD: Design and Rationale of the EFFORTLESS S-ICD Registry

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Lambiase, Pier; Boersma, Lucas V A

    2012-01-01

    utilization. Methods: The Registry is an observational, nonrandomized, standard of care evaluation to be conducted at approximately 50 investigational centers in Europe and New Zealand where the S-ICD is approved for use and distribution. Clinical Registry endpoints include perioperative (30 days postimplant......Background: Leads in and on the heart of the transvenous implantable cardioverter defibrillator (ICD) form the Achilles' heel of this system due to potential for peri- and postimplant complications. The S-ICD is a newer generation of the ICD that does not require leads on the heart...... or in the vasculature. We present the rationale and study design of the Evaluation oF FactORs ImpacTing CLinical Outcome and Cost EffectiveneSS of the S-ICD (EFFORTLESS S-ICD) Registry which was designed to evaluate the long-term performance of the S-ICD including patient quality of life and long-term resource...

  18. Deriving site-specific soil clean-up values for metals and metalloids: rationale for including protection of soil microbial processes.

    Science.gov (United States)

    Kuperman, Roman G; Siciliano, Steven D; Römbke, Jörg; Oorts, Koen

    2014-07-01

    Although it is widely recognized that microorganisms are essential for sustaining soil fertility, structure, nutrient cycling, groundwater purification, and other soil functions, soil microbial toxicity data were excluded from the derivation of Ecological Soil Screening Levels (Eco-SSL) in the United States. Among the reasons for such exclusion were claims that microbial toxicity tests were too difficult to interpret because of the high variability of microbial responses, uncertainty regarding the relevance of the various endpoints, and functional redundancy. Since the release of the first draft of the Eco-SSL Guidance document by the US Environmental Protection Agency in 2003, soil microbial toxicity testing and its use in ecological risk assessments have substantially improved. A wide range of standardized and nonstandardized methods became available for testing chemical toxicity to microbial functions in soil. Regulatory frameworks in the European Union and Australia have successfully incorporated microbial toxicity data into the derivation of soil threshold concentrations for ecological risk assessments. This article provides the 3-part rationale for including soil microbial processes in the development of soil clean-up values (SCVs): 1) presenting a brief overview of relevant test methods for assessing microbial functions in soil, 2) examining data sets for Cu, Ni, Zn, and Mo that incorporated soil microbial toxicity data into regulatory frameworks, and 3) offering recommendations on how to integrate the best available science into the method development for deriving site-specific SCVs that account for bioavailability of metals and metalloids in soil. Although the primary focus of this article is on the development of the approach for deriving SCVs for metals and metalloids in the United States, the recommendations provided in this article may also be applicable in other jurisdictions that aim at developing ecological soil threshold values for protection of

  19. Integration of e-learning outcomes into work processes

    Directory of Open Access Journals (Sweden)

    Kerstin Grundén

    2011-07-01

    Full Text Available Three case studies of in-house developed e-learning education in public organizations with different pedagogical approaches are used as a starting point for discussion regarding the implementation challenges of e-learning at work. The aim of this article is to contribute to the understanding of integrating mechanisms of e-learning outcomes into work processes in large, public organizations. The case studies were analyzed from a socio-cultural perspective using the MOA-model as a frame of reference. Although the pedagogical approaches for all of the cases seemed to be relevant and most of the learners showed overall positive attitudes towards the courses, there were problems with integration of the e-learning outcomes into work processes. There were deficiencies in the adaption of the course contents to the local educational needs. There was also a lack of adjusting the local work organization and work routines in order to facilitate the integration of the e-learning outcomes into the work processes. A lack of local management engagement affected the learners’ motivation negatively. Group discussions in local work groups facilitated the integration of the e-learning outcomes. Much of the difficulties of integrating e-learning outcomes into work processes in big organizations are related to the problems with adjusting centrally developed e-learning courses to local needs and a lack of co-operation among among the developers (often IT-professionals and the Human Resources Department of the organizations.

  20. Outcomes management: incorporating and sustaining processes critical to using outcome data to guide practice improvement.

    Science.gov (United States)

    Hodges, Kay; Wotring, James R

    2012-04-01

    An outcomes management system (OMS) greatly facilitates an organization or state achieving requirements regarding accountability and use of empirically based interventions. A case example of the authors' experience with a successful and enduring OMS is presented, followed by a review of the literature and a proposed model delineating the key components and benefits of an OMS. Building capacity to measure performance requires embedding utilization of youth-specific, clinically meaningful outcome data into the organization's processes and structures. An OMS measures outcomes associated with services, facilitates implementation of evidence-based practices, informs case decision making, enables better and more efficient clinical management, and provides aggregated information used to improve services. A case-specific supervisory model based on instantaneously available information, including progress to date, helps maximize consumer outcomes. Continuous quality improvement activities, which are databased and goal-oriented, become a positive change management tool. This paper describes organizational processes that facilitate the development of a highly functional OMS.

  1. Process Predictors of the Outcome of Group Drug Counseling

    Science.gov (United States)

    Crits-Christoph, Paul; Johnson, Jennifer E.; Connolly Gibbons, Mary Beth; Gallop, Robert

    2013-01-01

    Objective: This study examined the relation of process variables to the outcome of group drug counseling, a commonly used community treatment, for cocaine dependence. Method: Videotaped group drug counseling sessions from 440 adult patients (23% female, 41% minority) were rated for member alliance, group cohesion, participation, self-disclosure,…

  2. Reconciling Sex Differences in Information-Processing and Career Outcomes.

    Science.gov (United States)

    Wolleat, Patricia L.

    1990-01-01

    Information processing theory could be made more sensitive to differences in career outcomes for males and females by (1) examining the nature of the career decision; (2) expanding the notion of information; (3) relating the vocational schema to the gender schema; and (4) noting whether variables are general, sex related, or sex specific. (SK)

  3. Drugs, Recipes, Babies, Bathwater, and Psychotherapy Process-Outcome Relations.

    Science.gov (United States)

    Stiles, William B.

    1994-01-01

    Responds to critiques of Stiles and Shapiro's (1994) discussion of process-outcome correlation problem by Silberschatz (1994) and Sechrest (1994). Contends that, contrary to Silberschatz's and Sechrest's multivariate suggestions, problem is not in measures or analyses but in interpretation of results, particularly in failure to incorporate fully…

  4. Brain potentials associated with the outcome processing in framing effects.

    Science.gov (United States)

    Ma, Qingguo; Feng, Yandong; Xu, Qing; Bian, Jun; Tang, Huixian

    2012-10-24

    Framing effect is a cognitive bias referring to the phenomenon that people respond differently to different but objectively equivalent descriptions of the same problem. By measuring event-related potentials, the present study aimed to investigate the neural mechanisms underlying the framing effect, especially how the negative and positive frames influence the outcome processing in our brain. Participants were presented directly with outcomes framed either positively in terms of lives saved or negatively in terms of lives lost in large and small group conditions, and were asked to rate the favorableness of each of them. The behavioral results showed that the framing effect occurred in both group size conditions, with more favorable evaluations associated with positive framing. Compared with outcomes in positive framing condition, a significant feedback-related negativity (FRN) effect was elicited by outcomes in negative framing condition, even though the outcomes in different conditions were objectively equivalent. The results are explained in terms of the associative model of attribute framing effect which states that attribute framing effect occurs as a result of a valence-based associative processing. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  5. Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS): rationale, design, and methods

    NARCIS (Netherlands)

    Apers, Silke; Kovacs, Adrienne H.; Luyckx, Koen; Alday, Luis; Berghammer, Malin; Budts, Werner; Callus, Edward; Caruana, Maryanne; Chidambarathanu, Shanthi; Cook, Stephen C.; Dellborg, Mikael; Enomoto, Junko; Eriksen, Katrine; Fernandes, Susan M.; Jackson, Jamie L.; Johansson, Bengt; Khairy, Paul; Kutty, Shelby; Menahem, Samuel; Rempel, Gwen; Sluman, Maayke A.; Soufi, Alexandra; Thomet, Corina; Veldtman, Gruschen; Wang, Jou-Kou; White, Kamila; Moons, Philip; Maisuls, Héctor; Cabrera, Marcelo; Eaton, Sarah; Larion, Ruth; FengWang, Qi; van Deyk, Kristien; Goossens, Eva; Rassart, Jessica; Mackie, Andrew; Ballantyne, Ross; Rankin, Kathryn; Norris, Colleen; Taylor, Dylan; Vondermuhll, Isabelle; Windram, Jonathan; Heggie, Pamela; Lasiuk, Gerri; Proietti, Anna; Dore, Annie; Mercier, Lise-Andrée; Mongeon, François-Pierre; Marcotte, François; Mulder, Barbara

    2015-01-01

    Data on patient-reported outcomes (PROs) in adults with congenital heart disease (CHD) are inconsistent and vary across the world. Better understanding of PROs and their differences across cultural and geographic barriers can best be accomplished via international studies using uniform research

  6. A randomized controlled trial on the effectiveness of strength training on clinical and muscle cellular outcomes in patients with prostate cancer during androgen deprivation therapy: rationale and design

    International Nuclear Information System (INIS)

    Thorsen, Lene; Nilsen, Tormod S; Raastad, Truls; Courneya, Kerry S; Skovlund, Eva; Fosså, Sophie D

    2012-01-01

    Studies indicate that strength training has beneficial effects on clinical health outcomes in prostate cancer patients during androgen deprivation therapy. However, randomized controlled trials are needed to scientifically determine the effectiveness of strength training on the muscle cell level. Furthermore, close examination of the feasibility of a high-load strength training program is warranted. The Physical Exercise and Prostate Cancer (PEPC) trial is designed to determine the effectiveness of strength training on clinical and muscle cellular outcomes in non-metastatic prostate cancer patients after high-dose radiotherapy and during ongoing androgen deprivation therapy. Patients receiving androgen deprivation therapy for 9-36 months combined with external high-dose radiotherapy for locally advanced prostate cancer are randomized to an exercise intervention group that receives a 16 week high-load strength training program or a control group that is encouraged to maintain their habitual activity level. In both arms, androgen deprivation therapy is continued until the end of the intervention period. Clinical outcomes are body composition (lean body mass, bone mineral density and fat mass) measured by Dual-energy X-ray Absorptiometry, serological outcomes, physical functioning (muscle strength and cardio-respiratory fitness) assessed with physical tests and psycho-social functioning (mental health, fatigue and health-related quality of life) assessed by questionnaires. Muscle cellular outcomes are a) muscle fiber size b) regulators of muscle fiber size (number of myonuclei per muscle fiber, number of satellite cells per muscle fiber, number of satellite cells and myonuclei positive for androgen receptors and proteins involved in muscle protein degradation and muscle hypertrophy) and c) regulators of muscle fiber function such as proteins involved in cellular stress and mitochondrial function. Muscle cellular outcomes are measured on muscle cross sections and

  7. Vicarious neural processing of outcomes during observational learning.

    Directory of Open Access Journals (Sweden)

    Elisabetta Monfardini

    Full Text Available Learning what behaviour is appropriate in a specific context by observing the actions of others and their outcomes is a key constituent of human cognition, because it saves time and energy and reduces exposure to potentially dangerous situations. Observational learning of associative rules relies on the ability to map the actions of others onto our own, process outcomes, and combine these sources of information. Here, we combined newly developed experimental tasks and functional magnetic resonance imaging (fMRI to investigate the neural mechanisms that govern such observational learning. Results show that the neural systems involved in individual trial-and-error learning and in action observation and execution both participate in observational learning. In addition, we identified brain areas that specifically activate for others' incorrect outcomes during learning in the posterior medial frontal cortex (pMFC, the anterior insula and the posterior superior temporal sulcus (pSTS.

  8. Vicarious neural processing of outcomes during observational learning.

    Science.gov (United States)

    Monfardini, Elisabetta; Gazzola, Valeria; Boussaoud, Driss; Brovelli, Andrea; Keysers, Christian; Wicker, Bruno

    2013-01-01

    Learning what behaviour is appropriate in a specific context by observing the actions of others and their outcomes is a key constituent of human cognition, because it saves time and energy and reduces exposure to potentially dangerous situations. Observational learning of associative rules relies on the ability to map the actions of others onto our own, process outcomes, and combine these sources of information. Here, we combined newly developed experimental tasks and functional magnetic resonance imaging (fMRI) to investigate the neural mechanisms that govern such observational learning. Results show that the neural systems involved in individual trial-and-error learning and in action observation and execution both participate in observational learning. In addition, we identified brain areas that specifically activate for others' incorrect outcomes during learning in the posterior medial frontal cortex (pMFC), the anterior insula and the posterior superior temporal sulcus (pSTS).

  9. Predicting the outcome of chronic kidney disease by the estimated nephron number: The rationale and design of PRONEP, a prospective, multicenter, observational cohort study

    Directory of Open Access Journals (Sweden)

    Imasawa Toshiyuki

    2012-03-01

    Full Text Available Abstract Background The nephron number is thought to be associated with the outcome of chronic kidney disease (CKD. If the nephron number can be estimated in the clinical setting, it could become a strong tool to predict renal outcome. This study was designed to estimate the nephron number in CKD patients and to establish a method to predict the outcome by using the estimated nephron number. Methods/Design The hypothesis of this study is that the estimated nephron number can predict the outcome of a CKD patient. This will be a multicenter, prospective (minimum 3 and maximum 5 years follow-up study. The subjects will comprise CKD patients aged over 14 years who have undergone a kidney biopsy. From January 2011 to March 2013, we will recruit 600 CKD patients from 10 hospitals belonging to the National Hospital Organization of Japan. The primary parameter for assessment is the composite of total mortality, renal death, cerebro-cardiovascular events, and a 50% reduction in the eGFR. The secondary parameter is the rate of eGFR decline per year. The nephron number will be estimated by the glomerular density in biopsy specimens and the renal cortex volume. This study includes one sub-cohort study to establish the equation to calculate the renal cortex volume. Enrollment will be performed at the time of the kidney biopsy, and the data will consist of a medical interview, ultrasound for measurement of the kidney size, blood or urine test, and the pathological findings of the kidney biopsy. Patients will continue to have medical consultations and receive examinations and/or treatment as usual. The data from the patients will be collected once a year after the kidney biopsy until March 2016. All data using this study are easily obtained in routine clinical practice. Discussion This study includes the first trials to estimate the renal cortex volume and nephron number in the general clinical setting. Furthermore, this is the first prospective study to

  10. A Patient Advocate to facilitate access and improve communication, care, and outcomes in adults with moderate or severe asthma: Rationale, design, and methods of a randomized controlled trial

    Science.gov (United States)

    Apter, Andrea J.; Morales, Knashawn H.; Han, Xiaoyan; Perez, Luzmercy; Huang, Jingru; Ndicu, Grace; Localio, Anna; Nardi, Alyssa; Klusaritz, Heather; Rogers, Marisa; Phillips, Alexis; Cidav, Zuleyha; Schwartz, J. Sanford

    2017-01-01

    Few interventions to improve asthma outcomes have targeted low-income minority adults. Even fewer have focused on the real-world practice where care is delivered. We adapted a patient navigator, here called a Patient Advocate (PA), a term preferred by patients, to facilitate and maintain access to chronic care for adults with moderate or severe asthma and prevalent co-morbidities recruited from clinics serving low-income urban neighborhoods. We describe the planning, design, methodology (informed by patient and provider focus groups), baseline results, and challenges of an ongoing randomized controlled trial of 312 adults of a PA intervention implemented in a variety of practices. The PA coaches, models, and assists participants with preparations for a visit with the asthma clinician; attends the visit with permission of participant and provider; and confirms participants’ understanding of what transpired at the visit. The PA facilitates scheduling, obtaining insurance coverage, overcoming patients’ unique social and administrative barriers to carrying out medical advice and transfer of information between providers and patients. PA activities are individualized, take account of comorbidities, and are generalizable to other chronic diseases. PAs are recent college graduates interested in health-related careers, research experience, working with patients, and generally have the same race/ethnicity distribution as potential participants. We test whether the PA intervention, compared to usual care, is associated with improved and sustained asthma control and other asthma outcomes (prednisone bursts, ED visits, hospitalizations, quality of life, FEV1) relative to baseline. Mediators and moderators of the PA-asthma outcome relationship are examined along with the intervention’s cost-effectiveness. PMID:28315481

  11. Preventing AVF thrombosis: the rationale and design of the Omega-3 fatty acids (Fish Oils and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED study

    Directory of Open Access Journals (Sweden)

    Rosman Johan

    2009-01-01

    Full Text Available Abstract Background Haemodialysis (HD is critically dependent on the availability of adequate access to the systemic circulation, ideally via a native arteriovenous fistula (AVF. The Primary failure rate of an AVF ranges between 20–54%, due to thrombosis or failure of maturation. There remains limited evidence for the use of anti-platelet agents and uncertainty as to choice of agent(s for the prevention of AVF thrombosis. We present the study protocol for a randomised, double-blind, placebo-controlled, clinical trial examining whether the use of the anti-platelet agents, aspirin and omega-3 fatty acids, either alone or in combination, will effectively reduce the risk of early thrombosis in de novo AVF. Methods/Design The study population is adult patients with stage IV or V chronic kidney disease (CKD currently on HD or where HD is planned to start within 6 months in whom a planned upper or lower arm AVF is to be the primary HD access. Using a factorial-design trial, patients will be randomised to aspirin or matching placebo, and also to omega-3 fatty acids or matching placebo, resulting in four treatment groups (aspirin placebo/omega-3 fatty acid placebo, aspirin/omega-3 fatty acid placebo, aspirin placebo/omega-3 fatty acid, aspirin/omega-3 fatty acid. Randomisation will be achieved using a dynamic balancing method over the two stratification factors of study site and upper versus lower arm AVF. The medication will be commenced pre-operatively and continued for 3 months post surgery. The primary outcome is patency of the AVF at three months after randomisation. Secondary outcome measures will include functional patency at six and twelve months, primary patency time, secondary (assisted patency time, and adverse events, particularly bleeding. Discussion This multicentre Australian and New Zealand study has been designed to determine whether the outcome of surgery to create de novo AVF can be improved by the use of aspirin and/or omega-3 fatty

  12. Preventing AVF thrombosis: the rationale and design of the Omega-3 fatty acids (Fish Oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study.

    Science.gov (United States)

    Irish, Ashley; Dogra, Gursharan; Mori, Trevor; Beller, Elaine; Heritier, Stephane; Hawley, Carmel; Kerr, Peter; Robertson, Amanda; Rosman, Johan; Paul-Brent, Peta-Anne; Starfield, Melissa; Polkinghorne, Kevan; Cass, Alan

    2009-01-21

    Haemodialysis (HD) is critically dependent on the availability of adequate access to the systemic circulation, ideally via a native arteriovenous fistula (AVF). The Primary failure rate of an AVF ranges between 20-54%, due to thrombosis or failure of maturation. There remains limited evidence for the use of anti-platelet agents and uncertainty as to choice of agent(s) for the prevention of AVF thrombosis. We present the study protocol for a randomised, double-blind, placebo-controlled, clinical trial examining whether the use of the anti-platelet agents, aspirin and omega-3 fatty acids, either alone or in combination, will effectively reduce the risk of early thrombosis in de novo AVF. The study population is adult patients with stage IV or V chronic kidney disease (CKD) currently on HD or where HD is planned to start within 6 months in whom a planned upper or lower arm AVF is to be the primary HD access. Using a factorial-design trial, patients will be randomised to aspirin or matching placebo, and also to omega-3 fatty acids or matching placebo, resulting in four treatment groups (aspirin placebo/omega-3 fatty acid placebo, aspirin/omega-3 fatty acid placebo, aspirin placebo/omega-3 fatty acid, aspirin/omega-3 fatty acid). Randomisation will be achieved using a dynamic balancing method over the two stratification factors of study site and upper versus lower arm AVF. The medication will be commenced pre-operatively and continued for 3 months post surgery. The primary outcome is patency of the AVF at three months after randomisation. Secondary outcome measures will include functional patency at six and twelve months, primary patency time, secondary (assisted) patency time, and adverse events, particularly bleeding. This multicentre Australian and New Zealand study has been designed to determine whether the outcome of surgery to create de novo AVF can be improved by the use of aspirin and/or omega-3 fatty acids. Recently a placebo-controlled trial has shown that

  13. The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES study: background, design and rationale

    Directory of Open Access Journals (Sweden)

    McCargar Linda

    2010-10-01

    Full Text Available Abstract Background Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery. Methods/design Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada, with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference

  14. Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods part 1: rationale and methodology for the impedance threshold device (ITD) protocol.

    Science.gov (United States)

    Aufderheide, Tom P; Kudenchuk, Peter J; Hedges, Jerris R; Nichol, Graham; Kerber, Richard E; Dorian, Paul; Davis, Daniel P; Idris, Ahamed H; Callaway, Clifton W; Emerson, Scott; Stiell, Ian G; Terndrup, Thomas E

    2008-08-01

    The primary aim of this study is to compare survival to hospital discharge with a modified Rankin score (MRS)CPR) plus an active impedance threshold device (ITD) versus standard CPR plus a sham ITD in patients with out-of-hospital cardiac arrest. Secondary aims are to compare functional status and depression at discharge and at 3 and 6 months post-discharge in survivors. Prospective, double-blind, randomized, controlled, clinical trial. Patients with non-traumatic out-of-hospital cardiac arrest treated by emergency medical services (EMS) providers. EMS systems participating in the Resuscitation Outcomes Consortium. Based on a one-sided significance level of 0.025, power=0.90, a survival with MRSCPR and sham ITD, and two interim analyses, a maximum of 14,742 evaluable patients are needed to detect a 6.69% survival with MRSCPR and active ITD (1.36% absolute survival difference). If the ITD demonstrates the hypothesized improvement in survival, it is estimated that 2700 deaths from cardiac arrest per year would be averted in North America alone.

  15. Empathy Modulates the Evaluation Processing of Altruistic Outcomes

    Directory of Open Access Journals (Sweden)

    Xin Liu

    2018-04-01

    Full Text Available Empathy plays a central role in social decisions involving psychological conflict, such as whether to help another person at the cost of one’s own interests. Using the event-related potential (ERP technique, the current study explored the neural mechanisms underlying the empathic effect on the evaluation processing of outcomes in conflict-of-interest situations, in which the gain of others resulted in the performer’s loss. In the high-empathy condition, the beneficiaries were underprivileged students who were living in distress (stranger in need. In the low-empathy condition, the beneficiaries were general students without miserable information (stranger not in need. ERP results showed that the FRN was more negative-going for self no-gain than self gain, but showed reversed pattern for other’s outcome (i.e., more negative for gain than no-gain in the low-empathy condition, indicating that participants interpreted the gain of others as the loss of themselves. However, the reversed FRN pattern was not observed in the high-empathy condition, suggesting that the neural responses to one’s own loss are buffered by empathy. In addition, the P3 valence effect was observed only in the self condition, but not in the two stranger conditions, indicating that the P3 is more sensitive to self-relevant information. Moreover, the results of subjective rating showed that more empathic concern and altruistic motivation were elicited in the high-empathy condition than in the low-empathy condition, and these scores had negative linear correlations only with the FRN, but not with the P3. These findings suggest that when outcomes following altruistic decisions involve conflict of interest, the early stage of the processing of outcome evaluation could be modulated by the empathic level.

  16. Erythroleukemia shares biological features and outcome with myelodysplastic syndromes with excess blasts: a rationale for its inclusion into future classifications of myelodysplastic syndromes.

    Science.gov (United States)

    Calvo, Xavier; Arenillas, Leonor; Luño, Elisa; Senent, Leonor; Arnan, Montserrat; Ramos, Fernando; Ardanaz, María Teresa; Pedro, Carme; Tormo, Mar; Montoro, Julia; Díez-Campelo, María; Arrizabalaga, Beatriz; Xicoy, Blanca; Bonanad, Santiago; Jerez, Andrés; Nomdedeu, Benet; Ferrer, Ana; Sanz, Guillermo F; Florensa, Lourdes

    2016-12-01

    Erythroleukemia was considered an acute myeloid leukemia in the 2008 World Health Organization (WHO) classification and is defined by the presence of ≥50% bone marrow erythroblasts, having <20% bone marrow blasts from total nucleated cells but ≥20% bone marrow myeloblasts from nonerythroid cells. Erythroleukemia shares clinicopathologic features with myelodysplastic syndromes, especially with erythroid-predominant myelodysplastic syndromes (≥50% bone marrow erythroblasts). The upcoming WHO revision proposes to eliminate the nonerythroid blast cell count rule and to move erythroleukemia patients into the appropriate myelodysplastic syndrome category on the basis of the absolute blast cell count. We conducted a retrospective study of patients with de novo erythroleukemia and compared their clinico-biological features and outcome with those of de novo myelodysplastic syndromes, focusing on erythroid-predominant myelodysplastic syndromes. Median overall survival of 405 erythroid-predominant myelodysplastic syndromes without excess blasts was significantly longer than that observed in 57 erythroid-predominant refractory anemias with excess blasts-1 and in 59 erythroleukemias, but no significant difference was observed between erythroid-predominant refractory anemias with excess blasts-1 and erythroleukemias. In this subset of patients with ≥50% bone marrow erythroblasts and excess blasts, the presence of a high-risk karyotype defined by the International Prognostic Scoring System or by the Revised International Prognostic Scoring System was the main prognostic factor. In the same way, the survival of 459 refractory anemias with excess blasts-2, independently of having ≥20% bone marrow blasts from nonerythroid cells or not, was almost identical to the observed in 59 erythroleukemias. Interestingly, 11 low-blast count erythroleukemias with 5 to <10% bone marrow blasts from total nucleated cells showed similar survival than the rest of erythroleukemias. Our data

  17. Psychological risk factors of micro- and macrovascular outcomes in primary care patients with type 2 diabetes: rationale and design of the DiaDDZoB Study

    Directory of Open Access Journals (Sweden)

    Pop Victor JM

    2010-07-01

    Full Text Available Abstract Background Depression is a common psychiatric complication of diabetes, but little is known about the natural course and the consequences of depressive symptoms in primary care patients with type 2 diabetes. While depression has been related to poor glycemic control and increased risk for macrovascular disease, its association with microvascular complications remains understudied. The predictive role of other psychological risk factors such as Type D (distressed personality and the mechanisms that possibly link depression and Type D personality with poor vascular outcomes are also still unclear. Methods/Design This prospective cohort study will examine: (1 the course of depressive symptoms in primary care patients with type 2 diabetes; (2 whether depressive symptoms and Type D personality are associated with the development of microvascular and/or macrovascular complications and with the risk of all-cause or vascular mortality; and (3 the behavioral and physiological mechanisms that may mediate these associations. The DiaDDZoB Study is embedded within the larger DIAZOB Primary Care Diabetes study, which covers a comprehensive cohort of type 2 diabetes patients treated by over 200 primary care physicians in South-East Brabant, The Netherlands. These patients will be followed during their lifetime and are assessed annually for demographic, clinical, lifestyle and psychosocial factors. Measurements include an interviewer-administered and self-report questionnaire, regular care laboratory tests and physical examinations, and pharmacy medication records. The DiaDDZoB Study uses data that have been collected during the original baseline assessment in 2005 (M0; N = 2,460 and the 2007 (M1; N = 2,225 and 2008 (M2; N = 2,032 follow-up assessments. Discussion The DiaDDZoB Study is expected to contribute to the current understanding of the course of depression in primary care patients with type 2 diabetes and will also test whether depressed

  18. Integration of e-learning outcomes into work processes

    OpenAIRE

    Kerstin Grundén

    2011-01-01

    Three case studies of in-house developed e-learning education in public organizations with different pedagogical approaches are used as a starting point for discussion regarding the implementation challenges of e-learning at work. The aim of this article is to contribute to the understanding of integrating mechanisms of e-learning outcomes into work processes in large, public organizations. The case studies were analyzed from a socio-cultural perspective using the MOA-model as a frame of refe...

  19. DOE LLW classification rationale

    International Nuclear Information System (INIS)

    Flores, A.Y.

    1991-01-01

    This report was about the rationale which the US Department of Energy had with low-level radioactive waste (LLW) classification. It is based on the Nuclear Regulatory Commission's classification system. DOE site operators met to review the qualifications and characteristics of the classification systems. They evaluated performance objectives, developed waste classification tables, and compiled dose limits on the waste. A goal of the LLW classification system was to allow each disposal site the freedom to develop limits to radionuclide inventories and concentrations according to its own site-specific characteristics. This goal was achieved with the adoption of a performance objectives system based on a performance assessment, with site-specific environmental conditions and engineered disposal systems

  20. Change Processes in Residential Cognitive and Interpersonal Psychotherapy for Social Phobia: A Process-Outcome Study

    Science.gov (United States)

    Hoffart, Asle; Borge, Finn-Magnus; Sexton, Harold; Clark, David M.

    2009-01-01

    The purpose of this study was to test cognitive and interpersonal models for improving social phobia. Eighty patients with social phobia were randomized to 10-week residential cognitive (RCT) or residential interpersonal psychotherapy (RIPT). They completed process measures every Thursday and a sub-outcome measure every Monday. The ratings were…

  1. Process versus outcome: challenges of the chiropractic wellness paradigm

    Science.gov (United States)

    Russell, Eric G.

    2010-01-01

    Objective The purpose of this article is to discuss the term wellness in the context of the philosophy of chiropractic. Discussion PubMed and Index to Chiropractic Literature show an upward trend in use of the term wellness. Wellness may be used differently depending upon the profession and may be considered a process by some and an outcome by others. Conclusion There appears to be no consensus on the definition of wellness or how it is being used. Wellness is not exclusive to chiropractic, and wellness is not synonymous with health, although is often used that way. Wellness is a societal trend, and chiropractic as a health care profession may be a good fit for this concept. PMID:22693468

  2. Impact of HMO ownership on management processes and utilization outcomes.

    Science.gov (United States)

    Ahern, M; Molinari, C

    2001-05-01

    To examine the effects of health maintenance organization (HMO) ownership characteristics on selected utilization outcomes and management processes affecting utilization. We used 1995 HMO data from the American Association of Health Plans. Using regression analysis, we examined the relation between HMO utilization (hospital discharges, days, and average length of stay; cardiac catheterization procedures; and average cost of outpatient prescriptions) and the structural characteristics of HMOs: ownership type (insurance company, hospital, physician, independent, and national managed care company), HMO size, for-profit status, model type, geographic region, and payer mix. HMO ownership type is significantly associated with medical management processes, including risk sharing by providers, risk sharing by consumers, and other management strategies. Relative to hospital-owned HMOs, insurance company-owned HMOs have fewer hospital discharges, fewer hospital days, and longer lengths of stay. National managed care organization-owned HMOs have fewer cardiac catheterizations and lower average outpatient prescription costs. Independently owned HMOs have more cardiac catheterizations. For-profit HMOs have lower prescription costs. Relative to hospital-owned HMOs, insurance company-owned HMOs are more likely to use hospital risk sharing and provider capitation and less likely to use out-of-pocket payments for hospital use and a closed formulary. National managed care organization-owned HMOs are less likely to use provider capitation, out-of-pocket payments for hospital use, catastrophic case management, and hospital risk sharing. Physician-hospital-owned HMOs are less likely to use catastrophic case management. For-profit HMOs are more likely to use hospital risk sharing and catastrophic case management. HMO ownership type affects utilization outcomes and management strategies.

  3. The european primary care monitor: structure, process and outcome indicators

    Directory of Open Access Journals (Sweden)

    Wilson Andrew

    2010-10-01

    Full Text Available Abstract Background Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited. There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care. Methods A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1 the dimensions of primary care and their relevance to outcomes at (primary health system level; (2 essential features per dimension; (3 applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems. Results The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators

  4. Radiosensitizers: rationale and potential

    International Nuclear Information System (INIS)

    Brown, J.M.

    1981-01-01

    This paper briefly reviews agents that are capable of sensitizing hypoxic cells to radiation and chemotherapeutic agents. The first part is a synopsis of the development of hypoxic radiosensitizers, which concludes that misonidazole can be effective against human tumors. Unfortunately, neurotoxicity limits its effectiveness in humans because the dose that can be given in conjunction with daily fractionated radiation is five to ten times lower than is required for full radiosensitization of the hypoxic cells. The second part covers our recent efforts to develop a drug that does not produce such limiting neurotoxicity. The primary rationale of our program was to synthesize a drug with a short plasma half-life that was too hydrophilic to cross the blood-brain barrier but was able to penetrate tumors and radiosensitize hypoxic cells. From this program, a new drug, SR-2508, has been found that is as efficient as misonidazole in its radiosensitizing ability, but is four to ten times less toxic. Finally, the potential of radiosensitizers not only as agents that can sensitize tumor cells to radiation, but also as agents that can specifically sensitize tumors to chemotherapeutic agents, is discussed. In addition, these drugs may be potential cytotoxic agents that produce toxicity only in solid tumors

  5. Acute effects of alcohol on feedback processing and outcome evaluation during risky decision-making: an ERP study

    NARCIS (Netherlands)

    A.S. Euser (Anja); C.S. Meel (Catharine); M. Snelleman (Michelle); I.H.A. Franken (Ingmar)

    2011-01-01

    textabstractRationale: Although risky decision-making is one of the hallmarks of alcohol use disorders, relatively little is known about the acute psychopharmacological effects of alcohol on decision-making processes. Objective: The present study investigated the acute effects of alcohol on neural

  6. Improving energy audit process and report outcomes through planning initiatives

    Science.gov (United States)

    Sprau Coulter, Tabitha L.

    Energy audits and energy models are an important aspect of the retrofit design process, as they provide project teams with an opportunity to evaluate a facilities current building systems' and energy performance. The information collected during an energy audit is typically used to develop an energy model and an energy audit report that are both used to assist in making decisions about the design and implementation of energy conservation measures in a facility. The current lack of energy auditing standards results in a high degree of variability in energy audit outcomes depending on the individual performing the audit. The research presented is based on the conviction that performing an energy audit and producing a value adding energy model for retrofit buildings can benefit from a revised approach. The research was divided into four phases, with the initial three phases consisting of: 1.) process mapping activity - aimed at reducing variability in the energy auditing and energy modeling process. 2.) survey analysis -- To examine the misalignment between how industry members use the top energy modeling tools compared to their intended use as defined by software representatives. 3.) sensitivity analysis -- analysis of the affect key energy modeling inputs are having on energy modeling analysis results. The initial three phases helped define the need for an improved energy audit approach that better aligns data collection with facility owners' needs and priorities. The initial three phases also assisted in the development of a multi-criteria decision support tool that incorporates a House of Quality approach to guide a pre-audit planning activity. For the fourth and final research phase explored the impacts and evaluation methods of a pre-audit planning activity using two comparative energy audits as case studies. In each case, an energy audit professionals was asked to complete an audit using their traditional methods along with an audit which involved them first

  7. Attitudes of Austrian Psychotherapists Towards Process and Outcome Monitoring.

    Science.gov (United States)

    Kaiser, Tim; Schmutzhart, Lisa; Laireiter, Anton-Rupert

    2018-03-08

    While monitoring systems in psychotherapy have become more common, little is known about the attitudes that mental health practitioners have towards these systems. In an online survey among 111 Austrian psychotherapists and trainees, attitudes towards therapy monitoring were measured. A well-validated questionnaire measuring attitudes towards outcome monitoring, the Outcome Measurement Questionnaire, was used. Clinicians' theoretical orientations as well as previous knowledge and experience with monitoring systems were associated with positive attitudes towards monitoring. Possible factors that may have led to these findings, like the views of different theoretical orientations or obstacles in Austrian public health care, are discussed.

  8. Vicarious Neural Processing of Outcomes during Observational Learning

    NARCIS (Netherlands)

    Monfardini, Elisabetta; Gazzola, Valeria; Boussaoud, Driss; Brovelli, Andrea; Keysers, Christian; Wicker, Bruno

    2013-01-01

    Learning what behaviour is appropriate in a specific context by observing the actions of others and their outcomes is a key constituent of human cognition, because it saves time and energy and reduces exposure to potentially dangerous situations. Observational learning of associative rules relies on

  9. Theoretical rationale for music selection in oncology intervention research: an integrative review.

    Science.gov (United States)

    Burns, Debra S

    2012-01-01

    Music-based interventions have helped patients with cancer improve their quality of life, decrease treatment related distress, and manage pain. However, quantitative findings from music intervention studies are inconsistent. The purpose of this review was to explore the theoretical underpinnings for the selection of the music stimuli used to influence targeted outcomes. It was hypothesized that disparate findings were due in part to the atheoretical nature of music selection and the resulting diversity in music stimuli between and within studies. A systematic research synthesis including a comprehensive database and reference list search resulted in 22 studies. Included studies were compiled into two tables cataloging intervention theory, intervention content, and outcomes. A majority of studies did not provide a rationale or intervention theory for the delivery of music or choice of outcomes. Recorded music was the most common delivery method, but the specific music was rarely included within the report. Only two studies that included a theoretical framework reported null results on at least some of the outcomes. Null results are partially explained by an incomplete or mismatch in intervention theory and music selection and delivery. While the inclusion of an intervention theory does not guarantee positive results, including a theoretical rationale for the use of music, particular therapeutic processes or mechanisms, and the specifics of how music is selected and delivered increases scientific rigor and the probability of clinical translation.

  10. A statistical rationale for establishing process quality control limits using fixed sample size, for critical current verification of SSC superconducting wire

    International Nuclear Information System (INIS)

    Pollock, D.A.; Brown, G.; Capone, D.W. II; Christopherson, D.; Seuntjens, J.M.; Woltz, J.

    1992-03-01

    The purpose of this paper is to demonstrate a statistical method for verifying superconducting wire process stability as represented by I c . The paper does not propose changing the I c testing frequency for wire during Phase 1 of the present Vendor Qualification Program. The actual statistical limits demonstrated for one supplier's data are not expected to be suitable for all suppliers. However, the method used to develop the limits and the potential for improved process through their use, may be applied equally. Implementing the demonstrated method implies that the current practice of testing all pieces of wire from each billet, for the purpose of detecting manufacturing process errors (i.e. missing a heat-treatment cycle for a part of the billet, etc.) can be replaced by other less costly process control measures. As used in this paper process control limits for critical current are quantitative indicators of the source manufacturing process uniformity. The limits serve as alarms indicating the need for manufacturing process investigation

  11. Appendix C: safety design rationale

    International Nuclear Information System (INIS)

    Ghose, S.

    1985-01-01

    A brief discussion of the rationale for safety design of fusion plants is presented in the main text. Further detail safety considerations are presented in this appendix in the form of charts and tables. The author present some of the major safety criteria and other criteria used in blanket selection here

  12. Session 2 report the process of decision making in Finland: Its history and outcome

    International Nuclear Information System (INIS)

    Aebersold, M.

    2002-01-01

    The round-table discussions focussed on three questions: what were the most important steps in the decision-making process for the different stakeholders? What influenced the process and the outcome? What are the lessons learnt? (authors)

  13. A statistical rationale for establishing process quality control limits using fixed sample size, for critical current verification of SSC superconducting wire

    International Nuclear Information System (INIS)

    Pollock, D.A.; Brown, G.; Capone, D.W. II; Christopherson, D.; Seuntjens, J.M.; Woltz, J.

    1992-01-01

    This work has demonstrated the statistical concepts behind the XBAR R method for determining sample limits to verify billet I c performance and process uniformity. Using a preliminary population estimate for μ and σ from a stable production lot of only 5 billets, we have shown that reasonable sensitivity to systematic process drift and random within billet variation may be achieved, by using per billet subgroup sizes of moderate proportions. The effects of subgroup size (n) and sampling risk (α and β) on the calculated control limits have been shown to be important factors that need to be carefully considered when selecting an actual number of measurements to be used per billet, for each supplier process. Given the present method of testing in which individual wire samples are ramped to I c only once, with measurement uncertainty due to repeatability and reproducibility (typically > 1.4%), large subgroups (i.e. >30 per billet) appear to be unnecessary, except as an inspection tool to confirm wire process history for each spool. The introduction of the XBAR R method or a similar Statistical Quality Control procedure is recommend for use in the superconducing wire production program, particularly when the program transitions from requiring tests for all pieces of wire to sampling each production unit

  14. Influence of Efforts of Employer and Employee on Return-to-Work Process and Outcomes

    NARCIS (Netherlands)

    Muijzer, A.; Groothoff, J. W.; Geertzen, J. H. B.; Brouwer, S.

    2011-01-01

    Background Research on disability and RTW outcome has led to significant advances in understanding these outcomes, however, limited studies focus on measuring the RTW process. After a prolonged period of sickness absence, the assessment of the RTW process by investigating RTW Effort Sufficiency

  15. Influence of efforts of employer and employee on return-to-work process and outcomes

    NARCIS (Netherlands)

    Muijzer, A.; Groothoff, J. W.; Geertzen, J. H. B.; Brouwer, S.

    2011-01-01

    Research on disability and RTW outcome has led to significant advances in understanding these outcomes, however, limited studies focus on measuring the RTW process. After a prolonged period of sickness absence, the assessment of the RTW process by investigating RTW Effort Sufficiency (RTW-ES) is

  16. A Perspective on the History of Process and Outcome Research in Counseling Psychology.

    Science.gov (United States)

    Hill, Clara E.; Corbett, Maureen M.

    1993-01-01

    Traces development of process and outcome research from before foundation of counseling psychology in 1946 to present. Describes influence of Carl Rogers's theory, behavior, psychoanalytic, systems, interpersonal, and social influence theories. Covers Eysenck's challenge to efficacy of psychotherapy; uniformity myth that process and outcome are…

  17. The Effect of Competition on Process and Outcome Quality of Hospital Care in the Netherlands

    NARCIS (Netherlands)

    Shestalova, V.; Bijlsma, M.; Koning, P.W.C.

    2013-01-01

    We examine the impact of competition on outcome and process indicators of hospital quality. While earlier literature on the relationship between competition and hospital quality mainly focused on outcome indicators, we argue that the inclusion of process indicators in the analysis can provide

  18. Processes and Outcomes in Student Teamwork. An Empirical Study in a Marketing Subject

    Science.gov (United States)

    Bravo, Rafael; Lucia-Palacios, Laura; Martin, Maria J.

    2016-01-01

    The presence of student teamwork is increasing in most university degrees. However, there is still a gap in the literature regarding the connection between teamwork processes and their outcomes. In this paper, the authors analyze these processes and how they relate to teamwork outcomes from the students' perspective. Data was gathered from 129…

  19. Motivation Monitoring and Assessment Extension for Input-Process-Outcome Game Model

    Science.gov (United States)

    Ghergulescu, Ioana; Muntean, Cristina Hava

    2014-01-01

    This article proposes a Motivation Assessment-oriented Input-Process-Outcome Game Model (MotIPO), which extends the Input-Process-Outcome game model with game-centred and player-centred motivation assessments performed right from the beginning of the game-play. A feasibility case-study involving 67 participants playing an educational game and…

  20. Effects of Mobile Instant Messaging on Collaborative Learning Processes and Outcomes: The Case of South Korea

    Science.gov (United States)

    Kim, Hyewon; Lee, MiYoung; Kim, Minjeong

    2014-01-01

    The purpose of this paper was to investigate the effects of mobile instant messaging on collaborative learning processes and outcomes. The collaborative processes were measured in terms of different types of interactions. We measured the outcomes of the collaborations through both the students' taskwork and their teamwork. The collaborative…

  1. Home versus hospital birth--process and outcome.

    Science.gov (United States)

    Wax, Joseph R; Pinette, Michael G; Cartin, Angelina

    2010-02-01

    A constant small, but clinically important, number of American women choose to deliver at home. Contradictory professional and public policies reflect the polarization and politicization of the controversy surrounding this birth option. Women opting for home birth seek and often attain their goals of a nonmedicalized experience in comfortable, familiar surroundings wherein they maintain situational control. However, home deliveries in developed Western nations are often associated with excess perinatal and neonatal mortality, particularly among nonanomalous term infants. On the other hand, current home birth practices are, especially when birth attendants are highly trained and fully integrated into comprehensive health care delivery systems, associated with fewer cesareans, operative vaginal deliveries, episiotomies, infections, and third and fourth degree lacerations. Newborn benefits include less meconium staining, assisted ventilation, low birth weight, prematurity, and intensive care admissions. Existing data suggest areas of future research regarding the safety of home birth in the United States. Obstetricians & Gynecologists, Family Physicians. After completion of this educational activity, the participant should be better able to assess perinatal outcomes described in the reported literature associated with home births in developed countries, list potential advantages and disadvantages of planned home births, and identify confounders in current literature that impact our thorough knowledge of home birth outcomes.

  2. Participation process and outcome interactions: Exploring participation in water resource management

    Science.gov (United States)

    Carr, G.; Loucks, D. P.; Blöschl, G.

    2012-04-01

    Evaluating participation programmes, projects and activities aids understanding of effective mechanisms and enables the identification of improvements to current strategies. Characteristics of participation processes, such whether the process is cost effective, adequately facilitated, accessible, includes a representative section of society or interest groups and allocates power equivalently between participants, are commonly described and evaluated in the literature. A key question concerns whether effective processes lead to desirable outcomes. Two types of outcomes can be identified from participation programmes - tangible and non-tangible. Tangible outcomes include resource management changes or resource quality changes. Non tangible outcomes include developing and strengthening communication and action networks, building trust between individuals and/or organisations, developing innovative solutions, or developing shared knowledge and understandings of issues. To better understand how participation impacts upon resource management it is necessary to identify i) how non-tangible outcomes lead to resource management outcomes and ii) which characteristics of the participation process are connected to achieving non-tangible outcomes. This has been attempted with a literature based meta-analysis. Literature has been analysed to identify outcomes from participations programmes, and the process characteristics present that are associated with promoting or inhibiting their achievement. Preliminary analysis shows that process characteristics such as representation, facilitation and accessibility are important for achieving non-tangible outcomes. The relationship between non-tangible outcomes and resource management outcomes is less clear in the literature. This may be due to the different timescales over which the different types of outcomes emerge (resource management outcomes emerge over longer time periods) and the different contexts or settings in which

  3. Central auditory processing outcome after stroke in children

    Directory of Open Access Journals (Sweden)

    Karla M. I. Freiria Elias

    2014-09-01

    Full Text Available Objective To investigate central auditory processing in children with unilateral stroke and to verify whether the hemisphere affected by the lesion influenced auditory competence. Method 23 children (13 male between 7 and 16 years old were evaluated through speech-in-noise tests (auditory closure; dichotic digit test and staggered spondaic word test (selective attention; pitch pattern and duration pattern sequence tests (temporal processing and their results were compared with control children. Auditory competence was established according to the performance in auditory analysis ability. Results Was verified similar performance between groups in auditory closure ability and pronounced deficits in selective attention and temporal processing abilities. Most children with stroke showed an impaired auditory ability in a moderate degree. Conclusion Children with stroke showed deficits in auditory processing and the degree of impairment was not related to the hemisphere affected by the lesion.

  4. Assessing the integrity of the cognitive processes involved in belief reasoning by means of two nonverbal tasks: Rationale, normative data collection and illustration with brain-damaged patients

    Science.gov (United States)

    Biervoye, Aurélie; Meert, Gaëlle; Apperly, Ian A.; Samson, Dana

    2018-01-01

    Every day, we engage in social interactions with other people which require understanding their as well as our own mental states. Such capacity is commonly referred to as Theory of Mind (ToM). Disturbances of ToM are often reported in diverse pathologies which affect brain functioning and lead to problems in social interactions. Identifying ToM deficits is thus crucial to guide the clinicians in the establishment of adequate rehabilitation strategies for patients. Previous studies have demonstrated that ToM is not a unitary function yet currently there are very few standardized tests which allow identifying the type of cognitive processes affected when a patient exhibits a ToM deficit. In the current study, we present two belief reasoning tasks which have been used in previous research to disentangle two types of processes involved in belief reasoning: self-perspective inhibition and the spontaneous inference of another person’s belief. A three-step procedure was developed to provide clinicians with the tools to interpret the patients’ performances on the tasks. First, these tasks were standardized and normative data was collected on a sample of 124 healthy participants aged between 18 and 74. Data collected showed a decrease in performance as a function of age only in the task that loaded most in spontaneous other-perspective demands. There was however no effect of gender or educational level. Cut-off scores to identify deficits were then calculated for the different age groups separately. Secondly, the three-step procedure was applied to 21 brain-damaged patients and showed a large diversity of profiles, including selective deficits of the two targeted ToM processes. The diversity of profiles shows the importance to take into account the multiple facets of ToM during the diagnosis and rehabilitation of patients with suspected ToM deficits. PMID:29381730

  5. Assessing the integrity of the cognitive processes involved in belief reasoning by means of two nonverbal tasks: Rationale, normative data collection and illustration with brain-damaged patients.

    Directory of Open Access Journals (Sweden)

    Aurélie Biervoye

    Full Text Available Every day, we engage in social interactions with other people which require understanding their as well as our own mental states. Such capacity is commonly referred to as Theory of Mind (ToM. Disturbances of ToM are often reported in diverse pathologies which affect brain functioning and lead to problems in social interactions. Identifying ToM deficits is thus crucial to guide the clinicians in the establishment of adequate rehabilitation strategies for patients. Previous studies have demonstrated that ToM is not a unitary function yet currently there are very few standardized tests which allow identifying the type of cognitive processes affected when a patient exhibits a ToM deficit. In the current study, we present two belief reasoning tasks which have been used in previous research to disentangle two types of processes involved in belief reasoning: self-perspective inhibition and the spontaneous inference of another person's belief. A three-step procedure was developed to provide clinicians with the tools to interpret the patients' performances on the tasks. First, these tasks were standardized and normative data was collected on a sample of 124 healthy participants aged between 18 and 74. Data collected showed a decrease in performance as a function of age only in the task that loaded most in spontaneous other-perspective demands. There was however no effect of gender or educational level. Cut-off scores to identify deficits were then calculated for the different age groups separately. Secondly, the three-step procedure was applied to 21 brain-damaged patients and showed a large diversity of profiles, including selective deficits of the two targeted ToM processes. The diversity of profiles shows the importance to take into account the multiple facets of ToM during the diagnosis and rehabilitation of patients with suspected ToM deficits.

  6. Rationales for regulatory activity

    Energy Technology Data Exchange (ETDEWEB)

    Perhac, R.M. [Univ. of Tennessee, Knoxville, TN (United States)

    1997-02-01

    The author provides an outline which touches on the types of concerns about risk evaluation which are addressed in the process of establishing regulatory guides. Broadly he says regulatory activity serves three broad constituents: (1) Paternalism (private risk); (2) Promotion of social welfare (public risks); (3) Protection of individual rights (public risks). He then discusses some of the major issues encountered in reaching a decision on what is an acceptable level of risk within each of these areas, and how one establishes such a level.

  7. Rationales for Commonly "Challenged" Taught Books.

    Science.gov (United States)

    Shugert, Diane P., Ed.; And Others

    1983-01-01

    Intended for teachers, this focused journal issue contains separate rationales for teaching books that have been challenged as appropriate instructional materials. Following a discussion of the purpose for rationales and suggestions for using them, the journal presents rationales for teaching the following books: "To Kill a Mockingbird,""The Diary…

  8. Executive function processes predict mobility outcomes in older adults.

    Science.gov (United States)

    Gothe, Neha P; Fanning, Jason; Awick, Elizabeth; Chung, David; Wójcicki, Thomas R; Olson, Erin A; Mullen, Sean P; Voss, Michelle; Erickson, Kirk I; Kramer, Arthur F; McAuley, Edward

    2014-02-01

    To examine the relationship between performance on executive function measures and subsequent mobility outcomes in community-dwelling older adults. Randomized controlled clinical trial. Champaign-Urbana, Illinois. Community-dwelling older adults (N = 179; mean age 66.4). A 12-month exercise trial with two arms: an aerobic exercise group and a stretching and strengthening group. Established cognitive tests of executive function (flanker task, task switching, and a dual-task paradigm) and the Wisconsin card sort test. Mobility was assessed using the timed 8-foot up and go test and times to climb up and down a flight of stairs. Participants completed the cognitive tests at baseline and the mobility measures at baseline and after 12 months of the intervention. Multiple regression analyses were conducted to determine whether baseline executive function predicted postintervention functional performance after controlling for age, sex, education, cardiorespiratory fitness, and baseline mobility levels. Selective baseline executive function measurements, particularly performance on the flanker task (β = 0.15-0.17) and the Wisconsin card sort test (β = 0.11-0.16) consistently predicted mobility outcomes at 12 months. The estimates were in the expected direction, such that better baseline performance on the executive function measures predicted better performance on the timed mobility tests independent of intervention. Executive functions of inhibitory control, mental set shifting, and attentional flexibility were predictive of functional mobility. Given the literature associating mobility limitations with disability, morbidity, and mortality, these results are important for understanding the antecedents to poor mobility function that well-designed interventions to improve cognitive performance can attenuate. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  9. Process-outcome interrelationship and standard setting in medical education: the need for a comprehensive approach.

    Science.gov (United States)

    Christensen, Leif; Karle, Hans; Nystrup, Jørgen

    2007-09-01

    An outcome-based approach to medical education compared to a process/content orientation is currently being discussed intensively. In this article, the process and outcome interrelationship in medical education is discussed, with specific emphasis on the relation to the definition of standards in basic medical education. Perceptions of outcome have always been an integrated element of curricular planning. The present debate underlines the need for stronger focus on learning objectives and outcome assessment in many medical schools around the world. The need to maintain an integrated approach of process/content and outcome is underlined in this paper. A worry is expressed about the taxonomy of learning in pure outcome-based medical education, in which student assessment can be a major determinant for the learning process, leaving the control of the medical curriculum to medical examiners. Moreover, curricula which favour reductionism by stating everything in terms of instrumental outcomes or competences, do face a risk of lowering quality and do become a prey for political interference. Standards based on outcome alone rise unclarified problems in relationship to licensure requirements of medical doctors. It is argued that the alleged dichotomy between process/content and outcome seems artificial, and that formulation of standards in medical education must follow a comprehensive line in curricular planning.

  10. Overview: oxidant and particle photochemical processes above a south-east Asian tropical rainforest (the OP3 project: introduction, rationale, location characteristics and tools

    Directory of Open Access Journals (Sweden)

    C. N. Hewitt

    2010-01-01

    Full Text Available In April–July 2008, intensive measurements were made of atmospheric composition and chemistry in Sabah, Malaysia, as part of the "Oxidant and particle photochemical processes above a South-East Asian tropical rainforest" (OP3 project. Fluxes and concentrations of trace gases and particles were made from and above the rainforest canopy at the Bukit Atur Global Atmosphere Watch station and at the nearby Sabahmas oil palm plantation, using both ground-based and airborne measurements. Here, the measurement and modelling strategies used, the characteristics of the sites and an overview of data obtained are described. Composition measurements show that the rainforest site was not significantly impacted by anthropogenic pollution, and this is confirmed by satellite retrievals of NO2 and HCHO. The dominant modulators of atmospheric chemistry at the rainforest site were therefore emissions of BVOCs and soil emissions of reactive nitrogen oxides. At the observed BVOC:NOx volume mixing ratio (~100 pptv/pptv, current chemical models suggest that daytime maximum OH concentrations should be ca. 105 radicals cm−3, but observed OH concentrations were an order of magnitude greater than this. We confirm, therefore, previous measurements that suggest that an unexplained source of OH must exist above tropical rainforest and we continue to interrogate the data to find explanations for this.

  11. Blood irradiation: Rationale and technique

    International Nuclear Information System (INIS)

    Lewis, M.C.

    1990-01-01

    Upon request by the local American Red Cross, the Savannah Regional Center for Cancer Care irradiates whole blood or blood components to prevent post-transfusion graft-versus-host reaction in patients who have severely depressed immune systems. The rationale for blood irradiation, the total absorbed dose, the type of patients who require irradiated blood, and the regulations that apply to irradiated blood are presented. A method of irradiating blood using a linear accelerator is described

  12. Goal planning: a retrospective audit of rehabilitation process and outcome.

    Science.gov (United States)

    Duff, Jane; Evans, Matthew J; Kennedy, Paul

    2004-05-01

    To consider the effectiveness of a goal planning programme for people with spinal cord injury (SCI) and address some of the current evidence gaps in goal setting. Retrospective audit. Consecutive series of 65 newly injured SCI patients. The Needs Assessment Checklist (NAC) has been specifically developed for the SCI population, and is used to assess patient attainment in core rehabilitation areas. A 'Goal Planning Progress' form was also used to specifically detail the goal planning process. Across the 65 patients, 396 goal planning meetings were held with 6176 goals set in total. Seventy-two per cent of the goals set at the first goal planning meeting were achieved by the second meeting. The rate of achievement at subsequent meetings was 68%. Significant differences in the number of planned rehabilitation days, number of goal planning meetings, and goals set were identified between injury categories. Significant positive correlations were found between the number of goals set and achievement, as measured by the NAC, in certain rehabilitation domains. The findings of this study demonstrate that the Needs Assessment and Goal Planning framework is effective in planning SCI rehabilitation. The capacity of this goal planning system to reflect individual need has also been established. Further systematic analyses of this process could potentially lead to more efficient rehabilitation and the identification of care pathways within clinical areas.

  13. Stimulus-Outcome Learnability Differentially Activates Anterior Cingulate and Hippocampus at Feedback Processing

    Science.gov (United States)

    Rodriguez, Paul F.

    2009-01-01

    Memory systems are known to be influenced by feedback and error processing, but it is not well known what aspects of outcome contingencies are related to different memory systems. Here we use the Rescorla-Wagner model to estimate prediction errors in an fMRI study of stimulus-outcome association learning. The conditional probabilities of outcomes…

  14. Future planning: default network activity couples with frontoparietal control network and reward-processing regions during process and outcome simulations.

    Science.gov (United States)

    Gerlach, Kathy D; Spreng, R Nathan; Madore, Kevin P; Schacter, Daniel L

    2014-12-01

    We spend much of our daily lives imagining how we can reach future goals and what will happen when we attain them. Despite the prevalence of such goal-directed simulations, neuroimaging studies on planning have mainly focused on executive processes in the frontal lobe. This experiment examined the neural basis of process simulations, during which participants imagined themselves going through steps toward attaining a goal, and outcome simulations, during which participants imagined events they associated with achieving a goal. In the scanner, participants engaged in these simulation tasks and an odd/even control task. We hypothesized that process simulations would recruit default and frontoparietal control network regions, and that outcome simulations, which allow us to anticipate the affective consequences of achieving goals, would recruit default and reward-processing regions. Our analysis of brain activity that covaried with process and outcome simulations confirmed these hypotheses. A functional connectivity analysis with posterior cingulate, dorsolateral prefrontal cortex and anterior inferior parietal lobule seeds showed that their activity was correlated during process simulations and associated with a distributed network of default and frontoparietal control network regions. During outcome simulations, medial prefrontal cortex and amygdala seeds covaried together and formed a functional network with default and reward-processing regions. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  15. Narrative Processes in Psychotherapy: differences between Good and Poor Outcome Clients

    Directory of Open Access Journals (Sweden)

    Luis Botella

    2015-12-01

    Full Text Available This paper compares 30 patients with good therapeutic outcome to 30 with poor therapeutic outcome in terms of the differential distribution of (1 Intake Variables (2 Outcome and Process Variables, and (3 Narrative Variables. Results indicated that psychosocial functioning, motivation, pre-therapy symptoms, Working Alliance, total number of therapy sessions, total pre-post symptom reduction, and mean scoring for total working alliance in sessions 3, 4, and 8 discriminated between both groups. Results also showed that almost all narrative variables except some of them discriminated good outcome clients from poor outcome ones from the beginning, midpoint and final stage of their therapeutic process. These results are discussed according to their relevance for clinical practice.

  16. A Process and Outcome Evaluation of Police Working with Youth Programs

    Directory of Open Access Journals (Sweden)

    Stephen A. Anderson

    2008-09-01

    Full Text Available A process and outcome evaluation of 10 Police Working with Youth Programs was conducted. Process results indicated that the core components of the programs were consistent with those identified in previous literature as characteristic of quality youth development programs. Outcome results indicated that youth participants reported significantly improved attitudes toward police and social support received from significant, non-familial adults. Two subgroups of youth, most notably minority youth and younger participants in lower grade levels, reported positive changes in their capacity to resist peer pressures. Minority youth reported positive changes in their sense of mastery over stressful life situations. Relationships between core program components and youth outcomes also were examined. Implications of the findings and future process and outcome evaluations of youth programs are discussed.

  17. Donabedian's structure-process-outcome quality of care model: Validation in an integrated trauma system.

    Science.gov (United States)

    Moore, Lynne; Lavoie, André; Bourgeois, Gilles; Lapointe, Jean

    2015-06-01

    According to Donabedian's health care quality model, improvements in the structure of care should lead to improvements in clinical processes that should in turn improve patient outcome. This model has been widely adopted by the trauma community but has not yet been validated in a trauma system. The objective of this study was to assess the performance of an integrated trauma system in terms of structure, process, and outcome and evaluate the correlation between quality domains. Quality of care was evaluated for patients treated in a Canadian provincial trauma system (2005-2010; 57 centers, n = 63,971) using quality indicators (QIs) developed and validated previously. Structural performance was measured by transposing on-site accreditation visit reports onto an evaluation grid according to American College of Surgeons criteria. The composite process QI was calculated as the average sum of proportions of conformity to 15 process QIs derived from literature review and expert opinion. Outcome performance was measured using risk-adjusted rates of mortality, complications, and readmission as well as hospital length of stay (LOS). Correlation was assessed with Pearson's correlation coefficients. Statistically significant correlations were observed between structure and process QIs (r = 0.33), and process and outcome QIs (r = -0.33 for readmission, r = -0.27 for LOS). Significant positive correlations were also observed between outcome QIs (r = 0.37 for mortality-readmission; r = 0.39 for mortality-LOS and readmission-LOS; r = 0.45 for mortality-complications; r = 0.34 for readmission-complications; 0.63 for complications-LOS). Significant correlations between quality domains observed in this study suggest that Donabedian's structure-process-outcome model is a valid model for evaluating trauma care. Trauma centers that perform well in terms of structure also tend to perform well in terms of clinical processes, which in turn has a favorable influence on patient outcomes

  18. Assessing the additional impact of Process Recovery Communications on Customer Outcomes: A Comprehensive Service Recovery Approach

    OpenAIRE

    Y. VAN VAERENBERGH; B. LARIVIÈRE; I. VERMEIR

    2009-01-01

    Purpose – Services recoveries following service failures not only imply customer recovery opportunities in which customer-company relationships can be restored, they can also result in process improvements (i.e. process recoveries in literature). This paper seeks to identify the additional impact of process recoveries on four customer outcome variables (satisfaction with service recovery, overall satisfaction, repurchase intent and word-of-mouth) by communicating these improvements back to th...

  19. Rationale and methods of the EFCOSUM project

    NARCIS (Netherlands)

    Brussaard, J.H.; Johansson, L.; Kearney, J.

    2002-01-01

    Objective: To describe the rationale and methods for a European project (EFCOSUM) to develop a method for a European food consumption survey that delivers internationally comparable data on a set of policy-relevant nutritional indicators. Rationale and methods: Currently Member States are collecting

  20. Event-related potential studies of outcome processing and feedback-guided learning

    Directory of Open Access Journals (Sweden)

    René eSan Martín

    2012-11-01

    Full Text Available In order to control behavior in an adaptive manner the brain has to learn how some situations and actions predict positive or negative outcomes. During the last decade cognitive neuroscientists have shown that the brain is able to evaluate and learn from outcomes within a few hundred milliseconds of their occurrence. This research has been primarily focused on the feedback-related negativity (FRN and the P3, two event-related potential (ERP components that are elicited by outcomes. The FRN is a frontally distributed negative-polarity ERP component that typically reaches its maximal amplitude 250 ms after outcome presentation and tends to be larger for negative than for positive outcomes. The FRN has been associated with activity in the anterior cingulate cortex. The P3 (~300-600 ms is a parietally distributed positive-polarity ERP component that tends to be larger for large magnitude than for small magnitude outcomes. The neural sources of the P3 are probably distributed over different regions of the cortex. This paper examines the theories that have been proposed to explain the functional role of these two ERP components during outcome processing. Special attention is paid to extant literature addressing how these ERP components are modulated by outcome valence (negative vs. positive, outcome magnitude (large vs. small, outcome probability (unlikely vs. likely and behavioral adjustment. The literature offers few generalizable conclusions, but is beset with a number of inconsistencies across studies. This paper discusses the potential reasons for these inconsistencies and points out some challenges that will shape the field over the next decade.

  1. Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study

    NARCIS (Netherlands)

    Reurink, Gustaaf; Goudswaard, Gert Jan; Moen, Maarten H.; Weir, Adam; Verhaar, Jan A. N.; Bierma-Zeinstra, Sita M. A.; Maas, Mario; Tol, Johannes L.

    2015-01-01

    Platelet-rich plasma (PRP) injections are an experimental treatment for acute muscle injuries. We examined whether PRP injections would accelerate return to play after hamstring injury. The methods and the primary outcome measure were published in the New England Journal of Medicine (NEJM) as

  2. A meta-analysis of multicultural competencies and psychotherapy process and outcome.

    Science.gov (United States)

    Tao, Karen W; Owen, Jesse; Pace, Brian T; Imel, Zac E

    2015-07-01

    For decades, psychologists have emphasized the provision of multiculturally competent psychotherapy to reduce racial and ethnic disparities in mental health treatment. However, the relationship between multicultural competencies (MC) and other measures of clinical process and treatment outcome has shown heterogeneity in effect sizes. This meta-analysis tested the association of client ratings of therapist MC with measures of therapeutic processes and outcome, including: (a) working alliance, (b) client satisfaction, (c) general counseling competence, (d) session impact, and (e) symptom improvement. Among 18 studies (20 independent samples) included in the analysis, the correlation between therapist MC and outcome (r = .29) was much smaller than the association with process measures (r = .75), but there were no significant differences in correlations across different types of MC or clinical process measures. Providing some evidence of publication bias, effect sizes from published studies (r = .67) were larger than those from unpublished dissertations (r = .28). Moderator analyses indicated that client age, gender, the representation of racial-ethnic minority (R-EM) clients, and clinical setting were not associated with effect size variability. Based on these findings, we discuss implications and recommendations for future research that might lead to a better understanding of the effects of therapist MC on treatment process and outcome. Primary needs in future research include the development and evaluation of observer ratings of therapist MC and the implementation of longitudinal research designs. (c) 2015 APA, all rights reserved).

  3. A review of assertions about the processes and outcomes of social learning in natural resource management.

    Science.gov (United States)

    Cundill, G; Rodela, R

    2012-12-30

    Social learning has become a central theme in natural resource management. This growing interest is underpinned by a number of assertions about the outcomes of social learning, and about the processes that support these outcomes. Yet researchers and practitioners who seek to engage with social learning through the natural resource management literature often become disorientated by the myriad processes and outcomes that are identified. We trace the roots of current assertions about the processes and outcomes of social learning in natural resource management, and assess the extent to which there is an emerging consensus on these assertions. Results suggest that, on the one hand, social learning is described as taking place through deliberative interactions amongst multiple stakeholders. During these interactions, it is argued that participants learn to work together and build relationships that allow for collective action. On the other hand, social learning is described as occurring through deliberate experimentation and reflective practice. During these iterative cycles of action, monitoring and reflection, participants learn how to cope with uncertainty when managing complex systems. Both of these processes, and their associated outcomes, are referred to as social learning. Where, therefore, should researchers and practitioners focus their attention? Results suggest that there is an emerging consensus that processes that support social learning involve sustained interaction between stakeholders, on-going deliberation and the sharing of knowledge in a trusting environment. There is also an emerging consensus that the key outcome of such learning is improved decision making underpinned by a growing awareness of human-environment interactions, better relationships and improved problem-solving capacities for participants. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Decision making, procedural compliance, and outcomes definition in U.S. forest service planning processes

    International Nuclear Information System (INIS)

    Stern, Marc J.; Predmore, S. Andrew

    2011-01-01

    The National Environmental Policy Act (NEPA) dictates a process of analyzing and disclosing the likely impacts of proposed agency actions on the human environment. This study addresses two key questions related to NEPA implementation in the U.S. Forest Service: 1) how do Interdisciplinary (ID) team leaders and decision makers conceptualize the outcomes of NEPA processes? And 2), how does NEPA relate to agency decision making? We address these questions through two separate online surveys that posed questions about recently completed NEPA processes - the first with the ID team leaders tasked with carrying out the processes, and the second with the line officers responsible for making the processes' final decisions. Outcomes of NEPA processes include impacts on public relations, on employee morale and team functioning, on the achievement of agency goals, and on the achievement of NEPA's procedural requirements (disclosure) and substantive intent (minimizing negative environmental impacts). Although both tended to view public relations outcomes as important, decision makers' perceptions of favorable outcomes were more closely linked to the achievement of agency goals and process efficiency than was the case for ID team leaders. While ID team leaders' responses suggest that they see decision making closely integrated with the NEPA process, decision makers more commonly decoupled decision making from the NEPA process. These findings suggest a philosophical difference between ID team leaders and decision makers that may pose challenges for both the implementation and the evaluation of agency NEPA. We discuss the pros and cons of integrating NEPA with decision making or separating the two. We conclude that detaching NEPA from decision making poses greater risks than integrating them.

  5. Telework rationale and implementation for people with disabilities: considerations for employer policymaking.

    Science.gov (United States)

    Moon, Nathan W; Linden, Maureen A; Bricout, John C; Baker, Paul M A

    2014-01-01

    Telework has been promoted as a viable workplace accommodation for people with disabilities since the 1990s, when information and communication technologies (ICT) had developed sufficiently to facilitate its widespread adoption. This initial research and accompanying policy recommendations were prescriptive in nature and frequently aimed at employers. This article adds to existing policy models for facilitating successful telework outcomes for people with disabilities. Drawing upon two studies by the Rehabilitation Engineering Research Center on Workplace Accommodations, we expound on employee-side considerations in the implementation of telework. Our policy model utilizes established typologies for policy evaluation to develop a process model that considers rationales and implementation factors for telework among people with physical disabilities. Telework may be used as an accommodation for disability, but employee rationales for telework are more complex, involving work-life balance, strategies for pain and fatigue not formally recognized as disability, and expediency in travel and transportation. Implementation of telework as a component of workplace operations is similarly multifaceted, involving non-technology accommodations to realize job restructuring left incomplete by telework. Our model grounds new empirical research in this area. We also renew our call for additional research on effective telework practices for people with disabilities.

  6. A preliminary report of music-based training for adult cochlear implant users: rationales and development

    Science.gov (United States)

    Gfeller, Kate; Guthe, Emily; Driscoll, Virginia; Brown, Carolyn J.

    2015-01-01

    Objective This paper provides a preliminary report of a music-based training program for adult cochlear implant (CI) recipients. Included in this report are descriptions of the rationale for music-based training, factors influencing program development, and the resulting program components. Methods Prior studies describing experience-based plasticity in response to music training, auditory training for persons with hearing impairment, and music training for cochlear implant recipients were reviewed. These sources revealed rationales for using music to enhance speech, factors associated with successful auditory training, relevant aspects of electric hearing and music perception, and extant evidence regarding limitations and advantages associated with parameters for music training with CI users. This information formed the development of a computer-based music training program designed specifically for adult CI users. Results Principles and parameters for perceptual training of music, such as stimulus choice, rehabilitation approach, and motivational concerns were developed in relation to the unique auditory characteristics of adults with electric hearing. An outline of the resulting program components and the outcome measures for evaluating program effectiveness are presented. Conclusions Music training can enhance the perceptual accuracy of music, but is also hypothesized to enhance several features of speech with similar processing requirements as music (e.g., pitch and timbre). However, additional evaluation of specific training parameters and the impact of music-based training on speech perception of CI users are required. PMID:26561884

  7. Rationale and study protocol for the supporting children's outcomes using rewards, exercise and skills (SCORES) group randomized controlled trial: a physical activity and fundamental movement skills intervention for primary schools in low-income communities.

    Science.gov (United States)

    Lubans, David R; Morgan, Philip J; Weaver, Kristen; Callister, Robin; Dewar, Deborah L; Costigan, Sarah A; Finn, Tara L; Smith, Jordan; Upton, Lee; Plotnikoff, Ronald C

    2012-06-12

    Many Australian children are insufficiently active to accrue health benefits and physical activity (PA) levels are consistently lower among youth of low socio-economic position. PA levels decline dramatically during adolescence and evidence suggests that competency in a range of fundamental movement skills (FMS) may serve as a protective factor against this trend. The Supporting Children's Outcomes Using Rewards Exercise and Skills (SCORES) intervention is a multi-component PA and FMS intervention for primary schools in low-income communities, which will be evaluated using a group randomized controlled trial. The socio-ecological model provided a framework for the 12-month intervention, which includes the following components: teacher professional learning, student leadership workshops (including leadership accreditation and rewards, e.g., stickers, water bottles), PA policy review, PA equipment packs, parental engagement via newsletters, FMS homework and a parent evening, and community partnerships with local sporting organizations. Outcomes will be assessed at baseline, 6- and 12-months. The primary outcomes are PA (accelerometers), FMS (Test of Gross Motor Development II) and cardiorespiratory fitness (multi-stage fitness test). Secondary outcomes include body mass index [using weight (kg)/height (m2)], perceived competence, physical self-esteem, and resilience. Individual and environmental mediators of behavior change (e.g. social support and enjoyment) will also be assessed. The System for Observing Fitness Instruction Time will be used to assess the impact of the intervention on PA within physical education lessons. Statistical analyses will follow intention-to-treat principles and hypothesized mediators of PA behavior change will be explored. SCORES is an innovative primary school-based PA and FMS intervention designed to support students attending schools in low-income communities to be more skilled and active. The findings from the study may be used to

  8. Rationale and study protocol for the supporting children’s outcomes using rewards, exercise and skills (SCORES) group randomized controlled trial: A physical activity and fundamental movement skills intervention for primary schools in low-income communities

    Science.gov (United States)

    2012-01-01

    Background Many Australian children are insufficiently active to accrue health benefits and physical activity (PA) levels are consistently lower among youth of low socio-economic position. PA levels decline dramatically during adolescence and evidence suggests that competency in a range of fundamental movement skills (FMS) may serve as a protective factor against this trend. Methods/design The Supporting Children’s Outcomes Using Rewards Exercise and Skills (SCORES) intervention is a multi-component PA and FMS intervention for primary schools in low-income communities, which will be evaluated using a group randomized controlled trial. The socio-ecological model provided a framework for the 12-month intervention, which includes the following components: teacher professional learning, student leadership workshops (including leadership accreditation and rewards, e.g., stickers, water bottles), PA policy review, PA equipment packs, parental engagement via newsletters, FMS homework and a parent evening, and community partnerships with local sporting organizations. Outcomes will be assessed at baseline, 6- and 12-months. The primary outcomes are PA (accelerometers), FMS (Test of Gross Motor Development II) and cardiorespiratory fitness (multi-stage fitness test). Secondary outcomes include body mass index [using weight (kg)/height (m2)], perceived competence, physical self-esteem, and resilience. Individual and environmental mediators of behavior change (e.g. social support and enjoyment) will also be assessed. The System for Observing Fitness Instruction Time will be used to assess the impact of the intervention on PA within physical education lessons. Statistical analyses will follow intention-to-treat principles and hypothesized mediators of PA behavior change will be explored. Discussion SCORES is an innovative primary school-based PA and FMS intervention designed to support students attending schools in low-income communities to be more skilled and active. The

  9. Rationale, study design and sample characteristics of a randomized controlled trial of directly administered antiretroviral therapy for HIV-infected prisoners transitioning to the community - a potential conduit to improved HIV treatment outcomes.

    Science.gov (United States)

    Saber-Tehrani, Ali Shabahang; Springer, Sandra A; Qiu, Jingjun; Herme, Maua; Wickersham, Jeffrey; Altice, Frederick L

    2012-03-01

    HIV-infected prisoners experience poor HIV treatment outcomes post-release. Directly administered antiretroviral therapy (DAART) is a CDC-designated, evidence-based adherence intervention for drug users, yet untested among released prisoners. Sentenced HIV-infected prisoners on antiretroviral therapy (ART) and returning to New Haven or Hartford, Connecticut were recruited and randomized 2:1 to a prospective controlled trial (RCT) of 6 months of DAART versus self-administered therapy (SAT); all subjects received case management services. Subjects meeting DSM-IV criteria for opioid dependence were offered immediate medication-assisted treatment. Trained outreach workers provided DAART once-daily, seven days per week, including behavioral skills training during the last intervention month. Both study groups were assessed for 6 months after the intervention period. Assessments occurred within 90 days pre-release (baseline), day of release, and then monthly for 12 months. Viral load (VL) and CD4 testing was conducted baseline and quarterly; genotypic resistance testing was conducted at baseline, 6 and 12 months. The primary outcome was pre-defined as viral suppression (VLHIV treatment outcomes after release from prison, a period associated with adverse HIV and other medical consequences. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Life Design Counseling Group Intervention with Portuguese Adolescents: A Process and Outcome Study

    Science.gov (United States)

    Cardoso, Paulo; Janeiro, Isabel Nunes; Duarte, Maria Eduarda

    2018-01-01

    This article examines the process and outcome of a life design counseling group intervention with students in Grades 9 and 12. First, we applied a quasi-experimental methodology to analyze the intervention's effectiveness in promoting career certainty, career decision-making, self-efficacy, and career adaptability in a sample of 236 students.…

  11. Children with and without Learning Disabilities: A Comparison of Processes and Outcomes Following Group Counseling

    Science.gov (United States)

    Leichtentritt, Judith; Shechtman, Zipora

    2010-01-01

    This study compared outcomes and processes in counseling groups of an expressive-supportive modality for children with learning disabilities (LD) and without them (NLD). Participants were 266 students (ages 10-18), all referred for emotional, social, and behavioral difficulties; of these, 123 were identified with LD and 143 were not. There were 40…

  12. The association between residents' work-rounds styles and the process and outcome of medical care.

    Science.gov (United States)

    Ashton, C M; Wray, N P; Friedland, J A; Zollo, A J; Scheurich, J W

    1994-04-01

    To determine whether the manner in which residents conduct work rounds is associated with the adequacy of their care processes and the outcomes of their patients. Two types of data were collected: time and motion data for residents (n = 12) during work rounds, and clinical and outcome data for the patients they cared for during the observation period (n = 211). Five residents were classified as data gatherers because they spent twice as much time gathering clinical data about their patients as they spent engaging in other activities. Three physicians blinded to the resident's identity rated the quality of the care process and assessed the frequency of undesirable events occurring during the stay and after discharge. A data-gathering style was associated with higher quality of care as judged by both process and outcomes. The data gatherers were more likely to comply with the "stability of medications before discharge" criterion (86% of the data gatherers' cases vs 73% of others', p = 0.07), and their patients were less likely to have unanticipated problems, in that fewer required calls from nurses (20% vs 37%, p work-rounds style is associated with better process and outcome. Residency programs should provide formal instruction to trainees in the conduct of work rounds.

  13. The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe

    NARCIS (Netherlands)

    Mahdavi, M. (Mahdi); J. Vissers (Jan); S. Elkhuizen (Sylvia); Van Dijk, M. (Mattees); Vanhala, A. (Antero); Karampli, E. (Eleftheria); R. Faubel (Raquel); P. Forte (Paul); Coroian, E. (Elena); J.J. van de Klundert (Joris)

    2018-01-01

    textabstractBackground While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single

  14. The effect of competition on process and outcome quality within hospital care in The Netherlands

    NARCIS (Netherlands)

    Bijlsma, M.; Koning, P.W.C.; Shestalova, V.

    2011-01-01

    This study examines the impact of competition on hospital quality. Our panel covers all Dutch hospitals in the period 2004–2008, in which the transparency of hospital quality information increased substantially. The paper contributes to the existing literature by including both outcome and process

  15. Process and Outcome Evaluation of an Art Therapy Program for People Living with HIV/AIDS

    Science.gov (United States)

    Feldman, Matthew B.; Betts, Donna J.; Blausey, Daniel

    2014-01-01

    Program evaluation offers an opportunity for improving the implementation and impact of art therapy. This article describes a process and outcomes evaluation of an art therapy program within the mental health services unit of a community-based organization for people living with HIV/AIDS. The aims were to assess utilization patterns and program…

  16. Quality Assurance Processes in Finnish Universities: Direct and Indirect Outcomes and Organisational Conditions

    Science.gov (United States)

    Haapakorpi, Arja

    2011-01-01

    In Finland, quality assurance related to the Bologna process has been adapted to existing systems of higher education at the national level and a form of implementation is also recognised at the level of the higher education institution. In universities, varied outcomes of quality assurance are based on interaction of organisational structures,…

  17. Expectancy-Value and Cognitive Process Outcomes in Mathematics Learning: A Structural Equation Analysis

    Science.gov (United States)

    Phan, Huy P.

    2014-01-01

    Existing research has yielded evidence to indicate that the expectancy-value theoretical model predicts students' learning in various achievement contexts. Achievement values and self-efficacy expectations, for example, have been found to exert positive effects on cognitive process and academic achievement outcomes. We tested a conceptual model…

  18. Potential donor families' experiences of organ and tissue donation-related communication, processes and outcome.

    Science.gov (United States)

    Marck, C H; Neate, S L; Skinner, M; Dwyer, B; Hickey, B B; Radford, S T; Weiland, T J; Jelinek, G A

    2016-01-01

    We aimed to describe the experiences of families of potential organ and tissue donors eligible for donation after circulatory death or brain death. Forty-nine family members of potential donors from four Melbourne hospitals were interviewed to assess their experiences of communication, processes and the outcomes of donation. Interviews were recorded, transcribed verbatim and analysed thematically. Families expressed a range of perspectives on themes of communication, hospital processes and care, the processes of consent and donation and reflected on decisions and outcomes. They expressed satisfaction overall with communication when receiving bad news, discussing death and donation. Honest and frank communication and being kept up-to-date and prepared for potential outcomes were important aspects for families, especially those of post circulatory death donors. Participants reported high levels of trust in healthcare professionals and satisfaction with the level of care received. Many donor families indicated the process was lengthy and stressful, but not significantly enough to adversely affect their satisfaction with the outcome. Both the decision itself and knowing others' lives had been saved provided them with consolation. No consenting families, and only some non-consenting families, regretted their decisions. Many expressed they would benefit from a follow-up opportunity to ask questions and clarify possible misunderstandings. Overall, while experiences varied, Australian families valued frank communication, trusted health professionals, were satisfied with the care their family member received and with donation processes, despite some apparent difficulties. Family satisfaction, infrequently assessed, is an important outcome and these findings may assist education for Australian organ donation professionals.

  19. The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe.

    Science.gov (United States)

    Mahdavi, Mahdi; Vissers, Jan; Elkhuizen, Sylvia; van Dijk, Mattees; Vanhala, Antero; Karampli, Eleftheria; Faubel, Raquel; Forte, Paul; Coroian, Elena; van de Klundert, Joris

    2018-01-01

    While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian's Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Data collection consisted of: a) systematic modelling of provider network's structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011-2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian's SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. While the selected structure and process variables explain much of the variance in service satisfaction, this is

  20. Rationale and study protocol for the supporting children’s outcomes using rewards, exercise and skills (SCORES group randomized controlled trial: A physical activity and fundamental movement skills intervention for primary schools in low-income communities

    Directory of Open Access Journals (Sweden)

    Lubans David R

    2012-06-01

    Full Text Available Abstract Background Many Australian children are insufficiently active to accrue health benefits and physical activity (PA levels are consistently lower among youth of low socio-economic position. PA levels decline dramatically during adolescence and evidence suggests that competency in a range of fundamental movement skills (FMS may serve as a protective factor against this trend. Methods/design The Supporting Children’s Outcomes Using Rewards Exercise and Skills (SCORES intervention is a multi-component PA and FMS intervention for primary schools in low-income communities, which will be evaluated using a group randomized controlled trial. The socio-ecological model provided a framework for the 12-month intervention, which includes the following components: teacher professional learning, student leadership workshops (including leadership accreditation and rewards, e.g., stickers, water bottles, PA policy review, PA equipment packs, parental engagement via newsletters, FMS homework and a parent evening, and community partnerships with local sporting organizations. Outcomes will be assessed at baseline, 6- and 12-months. The primary outcomes are PA (accelerometers, FMS (Test of Gross Motor Development II and cardiorespiratory fitness (multi-stage fitness test. Secondary outcomes include body mass index [using weight (kg/height (m2], perceived competence, physical self-esteem, and resilience. Individual and environmental mediators of behavior change (e.g. social support and enjoyment will also be assessed. The System for Observing Fitness Instruction Time will be used to assess the impact of the intervention on PA within physical education lessons. Statistical analyses will follow intention-to-treat principles and hypothesized mediators of PA behavior change will be explored. Discussion SCORES is an innovative primary school-based PA and FMS intervention designed to support students attending schools in low-income communities to be more skilled

  1. Proton therapy for head and neck cancer: Rationale, potential indications, practical considerations, and current clinical evidence

    International Nuclear Information System (INIS)

    Mendenhall, Nancy P.; Malyapa, Robert S.; Su, Zhong; Yeung, Daniel; Mendenhall, William M.; Li, Zuofeng

    2011-01-01

    There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT. To date, few clinical data are available, but early clinical experiences in sinonasal tumors in particular suggest significant improvements in both disease control and radiation-related toxicity

  2. Proton therapy for head and neck cancer: Rationale, potential indications, practical considerations, and current clinical evidence

    Energy Technology Data Exchange (ETDEWEB)

    Mendenhall, Nancy P.; Malyapa, Robert S.; Su, Zhong; Yeung, Daniel; Mendenhall, William M.; Li, Zuofeng (Univ. of Florida Proton Therapy Inst., Jacksonville, Florida (United States)), e-mail: menden@shands.ufl.edu

    2011-08-15

    There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT. To date, few clinical data are available, but early clinical experiences in sinonasal tumors in particular suggest significant improvements in both disease control and radiation-related toxicity

  3. Caregiving decision making by older mothers and adult children: process and expected outcome.

    Science.gov (United States)

    Cicirelli, Victor G

    2006-06-01

    Dyadic caregiving decision making was studied in 30 mother-son and 29 mother-daughter pairs (mother's age=65-94 years) who responded to a vignette depicting a caregiving decision situation. The observed decision-making process of mother-child pairs was largely naturalistic, with few alternatives proposed and quick convergence to a decision followed by a postdecision justification; a degree of more rational decision making was seen in some pairs. Among significant findings, adult children, especially sons, dominated the decision process, doing more talking and introducing more alternatives than did their mothers, who played a more subordinate role. Mother-son pairs expected more negative outcomes and greater regrets regarding their decisions than mother-daughter pairs. Closeness of the parent-child relationship influenced the decision-making process, expected outcomes, and regrets. Copyright (c) 2006 APA, all rights reserved.

  4. Initiating statistical process control to improve quality outcomes in colorectal surgery.

    Science.gov (United States)

    Keller, Deborah S; Stulberg, Jonah J; Lawrence, Justin K; Samia, Hoda; Delaney, Conor P

    2015-12-01

    Unexpected variations in postoperative length of stay (LOS) negatively impact resources and patient outcomes. Statistical process control (SPC) measures performance, evaluates productivity, and modifies processes for optimal performance. The goal of this study was to initiate SPC to identify LOS outliers and evaluate its feasibility to improve outcomes in colorectal surgery. Review of a prospective database identified colorectal procedures performed by a single surgeon. Patients were grouped into elective and emergent categories and then stratified by laparoscopic and open approaches. All followed a standardized enhanced recovery protocol. SPC was applied to identify outliers and evaluate causes within each group. A total of 1294 cases were analyzed--83% elective (n = 1074) and 17% emergent (n = 220). Emergent cases were 70.5% open and 29.5% laparoscopic; elective cases were 36.8% open and 63.2% laparoscopic. All groups had a wide range in LOS. LOS outliers ranged from 8.6% (elective laparoscopic) to 10.8% (emergent laparoscopic). Evaluation of outliers demonstrated patient characteristics of higher ASA scores, longer operating times, ICU requirement, and temporary nursing at discharge. Outliers had higher postoperative complication rates in elective open (57.1 vs. 20.0%) and elective lap groups (77.6 vs. 26.1%). Outliers also had higher readmission rates for emergent open (11.4 vs. 5.4%), emergent lap (14.3 vs. 9.2%), and elective lap (32.8 vs. 6.9%). Elective open outliers did not follow trends of longer LOS or higher reoperation rates. SPC is feasible and promising for improving colorectal surgery outcomes. SPC identified patient and process characteristics associated with increased LOS. SPC may allow real-time outlier identification, during quality improvement efforts, and reevaluation of outcomes after introducing process change. SPC has clinical implications for improving patient outcomes and resource utilization.

  5. Educational Rationale Metadata for Learning Objects

    Directory of Open Access Journals (Sweden)

    Tom Carey

    2002-10-01

    Full Text Available Instructors searching for learning objects in online repositories will be guided in their choices by the content of the object, the characteristics of the learners addressed, and the learning process embodied in the object. We report here on a feasibility study for metadata to record process-oriented information about instructional approaches for learning objects, though a set of Educational Rationale [ER] tags which would allow authors to describe the critical elements in their design intent. The prototype ER tags describe activities which have been demonstrated to be of value in learning, and authors select the activities whose support was critical in their design decisions. The prototype ER tag set consists descriptors of the instructional approach used in the design, plus optional sub-elements for Comments, Importance and Features which implement the design intent. The tag set was tested by creators of four learning object modules, three intended for post-secondary learners and one for K-12 students and their families. In each case the creators reported that the ER tag set allowed them to express succinctly the key instructional approaches embedded in their designs. These results confirmed the overall feasibility of the ER tag approach as a means of capturing design intent from creators of learning objects. Much work remains to be done before a usable ER tag set could be specified, including evaluating the impact of ER tags during design to improve instructional quality of learning objects.

  6. Quality Improvement Process in a Large Intensive Care Unit: Structure and Outcomes.

    Science.gov (United States)

    Reddy, Anita J; Guzman, Jorge A

    2016-11-01

    Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution's successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line-associated bloodstream infections, and medication errors. © The Author(s) 2015.

  7. Self-reflection modulates the outcome evaluation process: Evidence from an ERP study.

    Science.gov (United States)

    Zhu, Xiangru; Gu, Ruolei; Wu, Haiyan; Luo, Yuejia

    2015-12-01

    Recent research demonstrated structural overlap between reward and self processing, but the functional relationship that explains how self processing influences reward processing remains unclear. The present study used an experimentally constrained reflection task to investigate whether individuals' outcome evaluations in a gambling task are modulated by task-unrelated self- and other-reflection processes. The self- and other-reflection task contained descriptions of the self or others, and brain event-related potentials (ERPs) were recorded while 16 normal adults performed a gambling task. The ERP analysis focused on the feedback-related negativity (FRN) component. We found that the difference wave of FRN increased in the self-reflection condition compared with the other-reflection condition. The present findings provide direct evidence that self processing can influence reward processing. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Using design rationale to improve SPL traceability

    NARCIS (Netherlands)

    Galvao, I.; Aksit, Mehmet; van den Broek, P.M.; Hendriks, M.F.H.; Rashid, Awais; Royer, Jean-Claude; Rummler, Andreas

    In order to improve SPL traceability by using design rationale, this chapter introduces the traceability analysis framework (TAF), which, when combined with the AMPLE Traceability Framework, provides extra traceability capabilities for variability management. The TAF is a programmable and extensible

  9. Bioethics: A Rationale and a Model

    Science.gov (United States)

    Barman, Charles R.; Rusch, John J.

    1978-01-01

    Discusses the rationale for and development of an undergraduate bioethics course. Based on experiences with the course, general suggestions are offered to instructors planning to add bioethics to existing curricula. (MA)

  10. The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions.

    Science.gov (United States)

    Fridrich, Annemarie; Jenny, Gregor J; Bauer, Georg F

    2015-01-01

    To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results.

  11. The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions

    Science.gov (United States)

    Fridrich, Annemarie; Jenny, Gregor J.; Bauer, Georg F.

    2015-01-01

    To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results. PMID:26557665

  12. New Rationales for Women on Boards

    OpenAIRE

    Choudhury, B.

    2014-01-01

    Should measures promoting women to corporate boards be solely justified in terms of economic arguments? Traditionally, such measures have tended to rely on utilitarian arguments, despite the fact that the most prominent of these arguments—the relationship between women’s presence on boards and firm financial performance—is equivocal. Conversely, this article argues that rationales for increasing women on boards should be based on both equality and economics grounds. An equality rationale is n...

  13. Electrophysiological Correlates of Cue-Related Processing in a Gambling Task: Early Outcome Evaluation or Outcome Expectation?

    Directory of Open Access Journals (Sweden)

    Xiaoyi Zhang

    2017-06-01

    Full Text Available Several recent studies have suggested that cues that predict outcomes elicit a feedback-related-like negativity (FRN-like negativity reflecting initial appraisals of whether desired outcomes are probable. Some other studies, however, have found that the cues that predict outcomes elicited event-related potentials (ERPs that reflect the expectation to outcomes (e.g., outcome expectations. Given these mixed findings, this study aimed to examine whether the brain activity elicited by predictive cues in a gambling task reflected the initial evaluations of the outcomes, the outcome expectations, or both. We used a gambling task in which the participants were told to guess which of two doors hid a reward. At the beginning of each trial, a cue was presented to inform the participants of how many doors hid a reward. We found that these predictive cues elicited a FRN-like negativity at the frontal sites within around 200–300 ms. However, this negativity did not significantly differ between the cues that fully predicted gains and the cues that fully predicted losses. Furthermore, predictive cues elicited an expectation-related slow wave, and cues that predicted gains with a 50% probability elicited a larger expectation-related slow wave than cues that fully predicted gains or losses. Our results suggest that cues predicting outcomes reflect outcome expectations rather than initial evaluations of the forthcoming outcomes.

  14. A framework for monitoring social process and outcomes in environmental programs.

    Science.gov (United States)

    Chapman, Sarah

    2014-12-01

    When environmental programs frame their activities as being in the service of human wellbeing, social variables need to be integrated into monitoring and evaluation (M&E) frameworks. This article draws upon ecosystem services theory to develop a framework to guide the M&E of collaborative environmental programs with anticipated social benefits. The framework has six components: program need, program activities, pathway process variables, moderating process variables, outcomes, and program value. Needs are defined in terms of ecosystem services, as well as other human needs that must be addressed to achieve outcomes. The pathway variable relates to the development of natural resource governance capacity in the target community. Moderating processes can be externalities such as the inherent capacity of the natural system to service ecosystem needs, local demand for natural resources, policy or socio-economic drivers. Internal program-specific processes relate to program service delivery, targeting and participant responsiveness. Ecological outcomes are expressed in terms of changes in landscape structure and function, which in turn influence ecosystem service provision. Social benefits derived from the program are expressed in terms of the value of the eco-social service to user-specified goals. The article provides suggestions from the literature for identifying indicators and measures for components and component variables, and concludes with an example of how the framework was used to inform the M&E of an adaptive co-management program in western Kenya. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Outcome and process differences between professional and nonprofessional therapists in time-limited group psychotherapy.

    Science.gov (United States)

    Burlingame, G M; Barlow, S H

    1996-10-01

    The outcome of clients who saw one of four "expert" professional group therapists selected by peer nomination or four "natural helper" nonprofessional nominated by students is contrasted in a 15-session psychotherapy group. Process measures tapping specific group and "common factors" were drawn from sessions 3, 8, and 14; outcome was assessed at pre, mid, posttreatment, and a 6-month follow-up. Results were examined by leader condition (professional vs. nonprofessional therapists) and time (group development). Virtually no reliable differences were found on measures of outcome primarily because of a floor effect on several measures. Therapist differences on the process measures tapping the "common factors" of therapeutic alliance, client expectancy, and perception of therapists were either nonsignificant or disappeared by the end of treatment. A complex picture of differences on one therapeutic factor (insight), common factor measures and subtle variation in the outcome data suggests a distinct pattern of change, however. Methodological limitations are also addressed including problems inherent in large-scale clinical-trial studies, ethical concerns raised by using nonprofessional leaders, and problems with generalizability, given the absence of significant psychopathology in group members.

  16. Resolution of conflict between goal-directed actions: outcome encoding and neural control processes.

    Science.gov (United States)

    de Wit, Sanne; Ostlund, Sean B; Balleine, Bernard W; Dickinson, Anthony

    2009-07-01

    According to O-R theory of instrumental learning, incongruent biconditional discriminations should be impossible to solve in a goal-directed manner because the event acting as the outcome of one response also acts as a discriminative stimulus for an opposite response. Each event should therefore be associated with two competing responses. However, Dickinson and de Wit (2003) have presented evidence that rats can learn incongruent discriminations. The present study investigated whether rats were able to engage additional processes to solve incongruent discriminations in a goal-directed manner. Experiment 1 provides evidence that rats resolve the response conflict that arises in the incongruent discrimination by differentially encoding events in their roles as discriminative stimulus and as outcome. Furthermore, Experiment 2 shows that once goal-directed control has been established the dorsomedial prefrontal cortex is not directly involved in its maintenance but rather plays a central role in conflict resolution processes.

  17. Australian private midwives with hospital visiting rights in Queensland: Structures and processes impacting clinical outcomes.

    Science.gov (United States)

    Fenwick, J; Brittain, H; Gamble, J

    2017-12-01

    Reporting the outcomes for women and newborns accessing private midwives with visiting rights in Australia is important, especially since this data cannot currently be disaggregated from routinely collected perinatal data. 1) Evaluate the outcomes of women and newborns cared for by midwives with visiting access at one Queensland facility and 2) explore private midwives views about the structures and processes contributing to clinical outcomes. Mixed methods. An audit of the 'all risk' 529 women receiving private midwifery care. Data were compared with national core maternity variables using Chi square statistics. Telephone interviews were conducted with six private midwives and data analysed using thematic analysis. Compared to national data, women with a private midwife were significantly more likely to be having a first baby (49.5% vs 43.6% p=0.007), to commence labour spontaneously (84.7% vs 52.7%, p<0.001), experience a spontaneous vaginal birth (79% vs 54%, p<0.001) and not require pharmacological pain relief (52.9% vs 23.1%, p<0.001). The caesarean section rate was significantly lower than the national rate (13% vs 32.8%, p<0.001). In addition fewer babies required admission to the Newborn Care Unit (5.1% vs 16%, p<0.001). Midwives were proud of their achievements. Continuity of care was considered fundamental to achieving quality outcomes. Midwives valued the governance processes embedded around the model. Private midwives with access to the public system is safe. Ensuring national data collection accurately captures outcomes relative to model of care in both the public and private sector should be prioritised. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  18. The effects of frame, appeal, and outcome extremity of antismoking messages on cognitive processing.

    Science.gov (United States)

    Leshner, Glenn; Cheng, I-Huei

    2009-04-01

    Research on the impact of antismoking advertisements in countermarketing cigarette advertising is equivocal. Although many studies examined how different message appeal types influence people's attitudes and behavior, there have been few studies that have explored the mechanism of how individuals attend to and remember antismoking information. This study examined how message attributes of antismoking TV ads (frame, appeal type, and outcome extremity) interacted to influence people's attention (secondary task reaction time) and memory (recognition). Antismoking public service announcements were chosen that were either loss- or gain-framed, had either a health or social appeal, or had either a more or less extreme outcome described in the message. Among the key findings were that loss-framed messages with more extreme outcomes required the most processing resources (i.e., had the slowest secondary task reaction times) and were the best remembered (i.e., were best recognized). These findings indicate ways that different message attributes affect individuals' cognitive processing, and they are discussed in light of prior framing and persuasion research.

  19. The RESTORE program of restorative justice for sex crimes: vision, process, and outcomes.

    Science.gov (United States)

    Koss, Mary P

    2014-06-01

    The article reports empirical evaluation of RESTORE, a restorative justice (RJ) conferencing program adapted to prosecutor-referred adult misdemeanor and felony sexual assaults. RESTORE conferences included voluntary enrollment, preparation, and a face-to-face meeting where primary and secondary victims voice impacts, and responsible persons acknowledge their acts and together develop a re-dress plan that is supervised for 1 year. Process data included referral and consent rates, participant characteristics, observational ratings of conferences compared with program design, services delivered, and safety monitoring. Outcome evaluation used 22 cases to assess (a) pre-post reasons for choosing RESTORE, (b) preparation and conference experiences, (c) overall program and justice satisfaction, and (d) completion rates. This is the first peer-reviewed quantitative evaluation of RJ conferencing for adult sexual assault. Although the data have limitations, the results support cautious optimism regarding feasibility, safety, and satisfactory outcomes. They help envision how conferencing could expand and individualize justice options for sexual assault.

  20. Support Vector Hazards Machine: A Counting Process Framework for Learning Risk Scores for Censored Outcomes.

    Science.gov (United States)

    Wang, Yuanjia; Chen, Tianle; Zeng, Donglin

    2016-01-01

    Learning risk scores to predict dichotomous or continuous outcomes using machine learning approaches has been studied extensively. However, how to learn risk scores for time-to-event outcomes subject to right censoring has received little attention until recently. Existing approaches rely on inverse probability weighting or rank-based regression, which may be inefficient. In this paper, we develop a new support vector hazards machine (SVHM) approach to predict censored outcomes. Our method is based on predicting the counting process associated with the time-to-event outcomes among subjects at risk via a series of support vector machines. Introducing counting processes to represent time-to-event data leads to a connection between support vector machines in supervised learning and hazards regression in standard survival analysis. To account for different at risk populations at observed event times, a time-varying offset is used in estimating risk scores. The resulting optimization is a convex quadratic programming problem that can easily incorporate non-linearity using kernel trick. We demonstrate an interesting link from the profiled empirical risk function of SVHM to the Cox partial likelihood. We then formally show that SVHM is optimal in discriminating covariate-specific hazard function from population average hazard function, and establish the consistency and learning rate of the predicted risk using the estimated risk scores. Simulation studies show improved prediction accuracy of the event times using SVHM compared to existing machine learning methods and standard conventional approaches. Finally, we analyze two real world biomedical study data where we use clinical markers and neuroimaging biomarkers to predict age-at-onset of a disease, and demonstrate superiority of SVHM in distinguishing high risk versus low risk subjects.

  1. Addiction treatment outcomes, process and change: Texas Institute of Behavioral Research at Texas Christian University.

    Science.gov (United States)

    Simpson, D Dwayne; Joe, George W; Dansereau, Donald F; Flynn, Patrick M

    2011-10-01

    For more than 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs-the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-89), the second focused upon modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus upon adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases, organizational and systems functioning, treatment costs and process related to implementation of evidence-based practices. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

  2. Addiction treatment outcomes, process, and change: Texas Institute of Behavioral Research at TCU

    Science.gov (United States)

    Simpson, D. Dwayne; Joe, George W.; Dansereau, Donald F.; Flynn, Patrick M.

    2010-01-01

    For over 40 years the Texas Institute of Behavioral Research (IBR) has given special attention to assessment and evaluation of drug user populations, addiction treatment services, and various cognitive and behavioral interventions. Emphasis has been on studies in real-world settings and the use of multivariate methodologies to address evaluation issues within the context of longitudinal natural designs. Historically, its program of addiction treatment research may be divided into three sequential epochs – the first era dealt mainly with client assessment and its role in treatment outcome and evaluation (1969-1989), the second focused on modeling the treatment process and the importance of conceptual frameworks (1989-2009) in explaining the relationships among treatment environment, client attributes, treatment process, and outcome, and the third (and current) era has expanded into studying tactical deployment of innovations and implementation. Recent projects focus on adapting and implementing innovations for improving early engagement in adolescent residential treatment settings and drug-dependent criminal justice populations. Related issues include the spread of HIV/AIDS and other infectious diseases, organizational and systems functioning, treatment costs, and process related to implementation of evidence-based practices. PMID:20840168

  3. International Heart Valve Bank Survey: A Review of Processing Practices and Activity Outcomes

    Science.gov (United States)

    Albrecht, Helmi; Lim, Yeong Phang; Manning, Linda

    2013-01-01

    A survey of 24 international heart valve banks was conducted to acquire information on heart valve processing techniques used and outcomes achieved. The objective was to provide an overview of heart valve banking activities for tissue bankers, tissue banking associations, and regulatory bodies worldwide. Despite similarities found for basic manufacturing processes, distinct differences in procedural details were also identified. The similarities included (1) use of sterile culture media for procedures, (2) antibiotic decontamination, (3) use of dimethyl sulfoxide (DMSO) as a cryoprotectant, (4) controlled rate freezing for cryopreservation, and (5) storage at ultralow temperatures of below −135°C. Differences in procedures included (1) type of sterile media used, (2) antibiotics combination, (3) temperature and duration used for bioburden reduction, (4) concentration of DMSO used for cryopreservation, and (5) storage duration for released allografts. For most banks, the primary reasons why allografts failed to meet release criteria were positive microbiological culture and abnormal morphology. On average, 85% of allografts meeting release criteria were implanted, with valve size and type being the main reasons why released allografts were not used clinically. The wide variation in percentage of allografts meeting release requirements, despite undergoing validated manufacturing procedures, justifies the need for regular review of important outcomes as cited in this paper, in order to encourage comparison and improvements in the HVBs' processes. PMID:24163756

  4. Business Professional Doctoral Programs: Student Motivations, Educational Process, and Graduate Career Outcomes

    Directory of Open Access Journals (Sweden)

    Louis J. Grabowski

    2015-08-01

    Full Text Available The emerging body of research on business professional doctoral programs has focused primarily on the programs’ composition and management, offering limited insight into students’ motivations and the impact the degree has on graduates and their careers. However, understanding these student motivations and career impacts is valuable for several reasons. In addition to helping future candidates assess various programs and the business professional doctoral degree itself, it can help enrolled students maximize their academic experience and help administrators improve these programs so that they better meet students’ personal and professional expectations. To bridge this research gap, this study pursued a mixed-methods approach to glean insights into why people pursue professional doctorates in business, the ultimate personal and professional outcomes of students, and the educational process producing those outcomes. The study revealed that most students entered these programs with a desire for personal or professional transformation, including the possibility of entering academia or a new industry. Moreover, the vast majority of program graduates believed they had experienced such a transformation, often in both professional and personal ways. Further, while important to personal growth, alumni perceived that certain program elements—such as the student networks they created and non-research related coursework—had little to no effect upon their career and viewed their research and the research process as far more important to their professional development. Based upon these findings, the researchers propose a comprehensive process model to explain the personal and professional factors and outcomes for graduates of business professional doctoral programs. They also suggest practical steps that students and administrators can take to improve the business professional doctoral educational experience.

  5. National cultural values and the evolution of process and outcome discrepancies in international strategic alliances

    DEFF Research Database (Denmark)

    Kumar, Rajesh; Nti, Kofi O

    2004-01-01

    The article assesses the role played by national cultural values in shaping the evolution of international strategic alliances. The authors build on a systems dynamic model of alliance evolution in which the developmental path of an alliance depends on how the partners manage process and outcome...... discrepancies that may emerge during the course of an alliance. They argue that national culture affects alliance evolution by influencing partners sensitivity to discrepancy detection , shaping the nature of attributions they make, and by affecting the partners reactions to discrepancies. They focus...

  6. Effect of Weekend Admissions on the Treatment Process and Outcomes of Internal Medicine Patients

    Science.gov (United States)

    Huang, Chun-Che; Huang, Yu-Tung; Hsu, Nin-Chieh; Chen, Jin-Shing; Yu, Chong-Jen

    2016-01-01

    Abstract Many studies address the effect of weekend admission on patient outcomes. This population-based study aimed to evaluate the relationship between weekend admission and the treatment process and outcomes of general internal medicine patients in Taiwan. A total of 82,340 patients (16,657 weekend and 65,683 weekday admissions) aged ≥20 years and admitted to the internal medicine departments of 17 medical centers between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. A generalized estimating equation (GEE) analysis was used to compare patients admitted on weekends and those admitted on weekdays. Patients who were admitted on weekends were more likely to undergo intubation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.16–1.39; P internal medicine patients who were admitted on weekends experienced more intensive care procedures and higher ICU admission, in-hospital mortality, and treatment cost. Intensive care utilization may serve as early indicator of poorer outcomes and a potential entry point to offer preventive intervention before proceeding to intensive treatment. PMID:26871788

  7. Structure, Processes, and Retrospective Outcomes From an Intensive Comprehensive Aphasia Program.

    Science.gov (United States)

    Babbitt, Edna M; Worrall, Linda; Cherney, Leora R

    2015-11-01

    This study describes the structure, processes, and outcomes of an intensive comprehensive aphasia program (ICAP). The aim was to identify treatment gains and determine if outcomes were significantly different between participants grouped according to severity and type of aphasia, and time postonset. Data from 74 first-time ICAP participants were analyzed. Pre- and posttreatment scores on the Western Aphasia Battery-Revised and other impairment and participation measures were compared using paired t tests. Analyses of variance were used to compare outcomes related to aphasia severity (severe, moderate, and mild aphasia), aphasia type (fluent, nonfluent), and chronicity (0-6 months postonset, 7-12 months postonset, and 12+ months postonset). Participants made significant changes on all impairment and participation measures. Large effect sizes were noted for one participation and three impairment measures. Medium effect sizes were noted for one impairment and three participation measures. There was no significant difference among groups on any factor. ICAPs can have a significant effect on the language impairment and participation of people with aphasia, but further research is required to determine if the effect is comparable to other types of service delivery.

  8. Insect herbivores change the outcome of plant competition through both inter- and intraspecific processes.

    Science.gov (United States)

    Kim, Tania N; Underwood, Nora; Inouye, Brian D

    2013-08-01

    Insect herbivores can affect plant abundance and community composition, and theory suggests that herbivores influence plant communities by altering interspecific interactions among plants. Because the outcome of interspecific interactions is influenced by the per capita competitive ability of plants, density dependence, and intrinsic rates of increase, measuring herbivore effects on all these processes is necessary to understand the mechanisms by which herbivores influence plant communities. We fit alternative competition models to data from a response surface experiment conducted over four years to examine how herbivores affected the outcome of competition between two perennial plants, Solidago altissima and Solanum carolinense. Within a growing season, herbivores reduced S. carolinense plant size but did not affect the size of S. altissima, which exhibited compensatory growth. Across seasons, herbivores did not affect S. carolinense density or biomass but reduced both the density and population growth of S. altissima. The best-fit models indicated that the effects of herbivores varied with year. In some years, herbivores increased the per capita competitive effect of S. altissima on S. carolinense; in other years, herbivores influenced the intrinsic rate of increase of S. altissima. We examined possible herbivore effects on the longer-term outcome of competition (over the time scale of a typical old-field habitat), using simulations based on the best-fit models. In the absence of herbivores, plant coexistence was observed. In the presence of herbivores, S. carolinense was excluded by S. altissima in 72.3% of the simulations. We demonstrate that herbivores can influence the outcome of competition through changes in both per capita competitive effects and intrinsic rates of increase. We discuss the implications of these results for ecological succession and biocontrol.

  9. Biophilic architecture: a review of the rationale and outcomes

    Directory of Open Access Journals (Sweden)

    Jana Söderlund

    2015-12-01

    Full Text Available Contemporary cities have high stress levels, mental health issues, high crime levels and ill health, while the built environment shows increasing problems with urban heat island effects and air and water pollution. Emerging from these concerns is a new set of design principles and practices where nature needs to play a bigger part called “biophilic architecture”. This design approach asserts that humans have an innate connection with nature that can assist to make buildings and cities more effective human abodes. This paper examines the evidence for this innate human psychological and physiological link to nature and then assesses the emerging research supporting the multiple social, environmental and economic benefits of biophilic architecture.

  10. Early language processing efficiency predicts later receptive vocabulary outcomes in children born preterm.

    Science.gov (United States)

    Marchman, Virginia A; Adams, Katherine A; Loi, Elizabeth C; Fernald, Anne; Feldman, Heidi M

    2016-01-01

    As rates of prematurity continue to rise, identifying which preterm children are at increased risk for learning disabilities is a public health imperative. Identifying continuities between early and later skills in this vulnerable population can also illuminate fundamental neuropsychological processes that support learning in all children. At 18 months adjusted age, we used socioeconomic status (SES), medical variables, parent-reported vocabulary, scores on the Bayley Scales of Infant and Toddler Development (third edition) language composite, and children's lexical processing speed in the looking-while-listening (LWL) task as predictor variables in a sample of 30 preterm children. Receptive vocabulary as measured by the Peabody Picture Vocabulary Test (fourth edition) at 36 months was the outcome. Receptive vocabulary was correlated with SES, but uncorrelated with degree of prematurity or a composite of medical risk. Importantly, lexical processing speed was the strongest predictor of receptive vocabulary (r = -.81), accounting for 30% unique variance. Individual differences in lexical processing efficiency may be able to serve as a marker for information processing skills that are critical for language learning.

  11. Coordination processes and outcomes in the public service: the challenge of inter-organizational food safety coordination in Norway.

    Science.gov (United States)

    Lie, Amund

    2011-01-01

    In 2004 Norway implemented a food safety reform programme aimed at enhancing inter-organizational coordination processes and outcomes. Has this programme affected inter-organizational coordination processes and outcomes, both vertically and horizontally – and if so how? This article employs the concept of inter-organizational coordination as an analytical tool, examining it in the light of two theoretical perspectives and coupling it with the empirical findings. The argument presented is that the chances of strong coordination outcomes may increase if inter-organizational processes feature a clear division of labour, arenas for coordination, active leadership, a lack of major conflicting goals, and shared obligations.

  12. Using adaptive processes and adverse outcome pathways to develop meaningful, robust, and actionable environmental monitoring programs.

    Science.gov (United States)

    Arciszewski, Tim J; Munkittrick, Kelly R; Scrimgeour, Garry J; Dubé, Monique G; Wrona, Fred J; Hazewinkel, Rod R

    2017-09-01

    The primary goals of environmental monitoring are to indicate whether unexpected changes related to development are occurring in the physical, chemical, and biological attributes of ecosystems and to inform meaningful management intervention. Although achieving these objectives is conceptually simple, varying scientific and social challenges often result in their breakdown. Conceptualizing, designing, and operating programs that better delineate monitoring, management, and risk assessment processes supported by hypothesis-driven approaches, strong inference, and adverse outcome pathways can overcome many of the challenges. Generally, a robust monitoring program is characterized by hypothesis-driven questions associated with potential adverse outcomes and feedback loops informed by data. Specifically, key and basic features are predictions of future observations (triggers) and mechanisms to respond to success or failure of those predictions (tiers). The adaptive processes accelerate or decelerate the effort to highlight and overcome ignorance while preventing the potentially unnecessary escalation of unguided monitoring and management. The deployment of the mutually reinforcing components can allow for more meaningful and actionable monitoring programs that better associate activities with consequences. Integr Environ Assess Manag 2017;13:877-891. © 2017 The Authors. Integrated Environmental Assessment and Management Published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC). © 2017 The Authors. Integrated Environmental Assessment and Management Published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

  13. Compromised Motor Dexterity Confounds Processing Speed Task Outcomes in Stroke Patients

    Directory of Open Access Journals (Sweden)

    Essie Low

    2017-09-01

    Full Text Available Most conventional measures of information processing speed require motor responses to facilitate performance. However, although not often addressed clinically, motor impairment, whether due to age or acquired brain injury, would be expected to confound the outcome measure of such tasks. The current study recruited 29 patients (20 stroke and 9 transient ischemic attack with documented reduction in dexterity of the dominant hand, and 29 controls, to investigate the extent to which 3 commonly used processing speed measures with varying motor demands (a Visuo-Motor Reaction Time task, and the Wechsler Adult Intelligence Scale-IV Symbol Search and Coding subtests may be measuring motor-related speed more so than cognitive speed. Analyses include correlations between indices of cognitive and motor speed obtained from two other tasks (Inspection Time and Pegboard task, respectively with the three speed measures, followed by hierarchical regressions to determine the relative contribution of cognitive and motor speed indices toward task performance. Results revealed that speed outcomes on tasks with relatively high motor demands, such as Coding, were largely reflecting motor speed in individuals with reduced dominant hand dexterity. Thus, findings indicate the importance of employing measures with minimal motor requirements, especially when the assessment of speed is aimed at understanding cognitive rather than physical function.

  14. Visual Processing Recruits the Auditory Cortices in Prelingually Deaf Children and Influences Cochlear Implant Outcomes.

    Science.gov (United States)

    Liang, Maojin; Chen, Yuebo; Zhao, Fei; Zhang, Junpeng; Liu, Jiahao; Zhang, Xueyuan; Cai, Yuexin; Chen, Suijun; Li, Xianghui; Chen, Ling; Zheng, Yiqing

    2017-09-01

    Although visual processing recruitment of the auditory cortices has been reported previously in prelingually deaf children who have a rapidly developing brain and no auditory processing, the visual processing recruitment of auditory cortices might be different in processing different visual stimuli and may affect cochlear implant (CI) outcomes. Ten prelingually deaf children, 4 to 6 years old, were recruited for the study. Twenty prelingually deaf subjects, 4 to 6 years old with CIs for 1 year, were also recruited; 10 with well-performing CIs, 10 with poorly performing CIs. Ten age and sex-matched normal-hearing children were recruited as controls. Visual ("sound" photo [photograph with imaginative sound] and "nonsound" photo [photograph without imaginative sound]) evoked potentials were measured in all subjects. P1 at Oz and N1 at the bilateral temporal-frontal areas (FC3 and FC4) were compared. N1 amplitudes were strongest in the deaf children, followed by those with poorly performing CIs, controls and those with well-performing CIs. There was no significant difference between controls and those with well-performing CIs. "Sound" photo stimuli evoked a stronger N1 than "nonsound" photo stimuli. Further analysis showed that only at FC4 in deaf subjects and those with poorly performing CIs were the N1 responses to "sound" photo stimuli stronger than those to "nonsound" photo stimuli. No significant difference was found for the FC3 and FC4 areas. No significant difference was found in N1 latencies and P1 amplitudes or latencies. The results indicate enhanced visual recruitment of the auditory cortices in prelingually deaf children. Additionally, the decrement in visual recruitment of auditory cortices was related to good CI outcomes.

  15. Teacher Grading Decisions: Influences, Rationale, and Practices

    Science.gov (United States)

    Kunnath, Joshua P.

    2017-01-01

    This mixed-methods study applied a decision-making theoretical framework to an investigation of teacher grading in a large urban school district in California. A sample of 251 high school teachers of core subjects were surveyed, and 15 teachers participated in four focus group interviews in order provide data on the influences, rationale, and…

  16. Rationales for the Lightning Launch Commit Criteria

    Science.gov (United States)

    Willett, John C. (Editor); Merceret, Francis J. (Editor); Krider, E. Philip; O'Brien, T. Paul; Dye, James E.; Walterscheid, Richard L.; Stolzenburg, Maribeth; Cummins, Kenneth; Christian, Hugh J.; Madura, John T.

    2016-01-01

    Since natural and triggered lightning are demonstrated hazards to launch vehicles, payloads, and spacecraft, NASA and the Department of Defense (DoD) follow the Lightning Launch Commit Criteria (LLCC) for launches from Federal Ranges. The LLCC were developed to prevent future instances of a rocket intercepting natural lightning or triggering a lightning flash during launch from a Federal Range. NASA and DoD utilize the Lightning Advisory Panel (LAP) to establish and develop robust rationale from which the criteria originate. The rationale document also contains appendices that provide additional scientific background, including detailed descriptions of the theory and observations behind the rationales. The LLCC in whole or part are used across the globe due to the rigor of the documented criteria and associated rationale. The Federal Aviation Administration (FAA) adopted the LLCC in 2006 for commercial space transportation and the criteria were codified in the FAA's Code of Federal Regulations (CFR) for Safety of an Expendable Launch Vehicle (Appendix G to 14 CFR Part 417, (G417)) and renamed Lightning Flight Commit Criteria in G417.

  17. Audit filters for improving processes of care and clinical outcomes in trauma systems.

    Science.gov (United States)

    Evans, Christopher; Howes, Daniel; Pickett, William; Dagnone, Luigi

    2009-10-07

    Traumatic injuries represent a considerable public health burden with significant personal and societal costs. The care of the severely injured patient in a trauma system progresses along a continuum that includes numerous interventions being provided by a multidisciplinary group of healthcare personnel. Despite the recent emphasis on quality of care in medicine, there has been little research to direct trauma clinicians and administrators on how optimally to monitor and improve upon the quality of care delivered within a trauma system. Audit filters are one mechanism for improving quality of care and are defined as specific clinical processes or outcomes of care that, when they occur, represent unfavorable deviations from an established norm and which prompt review and feedback. Although audit filters are widely utilized for performance improvement in trauma systems they have not been subjected to systematic review of their effectiveness. To determine the effectiveness of using audit filters for improving processes of care and clinical outcomes in trauma systems. Our search strategy included an electronic search of the Cochrane Injuries Group Specialized Register, the Cochrane EPOC Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, PubMed, EMBASE, CINAHL, and ISI Web of Science: (SCI-EXPANDED and CPCI-S). We handsearched the Journal of Trauma, Injury, Annals of Emergency Medicine, Academic Emergency Medicine, and Injury Prevention. We searched two clinical trial registries: 1) The World Health Organization International Clinical Trials Registry Platform and, 2) Clinical Trials.gov. We also contacted content experts for further articles. The most recent electronic search was completed in December 2008 and the handsearch was completed up to February 2009. We searched for randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series studies that used audit filters as an

  18. Fair processes and fair outcomes: involving local stakeholders in RWM decisions

    International Nuclear Information System (INIS)

    Vari, A.

    2004-01-01

    There is a general agreement on the requirements to be met by radioactive waste management strategies. One of the requirements is that both the outcomes of any decisions and the decision-making processes must be seen to be fair. However, there exist multiple legitimate views on fairness and there is no meta-theory that could help decide which of the competing views should be considered valid in a concrete case. Referring to the plurality of views on fairness, Linnerooth-Bayer (forthcoming) argues that the impasse in facility siting processes can be attributed to the failure to take adequate account of the diverse views held by the various stakeholders on fair processes and outcomes. Three fundamental ethical principles have been derived from three basic ethical theories: well-being which is the central concept of utilitarian ethics, justice which is a key notion in egalitarian ethics, and dignity which is central to deontology (Bay and Oughton, 2003). According to utilitarian ethics fairness means that public welfare is maximized even at the cost of stakeholders' individual rights. Costs and benefits can be legitimately distributed in any way; only their overall balance has to be enhanced. In contrary, egalitarian ethics aims for a fair distribution of benefits and costs among stakeholders, while deontology acknowledges universal values of actions, e.g. the respect for individual rights, apart from their consequences. According to the latter ethics, fairness means that stakeholders themselves have the opportunity to learn about the benefits and costs of various options, and having considered them, decide on their position to accept them. How do diverse views on fair decisions materialize in RWM debates? (author)

  19. Pediatric Intubation by Paramedics in a Large Emergency Medical Services System: Process, Challenges, and Outcomes.

    Science.gov (United States)

    Prekker, Matthew E; Delgado, Fernanda; Shin, Jenny; Kwok, Heemun; Johnson, Nicholas J; Carlbom, David; Grabinsky, Andreas; Brogan, Thomas V; King, Mary A; Rea, Thomas D

    2016-01-01

    Pediatric intubation is a core paramedic skill in some emergency medical services (EMS) systems. The literature lacks a detailed examination of the challenges and subsequent adjustments made by paramedics when intubating children in the out-of-hospital setting. We undertake a descriptive evaluation of the process of out-of-hospital pediatric intubation, focusing on challenges, adjustments, and outcomes. We performed a retrospective analysis of EMS responses between 2006 and 2012 that involved attempted intubation of children younger than 13 years by paramedics in a large, metropolitan EMS system. We calculated the incidence rate of attempted pediatric intubation with EMS and county census data. To summarize the intubation process, we linked a detailed out-of-hospital airway registry with clinical records from EMS, hospital, or autopsy encounters for each child. The main outcome measures were procedural challenges, procedural success, complications, and patient disposition. Paramedics attempted intubation in 299 cases during 6.3 years, with an incidence of 1 pediatric intubation per 2,198 EMS responses. Less than half of intubations (44%) were for patients in cardiac arrest. Two thirds of patients were intubated on the first attempt (66%), and overall success was 97%. The most prevalent challenge was body fluids obscuring the laryngeal view (33%). After a failed first intubation attempt, corrective actions taken by paramedics included changing equipment (33%), suctioning (32%), and repositioning the patient (27%). Six patients (2%) experienced peri-intubation cardiac arrest and 1 patient had an iatrogenic tracheal injury. No esophageal intubations were observed. Of patients transported to the hospital, 86% were admitted to intensive care and hospital mortality was 27%. Pediatric intubation by paramedics was performed infrequently in this EMS system. Although overall intubation success was high, a detailed evaluation of the process of intubation revealed specific

  20. DEFINING THE RELEVANT OUTCOME MEASURES IN MEDICAL DEVICE ASSESSMENTS: AN ANALYSIS OF THE DEFINITION PROCESS IN HEALTH TECHNOLOGY ASSESSMENT.

    Science.gov (United States)

    Jacobs, Esther; Antoine, Sunya-Lee; Prediger, Barbara; Neugebauer, Edmund; Eikermann, Michaela

    2017-01-01

    Defining relevant outcome measures for clinical trials on medical devices (MD) is complex, as there is a large variety of potentially relevant outcomes. The chosen outcomes vary widely across clinical trials making the assessment in evidence syntheses very challenging. The objective is to provide an overview on the current common procedures of health technology assessment (HTA) institutions in defining outcome measures in MD trials. In 2012-14, the Web pages of 126 institutions involved in HTA were searched for methodological manuals written in English or German that describe methods for the predefinition process of outcome measures. Additionally, the institutions were contacted by email. Relevant information was extracted. All process steps were performed independently by two reviewers. Twenty-four manuals and ten responses from the email request were included in the analysis. Overall, 88.5 percent of the institutions describe the type of outcomes that should be considered in detail and 84.6 percent agree that the main focus should be on patient relevant outcomes. Specifically related to MD, information could be obtained in 26 percent of the included manuals and email responses. Eleven percent of the institutions report a particular consideration of MD related outcomes. This detailed analysis on common procedures of HTA institutions in the context of defining relevant outcome measures for the assessment of MD shows that standardized procedures for MD from the perspective of HTA institutions are not widespread. This leads to the question if a homogenous approach should be implemented in the field of HTA on MD.

  1. Comparing Hospital Processes and Outcomes in California Medicare Beneficiaries: Simulation Prompts Reconsideration.

    Science.gov (United States)

    Escobar, Gabriel J; Baker, Jennifer M; Turk, Benjamin J; Draper, David; Liu, Vincent; Kipnis, Patricia

    2017-01-01

    This article is not a traditional research report. It describes how conducting a specific set of benchmarking analyses led us to broader reflections on hospital benchmarking. We reexamined an issue that has received far less attention from researchers than in the past: How variations in the hospital admission threshold might affect hospital rankings. Considering this threshold made us reconsider what benchmarking is and what future benchmarking studies might be like. Although we recognize that some of our assertions are speculative, they are based on our reading of the literature and previous and ongoing data analyses being conducted in our research unit. We describe the benchmarking analyses that led to these reflections. The Centers for Medicare and Medicaid Services' Hospital Compare Web site includes data on fee-for-service Medicare beneficiaries but does not control for severity of illness, which requires physiologic data now available in most electronic medical records.To address this limitation, we compared hospital processes and outcomes among Kaiser Permanente Northern California's (KPNC) Medicare Advantage beneficiaries and non-KPNC California Medicare beneficiaries between 2009 and 2010. We assigned a simulated severity of illness measure to each record and explored the effect of having the additional information on outcomes. We found that if the admission severity of illness in non-KPNC hospitals increased, KPNC hospitals' mortality performance would appear worse; conversely, if admission severity at non-KPNC hospitals' decreased, KPNC hospitals' performance would appear better. Future hospital benchmarking should consider the impact of variation in admission thresholds.

  2. Can we decide which outcomes should be measured in every clinical trial? A scoping review of the existing conceptual frameworks and processes to develop core outcome sets.

    Science.gov (United States)

    Idzerda, Leanne; Rader, Tamara; Tugwell, Peter; Boers, Maarten

    2014-05-01

    The usefulness of randomized control trials to advance clinical care depends upon the outcomes reported, but disagreement on the choice of outcome measures has resulted in inconsistency and the potential for reporting bias. One solution to this problem is the development of a core outcome set: a minimum set of outcome measures deemed critical for clinical decision making. Within rheumatology the Outcome Measures in Rheumatology (OMERACT) initiative has pioneered the development of core outcome sets since 1992. As the number of diseases addressed by OMERACT has increased and its experience in formulating core sets has grown, clarification and update of the conceptual framework and formulation of a more explicit process of area/domain core set development has become necessary. As part of the update process of the OMERACT Filter criteria to version 2, a literature review was undertaken to compare and contrast the OMERACT conceptual framework with others within and outside rheumatology. A scoping search was undertaken to examine the extent, range, and nature of conceptual frameworks for core set outcome selection in health. We searched the following resources: Cochrane Library Methods Group Register; Medline; Embase; PsycInfo; Environmental Studies and Policy Collection; and ABI/INFORM Global. We also conducted a targeted Google search. Five conceptual frameworks were identified: the WHO tripartite definition of health; the 5 Ds (discomfort, disability, drug toxicity, dollar cost, and death); the International Classification of Functioning (ICF); PROMIS (Patient-Reported Outcomes Measurement System); and the Outcomes Hierarchy. Of these, only the 5 Ds and ICF frameworks have been systematically applied in core set development. Outside the area of rheumatology, several core sets were identified; these had been developed through a limited range of consensus-based methods with varying degrees of methodological rigor. None applied a framework to ensure content validity of

  3. A mechanism for revising accreditation standards: a study of the process, resources required and evaluation outcomes.

    Science.gov (United States)

    Greenfield, David; Civil, Mike; Donnison, Andrew; Hogden, Anne; Hinchcliff, Reece; Westbrook, Johanna; Braithwaite, Jeffrey

    2014-11-21

    The study objective was to identify and describe the process, resources and expertise required for the revision of accreditation standards, and report outcomes arising from such activities. Secondary document analysis of materials from an accreditation standards development agency. The Royal Australian College of General Practitioners' (RACGP) documents, minutes and reports related to the revision of the accreditation standards were examined. The RACGP revision of the accreditation standards was conducted over a 12 month period and comprised six phases with multiple tasks, including: review methodology planning; review of the evidence base and each standard; new material development; constructing field trial methodology; drafting, trialling and refining new standards; and production of new standards. Over 100 individuals participated, with an additional 30 providing periodic input and feedback. Participants were drawn from healthcare professional associations, primary healthcare services, accreditation agencies, government agencies and public health organisations. Their expertise spanned: project management; standards development and writing; primary healthcare practice; quality and safety improvement methodologies; accreditation implementation and surveying; and research. The review and development process was shaped by five issues: project expectations; resource and time requirements; a collaborative approach; stakeholder engagement; and the product produced. The RACGP evaluation was that participants were positive about their experience, the standards produced and considered them relevant for the sector. The revision of accreditation standards requires considerable resources and expertise, drawn from a broad range of stakeholders. Collaborative, inclusive processes that engage key stakeholders helps promote greater industry acceptance of the standards.

  4. Traumatogenic Processes and Pathways to Mental Health Outcomes for Sexual Minorities Exposed to Bias Crime Information.

    Science.gov (United States)

    Lannert, Brittany K

    2015-07-01

    Vicarious traumatization of nonvictim members of communities targeted by bias crimes has been suggested by previous qualitative studies and often dominates public discussion following bias events, but proximal and distal responses of community members have yet to be comprehensively modeled, and quantitative research on vicarious responses is scarce. This comprehensive review integrates theoretical and empirical literatures in social, clinical, and physiological psychology in the development of a model of affective, cognitive, and physiological responses of lesbian, gay, and bisexual individuals upon exposure to information about bias crimes. Extant qualitative research in vicarious response to bias crimes is reviewed in light of theoretical implications and methodological limitations. Potential pathways to mental health outcomes are outlined, including accumulative effects of anticipatory defensive responding, multiplicative effects of minority stress, and putative traumatogenic physiological and cognitive processes of threat. Methodological considerations, future research directions, and clinical implications are also discussed. © The Author(s) 2014.

  5. The impact of maternal obesity on inflammatory processes and consequences for later offspring health outcomes.

    Science.gov (United States)

    Segovia, S A; Vickers, M H; Reynolds, C M

    2017-10-01

    Obesity is a global epidemic, affecting both developed and developing countries. The related metabolic consequences that arise from being overweight or obese are a paramount global health concern, and represent a significant burden on healthcare systems. Furthermore, being overweight or obese during pregnancy increases the risk of offspring developing obesity and other related metabolic complications in later life, which can therefore perpetuate a transgenerational cycle of obesity. Obesity is associated with a chronic state of low-grade metabolic inflammation. However, the role of maternal obesity-mediated alterations in inflammatory processes as a mechanism underpinning developmental programming in offspring is less understood. Further, the use of anti-inflammatory agents as an intervention strategy to ameliorate or reverse the impact of adverse developmental programming in the setting of maternal obesity has not been well studied. This review will discuss the impact of maternal obesity on key inflammatory pathways, impact on pregnancy and offspring outcomes, potential mechanisms and avenues for intervention.

  6. Risk analysis and safety rationale

    International Nuclear Information System (INIS)

    Bengtsson, G.

    1989-01-01

    Decision making with respect to safety is becoming more and more complex. The risk involved must be taken into account together with numerous other factors such as the benefits, the uncertainties and the public perception. Can the decision maker be aided by some kind of system, general rules of thumb, or broader perspective on similar decisions? This question has been addressed in a joint Nordic project relating to nuclear power. Modern techniques for risk assessment and management have been studied, and parallels drawn to such areas as offshore safety and management of toxic chemicals in the environment. The report summarises the finding of 5 major technical reports which have been published in the NORD-series. The topics includes developments, uncertainties and limitations in probabilistic safety assessments, negligible risks, risk-cost trade-offs, optimisation of nuclear safety and radiation protection, and the role of risks in the decision making process. (author) 84 refs

  7. Outpatient rehabilitation care process factors and clinical outcomes among patients discharged home following unilateral total knee arthroplasty.

    Science.gov (United States)

    Brennan, Gerard P; Fritz, Julie M; Houck, L T C Kevin M; Hunter, Stephen J

    2015-05-01

    Research examining care process variables and their relationship to clinical outcomes after total knee arthroplasty has focused primarily on inpatient variables. Care process factors related to outpatient rehabilitation have not been adequately examined. We conducted a retrospective review of 321 patients evaluating outpatient care process variables including use of continuous passive motion, home health physical therapy, number of days from inpatient discharge to beginning outpatient physical therapy, and aspects of outpatient physical therapy (number of visits, length of stay) as possible predictors of pain and disability outcomes of outpatient physical therapy. Only the number of days between inpatient discharge and outpatient physical therapy predicted better outcomes, suggesting that this may be a target for improving outcomes after total knee arthroplasty for patients discharged directly home. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. New knowledge network evaluation method for design rationale management

    Science.gov (United States)

    Jing, Shikai; Zhan, Hongfei; Liu, Jihong; Wang, Kuan; Jiang, Hao; Zhou, Jingtao

    2015-01-01

    Current design rationale (DR) systems have not demonstrated the value of the approach in practice since little attention is put to the evaluation method of DR knowledge. To systematize knowledge management process for future computer-aided DR applications, a prerequisite is to provide the measure for the DR knowledge. In this paper, a new knowledge network evaluation method for DR management is presented. The method characterizes the DR knowledge value from four perspectives, namely, the design rationale structure scale, association knowledge and reasoning ability, degree of design justification support and degree of knowledge representation conciseness. The DR knowledge comprehensive value is also measured by the proposed method. To validate the proposed method, different style of DR knowledge network and the performance of the proposed measure are discussed. The evaluation method has been applied in two realistic design cases and compared with the structural measures. The research proposes the DR knowledge evaluation method which can provide object metric and selection basis for the DR knowledge reuse during the product design process. In addition, the method is proved to be more effective guidance and support for the application and management of DR knowledge.

  9. Specialization in i* strategic rationale diagrams

    OpenAIRE

    López Cuesta, Lidia; Franch Gutiérrez, Javier; Marco Gómez, Jordi

    2012-01-01

    ER 2012 Best Student Paper Award The specialization relationship is offered by the i* modeling language through the is-a construct defined over actors (a subactor is-a superactor). Although the overall meaning of this construct is highly intuitive, its semantics when it comes to the fine-grained level of strategic rationale (SR) diagrams is not defined, hampering seriously its appropriate use. In this paper we provide a formal definition of the specialization relationship at the lev...

  10. Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

    DEFF Research Database (Denmark)

    Terslev, Lene; Gutierrez, Marwin; Schmidt, Wolfgang A

    2015-01-01

    OBJECTIVE: To summarize the work performed by the Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group on the validation of US as a potential outcome measure in gout. METHODS: Based on the lack of definitions, highlighted in a recent literature review on US as an outcome tool...

  11. [Acute complicated and uncomplicated pyelonephritis in the emergency department: process-of-care indicators and outcomes].

    Science.gov (United States)

    Delgado Vicente, Miriam; Lecaroz Agara, Mª Concepción; Barrios Andrés, José Luis; Canut Blasco, Andrés

    2017-02-01

    To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.

  12. Effect of Process Changes in Surgical Training on Quantitative Outcomes From Surgery Residency Programs.

    Science.gov (United States)

    Dietl, Charles A; Russell, John C

    2016-01-01

    The purpose of this article is to review the literature on process changes in surgical training programs and to evaluate their effect on the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies, American Board of Surgery In-Training Examination (ABSITE) scores, and American Board of Surgery (ABS) certification. A literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, Google Scholar on all peer-reviewed studies published since 2003 using the following search queries: surgery residency training, surgical education, competency-based surgical education, ACGME core competencies, ABSITE scores, and ABS pass rate. Our initial search list included 990 articles on surgery residency training models, 539 on competency-based surgical education, 78 on ABSITE scores, and 33 on ABS pass rate. Overall, 31 articles met inclusion criteria based on their effect on ACGME Core Competencies, ABSITE scores, and ABS certification. Systematic review showed that 5/31, 19/31, and 6/31 articles on process changes in surgical training programs had a positive effect on patient care, medical knowledge, and ABSITE scores, respectively. ABS certification was not analyzed. The other ACGME core competencies were addressed in only 6 studies. Several publications on process changes in surgical training programs have shown a positive effect on patient care, medical knowledge, and ABSITE scores. However, the effect on ABS certification, and other quantitative outcomes from residency programs, have not been addressed. Studies on education strategies showing evidence that residency program objectives are being achieved are still needed. This article addresses the 6 ACGME Core Competencies. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  13. Suicide prevention as a community development process: understanding circumpolar youth suicide prevention through community level outcomes.

    Science.gov (United States)

    Allen, James; Mohatt, Gerald; Fok, Carlotta Ching Ting; Henry, David

    2009-06-01

    Community-based models have become increasingly prominent in prevention, and have special relevance for suicide prevention in circumpolar Indigenous communities. It follows that outcomes from circumpolar suicide prevention programs might be more completely understood at the community level. We present here a methodology for analysis at this level. This paper seeks to understand a cultural prevention program for rural Yup'ik youth in Alaska targeting suicide and co-occurring alcohol abuse as a community development process through changes at the community level. Quasi-experimental design with assessment at pre- and post-intervention or at 4 time points. The community development process for this project began in October 2004. The first program baseline assessment began in November 2006, prior to prevention activities with youth and parents, and the post-intervention assessment concluded in March 2008. Five key informants pre- and post-intervention completed a community readiness assessment, which is a structured procedure assessing a community's awareness of suicide as an issue and its, organizational readiness for prevention programming. Forty-three adult caregivers or sponsors of youth in the prevention program completed an assessment of behaviours that contributed to community protective factors from youth suicide and alcohol abuse at 4 time points before, during and after the intervention. The 54 youth who participated in the prevention program completed an assessment of community protective factors, also at 4 time points before, during and after the intervention. The community protective factors from suicide that were assessed included safety, enforcement of alcohol prohibitions, role models, support and opportunities for youth. Community readiness for the prevention efforts increased to new developmental stages of readiness post-intervention, and a trend in the data suggested community protective factors increased in the amount of protective behaviours

  14. Casemix and process indicators of outcome in stroke. The Royal College of Physicians minimum data set for stroke.

    Science.gov (United States)

    Irwin, P; Rudd, A

    1998-01-01

    The emphasis on outcomes measurement requires that casemix is considered in any comparative studies. In 1996 the Intercollegiate Working Party for Stroke agreed a minimum data set to measure the severity of casemix in stroke. The reasons for its development, the evidence base supporting the items included and the possible uses of the data set are described. It is currently being evaluated in national outcome and process audits to be reported at a later date.

  15. On framing effects in decision making: linking lateral versus medial orbitofrontal cortex activation to choice outcome processing.

    Science.gov (United States)

    Windmann, Sabine; Kirsch, Peter; Mier, Daniela; Stark, Rudolf; Walter, Bertram; Güntürkün, Onur; Vaitl, Dieter

    2006-07-01

    Two correlates of outcome processing in the orbitofrontal cortex (OFC) have been proposed in the literature: One hypothesis suggests that the lateral/medial division relates to representation of outcome valence (negative vs. positive), and the other suggests that the medial OFC maintains steady stimulus-outcome associations, whereas the lateral OFC represents changing (unsteady) outcomes to prepare for response shifts. These two hypotheses were contrasted by comparing the original with the inverted version of the Iowa Gambling Task in an event-related functional magnetic resonance imaging experiment. Results showed (1) that (caudo) lateral OFC was indeed sensitive to the steadiness of the outcomes and not merely to outcome valence and (2) that the original and the inverted tasks, although both designed to measure sensitivity for future outcomes, were not equivalent as they enacted different behaviors and brain activation patterns. Results are interpreted in terms of Kahneman and Tversky's prospect theory suggesting that cognitions and decisions are biased differentially when probabilistic future rewards are weighed against consistent punishments relative to the opposite scenario [Kahneman, D., & Tversky, A. Choices, values, and frames. American Psychologist, 39, 341-350, 1984]. Specialized processing of unsteady rewards (involving caudolateral OFC) may have developed during evolution in support of goal-related thinking, prospective planning, and problem solving.

  16. Glucocorticoid augmentation of prolonged exposure therapy: rationale and case report

    Directory of Open Access Journals (Sweden)

    Laura Pratchett

    2010-12-01

    Full Text Available Rationale: Prolonged exposure (PE therapy has been found to reduce symptoms of posttraumatic stress disorder (PTSD; however, it is difficult for many patients to engage fully in the obligatory retelling of their traumatic experiences. This problem is compounded by the fact that habituation and cognitive restructuring – the main mechanisms through which PE is hypothesized to work – are not instantaneous processes, and often require several weeks before the distress associated with imaginal exposure abates. Case reports: Two cases are described that respectively illustrate the use of hydrocortisone and placebo, in combination with PE, for the treatment of combat-related PTSD. Based on known effects of glucocorticoids on learning and memory performance, we hypothesized that augmentation with hydrocortisone would improve the therapeutic effects of PE by hastening “new” learning and facilitating decreases in the emotional impact of fear memories during the course of treatment. The veteran receiving hydrocortisone augmentation of PE displayed an accelerated and ultimately greater decline in PTSD symptoms than the veteran receiving placebo. Conclusions: While no general conclusion can be derived from comparison of two patients, the findings are consistent with the rationale for augmentation. These case reports support the potential for an appropriately designed and powered clinical trial to examine the efficacy of glucocorticoids in augmenting the effects of psychotherapy for PTSD.

  17. Suicidality in pediatric bipolar disorder: predictor or outcome of family processes and mixed mood presentation?

    Science.gov (United States)

    Algorta, Guillermo Pérez; Youngstrom, Eric A; Frazier, Thomas W; Freeman, Andrew J; Youngstrom, Jennifer Kogos; Findling, Robert L

    2011-02-01

    Pediatric bipolar disorder (PBD) involves a potent combination of mood dysregulation and interpersonal processes, placing these youth at significantly greater risk of suicide. We examined the relationship between suicidal behavior, mood symptom presentation, family functioning, and quality of life (QoL) in youth with PBD. Participants were 138 youths aged 5-18 years presenting to outpatient clinics with DSM-IV diagnoses of bipolar I disorder (n=27), bipolar II disorder (n=18), cyclothymic disorder (n=48), and bipolar disorder not otherwise specified (n=45). Twenty PBD patients had lifetime suicide attempts, 63 had past or current suicide ideation, and 55 were free of suicide ideation and attempts. Attempters were older than nonattempters. Suicide ideation and attempts were linked to higher depressive symptoms, and rates were even higher in youths meeting criteria for the mixed specifier proposed for DSM-5. Both suicide ideation and attempts were associated with lower youth QoL and poorer family functioning. Parent effects (with suicidality treated as outcome) and child effects (where suicide was the predictor of poor family functioning) showed equally strong evidence in regression models, even after adjusting for demographics. These findings underscore the strong association between mixed features and suicidality in PBD, as well as the association between QoL, family functioning, and suicidality. It is possible that youths are not just a passive recipient of family processes, and their illness may play an active role in disrupting family functioning. Replication with longitudinal data and qualitative methods should investigate both child and parent effect models. © 2011 John Wiley and Sons A/S.

  18. Advanced control room evaluation: General approach and rationale

    International Nuclear Information System (INIS)

    O'Hara, J.M.; Wachtel, J.

    1991-01-01

    Advanced control rooms (ACRs) for future nuclear power plants (NPPs) are being designed utilizing computer-based technologies. The US Nuclear Regulatory Commission reviews the human engineering aspects of such control rooms to ensure that they are designed to good human factors engineering principles and that operator performance and reliability are appropriately supported in order to protect public health and safety. This paper describes the rationale and general approach to the development of a human factors review guideline for ACRs. The factors influencing the guideline development are discussed, including the review environment, the types of advanced technologies being addressed, the human factors issues associated with advanced technology, and the current state-of-the-art of human factors guidelines for advanced human-system interfaces (HSIs). The proposed approach to ACR review would track the design and implementation process through the application of review guidelines reflecting four review modules: planning, design process analysis, human factors engineering review, and dynamic performance evaluation. 21 refs

  19. A Combination of Outcome and Process Feedback Enhances Performance in Simulations of Child Sexual Abuse Interviews Using Avatars

    Directory of Open Access Journals (Sweden)

    Francesco Pompedda

    2017-09-01

    Full Text Available Simulated interviews in alleged child sexual abuse (CSA cases with computer-generated avatars paired with feedback improve interview quality. In the current study, we aimed to understand better the effect of different types of feedback in this context. Feedback was divided into feedback regarding conclusions about what happened to the avatar (outcome feedback and feedback regarding the appropriateness of question-types used by the interviewer (process feedback. Forty-eight participants each interviewed four different avatars. Participants were divided into four groups (no feedback, outcome feedback, process feedback, and a combination of both feedback types. Compared to the control group, interview quality was generally improved in all the feedback groups on all outcome variables included. Combined feedback produced the strongest effect on increasing recommended questions and correct conclusions. For relevant and neutral details elicited by the interviewers, no statistically significant differences were found between feedback types. For wrong details, the combination of feedback produced the strongest effect, but this did not differ from the other two feedback groups. Nevertheless, process feedback produced a better result compared to outcome feedback. The present study replicated previous findings regarding the effect of feedback in improving interview quality, and provided new knowledge on feedback characteristics that maximize training effects. A combination of process and outcome feedback showed the strongest effect in enhancing training in simulated CSA interviews. Further research is, however, needed.

  20. Rationale, design, and baseline characteristics of the CArdiovascular safety and Renal Microvascular outcomE study with LINAgliptin (CARMELINA®): a randomized, double-blind, placebo-controlled clinical trial in patients with type 2 diabetes and high cardio-renal risk.

    Science.gov (United States)

    Rosenstock, Julio; Perkovic, Vlado; Alexander, John H; Cooper, Mark E; Marx, Nikolaus; Pencina, Michael J; Toto, Robert D; Wanner, Christoph; Zinman, Bernard; Baanstra, David; Pfarr, Egon; Mattheus, Michaela; Broedl, Uli C; Woerle, Hans-Juergen; George, Jyothis T; von Eynatten, Maximilian; McGuire, Darren K

    2018-03-14

    Cardiovascular (CV) outcome trials in type 2 diabetes (T2D) have underrepresented patients with chronic kidney disease (CKD), leading to uncertainty regarding their kidney efficacy and safety. The CARMELINA ® trial aims to evaluate the effects of linagliptin, a DPP-4 inhibitor, on both CV and kidney outcomes in a study population enriched for cardio-renal risk. CARMELINA ® is a randomized, double-blind, placebo-controlled clinical trial conducted in 27 countries in T2D patients at high risk of CV and/or kidney events. Participants with evidence of CKD with or without CV disease and HbA1c 6.5-10.0% (48-86 mmol/mol) were randomized 1:1 to receive linagliptin once daily or matching placebo, added to standard of care adjusted according to local guidelines. The primary outcome is time to first occurrence of CV death, non-fatal myocardial infarction, or non-fatal stroke. The key secondary outcome is a composite of time to first sustained occurrence of end-stage kidney disease, ≥ 40% decrease in estimated glomerular filtration rate (eGFR) from baseline, or renal death. CV and kidney events are prospectively adjudicated by independent, blinded clinical event committees. CARMELINA ® was designed to continue until at least 611 participants had confirmed primary outcome events. Assuming a hazard ratio of 1.0, this provides 90% power to demonstrate non-inferiority of linagliptin versus placebo within the pre-specified non-inferiority margin of 1.3 at a one-sided α-level of 2.5%. If non-inferiority of linagliptin for the primary outcome is demonstrated, then its superiority for both the primary outcome and the key secondary outcome will be investigated with a sequentially rejective multiple test procedure. Between July 2013 and August 2016, 6980 patients were randomized and took ≥ 1 dose of study drug (40.6, 33.1, 16.9, and 9.4% from Europe, South America, North America, and Asia, respectively). At baseline, mean ± SD age was 65.8 ± 9.1 years, HbA1c

  1. The NordiNet® International Outcome Study and NovoNet® ANSWER Program®: rationale, design, and methodology of two international pharmacoepidemiological registry-based studies monitoring long-term clinical and safety outcomes of growth hormone therapy (Norditropin®).

    Science.gov (United States)

    Höybye, Charlotte; Sävendahl, Lars; Christesen, Henrik Thybo; Lee, Peter; Pedersen, Birgitte Tønnes; Schlumpf, Michael; Germak, John; Ross, Judith

    2013-01-01

    Randomized controlled trials have shown that growth hormone (GH) therapy has effects on growth, metabolism, and body composition. GH therapy is prescribed for children with growth failure and adults with GH deficiency. Carefully conducted observational study of GH treatment affords the opportunity to assess long-term treatment outcomes and the clinical factors and variables affecting those outcomes, in patients receiving GH therapy in routine clinical practice. The NordiNet® International Outcome Study (IOS) and the American Norditropin® Web Enabled Research (ANSWER Program®) are two complementary, non-interventional, observational studies that adhere to current guidelines for pharmacoepidemiological data. The studies include pediatric and adult patients receiving Norditropin®, as prescribed by their physicians. The studies gather long-term data on the safety and effectiveness of reallife treatment with the recombinant human GH, Norditropin®. We describe the origins, aims, objectives, and design methodology of the studies, as well as their governance and validity, strengths, and limitations. The NordiNet® IOS and ANSWER Program® studies will provide valid insights into the effectiveness and safety of GH treatment across a diverse and large patient population treated in accordance with real-world clinical practice and following the Good Pharmacoepidemiological Practice and STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines.

  2. Using data to improve medical practice by measuring processes and outcomes of care.

    Science.gov (United States)

    Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K

    2000-12-01

    The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not

  3. Rationale for reduced tornado design bases

    International Nuclear Information System (INIS)

    Rutherford, P.D.; Ho, H.W.; Hartung, J.A.; Kastenberg, W.E.

    1985-01-01

    This paper provides a rationale for relaxing the present NRC tornado design requirements, which are based on a design basis tornado (DBT) whose frequency of exceedance is 10 -7 per year. It is proposed that a reduced DBT frequency of 10 -5 to 10 -6 per year is acceptable. This change in the tornado design bases for LMFBRs (and possibly all types of nuclear plants) is justified based on (1) existing NRC regulations and guidelines, (2) probabilistic arguments, (3) consistency with NRC trial safety goals, and (4) cost-benefit analysis

  4. Linking implementation process to intervention outcomes in a middle school obesity prevention curriculum, ‘Choice, Control and Change’

    Science.gov (United States)

    Gray, Heewon Lee; Contento, Isobel R.; Koch, Pamela A.

    2015-01-01

    This study investigates the link between process evaluation components and the outcomes of a school-based nutrition curriculum intervention, ‘Choice, Control and Change’. Ten New York City public middle schools were recruited and randomly assigned into intervention or control condition. The curriculum was to improve sixth to seventh grade students’ energy balance related behaviors, based on social cognitive and self-determination theories, and implemented during the 2006–2007 school year (n = 1136). Behaviors and psychosocial variables were measured by self-reported questionnaires. Process components were evaluated with classroom observations, teacher interviews, and a student questionnaire. Using ‘Teacher Implementation’ (dose delivered) and ‘Student Reception’ (dose received) process data; intervention group was further categorized into medium- and high-implementation groups. Analysis of covariance revealed that, compared with control group, only high-implementation group showed significant improvement in students’ behavior and psychosocial outcomes. Hierarchical linear models showed that ‘Teacher Implementation’ and ‘Student Reception’ significantly predicted students’ sweetened beverage outcomes (P < 0.05). ‘Student Satisfaction’ was also greater when these implementation components were higher, and significantly associated with behavior and psychosocial outcomes (P < 0.05). Implementation process influenced the effectiveness of the ‘Choice, Control and Change’ intervention study. It is important to take into account the process components when interpreting the results of such research. PMID:25700557

  5. Description and Rationale for the Planning, Monitoring, and Implementation (PMI) Model: Rationale.

    Science.gov (United States)

    Cort, H. Russell

    The rationale for the Planning, Monitoring, and Implementation Model (PMI) is the subject of this paper. The Superintendent of the District of Columbia Public Schools requested a model for systematic evaluation of educational programs to determine their effectiveness. The school system's emphasis on objective-referenced instruction and testing,…

  6. Effects of Cognitive Complexity and Emotional Upset on Processing Supportive Messages: Two Tests of a Dual-Process Theory of Supportive Communication Outcomes

    Science.gov (United States)

    Bodie, Graham D.; Burleson, Brant R.; Holmstrom, Amanda J.; McCullough, Jennifer D.; Rack, Jessica J.; Hanasono, Lisa K.; Rosier, Jennifer G.

    2011-01-01

    We report tests of hypotheses derived from a theory of supportive communication outcomes that maintains the effects of supportive messages are moderated by factors influencing the motivation and ability to process these messages. Participants in two studies completed a measure of cognitive complexity, which provided an assessment of processing…

  7. Structure, Process, and Outcome Quality of Surgical Site Infection Surveillance in Switzerland.

    Science.gov (United States)

    Kuster, Stefan P; Eisenring, Marie-Christine; Sax, Hugo; Troillet, Nicolas

    2017-10-01

    OBJECTIVE To assess the structure and quality of surveillance activities and to validate outcome detection in the Swiss national surgical site infection (SSI) surveillance program. DESIGN Countrywide survey of SSI surveillance quality. SETTING 147 hospitals or hospital units with surgical activities in Switzerland. METHODS Site visits were conducted with on-site structured interviews and review of a random sample of 15 patient records per hospital: 10 from the entire data set and 5 from a subset of patients with originally reported infection. Process and structure were rated in 9 domains with a weighted overall validation score, and sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the identification of SSI. RESULTS Of 50 possible points, the median validation score was 35.5 (range, 16.25-48.5). Public hospitals (PSwitzerland (P=.021), and hospitals with longer participation in the surveillance (P=.018) had higher scores than others. Domains that contributed most to lower scores were quality of chart review and quality of data extraction. Of 49 infections, 15 (30.6%) had been overlooked in a random sample of 1,110 patient records, accounting for a sensitivity of 69.4% (95% confidence interval [CI], 54.6%-81.7%), a specificity of 99.9% (95% CI, 99.5%-100%), a positive predictive value of 97.1% (95% CI, 85.1%-99.9%), and a negative predictive value of 98.6% (95% CI, 97.7%-99.2%). CONCLUSIONS Irrespective of a well-defined surveillance methodology, there is a wide variation of SSI surveillance quality. The quality of chart review and the accuracy of data collection are the main areas for improvement. Infect Control Hosp Epidemiol 2017;38:1172-1181.

  8. Health and equity in all policies in local government: processes and outcomes in two Norwegian municipalities.

    Science.gov (United States)

    Von Heimburg, Dina; Hakkebo, Berit

    2017-08-01

    To identify key factors in implementing Health and Equity in All Policies (HEiAP) at the local level in two Norwegian municipalities in order to accelerate the progress of promoting health, well-being and equity in other local governments. This case study is presented as a narrative from policy-making processes in two Norwegian municipalities. The story is told from an insider perspective, with a focus on HEiAP policy makers in these two municipalities. The narrative identified key learning from implementing HEiAP at the local level, i.e. the importance of strengthening system and human capacities. System capacity is strengthened by governing HEiAP according to national legislation and a holistic governance system at the local level. Municipal plans are based on theory, evidence and local data. A 'main story' is developed to support the vision, defining joint societal goals and co-creation strategies. Policies are anchored by measuring and monitoring outcomes, sharing accountability and continuous dialogue to ensure political commitment. Human capacity is strengthened through participatory leadership, soft skills and health promotion competences across sectors. Health promotion competence at a strategic level in the organization, participation in professional networks, crowd sourcing toward common goals, and commitment through winning hearts and minds of politicians and other stakeholders are vital aspects. Our experience pinpoints the importance of strengthening system and human capacity in local governments. Further, we found it important to focus on the two strategic objectives in the European strategy 'Health 2020': (1) Improving health for all and reducing health inequalities; (2) improving leadership and participatory governance for health.

  9. The trees and the forest: mixed methods in the assessment of recovery based interventions' processes and outcomes in mental health.

    Science.gov (United States)

    Hasson-Ohayon, Ilanit; Roe, David; Yanos, Philip T; Lysaker, Paul H

    2016-12-01

    Recent developments in mental health have emphasized recovery as an outcome for people with serious mental illness (SMI). Accordingly, several studies have attempted to evaluate the process and outcome of recovery-oriented psychosocial interventions. To review and discuss quantitative and qualitative findings from previous efforts to study the impact of five recovery-oriented interventions: Illness Management and Recovery (IMR), Narrative Enhancement and Cognitive Therapy (NECT), Supported Employment (SE), Supported Socialization (SS), and Family Psychoeducation. Reviewing the literature on studies that examine the effectiveness of these interventions by using both quantitative and qualitative approach. Qualitative findings in these studies augment quantitative findings and at times draw attention to unexpected findings and uniquely illuminate the effects of these interventions on self-reflective processes. There is a need for further exploration of how mixed-methods can be implemented to explore recovery-oriented outcomes. Critical questions regarding the implications of qualitative findings are posed.

  10. Children's resilience and trauma-specific cognitive behavioral therapy: Comparing resilience as an outcome, a trait, and a process.

    Science.gov (United States)

    Happer, Kaitlin; Brown, Elissa J; Sharma-Patel, Komal

    2017-11-01

    Resilience, which is associated with relatively positive outcomes following negative life experiences, is an important research target in the field of child maltreatment (Luthar et al., 2000). The extant literature contains multiple conceptualizations of resilience, which hinders development in research and clinical utility. Three models emerge from the literature: resilience as an immediate outcome (i.e., behavioral or symptom response), resilience as a trait, and resilience as a dynamic process. The current study compared these models in youth undergoing trauma-specific cognitive behavioral therapy. Results provide the most support for resilience as a process, in which increase in resilience preceded associated decrease in posttraumatic stress and depressive symptoms. There was partial support for resilience conceptualized as an outcome, and minimal support for resilience as a trait. Results of the models are compared and discussed in the context of existing literature and in light of potential clinical implications for maltreated youth seeking treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Development of a measure of hypodontia patients' expectations of the process and outcome of combined orthodontic and restorative treatment.

    Science.gov (United States)

    Gassem, Afnan Ben; Foxton, Richard; Bister, Dirk; Newton, Tim

    2016-12-01

    To devise and assess the psychometric properties of a measure that investigates hypodontia patients' expectations of the process and outcome of combined orthodontic/restorative treatment. Specialised secondary care facility for individuals with hypodontia. Mixed research design with three phases: (a) Thematic analysis of data from individual interviews with 25 hypodontia patients/16 parents to generate the questionnaire items. (b) Questionnaire design, assessment of readability and face/content validity with 10 patients. (c) Survey of 32 new hypodontia patients to determine the internal consistency of the measure. Three main themes related to the treatment process emerged from the qualitative data: 'hypodontia clinic', 'orthodontic treatment' and 'restorative treatment'. Three main themes were also revealed relating to treatment outcome: 'changes in appearance', 'psychosocial changes' and 'functional changes'. A 28 item questionnaire was constructed using a mix of visual analogue scale (VAS) and categorical response format. The Flesch reading ease score of the measure was 78, equivalent to a reading age of 9-10 years. Face and content validity were good. The overall Cronbach's alpha was 0.80 while for the treatment process and treatment outcome subscales it was 0.71 and 0.88 respectively. A patient-based measure of the process and outcome of combined orthodontic/restorative treatment for hypodontia patients has been developed which has good face and construct validity and satisfactory internal consistency. Patient expectations of treatment are important in determining not only their satisfaction with treatment outcomes but also their engagement with the clinical process. This questionnaire is a first step in operationalising the expectations of hypodontia patients through assessment tools that can then determine whether pre-treatment counselling is required and aid the consent and treatment planning process, thus improving the quality of treatment provided by

  12. Design and rationale for examining neuroimaging genetics in ischemic stroke

    Science.gov (United States)

    Giese, Anne-Katrin; Schirmer, Markus D.; Donahue, Kathleen L.; Cloonan, Lisa; Irie, Robert; Winzeck, Stefan; Bouts, Mark J.R.J.; McIntosh, Elissa C.; Mocking, Steven J.; Dalca, Adrian V.; Sridharan, Ramesh; Xu, Huichun; Frid, Petrea; Giralt-Steinhauer, Eva; Holmegaard, Lukas; Roquer, Jaume; Wasselius, Johan; Cole, John W.; McArdle, Patrick F.; Broderick, Joseph P.; Jimenez-Conde, Jordi; Jern, Christina; Kissela, Brett M.; Kleindorfer, Dawn O.; Lemmens, Robin; Lindgren, Arne; Meschia, James F.; Rundek, Tatjana; Sacco, Ralph L.; Schmidt, Reinhold; Sharma, Pankaj; Slowik, Agnieszka; Thijs, Vincent; Woo, Daniel; Worrall, Bradford B.; Kittner, Steven J.; Mitchell, Braxton D.; Rosand, Jonathan; Golland, Polina; Wu, Ona

    2017-01-01

    Objective: To describe the design and rationale for the genetic analysis of acute and chronic cerebrovascular neuroimaging phenotypes detected on clinical MRI in patients with acute ischemic stroke (AIS) within the scope of the MRI–GENetics Interface Exploration (MRI-GENIE) study. Methods: MRI-GENIE capitalizes on the existing infrastructure of the Stroke Genetics Network (SiGN). In total, 12 international SiGN sites contributed MRIs of 3,301 patients with AIS. Detailed clinical phenotyping with the web-based Causative Classification of Stroke (CCS) system and genome-wide genotyping data were available for all participants. Neuroimaging analyses include the manual and automated assessments of established MRI markers. A high-throughput MRI analysis pipeline for the automated assessment of cerebrovascular lesions on clinical scans will be developed in a subset of scans for both acute and chronic lesions, validated against gold standard, and applied to all available scans. The extracted neuroimaging phenotypes will improve characterization of acute and chronic cerebrovascular lesions in ischemic stroke, including CCS subtypes, and their effect on functional outcomes after stroke. Moreover, genetic testing will uncover variants associated with acute and chronic MRI manifestations of cerebrovascular disease. Conclusions: The MRI-GENIE study aims to develop, validate, and distribute the MRI analysis platform for scans acquired as part of clinical care for patients with AIS, which will lead to (1) novel genetic discoveries in ischemic stroke, (2) strategies for personalized stroke risk assessment, and (3) personalized stroke outcome assessment. PMID:28852707

  13. Examining the Effects of Displaying Clicker Voting Results on High School Students' Voting Behaviors, Discussion Processes, and Learning Outcomes

    Science.gov (United States)

    Chien, Yu-Ta; Lee, Yu-Hsien; Li, Tsung-Yen; Chang, Chun-Yen

    2015-01-01

    This study explores the relationship between students' clicking behaviors, discussion processes, learning outcomes, and a prominent feature of clicker systems--the whole class' response results aggregated by clickers in real time. The results indicate that, while teaching Newton's laws of motion, displaying the real-time responses of the whole…

  14. In-session behaviours and adolescents' self-concept and loneliness: A psychodrama process-outcome study.

    Science.gov (United States)

    Orkibi, Hod; Azoulay, Bracha; Snir, Sharon; Regev, Dafna

    2017-11-01

    As adolescents spend many hours a day in school, it is crucial to examine the ways in which therapeutic practices in schools promote their well-being. This longitudinal pilot study examined the contribution of school-based psychodrama group therapy to the self-concept dimensions and perceived loneliness of 40 Israeli adolescents (aged 13-16, 60% boys) in public middle schools. From a process-outcome perspective, we also examined the understudied trajectory of adolescents' in-session behaviours (process variables) and its associations with changes in their self-concepts and loneliness (outcome variables). Psychodrama participants reported increases in global, social, and behavioural self-concepts and a decrease in loneliness compared to the control group. In-session productive behaviours increased and resistance decreased throughout the therapy, but varied process-outcome relationships were found. The study suggests that conducting further research into the process-outcome relationships in psychodrama group therapy is warranted to pinpoint specific mechanisms of change. Suggestions for future studies are provided. Copyright © 2017 John Wiley & Sons, Ltd.

  15. The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients.

    Science.gov (United States)

    Matsushima, Kazuhide; Goldwasser, Eleanor R; Schaefer, Eric W; Armen, Scott B; Indeck, Matthew C

    2013-09-01

    The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists' base specialty of training on the disparity of care process and patient outcome. We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists' base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79-2.80; P = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73-1.67; P = 0.63). Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists' base specialty of training. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Outcome and Process in Motor Performance: A Comparison of Jumping by Typically Developing Children and Those with Low Motor Proficiency

    Science.gov (United States)

    Williams, Morgan D.; Saunders, John E.; Maschette, Wayne E.; Wilson, Cameron J.

    2013-01-01

    The motivation for this study was to explore a conceptual framework to understand the outcomes and processes of motor performance in children. Vertical jumping, a fundamental movement skill, was used to compare children (ages 6-12 years) who were typically developing (TD) and those identified as having low motor proficiency (LMP). Jumps were…

  17. Learning Process and Learning Outcomes of Video Podcasts Including the Instructor and PPT Slides: A Chinese Case

    Science.gov (United States)

    Pi, Zhongling; Hong, Jianzhong

    2016-01-01

    Video podcasts have become one of the fastest developing trends in learning and teaching. The study explored the effect of the presenting mode of educational video podcasts on the learning process and learning outcomes. Prior to viewing a video podcast, the 94 Chinese undergraduates participating in the study completed a demographic questionnaire…

  18. The Therapeutic Process and Outcome during Cognitive Behavioral Therapy for Children with Anxiety and Autism Spectrum Disorders

    Science.gov (United States)

    Van Dyke, Marilyn Virginia

    2014-01-01

    The purpose of this dissertation was to investigate the therapeutic process and outcomes of cognitive behavioral therapy used to treat anxiety disorders in twenty-two elementary school-aged children (7- to 11-year-olds) who had autism spectrum disorder, by using child and parent verbalizations and behavior collected during a randomized controlled…

  19. A dual process model of diversity outcomes : The case of the South African Police Service in the Pretoria area

    NARCIS (Netherlands)

    Jackson, L.T.B.; van de Vijver, F.J.R.; Molokoane, D.H.

    2013-01-01

    Orientation: The study addresses the question of how employees of the South African Police Service (SAPS) cope with intercultural relations in an increasingly diverse organisation. Research purpose: A dual-process model of diversity outcomes was tested in which a distinction is made between a

  20. End-of-treatment abstinence self-efficacy, behavioral processes of change, and posttreatment drinking outcomes in Project MATCH.

    Science.gov (United States)

    Crouch, Taylor Berens; DiClemente, Carlo C; Pitts, Steven C

    2015-09-01

    This study evaluated whether alcohol abstinence self-efficacy at the end of alcohol treatment was moderated by utilization of behavioral processes of change (coping activities used during a behavior change attempt). It was hypothesized that self-efficacy would be differentially important in predicting posttreatment drinking outcomes depending on the level of behavioral processes, such that the relation between self-efficacy and outcomes would be stronger for individuals who reported low process use. Analyses were also estimated with end-of-treatment abstinence included as a covariate. Data were analyzed from alcohol-dependent individuals in both treatment arms of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity; N = 1,328), a large alcohol treatment study. Self-efficacy was moderated by behavioral process use in predicting drinking frequency 6 and 12 months posttreatment and drinking quantity 6 months posttreatment such that self-efficacy was more strongly related to posttreatment drinking when low levels of processes were reported than high levels, but interactions were attenuated when end-of-treatment abstinence was controlled for. Significant quadratic relations between end-of-treatment self-efficacy and 6- and 12-month posttreatment drinking quantity and frequency were found (p behavioral processes was attenuated when end-of-treatment abstinence was controlled for, the quadratic effect of self-efficacy on outcomes remained significant. The pattern of these effects did not support the idea of "overconfidence" as a negative indicator. (c) 2015 APA, all rights reserved).

  1. Tracing the Rationale Behind UML Model Change Through Argumentation

    Science.gov (United States)

    Jureta, Ivan J.; Faulkner, Stéphane

    Neglecting traceability—i.e., the ability to describe and follow the life of a requirement—is known to entail misunderstanding and miscommunication, leading to the engineering of poor quality systems. Following the simple principles that (a) changes to UML model instances ought be justified to the stakeholders, (b) justification should proceed in a structured manner to ensure rigor in discussions, critique, and revisions of model instances, and (c) the concept of argument instantiated in a justification process ought to be well defined and understood, the present paper introduces the UML Traceability through Argumentation Method (UML-TAM) to enable the traceability of design rationale in UML while allowing the appropriateness of model changes to be checked by analysis of the structure of the arguments provided to justify such changes.

  2. Patient perception of nursing service quality; an applied model of Donabedian's structure-process-outcome approach theory.

    Science.gov (United States)

    Kobayashi, Hideyuki; Takemura, Yukie; Kanda, Katsuya

    2011-09-01

    Nursing is a labour-intensive field, and an extensive amount of latent information exists to aid in evaluating the quality of nursing service, with patients' experiences, the primary focus of such evaluations. To effect further improvement in nursing as well as medical care, Donabedian's structure-process-outcome approach has been applied. To classify and confirm patients' specific experiences with regard to nursing service based on Donabedian's structure-process-outcomes model for improving the quality of nursing care. Items were compiled from existing scales and assigned to structure, process or outcomes in Donabedian's model through discussion among expert nurses and pilot data collection. With regard to comfort, surroundings were classified as structure (e.g. accessibility to nurses, disturbance); with regard to patient-practitioner interaction, patient participation was classified as a process (e.g. expertise and skill, patient decision-making); and with regard to changes in patients, satisfaction was classified as an outcome (e.g. information support, overall satisfaction). Patient inquiry was carried out using the finalized questionnaire at general wards in Japanese hospitals in 2005-2006. Reliability and validity were tested using psychometric methods. Data from 1,810 patients (mean age: 59.7 years; mean length of stay: 23.7 days) were analysed. Internal consistency reliability was supported (α = 0.69-0.96), with factor analysis items of structure aggregated to one factor and overall satisfaction under outcome aggregated to one. The remaining items of outcome and process were distributed together in two factors. Inter-scale correlation (r = 0.442-0.807) supported the construct validity of each structure-process-outcome approach. All structure items were represented as negative-worded examples, as they dealt with basic conditions under Japanese universal health care system, and were regarded as representative related to concepts of dissatisfaction and no

  3. The association between visual, nonverbal cognitive abilities and speech, phonological processing, vocabulary and reading outcomes in children with cochlear implants.

    Science.gov (United States)

    Edwards, Lindsey; Anderson, Sara

    2014-01-01

    The aim of this study was to explore the possibility that specific nonverbal, visual cognitive abilities may be associated with outcomes after pediatric cochlear implantation. The study therefore examined the relationship between visual sequential memory span and visual sequential reasoning ability, and a range of speech, phonological processing, vocabulary knowledge, and reading outcomes in children with cochlear implants. A cross-sectional, correlational design was used. Sixty-six children aged 5 to 12 years completed tests of visual memory span and visual sequential reasoning, along with tests of speech intelligibility, phonological processing, vocabulary knowledge, and word reading ability (the outcome variables). Auditory memory span was also assessed, and its relationship with the other variables examined. Significant, positive correlations were found between the visual memory and reasoning tests, and each of the outcome variables. A series of regression analyses then revealed that for all the outcome variables, after variance attributable to the age at implantation was accounted for, visual memory span and visual sequential reasoning ability together accounted for significantly more variance (up to 25%) in each outcome measure. These findings have both clinical and theoretical implications. Clinically, the findings may help improve the identification of children at risk of poor progress after implantation earlier than has been possible to date as the nonverbal tests can be administered to children as young as 2 years of age. The results may also contribute to the identification of children with specific learning or language difficulties as well as improve our ability to develop intervention strategies for individual children based on their specific cognitive processing strengths or difficulties. Theoretically, these results contribute to the growing body of knowledge about learning and development in deaf children with cochlear implants.

  4. Outcomes of short-gap sensory nerve injuries reconstructed with processed nerve allografts from a multicenter registry study.

    Science.gov (United States)

    Rinker, Brian D; Ingari, John V; Greenberg, Jeffrey A; Thayer, Wesley P; Safa, Bauback; Buncke, Gregory M

    2015-06-01

    Short-gap digital nerve injuries are a common surgical problem, but the optimal treatment modality is unknown. A multicenter database was queried and analyzed to determine the outcomes of nerve gap reconstructions between 5 and 15 mm with processed nerve allograft. The current RANGER registry is designed to continuously monitor and compile injury, repair, safety, and outcomes data. Centers followed their own standard of care for treatment and follow-up. The database was queried for digital nerve injuries with a gap between 5 and 15 mm reporting sufficient follow-up data to complete outcomes analysis. Available quantitative outcome measures were reviewed and reported. Meaningful recovery was defined by the Medical Research Council Classification (MRCC) scale at S3-S4 for sensory function. Sufficient follow-up data were available for 24 subjects (37 repairs) in the prescribed gap range. Mean age was 43 years (range, 23-81). Mean gap was 11 ± 3 (5-15) mm. Time to repair was 13 ± 42 (0-215) days. There were 25 lacerations, 8 avulsion/amputations, 2 gunshots, 1 crush injury, and 1 injury of unknown mechanism. Meaningful recovery, defined as S3-S4 on the MRCC scales, was reported in 92% of repairs. Sensory recovery of S3+ or S4 was observed in 84% of repairs. Static 2PD was 7.1 ± 2.9 mm (n = 19). Return to light touch was observed in 23 out of 32 repairs reporting Semmes-Weinstein monofilament outcomes (SWMF). There were no reported nerve adverse events. Sensory outcomes for processed nerve allografts were equivalent to historical controls for nerve autograft and exceed those of conduit. Processed nerve allografts provide an effective solution for short-gap digital nerve reconstructions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. The ‘grey’ assessment practice of IA screening: Prevalence, influence and applied rationale

    International Nuclear Information System (INIS)

    Bidstrup, Morten

    2017-01-01

    Research focusing on the practices surrounding screening in Impact Assessment (IA) is limited. Yet, it has been found that development proposals sometimes are adjusted through an informal dialog with IA practitioners prior to or during screening. Such practice is often referred to as ‘grey IA’ in Denmark. This article explores the prevalence, influence and applied rationale of grey IA. Through a questionnaire, data was collected from 121 IA practitioners working within the fields of environmental impact assessment and strategic environmental assessment. It was found that grey IA is a common practice, which influences the outcomes of formal screening procedures through consideration of impacts on neighbours and spatial zones of protection. Grey IA is to some extent motivated by the opportunity to save the resources required for full-scale IA, but an additional ‘green’ rationale also exists. Grey IA may influence the effectiveness of IA systems, but further research is needed before any conclusions can be made. - Highlights: • Screening procedures may function as an informal, ‘grey’ assessment. • Grey assessment is common and influences formal screening outcomes. • Grey assessment is motivated by an opportunity to cut IA costs. • Yet, an environmental, ‘green’ rationale for grey assessment also exists.

  6. The ‘grey’ assessment practice of IA screening: Prevalence, influence and applied rationale

    Energy Technology Data Exchange (ETDEWEB)

    Bidstrup, Morten, E-mail: Bidstrup@plan.aau.dk

    2017-01-15

    Research focusing on the practices surrounding screening in Impact Assessment (IA) is limited. Yet, it has been found that development proposals sometimes are adjusted through an informal dialog with IA practitioners prior to or during screening. Such practice is often referred to as ‘grey IA’ in Denmark. This article explores the prevalence, influence and applied rationale of grey IA. Through a questionnaire, data was collected from 121 IA practitioners working within the fields of environmental impact assessment and strategic environmental assessment. It was found that grey IA is a common practice, which influences the outcomes of formal screening procedures through consideration of impacts on neighbours and spatial zones of protection. Grey IA is to some extent motivated by the opportunity to save the resources required for full-scale IA, but an additional ‘green’ rationale also exists. Grey IA may influence the effectiveness of IA systems, but further research is needed before any conclusions can be made. - Highlights: • Screening procedures may function as an informal, ‘grey’ assessment. • Grey assessment is common and influences formal screening outcomes. • Grey assessment is motivated by an opportunity to cut IA costs. • Yet, an environmental, ‘green’ rationale for grey assessment also exists.

  7. Maternal childhood trauma, postpartum depression, and infant outcomes: Avoidant affective processing as a potential mechanism.

    Science.gov (United States)

    Choi, Karmel W; Sikkema, Kathleen J; Vythilingum, Bavi; Geerts, Lut; Faure, Sheila C; Watt, Melissa H; Roos, Annerine; Stein, Dan J

    2017-03-15

    Women who have experienced childhood trauma may be at risk for postpartum depression, increasing the likelihood of negative outcomes among their children. Predictive pathways from maternal childhood trauma to child outcomes, as mediated by postpartum depression, require investigation. A longitudinal sample of South African women (N=150) was followed through pregnancy and postpartum. Measures included maternal trauma history reported during pregnancy; postpartum depression through six months; and maternal-infant bonding, infant development, and infant physical growth at one year. Structural equation models tested postpartum depression as a mediator between maternal experiences of childhood trauma and children's outcomes. A subset of women (N=33) also participated in a lab-based emotional Stroop paradigm, and their responses to fearful stimuli at six weeks were explored as a potential mechanism linking maternal childhood trauma, postpartum depression, and child outcomes. Women with childhood trauma experienced greater depressive symptoms through six months postpartum, which then predicted negative child outcomes at one year. Mediating effects of postpartum depression were significant, and persisted for maternal-infant bonding and infant growth after controlling for covariates and antenatal distress. Maternal avoidance of fearful stimuli emerged as a potential affective mechanism. Limitations included modest sample size, self-report measures, and unmeasured potential confounders. Findings suggest a mediating role of postpartum depression in the intergenerational transmission of negative outcomes. Perinatal interventions that address maternal trauma histories and depression, as well as underlying affective mechanisms, may help interrupt cycles of disadvantage, particularly in high-trauma settings such as South Africa. Copyright © 2017. Published by Elsevier B.V.

  8. Rationale for energy research and development programme

    Energy Technology Data Exchange (ETDEWEB)

    1976-04-01

    This paper describes the rationale for the expenditure of government money on energy research and development. The Committee, organized in 1974, established the following order of project priorities: projects to determine current and future energy demand; projects concerned with the conservation and more efficient use of energy; projects concerned with the assessment of indigenous energy resources; projects concerned with the assessment of the human, financial, and organizational resources for energy production and use; and projects concerned with economic, technological, social, and environmental aspects of energy use and production over the next 15 years and beyond the next 15 years. Significant factors affecting the national energy economy, the strategy for energy research and development, and the results of committee activities are summarized. An energy scenario research is laid out. (MCW)

  9. "Socialized Music": Historical Formations of Community Music through Social Rationales

    Science.gov (United States)

    Yerichuk, Deanna

    2014-01-01

    This article traces the formation of community music through professional and scholarly articles over the last century in North America, and argues that community music has been discursively formed through social rationales, although the specific rationales have shifted. The author employs an archaeological framework inspired by Michel Foucault to…

  10. The rehabilitation of attention in patients with mild cognitive impairment and brain subcortical vascular changes using the Attention Process Training-II. The RehAtt Study: rationale, design and methodology.

    Science.gov (United States)

    Salvadori, Emilia; Poggesi, Anna; Valenti, Raffaella; Della Rocca, Eleonora; Diciotti, Stefano; Mascalchi, Mario; Inzitari, Domenico; Pantoni, Leonardo

    2016-10-01

    Cerebral small vessel disease (SVD) may cause attentional and executive cognitive deficits. No drug is currently available to improve cognitive performance or to prevent dementia in SVD patients, and cognitive rehabilitation could be a promising approach. We aimed to investigate: (1) the effectiveness of the Attention Process Training-II program in the rehabilitation of patients with mild cognitive impairment (MCI) and SVD; (2) the impact of the induced cognitive improvement on functionality and quality of life; (3) the effect of training on brain activity at rest and the possibility of a training-induced plasticity effect. The RehAtt study is designed as a 3-year prospective, single-blinded, randomized clinical trial. Inclusion criteria were: (1) MCI defined according to Winblad et al. criteria; (2) evidence of impairment across attention neuropsychological tests; (3) evidence on MRI of moderate/severe white matter hyperintensities. All enrolled patients are evaluated at baseline, and after 6 and 12 months, according to an extensive clinical, functional, MRI and neuropsychological protocol. The baseline RehAtt cohort includes 44 patients (66 % males, mean ± SD age and years of education 75.3 ± 6.8 and 8.3 ± 4.3, respectively). After baseline assessment, patients have been randomly assigned to 'attention training' or 'standard care'. Treatments and follow-up visits at 6 months are completed, while follow-up visits at 12 months are ongoing. This study is the first attempt to reduce attention deficits in patients affected by MCI with SVD. The results of this pilot experience will represent an essential background for designing larger multicenter, prospective, double-blinded, randomized and controlled clinical trials. NCT02033850 (ClinicalTrials.gov Identifier).

  11. Development of an institutional review board preapproval process for Doctor of Nursing Practice students: process and outcome.

    Science.gov (United States)

    Szanton, Sarah L; Taylor, Holly A; Terhaar, Mary

    2013-01-01

    As Doctor of Nursing Practice (DNP) programs proliferate, effective collaboration with institutional review boards (IRBs) is important to protect human subjects. It is particularly important that faculty and students recognize which DNP students' projects should be considered as "human subjects research" or "quality improvement." The former require IRB review, whereas the latter may be eligible for expedited review or may be considered exempt. We report outcomes following implementation of a combination of didactic training, one-to-one consultation, and a decision support protocol to improve preparation for and collaboration with the IRB at a large university. In the first year of using this protocol, 53% of projects were deemed human subjects research and received IRB review. The other 47% were deemed quality improvement projects and did not require IRB review. We offer our experience as an approach for teaching students how to protect the subjects included in their quality improvement activities. Copyright 2012, SLACK Incorporated.

  12. What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care, and health service outcomes in cancer care? A systematic review of controlled trials.

    Science.gov (United States)

    Kotronoulas, Grigorios; Kearney, Nora; Maguire, Roma; Harrow, Alison; Di Domenico, David; Croy, Suzanne; MacGillivray, Stephen

    2014-05-10

    The systematic use of patient-reported outcome measures (PROMs) has been advocated as an effective way to standardize cancer practice. Yet, the question of whether PROMs can lead to actual improvements in the quality of patient care remains under debate. This review examined whether inclusion of PROM in routine clinical practice is associated with improvements in patient outcomes, processes of care, and health service outcomes during active anticancer treatment. A systematic review of five electronic databases (Medline, EMBASE, CINAHL [Cumulative Index to Nursing and Allied Health Literature], PsycINFO, and Psychology and Behavioral Sciences Collection [PBSC]) was conducted from database inception to May 2012 to locate randomized and nonrandomized controlled trials of patients receiving active anticancer treatment or supportive care irrespective of type of cancer. Based on prespecified eligibility criteria, we included 26 articles that reported on 24 unique controlled trials. Wide variability in the design and use of interventions delivered, outcomes evaluated, and cancer- and modality-specific context was apparent. Health service outcomes were only scarcely included as end points. Overall, the number of statistically significant findings were limited and PROMs' intervention effect sizes were predominantly small-to-moderate. The routine use of PROMs increases the frequency of discussion of patient outcomes during consultations. In some studies, PROMs are associated with improved symptom control, increased supportive care measures, and patient satisfaction. Additional effort is required to ensure patient adherence, as well as additional support to clinicians who will respond to patient concerns and issues, with clear system guidelines in place to guide their responses. More research is required to support PROM cost-benefit in terms of patient safety, clinician burden, and health services usage.

  13. Systematic and heuristic processing of majority and minority-endorsed messages: the effects of varying outcome relevance and levels of orientation on attitude and message processing.

    Science.gov (United States)

    Martin, Robin; Hewstone, Miles; Martin, Pearl Y

    2007-01-01

    Two experiments investigated the conditions under which majority and minority sources instigate systematic processing of their messages. Both experiments crossed source status (majority vs. minority) with message quality (strong vs. weak arguments). In each experiment, message elaboration was manipulated by varying either motivational (outcome relevance, Experiment 1) or cognitive (orientating tasks, Experiment 2) factors. The results showed that when either motivational or cognitive factors encouraged low message elaboration, there was heuristic acceptance of the majority position without detailed message processing. When the level of message elaboration was intermediate, there was message processing only for the minority source. Finally, when message elaboration was high, there was message processing for both source conditions. These results show that majority and minority influence is sensitive to motivational and cognitive factors that constrain or enhance message elaboration and that both sources can lead to systematic processing under specific circumstances.

  14. The Cognitive Information-Processing Systems of Leaders and Their Relation to Student Learning Outcomes

    Science.gov (United States)

    Cerni, Tom; Curtis, Guy J.; Colmar, Susan H.

    2014-01-01

    Research has shown that school principals who display transformational leadership are likely to influence organizational commitment and job satisfaction (Koh, 1990), and this in turn is thought to influence student learning outcomes. Based on a sample of experienced educational leaders (n = 88), this study examined if transformational leadership…

  15. Growth as Product and as Process: Student Learning Outcomes Attained through College Experiences in China

    Science.gov (United States)

    Cen, Yuhao

    2012-01-01

    Little empirical research has been done on student learning outcomes and college experiences in China, where the gross enrollment rate in higher education reached 26.5 percent and the undergraduate population exceeded 22 million in 2010. This study seeks to describe, explain, and interpret student learning as perceived from students in Chinese…

  16. A Millennium Learning Goal for Education Post-2015: A Question of Outcomes or Processes

    Science.gov (United States)

    Barrett, Angeline M.

    2011-01-01

    As the target year for the current Millennium Development Goal of universal completion of primary education approaches, three World Bank economists have proposed its replacement with a Millennium Learning Goal. This is part of a trend of increased privileging of learning outcomes. The proposal is assessed from the perspective of human rights-based…

  17. Accreditation Outcome Scores: Teacher Attitudes toward the Accreditation Process and Professional Development

    Science.gov (United States)

    Ulmer, Phillip Gregory

    2015-01-01

    Accreditation is an essential component in the history of education in the United States and is a central catalyst for quality education, continuous improvement, and positive growth in student achievement. Although previous researchers identified teachers as an essential component in meeting accreditation outcomes, additional information was…

  18. Evaluating the Student Learning Outcomes Assessment Process in Undergraduate Parks and Recreation Academic Programs

    Science.gov (United States)

    Ross, Craig M.; Young, Sarah J.; Sturts, Jill R.

    2012-01-01

    Institutions of higher education are increasingly being held more accountable for assessing student learning both in and out of their classrooms along with reporting results to their stakeholders. The purpose of this study, which examined assessment of student learning outcomes in undergraduate park and recreation academic programs, was two-fold:…

  19. Relationships among Relational Communication Processes and Consultation Outcomes for Students with Attention Deficit Hyperactivity Disorder

    Science.gov (United States)

    Erchul, William P.; DuPaul, George J.; Grissom, Priscilla F.; Junod, Rosemary E. Vile; Jitendra, Asha K.; Mannella, Mark C.; Tresco, Katy E.; Flammer-Rivera, Lizette M.; Volpe, Robert J.

    2007-01-01

    Consultation has been shown to be an effective means to deliver school-based psychological services. The purpose of this study was to link patterns of consultant and teacher verbal interactions to consultation outcomes. Relational communication (Rogers & Escudero, 2004) was the research perspective taken, and the source of the consultation…

  20. From Process to Outcome: The Effect of Portfolio Assessment on Student Learning.

    Science.gov (United States)

    Tiwari, Agnes; Tang, Catherine

    2003-01-01

    Three findings emerged from 12 Hong Kong student nurses' descriptions of their experiences of portfolio assessment: (1) despite initial anxiety, all favored portfolio use; (2) portfolios had positive academic and affective outcomes; and (3) unexpectedly, spontaneous collaborative learning and increased motivation resulted. (Contains 35…

  1. Development of a Mixed Methods Investigation of Process and Outcomes of Community-Based Participatory Research

    Science.gov (United States)

    Lucero, Julie; Wallerstein, Nina; Duran, Bonnie; Alegria, Margarita; Greene-Moton, Ella; Israel, Barbara; Kastelic, Sarah; Magarati, Maya; Oetzel, John; Pearson, Cynthia; Schulz, Amy; Villegas, Malia; White Hat, Emily R.

    2018-01-01

    This article describes a mixed methods study of community-based participatory research (CBPR) partnership practices and the links between these practices and changes in health status and disparities outcomes. Directed by a CBPR conceptual model and grounded in indigenous-transformative theory, our nation-wide, cross-site study showcases the value…

  2. Using Rationale To Assist Student Cognitive And Intellectual Development

    Directory of Open Access Journals (Sweden)

    Janet E. Burge

    2010-01-01

    Full Text Available One of the questions posed at the National Science Foundation (NSF-sponsored workshop on Creativity and Rationale in Software Design was on the role of rationale in supporting idea generation in the classroom. College students often struggle with problems where more than one possible solution exists. Part of the difficulty lies in the need for students to progress through different levels of development cognitively and intellectually before they can tackle creative problem solving. Argumentation-based rationale provides a natural mechanism for representing problems, candidate solutions, criteria, and arguments relating those criteria to the candidate solutions. Explicitly expressing rationale for their work encourages students to reflect on why they made their choices, and to actively consider multiple alternatives. We report on an experiment performed during a Data Structures course where students captured rationale.

  3. A dual-process model of diversity outcomes: The case South African police service in the Pretoria area

    Directory of Open Access Journals (Sweden)

    Leon T.B. Jackson

    2013-09-01

    Full Text Available Orientation: The study addresses the question of how employees of the South African Police Service (SAPS cope with intercultural relations in an increasingly diverse organisation. Research purpose: A dual-process model of diversity outcomes was tested in which a distinction is made between a positive (work-related stream that links positive diversity conditions through active coping to work outcomes and a relatively independent health related stream of negative antecedents, mediating passive coping skills and ill-health related outcomes. Motivation for the study: To test the viability of a dual-process model to understand diversity outcomes in the workplace. Research design, approach and methods: A convenience sample (n= 158 was recruited from members of the SAPS in Gauteng, using a cross-sectional design. Instruments used in previous acculturation research were adapted to measure contextual factors, coping and diversity outcomes. Main findings: A very good fit for the proposed hypothetical model was found. Approach coping partially mediated the relationship between positive acculturation conditions and the subjective experience of work success whereas avoidance coping fully mediated the relationship between discrimination, and ill-health symptoms are related to ill-health symptoms. Practical/managerial implications: Mainstream-facilitating conditions and discrimination influence individual coping styles, which in turn impact on ill-health and the subjective experience of work success. In addition, ill-health also impacts negatively on work-success experiences amongst the sampled SAPS members. It would thus make sense for the SAPS to sanction discrimination. Contribution/value added: A variation of the mediated dual-process model for diversity (Jackson & Van de Vijver, in press, using coping strategies as mediators was supported. The model adds new insights in diversity in organisations.

  4. Individual Differences in Study Processes and the Quality of Learning Outcomes.

    Science.gov (United States)

    Biggs, John

    1979-01-01

    The relationship between students' study processes and the structural complexity of their learning is examined. Study processes are viewed in terms of three dimensions and are assessed by a questionnaire. Learning quality is expressed in levels of a taxonomy. A study that relates taxonomic levels and retention to study processes is reported.…

  5. A Combination of Outcome and Process Feedback Enhances Performance in Simulations of Child Sexual Abuse Interviews Using Avatars

    OpenAIRE

    Francesco Pompedda; Jan Antfolk; Jan Antfolk; Angelo Zappalà; Angelo Zappalà; Pekka Santtila; Pekka Santtila

    2017-01-01

    Simulated interviews in alleged child sexual abuse (CSA) cases with computer-generated avatars paired with feedback improve interview quality. In the current study, we aimed to understand better the effect of different types of feedback in this context. Feedback was divided into feedback regarding conclusions about what happened to the avatar (outcome feedback) and feedback regarding the appropriateness of question-types used by the interviewer (process feedback). Forty-eight participants eac...

  6. Sudden gains in the outpatient treatment of anorexia nervosa: A process-outcome study.

    Science.gov (United States)

    Cartwright, Anna; Cheng, Yat Ping; Schmidt, Ulrike; Landau, Sabine

    2017-10-01

    Sudden gains (SGs), broadly defined as sudden symptom reductions occurring between two consecutive treatment sessions, have been associated with improved treatment outcomes in anxiety and depression. The present study is the first to formally define SGs in anorexia nervosa and explore the characteristics, demographic and baseline clinical predictors, and clinical impact of SGs in anorexia nervosa. This is a secondary analysis of data from 89 outpatients with broadly defined anorexia nervosa who received one of two psychotherapeutic interventions as part of the MOSAIC trial (Schmidt et al., 2015). SGs were defined using session-by-session body mass index (BMI) measures. This study investigated whether SGs were associated with changes in BMI, eating disorder symptomology, general psychopathology, and psychosocial impairment between baseline and 6, 12, and 24 months follow-up. SGs, experienced by 61.8% of patients, mostly occurred during the early and middle phases of treatment. A larger proportion of SGs predicted larger increases in BMI between baseline and 6, 12, and 24 months follow-up. Amongst those experiencing at least one SG, fewer days between baseline and a patient's first SG predicted a larger increase in BMI between baseline and both 6 and 12 months follow-up. The proportion and timing of SGs did not predict changes in other outcome measures. SGs in BMI during the outpatient treatment of anorexia nervosa are clinically useful predictors of longer-term weight outcomes. © 2017 Wiley Periodicals, Inc.

  7. The Provision of Powered Mobility Devices in Italy: Linking Process with Outcomes

    Directory of Open Access Journals (Sweden)

    Lorenzo Desideri

    2016-09-01

    Full Text Available The present paper reports on a series of studies conducted at the Regional Center for Assistive Technology (Centro Regionale Ausili, CRA in Bologna, Italy. Our purpose was to identify a set of internationally validated instruments and a training circuit with a view to developing a structured and validated Powered Mobility Device (PMD assessment and training program. To develop the program, three studies were conducted in order to identify: validated measures for assessing the user’s driving skills and training needs for using a PMD (Study 1; measures for evaluating the outcomes of the PMD (Study 2; and, the elements necessary for building a circuit for conducting PMD training (Study 3. In studies 1 and 2, the Wheelchair Skill Test 4.2 Power Wheelchair (WST and the Wheelchair Outcome Measure (WhOM were selected and pilot tested using QUEST 2.0. These studies represent an important step in the development and definition of a PMD assessment and training program to be implemented in routine clinical activities in a regional center for assistive technology in Italy. The measures, the circuit and the program will be further tested in future for validity and reliability in order to assess their efficacy in helping professionals to select the most adequate PMD for users, to conduct specific PMD training, and to evaluate PMD outcomes.

  8. Evaluating the outcomes and processes of a research-action partnership: The need for continuous reflective evaluation

    Directory of Open Access Journals (Sweden)

    Chantal Taylor

    2016-12-01

    Full Text Available Background: The KwaZulu-Natal Sandstone Sourveld (KZNSS Research Programme is part of a collaborative, transdisciplinary research partnership between the University of KwaZulu-Natal and the eThekwini Municipality (EM, aimed at bridging the science-policy-practice gap. The research programme focuses on generating knowledge and capacity to support local land-use planning, management and policy development related to biodiversity and climate change issues. Objectives: The objectives were (1 to describe how a continuous reflective evaluation approach helped to better understand the research programme and its outcomes; and (2 to assess research outputs and outcomes, relevance of outcomes to the requirements of EM, and participants’ perceptions of the programme (both the outcomes and the process. Methods: The evaluation took a mixed methods approach, combining various quantitative and qualitative methods such as anonymous individual questionnaires, reflective exercises and group reflections. Results: The KZNSS programme was successful in capacity building and establishing a long-term partnership, but had lower scientific publication output and practice uptake than expected. Participants’ perceptions changed over time, with a decrease in the perceived success of addressing tangible research outcomes, and an increase in the perceived success of collaborative relationships in the partnership. Conclusion: Transdisciplinary partnerships can be a means of integrating research into policy and practice through knowledge exchange. An important lesson in the early stages of this partnership was to pay attention to the process and not only the outputs. The study highlights the importance of continuous participatory reflection and evaluation in such partnerships.

  9. Improving Orientation Outcomes: Implementation of Phased Orientation Process in an Intermediate Special Care Nursery.

    Science.gov (United States)

    Rivera, Emily K; Shedenhelm, Heidi J; Gibbs, Ardyce L

    2015-01-01

    In response to changing needs of registered nurse orientees, the staff education committee in the Intermediate Special Care Nursery has implemented a phased orientation process. This phased process includes a mentoring experience postorientation to support a new nurse through the first year of employment. Since implementing the phased orientation process in the Intermediate Special Care Nursery, orientee satisfaction and preparation to practice have increased, and length of orientation has decreased.

  10. Community-Based Psychosocial Treatment Has an Impact on Social Processing and Functional Outcome in Schizophrenia

    Directory of Open Access Journals (Sweden)

    Eszter Varga

    2018-06-01

    Full Text Available Schizophrenic patients have serious impairments in social cognition, which often persists after significant reduction in clinical symptoms. Community-based psychosocial treatments aim to recover social functioning for mentally ill individuals. Our aim was to examine prospective changes in social cognition and functional outcomes in two groups of schizophrenic patients involved in two forms of community-based psychosocial treatments namely case management (CM and community-based club (CC compared to a matched, treatment as usual (TAU group of patients. We hypothesized that CC and CM groups would exhibit better functional and social cognitive outcomes after a 6-month long psychosocial treatment period. Seventy-five patients participated either in CC, CM or TAU. Both CC and CM took part in community-based psychosocial treatment programs including trainings, such as communication and assertiveness trainings. In addition, CC provided group therapeutic treatments and a continuously available day care where patients had the possibility to participate in various social interactions. All participants were in remission, and on maintenance antipsychotic treatment. Participants were assessed on all study variables at two time points: baseline and after 6 months with a battery of questionnaires that examined affective face perception, affective prosody perception, pragmatic language comprehension and ToM. Our results showed that functional outcomes improved significantly in the CC as well as in the CM groups, in contrast to the TAU group. While analyzing summary scores of social cognition, it was found that only the CC group increased its performance in social cognition. In addition, a significant between-group difference in social cognitive function was found after 6 months between the three groups, with the CC group performing best. When investigating associations between changes in social cognition and changes in functional outcomes during a 6-month long

  11. A Rationale for Music Training to Enhance Executive Functions in Parkinson’s Disease: An Overview of the Problem

    Directory of Open Access Journals (Sweden)

    Teresa Lesiuk

    2018-04-01

    Full Text Available Music listening interventions such as Rhythmic Auditory Stimulation can improve mobility, balance, and gait in Parkinson’s Disease (PD. Yet, the impact of music training on executive functions is not yet known. Deficits in executive functions (e.g., attention, processing speed in patients with PD result in gait interference, deficits in emotional processing, loss of functional capacity (e.g., intellectual activity, social participation, and reduced quality of life. The model of temporal prediction and timing suggests two networks collectively contribute to movement generation and execution: the basal ganglia-thalamocortical network (BGTC and the cerebellar-thalamocortical network (CTC. Due to decreases in dopamine responsible for the disruption of the BGTC network in adults with PD, it is hypothesized that rhythmic auditory cues assist patients through recruiting an alternate network, the CTC, which extends to the supplementary motor areas (SMA and the frontal cortices. In piano training, fine motor finger movements activate the cerebellum and SMA, thereby exercising the CTC network. We hypothesize that exercising the CTC network through music training will contribute to enhanced executive functions. Previous research suggested that music training enhances cognitive performance (i.e., working memory and processing speed in healthy adults and adults with cognitive impairments. This review and rationale provides support for the use of music training to enhance cognitive outcomes in patients with Parkinson’s Disease (PD.

  12. A Rationale for Music Training to Enhance Executive Functions in Parkinson's Disease: An Overview of the Problem.

    Science.gov (United States)

    Lesiuk, Teresa; Bugos, Jennifer A; Murakami, Brea

    2018-04-22

    Music listening interventions such as Rhythmic Auditory Stimulation can improve mobility, balance, and gait in Parkinson’s Disease (PD). Yet, the impact of music training on executive functions is not yet known. Deficits in executive functions (e.g., attention, processing speed) in patients with PD result in gait interference, deficits in emotional processing, loss of functional capacity (e.g., intellectual activity, social participation), and reduced quality of life. The model of temporal prediction and timing suggests two networks collectively contribute to movement generation and execution: the basal ganglia-thalamocortical network (BGTC) and the cerebellar-thalamocortical network (CTC). Due to decreases in dopamine responsible for the disruption of the BGTC network in adults with PD, it is hypothesized that rhythmic auditory cues assist patients through recruiting an alternate network, the CTC, which extends to the supplementary motor areas (SMA) and the frontal cortices. In piano training, fine motor finger movements activate the cerebellum and SMA, thereby exercising the CTC network. We hypothesize that exercising the CTC network through music training will contribute to enhanced executive functions. Previous research suggested that music training enhances cognitive performance (i.e., working memory and processing speed) in healthy adults and adults with cognitive impairments. This review and rationale provides support for the use of music training to enhance cognitive outcomes in patients with Parkinson’s Disease (PD).

  13. Cultural processes in parenting and youth outcomes: examining a model of racial-ethnic socialization and identity in diverse populations.

    Science.gov (United States)

    Rodriguez, James; Umaña-Taylor, Adriana; Smith, Emilie Phillips; Johnson, Deborah J

    2009-04-01

    We review and summarize the findings across 7 studies contained in the special section titled, "Racial-Ethnic Socialization, Identity, and Youth Outcomes: Excavating Culture." These studies represent a significant advance for research in issues related to the impact of racial-ethnic socialization and identity on child outcomes. All 7 studies attempted to test in whole or part a hypothetical model in which ethnic-racial socialization in families of color is related to child psychosocial and academic outcomes directly and indirectly through effects on self-system variables such as racial-ethnic identity and self-esteem. Two types of racial socialization messages were of particular interest: messages that promote cultural pride (referred to as ethnic or cultural socialization) and messages that address children's exposure to discrimination (referred to as racial socialization). Collectively, the studies suggest that ethnic-racial socialization processes are related to youth outcomes through indirect associations with ethnic-racial identity and self-esteem. Findings were most consistent in the studies with African American youth and some aspects of the model were not supported for American Indian and Chinese youth. Ethnic and racial group differences and directions for future research are discussed.

  14. Developing a blended learning program for nursing and midwifery students in Iran: Process and preliminary outcomes

    Science.gov (United States)

    Zolfaghari, Mitra; Negarandeh, Reza; Eybpoosh, Sana

    2013-01-01

    Background: We aimed to develop and evaluate outcomes of a blended learning (BL) program for educating nursing and midwifery students of Tehran university of medical sciences (Tehran, Iran). Materials and Methods: This was a participatory action research project. After designing BL website, providing technological infrastructures, and holding preparatory workshops, 22 blended courses were designed. BL method was implemented for one semester. Students’ grade point average, participation with courses, and opinion about educational methods, and instructors’ attitude and opinion about educational methods were assessed. Results: Most students (n = 181; 72.1%) and 17 instructors (28.3%) consented to participate in the study. Students’ grade point average and participation was significantly higher in BL rather than in face-to-face method (P students preferred BL method and felt more independent in this method. However, they complained about lack of easy access to Internet and weakness in computer skills. Instructors admired the flexibility and incentives that had been provided in the program. However, some of them complained about the time-consuming nature of BL course design. Conclusion: The program showed positive effect on students’ learning outcomes and participation. The strengths and weaknesses of the program should be considered for development of next phase of the project. Lessons learned in this phase might be helpful for decision makers who tend to develop similar programs in Iran. Motivational and communicational issues and users’ IT skills should be addressed in every BL program. PMID:23983723

  15. Reregulation of the Swedish pharmacy sector-A qualitative content analysis of the political rationale.

    Science.gov (United States)

    Wisell, Kristin; Winblad, Ulrika; Sporrong, Sofia Kälvemark

    2015-05-01

    In 2009, a reregulation of the Swedish pharmacy sector took place, and a fundamental change in ownership and structure followed. The reregulation provides an opportunity to reveal the politicians' views on pharmacies. The aim of this study was to explore and analyze the political arguments for the reregulation of the Swedish pharmacy sector in 2009. The method used was a qualitative content analysis of written political documents regarding the reregulation. The primary rationales for the reregulation were better availability, efficiency, price pressure, and safe usage of medicines. During the preparatory work, the rationales of diversity on the market and entrepreneurship were added, while the original rationales of efficiency, price pressure, and better usage of medicines were abandoned. The reform can be seen as a typical New Public Management reform influenced by the notion that private actors are better equipped to perform public activities. The results point to that the reform was done almost solely in order to introduce private ownership in the pharmacy sector, and was not initiated in order to solve any general problems, or to enhance patient outcomes of medicine use. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Neonatal Brain Pathology Predicts Adverse Attention and Processing Speed Outcomes in Very Preterm and/or Very Low Birth Weight Children

    Science.gov (United States)

    Murray, Andrea L; Scratch, Shannon E; Thompson, Deanne K; Inder, Terrie E; Doyle, Lex W; Anderson, Jacqueline F. I.; Anderson, Peter J

    2014-01-01

    Objective This study aimed to examine attention and processing speed outcomes in very preterm (VPT; deep gray matter, and cerebellar abnormalities. Attention and processing speed were assessed at 7 years using standardized neuropsychological tests. Group differences were tested in attention and processing speed, and the relationships between these cognitive domains and brain abnormalities at birth were investigated. Results At 7 years of age, the VPT/VLBW group performed significantly poorer than term controls on all attention and processing speed outcomes. Associations between adverse attention and processing speed performances at 7 years and higher neonatal brain abnormality scores were found; in particular, white matter and deep gray matter abnormalities were reasonable predictors of long-term cognitive outcomes. Conclusion Attention and processing speed are significant areas of concern in VPT/VLBW children. This is the first study to show that adverse attention and processing speed outcomes at 7 years are associated with neonatal brain pathology. PMID:24708047

  17. Predictive images of postoperative levator resection outcome using image processing software.

    Science.gov (United States)

    Mawatari, Yuki; Fukushima, Mikiko

    2016-01-01

    This study aims to evaluate the efficacy of processed images to predict postoperative appearance following levator resection. Analysis involved 109 eyes from 65 patients with blepharoptosis who underwent advancement of levator aponeurosis and Müller's muscle complex (levator resection). Predictive images were prepared from preoperative photographs using the image processing software (Adobe Photoshop ® ). Images of selected eyes were digitally enlarged in an appropriate manner and shown to patients prior to surgery. Approximately 1 month postoperatively, we surveyed our patients using questionnaires. Fifty-six patients (89.2%) were satisfied with their postoperative appearances, and 55 patients (84.8%) positively responded to the usefulness of processed images to predict postoperative appearance. Showing processed images that predict postoperative appearance to patients prior to blepharoptosis surgery can be useful for those patients concerned with their postoperative appearance. This approach may serve as a useful tool to simulate blepharoptosis surgery.

  18. Does Value Stream Mapping affect the structure, process, and outcome quality in care facilities? A systematic review.

    Science.gov (United States)

    Nowak, Marina; Pfaff, Holger; Karbach, Ute

    2017-08-24

    Quality improvement within health and social care facilities is needed and has to be evidence-based and patient-centered. Value Stream Mapping, a method of Lean management, aims to increase the patients' value and quality of care by a visualization and quantification of the care process. The aim of this research is to examine the effectiveness of Value Stream Mapping on structure, process, and outcome quality in care facilities. A systematic review is conducted. PubMed, EBSCOhost, including Business Source Complete, Academic Search Complete, PSYCInfo, PSYNDX, SocINDEX with Full Text, Web of Knowledge, and EMBASE ScienceDirect are searched in February 2016. All peer-reviewed papers evaluating Value Stream Mapping and published in English or German from January 2000 are included. For data synthesis, all study results are categorized into Donabedian's model of structure, process, and outcome quality. To assess and interpret the effectiveness of Value Stream Mapping, the frequencies of the results statistically examined are considered. Of the 903 articles retrieved, 22 studies fulfill the inclusion criteria. Of these, 11 studies are used to answer the research question. Value Stream Mapping has positive effects on the time dimension of process and outcome quality. It seems to reduce non-value-added time (e.g., waiting time) and length of stay. All study designs are before and after studies without control, and methodologically sophisticated studies are missing. For a final conclusion about Value Stream Mapping's effectiveness, more research with improved methodology is needed. Despite this lack of evidence, Value Stream Mapping has the potential to improve quality of care on the time dimension. The contextual influence has to be investigated to make conclusions about the relationship between different quality domains when applying Value Stream Mapping. However, for using this review's conclusion, the limitation of including heterogeneous and potentially biased results

  19. The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication, Patient Care Processes, and Patient Outcomes.

    Science.gov (United States)

    Real, Kevin; Bardach, Shoshana H; Bardach, David R

    2017-12-01

    Increasingly, health communication scholars are attending to how hospital built environments shape communication, patient care processes, and patient outcomes. This multimethod study was conducted on two floors of a newly designed urban hospital. Nine focus groups interviews were conducted with 35 health care professionals from 10 provider groups. Seven of the groups were homogeneous by profession or level: nursing (three groups), nurse managers (two groups), and one group each of nurse care technicians ("techs") and physicians. Two mixed groups were comprised of staff from pharmacy, occupational therapy, patient care facilitators, physical therapy, social work, and pastoral care. Systematic qualitative analysis was conducted using a conceptual framework based on systems theory and prior health care design and communication research. Additionally, quantitative modeling was employed to assess walking distances in two different hospital designs. Results indicate nurses walked significantly more in the new hospital environment. Qualitative analysis revealed three insights developed in relationship to system structures, processes, and outcomes. First, decentralized nurse stations changed system interdependencies by reducing nurse-to-nurse interactions and teamwork while heightening nurse interdependencies and teamwork with other health care occupations. Second, many nursing-related processes remained centralized while nurse stations were decentralized, creating systems-based problems for nursing care. Third, nursing communities of practices were adversely affected by the new design. Implications of this study suggest that nurse station design shapes communication, patient care processes, and patient outcomes. Further, it is important to understand how the built environment, often treated as invisible in communication research, is crucial to understanding communication within complex health care systems.

  20. The Effect of Guided Inquiry Learning with Mind Map to Science Process Skills and Learning Outcomes of Natural Sciences

    Directory of Open Access Journals (Sweden)

    Hilman .

    2015-04-01

    Full Text Available Pengaruh Pembelajaran Inkuiri Terbimbing dengan Mind Map terhadap Keterampilan Proses Sains dan Hasil Belajar IPA   Abstract: Science learning in junior high school aims to enable students conducts scientific inquiry, improves knowledge, concepts, and science skills. Organization materials for students supports learning process so that needs to be explored techniques that allows students to enable it. This study aimed to determine the effect of guided inquiry learning with mind map on science process skills and cognitive learning outcomes. This experimental quasi studey used pretest-posttest control group design and consisted eighth grade students of SMP Negeri 1 Papalang Mamuju of West Sulawesi. The results showed there where significant positive effect of guided inquiry learning with mind map on process science skills and cognitive learning outcomes. Key Words: guided inquiry, mind map, science process skills, cognitive learning outcomes   Abstrak: Pembelajaran Ilmu Pengetahuan Alam (IPA di SMP bertujuan agar siswa dapat melakukan inkuiri ilmiah, meningkatkan pengetahuan, konsep, dan keterampilan IPA. Dalam pembelajaran, organisasi materi berperan penting dalam memudahkan anak belajar sehingga perlu ditelaah teknik yang memudahkan siswa membuat organisasi materi. Penelitian ini bertujuan mengetahui pengaruh pembelajaran inkuiri terbimbing dengan mind map terhadap keterampilan proses sains dan hasil belajar kognitif. Penelitian kuasi eksperimen ini menggunakan rancangan pre test-post test control group design dengan subjek penelitian siswa kelas VIII SMP Negeri 1 Papalang. Hasil penelitian menunjukkan ada pengaruh positif yang signifikan pembelajaran inkuiri terbimbing dengan mind map terhadap kemampuan keterampilan proses sains dan hasil belajar kognitif siswa. Kata kunci:  inkuiri terbimbing, mind map, keterampilan proses sains,  hasil belajar kognitif

  1. Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care

    DEFF Research Database (Denmark)

    Hedegaard, Ulla; Hallas, Jesper; Ravn-Nielsen, Lene Vestergaard

    2016-01-01

    BACKGROUND: Adherence to antihypertensive medications is suboptimal. Hospital pharmacist interventions including motivational interviewing (MI) might assist in improving adherence in patients with hypertension. For an intervention to be useful, it is important to have tools that can easily identify...... potential adherence problems. OBJECTIVES: To evaluate process outcomes and patient- and pharmacist-reported outcomes of a pharmacist adherence intervention for hypertensive patients treated in hospital outpatient clinics. Secondly, to determine the agreement between two different adherence metrics......-39% reported increased knowledge, confidence and skills in relation to their medication as well as better quality of life. The pharmacists found that the intervention elements were meaningful pharmacist tasks, and that the DRAW tool was easy to use and helped them focus on addressing reasons for non...

  2. Overcoming the tyranny of distance: An audit of process and outcomes from a pilot telehealth spinal assessment clinic.

    Science.gov (United States)

    Beard, Matthew; Orlando, Joseph F; Kumar, Saravana

    2017-09-01

    Introduction There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions. Methods A prospective audit was conducted on a Spinal Assessment Clinic Telehealth pilot trial for patients with spinal disorders requiring non-urgent surgical consultation. Data were recorded from all consultations managed using videoconferencing technology between the Royal Adelaide Hospital and Port Augusta Community Health Service, South Australia between September 2013 and January 2014. Outcomes included analysis of process, service activity, clinical actions, safety and costs. Data were compared to a previous spinal assessment outreach clinic in the same area between August and December 2012. Results There were 25 consultations with 22 patients over the five-month telehealth pilot trial. Spinal disorders were predominantly of the lumbar region (88%); the majority of initial consultations (64%) were discharged to the general practitioner. There were three requests for further imaging, five for minor interventions and three for other specialist/surgical consultation. Patient follow-up post telehealth pilot trial revealed no adverse outcomes. The total cost of AUD$11,187 demonstrated a 23% reduction in favour of the spinal assessment telehealth pilot trial, with the greatest savings in travel costs. Discussion The telehealth model of care demonstrated the efficient management of patients with spinal disorders in rural regions requiring non-urgent surgical consultation at low costs with

  3. Multiple aspects of high school students' strategic processing on reading outcomes: The role of quantity, quality, and conjunctive strategy use.

    Science.gov (United States)

    Parkinson, Meghan M; Dinsmore, Daniel L

    2018-03-01

    While the literature on strategy use is relatively mature, measures of strategy use overwhelmingly measure only one aspect of that use, frequency, when relating that strategy use to performance outcomes. While this might be one important attribute of strategy use, there is increasing evidence that quality and conditional use of cognitive and metacognitive strategies may also be important. This study examines how multiple aspects of strategy use, namely frequency, quality, and conjunctive use of strategies, influence task performance on both well- and ill-structured task outcomes in addition to other concomitant variables that may interact with strategic processing during reading. The sample consisted of 21 high school students enrolled in an upper-level biology class in a suburban school in the north-eastern United States. These participants completed measures of prior knowledge and interest, then read either an expository or persuasive text while thinking aloud. They then completed a passage recall and open-ended response following passage completion. In general, quantity was not positively related to the study outcomes and was negatively related to one of them. Quality of strategy use, on the other hand, was consistently related to positive reading outcomes. The influence of knowledge and interest in terms of strategies is also discussed as well as six cases which illustrate the relation of aspects of strategy use and the other concomitant variables. Evaluating strategy use by solely examining the frequency of strategy use did not explain differences in task performance as well as evaluating the quality and conjunctive use of strategies. Further, important relations between prior knowledge, interest, and the task outcomes appeared to be mediated and moderated by the aspects of strategy use investigated. © 2017 The British Psychological Society.

  4. Processed red meat contribution to dietary patterns and the associated cardio-metabolic outcomes.

    Science.gov (United States)

    Lenighan, Yvonne M; Nugent, Anne P; Li, Kaifeng F; Brennan, Lorraine; Walton, Janette; Flynn, Albert; Roche, Helen M; McNulty, Breige A

    2017-08-01

    Evidence suggests that processed red meat consumption is a risk factor for CVD and type 2 diabetes (T2D). This analysis investigates the association between dietary patterns, their processed red meat contributions, and association with blood biomarkers of CVD and T2D, in 786 Irish adults (18-90 years) using cross-sectional data from a 2011 national food consumption survey. All meat-containing foods consumed were assigned to four food groups (n 502) on the basis of whether they contained red or white meat and whether they were processed or unprocessed. The remaining foods (n 2050) were assigned to twenty-nine food groups. Two-step and k-means cluster analyses were applied to derive dietary patterns. Nutrient intakes, plasma fatty acids and biomarkers of CVD and T2D were assessed. A total of four dietary patterns were derived. In comparison with the pattern with lower contributions from processed red meat, the dietary pattern with greater processed red meat intakes presented a poorer Alternate Healthy Eating Index (21·2 (sd 7·7)), a greater proportion of smokers (29 %) and lower plasma EPA (1·34 (sd 0·72) %) and DHA (2·21 (sd 0·84) %) levels (Pprocessed red meat consumption as a risk factor for CVD and T2D may need to be re-assessed.

  5. Predictive images of postoperative levator resection outcome using image processing software

    Directory of Open Access Journals (Sweden)

    Mawatari Y

    2016-09-01

    Full Text Available Yuki Mawatari,1 Mikiko Fukushima2 1Igo Ophthalmic Clinic, Kagoshima, 2Department of Ophthalmology, Faculty of Life Science, Kumamoto University, Chuo-ku, Kumamoto, Japan Purpose: This study aims to evaluate the efficacy of processed images to predict postoperative appearance following levator resection.Methods: Analysis involved 109 eyes from 65 patients with blepharoptosis who underwent advancement of levator aponeurosis and Müller’s muscle complex (levator resection. Predictive images were prepared from preoperative photographs using the image processing software (Adobe Photoshop®. Images of selected eyes were digitally enlarged in an appropriate manner and shown to patients prior to surgery.Results: Approximately 1 month postoperatively, we surveyed our patients using questionnaires. Fifty-six patients (89.2% were satisfied with their postoperative appearances, and 55 patients (84.8% positively responded to the usefulness of processed images to predict postoperative appearance.Conclusion: Showing processed images that predict postoperative appearance to patients prior to blepharoptosis surgery can be useful for those patients concerned with their postoperative appearance. This approach may serve as a useful tool to simulate blepharoptosis surgery. Keywords: levator resection, blepharoptosis, image processing, Adobe Photoshop® 

  6. Hermeneutics framework: integration of design rationale and optimizing software modules

    NARCIS (Netherlands)

    Aksit, Mehmet; Malakuti Khah Olun Abadi, Somayeh

    To tackle the evolution challenges of adaptive systems, this paper argues on the necessity of hermeneutic approaches that help to avoid too early elimination of design alternatives. This visionary paper proposes the Hermeneutics Framework, which computationally integrates a design rationale

  7. Process and Outcome in Cardiac Rehabilitation: An Examination of Cross-Lagged Effects.

    Science.gov (United States)

    Evon, Donna M.; Burns, John W.

    2004-01-01

    Cardiac rehabilitation patients improve cardiorespiratory fitness and quality of life, yet therapeutic processes that produce these changes remain unknown. A cross-lagged panel design was used to determine whether early-treatment enhancement of self-efficacy regarding abilities to change diet and exercise habits and the quality of the…

  8. Parental Report of the Diagnostic Process and Outcome: ASD Compared with Other Developmental Disabilities

    Science.gov (United States)

    Oswald, Donald P.; Haworth, Shannon M.; Mackenzie, Bernadette K.; Willis, Janet H.

    2017-01-01

    Parents report that the process of getting an autism spectrum disorder (ASD) diagnosis is arduous, lengthy, and fraught with difficulties. This analysis of the Pathways survey data set examined the experiences of parents who said, at the time of the survey, that their child currently had ASD compared with parents who said, at the time of the…

  9. Strategies for Developing Positive Behaviour Management. Teacher Behaviour Outcomes and Attitudes to the Change Process

    Science.gov (United States)

    Hayes, Ben; Hindle, Sarah; Withington, Paul

    2007-01-01

    This paper describes an extended action research project run in a large secondary school over an 18-month period. The work was part of a wider strategy for change within the school. The data presented here describes some of the features of the change process and reflections on its impact. A key aim was to challenge and enable teachers to modify…

  10. Feminist Relational Advocacy: Processes and Outcomes from the Perspective of Low-Income Women with Depression

    Science.gov (United States)

    Goodman, Lisa A.; Glenn, Catherine; Bohlig, Amanda; Banyard, Victoria; Borges, Angela

    2009-01-01

    This article describes a qualitative study of how low-income women who are struggling with symptoms of depression experience feminist relational advocacy, a new model that is informed by feminist, multicultural, and community psychology theories. Using qualitative content analysis of participant interviews, the authors describe the processes and…

  11. Investigation of the Relationship between Learning Process and Learning Outcomes in E-Learning Environments

    Science.gov (United States)

    Yurdugül, Halil; Menzi Çetin, Nihal

    2015-01-01

    Problem Statement: Learners can access and participate in online learning environments regardless of time and geographical barriers. This brings up the umbrella concept of learner autonomy that contains self-directed learning, self-regulated learning and the studying process. Motivation and learning strategies are also part of this umbrella…

  12. Mentoring Novice Teachers: Motives, Process, and Outcomes from the Mentor's Point of View

    Science.gov (United States)

    Iancu-Haddad, Debbie; Oplatka, Izhar

    2009-01-01

    The purpose of this paper is to present the major motives leading senior teachers to be involved in a mentoring process of newly appointed teachers and its benefits for the mentor teacher. Based on semi-structured interviews with 12 experienced teachers who participated in a university-based mentoring program in Israel, the current study found a…

  13. On the Process and Outcomes of Inquiry Learning: Changing Approaches to Assessment [Organizer

    NARCIS (Netherlands)

    Ainsworth, Shaaron; de Jong, Ton; Hmelo-Silver, Cindy

    2010-01-01

    Inquiry learning is an educational approach that involves a process of exploration, asking questions and making discoveries in the search for new understandings. Researchers however are divided about the value of the approach. In the symposium, it is argued that one of the reasons for this

  14. Process and Outcome Evaluation of a Community Intervention for Orphan Adolescents in Western Kenya

    Science.gov (United States)

    Hallfors, Denise D.; Cho, Hyunsan; Mbai, Isabella; Milimo, Benson; Itindi, Janet

    2012-01-01

    We conducted a 2-year pilot randomized controlled trial (N = 105) in a high HIV-prevalence area in rural western Kenya to test whether providing young orphan adolescents with uniforms, school fees, and community visitors improves school retention and reduces HIV risk factors. The trial was a community intervention, limited to one community. In this paper, we examined intervention implementation and its association with outcomes using longitudinal data. We used both quantitative and qualitative methods to evaluate the community-based model for orphan HIV prevention, with recommendations for future studies. Despite promising effects after 1 year, GEE analyses showed null effects after 2 years. Volunteer community visitors, a key element of the intervention, showed little of the expected effect although qualitative reports documented active assistance to prevent orphans' school absence. For future research, we recommend capturing the transition to high school, a larger sample size, and biomarker data to add strength to the research design. We also recommend a school-based intervention approach to improve implementation and reduce infrastructure costs. Finally, we recommend evaluating nurses as agents for improving school attendance and preventing dropout because of their unique ability to address critical biopsychosocial problems. PMID:22350730

  15. A computer based, automated analysis of process and outcomes of diabetic care in 23 GP practices.

    LENUS (Irish Health Repository)

    Hill, F

    2012-02-01

    The predicted prevalence of diabetes in Ireland by 2015 is 190,000. Structured diabetes care in general practice has outcomes equivalent to secondary care and good diabetes care has been shown to be associated with the use of electronic healthcare records (EHRs). This automated analysis of EHRs in 23 practices took 10 minutes per practice compared with 15 hours per practice for manual searches. Data was extracted for 1901 type II diabetics. There was valid data for >80% of patients for 6 of the 9 key indicators in the previous year. 543 (34%) had a Hba1c > 7.5%, 142 (9%) had a total cholesterol >6 mmol\\/l, 83 (6%) had an LDL cholesterol >4 mmol\\/l, 367 (22%) had Triglycerides > 2.2 mmol\\/l and 162 (10%) had Blood Pressure > 160\\/100 mmHg. Data quality and key indicators of care compare well with manual audits in Ireland and the U.K. electronic healthcare records and automated audits should be a feature of all chronic disease management programs.

  16. Process and outcome evaluation of a community intervention for orphan adolescents in western Kenya.

    Science.gov (United States)

    Hallfors, Denise D; Cho, Hyunsan; Mbai, Isabella; Milimo, Benson; Itindi, Janet

    2012-10-01

    We conducted a 2-year pilot randomized controlled trial (N = 105) in a high HIV-prevalence area in rural western Kenya to test whether providing young orphan adolescents with uniforms, school fees, and community visitors improves school retention and reduces HIV risk factors. The trial was a community intervention, limited to one community. In this paper, we examined intervention implementation and its association with outcomes using longitudinal data. We used both quantitative and qualitative methods to evaluate the community-based model for orphan HIV prevention, with recommendations for future studies. Despite promising effects after 1 year, GEE analyses showed null effects after 2 years. Volunteer community visitors, a key element of the intervention, showed little of the expected effect although qualitative reports documented active assistance to prevent orphans' school absence. For future research, we recommend capturing the transition to high school, a larger sample size, and biomarker data to add strength to the research design. We also recommend a school-based intervention approach to improve implementation and reduce infrastructure costs. Finally, we recommend evaluating nurses as agents for improving school attendance and preventing dropout because of their unique ability to address critical biopsychosocial problems.

  17. A multilevel approach to family-centered prevention in schools: process and outcome.

    Science.gov (United States)

    Dishion, T J; Kavanagh, K

    2000-01-01

    The Adolescent Transitions Program (ATP) is a multilevel approach to family-based interventions within a middle-school setting. The intervention strategy is based on an ecological framework for studying social and emotional development in children and adolescents, emphasizing a network of contextual factors within which parenting is both directly and indirectly influential on the development of problem behavior. The ATP model includes a universal, selected, and indicated strategy for serving families with young adolescents. The model is designed to address the needs of families of young adolescents that present with a range of problem behavior and diverse developmental histories. The three interventions levels are described, and outcome data are presented, that support the effectiveness of the ATP model. This approach and the associated data are consistent with a broad literature supporting the effectiveness of family interventions, especially for high-risk youth. The effective implementation of family interventions within a school context suggests that these interventions can make a significant contribution to reducing problem behavior and substance use from a public health perspective.

  18. The processing of unexpected positive response outcomes in the mediofrontal cortex.

    Science.gov (United States)

    Ferdinand, Nicola K; Mecklinger, Axel; Kray, Jutta; Gehring, William J

    2012-08-29

    The human mediofrontal cortex, especially the anterior cingulate cortex, is commonly assumed to contribute to higher cognitive functions like performance monitoring. How exactly this is achieved is currently the subject of lively debate but there is evidence that an event's valence and its expectancy play important roles. One prominent theory, the reinforcement learning theory by Holroyd and colleagues (2002, 2008), assigns a special role to feedback valence, while the prediction of response-outcome (PRO) model by Alexander and Brown (2010, 2011) claims that the mediofrontal cortex is sensitive to unexpected events regardless of their valence. However, paradigms examining this issue have included confounds that fail to separate valence and expectancy. In the present study, we tested the two competing theories of performance monitoring by using an experimental task that separates valence and unexpectedness of performance feedback. The feedback-related negativity of the event-related potential, which is commonly assumed to be a reflection of mediofrontal cortex activity, was elicited not only by unexpected negative feedback, but also by unexpected positive feedback. This implies that the mediofrontal cortex is sensitive to the unexpectedness of events in general rather than their valence and by this supports the PRO model.

  19. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Rationale, Design, and Methods.

    Science.gov (United States)

    Humphrey, Jean H; Jones, Andrew D; Manges, Amee; Mangwadu, Goldberg; Maluccio, John A; Mbuya, Mduduzi N N; Moulton, Lawrence H; Ntozini, Robert; Prendergast, Andrew J; Stoltzfus, Rebecca J; Tielsch, James M

    2015-12-15

    Child stunting and anemia are intractable public health problems in developing countries and have profound short- and long-term consequences. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is motivated by the premise that environmental enteric dysfunction (EED) is a major underlying cause of both stunting and anemia, that chronic inflammation is the central characteristic of EED mediating these adverse effects, and that EED is primarily caused by high fecal ingestion due to living in conditions of poor water, sanitation, and hygiene (WASH). SHINE is a proof-of-concept, 2 × 2 factorial, cluster-randomized, community-based trial in 2 rural districts of Zimbabwe that will test the independent and combined effects of protecting babies from fecal ingestion (factor 1, operationalized through a WASH intervention) and optimizing nutritional adequacy of infant diet (factor 2, operationalized through an infant and young child feeding [IYCF] intervention) on length and hemoglobin at 18 months of age. Within SHINE we will measure 2 causal pathways. The program impact pathway comprises the series of processes and behaviors linking implementation of the interventions with the 2 child health primary outcomes; it will be modeled using measures of fidelity of intervention delivery and household uptake of promoted behaviors and practices. We will also measure a range of household and individual characteristics, social interactions, and maternal capabilities for childcare, which we hypothesize will explain heterogeneity along these pathways. The biomedical pathway comprises the infant biologic responses to the WASH and IYCF interventions that ultimately result in attained stature and hemoglobin concentration at 18 months of age; it will be elucidated by measuring biomarkers of intestinal structure and function (inflammation, regeneration, absorption, and permeability); microbial translocation; systemic inflammation; and hormonal determinants of growth and anemia

  20. The relationship between processes and outcomes for injured older adults: a study of a statewide trauma system.

    Science.gov (United States)

    Saillant, N N; Earl-Royal, E; Pascual, J L; Allen, S R; Kim, P K; Delgado, M K; Carr, B G; Wiebe, D; Holena, D N

    2017-02-01

    Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons' Trauma Quality Improvement Program (TQIP) has published "best practices" of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania's trauma centers. PA's level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status. 26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50). We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population. III. Descriptive.

  1. Effect of Weekend Admissions on the Treatment Process and Outcomes of Internal Medicine Patients: A Nationwide Cross-Sectional Study.

    Science.gov (United States)

    Huang, Chun-Che; Huang, Yu-Tung; Hsu, Nin-Chieh; Chen, Jin-Shing; Yu, Chong-Jen

    2016-02-01

    Many studies address the effect of weekend admission on patient outcomes. This population-based study aimed to evaluate the relationship between weekend admission and the treatment process and outcomes of general internal medicine patients in Taiwan.A total of 82,340 patients (16,657 weekend and 65,683 weekday admissions) aged ≥20 years and admitted to the internal medicine departments of 17 medical centers between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. A generalized estimating equation (GEE) analysis was used to compare patients admitted on weekends and those admitted on weekdays.Patients who were admitted on weekends were more likely to undergo intubation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.16-1.39; P internal medicine patients who were admitted on weekends experienced more intensive care procedures and higher ICU admission, in-hospital mortality, and treatment cost. Intensive care utilization may serve as early indicator of poorer outcomes and a potential entry point to offer preventive intervention before proceeding to intensive treatment.

  2. Comparative analysis of whole mount processing and systematic sampling of radical prostatectomy specimens: pathological outcomes and risk of biochemical recurrence.

    Science.gov (United States)

    Salem, Shady; Chang, Sam S; Clark, Peter E; Davis, Rodney; Herrell, S Duke; Kordan, Yakup; Wills, Marcia L; Shappell, Scott B; Baumgartner, Roxelyn; Phillips, Sharon; Smith, Joseph A; Cookson, Michael S; Barocas, Daniel A

    2010-10-01

    Whole mount processing is more resource intensive than routine systematic sampling of radical retropubic prostatectomy specimens. We compared whole mount and systematic sampling for detecting pathological outcomes, and compared the prognostic value of pathological findings across pathological methods. We included men (608 whole mount and 525 systematic sampling samples) with no prior treatment who underwent radical retropubic prostatectomy at Vanderbilt University Medical Center between January 2000 and June 2008. We used univariate and multivariate analysis to compare the pathological outcome detection rate between pathological methods. Kaplan-Meier curves and the log rank test were used to compare the prognostic value of pathological findings across pathological methods. There were no significant differences between the whole mount and the systematic sampling groups in detecting extraprostatic extension (25% vs 30%), positive surgical margins (31% vs 31%), pathological Gleason score less than 7 (49% vs 43%), 7 (39% vs 43%) or greater than 7 (12% vs 13%), seminal vesicle invasion (8% vs 10%) or lymph node involvement (3% vs 5%). Tumor volume was higher in the systematic sampling group and whole mount detected more multiple surgical margins (each p systematic sampling yield similar pathological information. Each method stratifies patients into comparable risk groups for biochemical recurrence. Thus, while whole mount is more resource intensive, it does not appear to result in improved detection of clinically important pathological outcomes or prognostication. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Alpha male replacements in nonhuman primates: Variability in processes, outcomes, and terminology.

    Science.gov (United States)

    Teichroeb, Julie A; Jack, Katharine M

    2017-07-01

    Alpha male replacements occur in all primates displaying a dominance hierarchy but the process can be extremely variable. Here, we review the primate literature to document differences in patterns of alpha male replacements, showing that group composition and dispersal patterns account for a large proportion of this variability. We also examine the consequences of alpha male replacements in terms of sexual selection theory, infanticide, and group compositions. Though alpha male replacements are often called takeovers in the literature, this term masks much of the variation that is present in these processes. We argue for more concise terminology and provide a list of terms that we suggest more accurately define these events. Finally, we introduce the papers in this special issue on alpha male replacements in the American Journal of Primatology and discuss areas where data are still lacking. © 2017 Wiley Periodicals, Inc.

  4. Predictive images of postoperative levator resection outcome using image processing software

    OpenAIRE

    Mawatari, Yuki; Fukushima, Mikiko

    2016-01-01

    Yuki Mawatari,1 Mikiko Fukushima2 1Igo Ophthalmic Clinic, Kagoshima, 2Department of Ophthalmology, Faculty of Life Science, Kumamoto University, Chuo-ku, Kumamoto, Japan Purpose: This study aims to evaluate the efficacy of processed images to predict postoperative appearance following levator resection.Methods: Analysis involved 109 eyes from 65 patients with blepharoptosis who underwent advancement of levator aponeurosis and Müller’s muscle complex (levator resection). P...

  5. Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes.

    Science.gov (United States)

    Stevens, Bonnie J; Yamada, Janet; Estabrooks, Carole A; Stinson, Jennifer; Campbell, Fiona; Scott, Shannon D; Cummings, Greta

    2014-01-01

    Hospitalized children frequently receive inadequate pain assessment and management despite substantial evidence to support effective pediatric pain practices. The objective of this study was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical and critical care units. A prospective cohort study compared 16 interventions using EPIQ and 16 standard care (SC) units in 8 Canadian pediatric hospitals. Chart reviews at baseline (time 1) and intervention completion (time 2) determined the nature and frequency of painful procedures and of pain assessment and pain management practices. Trained pain experts evaluated pain intensity 6 months post-intervention (time 3) during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time. EPIQ units used significantly more validated pain assessment tools (Ppatients who received analgesics (P=0.03) and physical pain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4-6/10) and severe (7-10/10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (adjusted OR: 0.49, 95% CI: 0.26-0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain the variability in pain processes and clinical outcomes. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  6. Developing an Information Literacy Assessment Rubric: A Case Study of Collaboration, Process, and Outcomes

    Directory of Open Access Journals (Sweden)

    Christina Hoffman Gola

    2014-07-01

    Full Text Available A team of four librarians at the [Institution Name] ([Institution Initials] Libraries partnered with the [Institution Initials] Office of Institutional Effectiveness and its Director of Assessment & Accreditation Services for General Education to conduct a campus-wide, exploratory assessment of undergraduate information literacy skills. The project evaluated a selection of graduating, senior-level student papers using a rubric developed as part of the collaboration. This paper describes and discusses the collaborative rubric development and rating process, the practical implications for other librarians seeking to conduct a similar assessment, and the impact the project is having on the library instruction program.

  7. Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes

    Directory of Open Access Journals (Sweden)

    Thabane Lehana

    2009-01-01

    Full Text Available Abstract Background There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children. Methods A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts. Results A total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity. Conclusion A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and

  8. Reflections on Researcher Identity and Power: The Impact of Positionality on Community Based Participatory Research (CBPR) Processes and Outcomes.

    Science.gov (United States)

    Muhammad, Michael; Wallerstein, Nina; Sussman, Andrew L; Avila, Magdalena; Belone, Lorenda; Duran, Bonnie

    2015-11-01

    The practice of community based participatory research (CBPR) has evolved over the past 20 years with the recognition that health equity is best achieved when academic researchers form collaborative partnerships with communities. This article theorizes the possibility that core principles of CBPR cannot be realistically applied unless unequal power relations are identified and addressed. It provides theoretical and empirical perspectives for understanding power, privilege, researcher identity and academic research team composition, and their effects on partnering processes and health disparity outcomes. The team's processes of conducting seven case studies of diverse partnerships in a national cross-site CBPR study are analyzed; the multi-disciplinary research team's self-reflections on identity and positionality are analyzed, privileging its combined racial, ethnic, and gendered life experiences, and integrating feminist and post-colonial theory into these reflections. Findings from the inquiry are shared, and incorporating academic researcher team identity is recommended as a core component of equalizing power distribution within CBPR.

  9. Rationale for a natural products approach to herbicide discovery.

    Science.gov (United States)

    Dayan, Franck E; Owens, Daniel K; Duke, Stephen O

    2012-04-01

    Weeds continue to evolve resistance to all the known modes of herbicidal action, but no herbicide with a new target site has been commercialized in nearly 20 years. The so-called 'new chemistries' are simply molecules belonging to new chemical classes that have the same mechanisms of action as older herbicides (e.g. the protoporphyrinogen-oxidase-inhibiting pyrimidinedione saflufenacil or the very-long-chain fatty acid elongase targeting sulfonylisoxazoline herbicide pyroxasulfone). Therefore, the number of tools to manage weeds, and in particular those that can control herbicide-resistant weeds, is diminishing rapidly. There is an imminent need for truly innovative classes of herbicides that explore chemical spaces and interact with target sites not previously exploited by older active ingredients. This review proposes a rationale for a natural-products-centered approach to herbicide discovery that capitalizes on the structural diversity and ingenuity afforded by these biologically active compounds. The natural process of extended-throughput screening (high number of compounds tested on many potential target sites over long periods of times) that has shaped the evolution of natural products tends to generate molecules tailored to interact with specific target sites. As this review shows, there is generally little overlap between the mode of action of natural and synthetic phytotoxins, and more emphasis should be placed on applying methods that have proved beneficial to the pharmaceutical industry to solve problems in the agrochemical industry. Published 2012 by John Wiley & Sons, Ltd.

  10. Data processing has major impact on the outcome of quantitative label-free LC-MS analysis.

    Science.gov (United States)

    Chawade, Aakash; Sandin, Marianne; Teleman, Johan; Malmström, Johan; Levander, Fredrik

    2015-02-06

    High-throughput multiplexed protein quantification using mass spectrometry is steadily increasing in popularity, with the two major techniques being data-dependent acquisition (DDA) and targeted acquisition using selected reaction monitoring (SRM). However, both techniques involve extensive data processing, which can be performed by a multitude of different software solutions. Analysis of quantitative LC-MS/MS data is mainly performed in three major steps: processing of raw data, normalization, and statistical analysis. To evaluate the impact of data processing steps, we developed two new benchmark data sets, one each for DDA and SRM, with samples consisting of a long-range dilution series of synthetic peptides spiked in a total cell protein digest. The generated data were processed by eight different software workflows and three postprocessing steps. The results show that the choice of the raw data processing software and the postprocessing steps play an important role in the final outcome. Also, the linear dynamic range of the DDA data could be extended by an order of magnitude through feature alignment and a charge state merging algorithm proposed here. Furthermore, the benchmark data sets are made publicly available for further benchmarking and software developments.

  11. Understanding the local socio-political processes affecting conservation management outcomes in Corbett Tiger Reserve, India.

    Science.gov (United States)

    Rastogi, Archi; Hickey, Gordon M; Badola, Ruchi; Hussain, Syed Ainul

    2014-05-01

    Several measures have been recommended to guarantee a sustainable population of tigers: sufficient inviolate spaces for a viable population, sufficient prey populations, trained and skilled manpower to guard against poaching and intrusion, banning trade in tiger products to reduce poaching, and importantly, the political will to precipitate these recommendations into implementation. Of these, the creation of sufficient inviolate spaces (generally in the form of protected areas) has created the most issues with local resource-dependent communities, often resulting in significant challenges for tiger conservation policy and management. Very little empirical research has, however, been done to understand and contextualize the local-level socio-political interactions that may influence the efficacy of tiger conservation in India. In this paper, we present the results of exploratory research into the ways in which local-stakeholder groups affect the management of Corbett Tiger Reserve (CTR). Using a combined grounded theory-case study research design, and the Institutional Analysis and Development framework for analysis, we identify the socio-political processes through which local-stakeholder groups are able to articulate their issues and elicit desirable actions from the management of CTR. Increasing our awareness of these processes can help inform the design and implementation of more effective tiger conservation management and policy strategies that have the potential to create more supportive coalitions of tiger conservation stakeholders at the local level.

  12. Understanding the Local Socio-political Processes Affecting Conservation Management Outcomes in Corbett Tiger Reserve, India

    Science.gov (United States)

    Rastogi, Archi; Hickey, Gordon M.; Badola, Ruchi; Hussain, Syed Ainul

    2014-05-01

    Several measures have been recommended to guarantee a sustainable population of tigers: sufficient inviolate spaces for a viable population, sufficient prey populations, trained and skilled manpower to guard against poaching and intrusion, banning trade in tiger products to reduce poaching, and importantly, the political will to precipitate these recommendations into implementation. Of these, the creation of sufficient inviolate spaces (generally in the form of protected areas) has created the most issues with local resource-dependent communities, often resulting in significant challenges for tiger conservation policy and management. Very little empirical research has, however, been done to understand and contextualize the local-level socio-political interactions that may influence the efficacy of tiger conservation in India. In this paper, we present the results of exploratory research into the ways in which local-stakeholder groups affect the management of Corbett Tiger Reserve (CTR). Using a combined grounded theory-case study research design, and the Institutional Analysis and Development framework for analysis, we identify the socio-political processes through which local-stakeholder groups are able to articulate their issues and elicit desirable actions from the management of CTR. Increasing our awareness of these processes can help inform the design and implementation of more effective tiger conservation management and policy strategies that have the potential to create more supportive coalitions of tiger conservation stakeholders at the local level.

  13. In vitro biological outcome of laser application for modification or processing of titanium dental implants.

    Science.gov (United States)

    Hindy, Ahmed; Farahmand, Farzam; Tabatabaei, Fahimeh Sadat

    2017-07-01

    There are numerous functions for laser in modern implant dentistry including surface treatment, surface coating, and implant manufacturing. As laser application may potentially improve osseointegration of dental implants, we systematically reviewed the literature for in vitro biological responses to laser-modified or processed titanium dental implants. The literature was searched in PubMed, ISI Web, and Scopus, using keywords "titanium dental implants," "laser," "biocompatibility," and their synonyms. After screening the 136 references obtained, 28 articles met the inclusion criteria. We found that Nd:YAG laser was the most commonly used lasers in the treatment or processing of titanium dental implants. Most of the experiments used cell attachment and cell proliferation to investigate bioresponses of the implants. The most commonly used cells in these assays were osteoblast-like cells. Only one study was conducted in stem cells. These in vitro studies reported higher biocompatibility in laser-modified titanium implants. It seems that laser radiation plays a vital role in cell response to dental implants; however, it is necessary to accomplish more studies using different laser types and parameters on various cells to offer a more conclusive result.

  14. Effects of Role and Assignment Rationale on Attitudes Formed During Peer Tutoring

    Science.gov (United States)

    Bierman, Karen Linn; Furman, Wyndol

    2012-01-01

    This study examined the role of contextual factors, such as assignment rationale, on the attitudinal effects of peer tutoring. Fourth-grade children engaged in brief tutoring experiences as either a tutor or tutee. Subjects received four rationales for being selected as tutor or tutee: (a) a competence rationale, (b) a physical characteristic rationale, (c) a chance rationale, or (d) no rationale. As predicted, tutors had more positive attitudes than tutees when they had been given a competence or physical characteristic rationale but not when the tutors were provided a chance rationale or no rationale. Additionally, the tutors’ and tutees’ attitudes were enhanced when no rationale was provided. Results are discussed in terms of their implications for a role-theory analysis of tutoring and their implications for applied programs. PMID:23946549

  15. Acute effects of alcohol on feedback processing and outcome evaluation during risky decision-making: an ERP study.

    Science.gov (United States)

    Euser, Anja S; van Meel, Catharina S; Snelleman, Michelle; Franken, Ingmar H A

    2011-09-01

    Although risky decision-making is one of the hallmarks of alcohol use disorders, relatively little is known about the acute psychopharmacological effects of alcohol on decision-making processes. The present study investigated the acute effects of alcohol on neural mechanisms underlying feedback processing and outcome evaluation during risky decision-making, using event-related brain potentials (ERPs). ERPs elicited by positive and negative feedback were recorded during performance of a modified version of the Balloon Analogue Risk Task in male participants receiving either a moderate dose of alcohol (0.65 g/kg alcohol; n = 32) or a non-alcoholic placebo beverage (n = 32). Overall, there was no significant difference in the mean number of pumps between the alcohol and the placebo condition. However, when analyzing over time, it was found that the alcohol group made more riskier choices at the beginning of the task than the placebo group. ERPs demonstrated that alcohol consumption did not affect early processing of negative feedback, indexed by the feedback-related negativity. By contrast, alcohol-intoxicated individuals showed significantly reduced P300 amplitudes in response to negative feedback as compared to sober controls, suggesting that more elaborate evaluation to losses was significantly diminished. These results suggest that alcohol consumption does not influence the ability to rapidly evaluate feedback valence, but rather the ability to assign sufficient attention to further process motivationally salient outcomes. Blunted P300 amplitudes may reflect poor integration of feedback across trials, particularly adverse ones. Consequently, alcohol may keep people from effectively predicting the probability of future gains and losses based on their reinforcement history.

  16. Attachment and object relations in patients with narcissistic personality disorder: implications for therapeutic process and outcome.

    Science.gov (United States)

    Diamond, Diana; Meehan, Kevin B

    2013-11-01

    This article presents a therapeutic approach for patients with severe personality disorders, transference-focused psychotherapy (TFP), a manualized evidence-based treatment, which integrates contemporary object relations theory with attachment theory and research. Case material is presented from a narcissistic personality disorder (NPD) patient in TFP whose primary presenting problems were in the arena of sexuality and love relations, and whose attachment state of mind showed evidence of oscillation between dismissing and preoccupied mechanisms. Clinical process material is presented to illustrate the tactics and techniques of TFP and how they have been refined for treatment of individuals with NPD. The ways in which conflicts around sexuality and love relations were lived out in the transference is delineated with a focus on the interpretation of devalued and idealized representations of self and others, both of which are key components of the compensatory grandiose self that defensively protects the individual from an underlying sense of vulnerability and imperfection. © 2013 Wiley Periodicals, Inc.

  17. Partnering with Indigenous student co-researchers: improving research processes and outcomes.

    Science.gov (United States)

    Genuis, Shelagh K; Willows, Noreen; Jardine, Cindy G

    2015-01-01

    To examine the contribution of student co-researchers to a community-based participatory Photovoice investigation of Indigenous children's food-related lived experience. We examine co-researchers' contributions to the research process, their role in knowledge co-generation and dissemination, and factors that fostered research partnership with the teenage co-researchers. High school students attending a First Nation community school in Canada were trained as research partners. They contributed to aspects of research design, conducted interviews with grades 3 and 4 Photovoice participants, and participated in data analysis and the development of a culturally relevant photobook. The study was initiated by the community's research committee. It is informed by critical consciousness theory and the positive youth development framework. Student co-researchers incorporated culturally appropriate strategies as they interviewed participants. Co-researchers adopted conversational approaches, built rapport by articulating personal and cultural connections, and engaged in mentoring and health promotion as they interviewed participants. They made critical contributions to dissemination by developing photobook content that promoted the importance of traditional foods and the vital role of family and community in healthy eating practices. Relationships and "dialogic" space were important to building partnership with and promoting capacity development among youth co-researchers. Partnership between university researchers and Indigenous student co-researchers holds great promise for health promotion in communities. Co-researchers developed research and leadership skills, gained understanding of health challenges facing their community, and initiated health and cultural promotion through the project's Photobook. This investigation supports the powerful potential of student co-researchers to meaningfully contribute to research processes and to build knowledge that is relevant and

  18. Partnering with Indigenous student co-researchers: improving research processes and outcomes

    Directory of Open Access Journals (Sweden)

    Shelagh K. Genuis

    2015-07-01

    Full Text Available Objective: To examine the contribution of student co-researchers to a community-based participatory Photovoice investigation of Indigenous children's food-related lived experience. We examine co-researchers’ contributions to the research process, their role in knowledge co-generation and dissemination, and factors that fostered research partnership with the teenage co-researchers. Methods: High school students attending a First Nation community school in Canada were trained as research partners. They contributed to aspects of research design, conducted interviews with grades 3 and 4 Photovoice participants, and participated in data analysis and the development of a culturally relevant photobook. The study was initiated by the community's research committee. It is informed by critical consciousness theory and the positive youth development framework. Results: Student co-researchers incorporated culturally appropriate strategies as they interviewed participants. Co-researchers adopted conversational approaches, built rapport by articulating personal and cultural connections, and engaged in mentoring and health promotion as they interviewed participants. They made critical contributions to dissemination by developing photobook content that promoted the importance of traditional foods and the vital role of family and community in healthy eating practices. Relationships and “dialogic” space were important to building partnership with and promoting capacity development among youth co-researchers. Conclusions: Partnership between university researchers and Indigenous student co-researchers holds great promise for health promotion in communities. Co-researchers developed research and leadership skills, gained understanding of health challenges facing their community, and initiated health and cultural promotion through the project's Photobook. This investigation supports the powerful potential of student co-researchers to meaningfully contribute to

  19. Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study.

    Science.gov (United States)

    Mesterton, Johan; Lindgren, Peter; Ekenberg Abreu, Anna; Ladfors, Lars; Lilja, Monica; Saltvedt, Sissel; Amer-Wåhlin, Isis

    2016-05-31

    Unwarranted variation in care practice and outcomes has gained attention and inter-hospital comparisons are increasingly being used to highlight and understand differences between hospitals. Adjustment for case mix is a prerequisite for meaningful comparisons between hospitals with different patient populations. The objective of this study was to identify and quantify maternal characteristics that impact a set of important indicators of health outcomes, resource use and care process and which could be used for case mix adjustment of comparisons between hospitals. In this register-based study, 139 756 deliveries in 2011 and 2012 were identified in regional administrative systems from seven Swedish regions, which together cover 67 % of all deliveries in Sweden. Data were linked to the Medical birth register and Statistics Sweden's population data. A number of important indicators in childbirth care were studied: Caesarean section (CS), induction of labour, length of stay, perineal tears, haemorrhage > 1000 ml and post-partum infections. Sociodemographic and clinical characteristics deemed relevant for case mix adjustment of outcomes and resource use were identified based on previous literature and based on clinical expertise. Adjustment using logistic and ordinary least squares regression analysis was performed to quantify the impact of these characteristics on the studied indicators. Almost all case mix factors analysed had an impact on CS rate, induction rate and length of stay and the effect was highly statistically significant for most factors. Maternal age, parity, fetal presentation and multiple birth were strong predictors of all these indicators but a number of additional factors such as born outside the EU, body mass index (BMI) and several complications during pregnancy were also important risk factors. A number of maternal characteristics had a noticeable impact on risk of perineal tears, while the impact of case mix factors was less pronounced for

  20. Broader Impact Guidance for Florida Ocean Scientists: Process, Products and Outcomes

    Science.gov (United States)

    Cook, S.

    2016-02-01

    In response to the 2011 National Science Board report National Science Foundation's Merit Review Criteria: Review and Revision, in 2012 significant changes were made to the portions of the National Science Foundation's (NSF's) Grant Proposal Guide that describe the Foundation's expectations with respect to the Broader Impacts (BI) criterion and what reviewers should look for in assessing the quality of the required BI components of proposals. Over the past 5 years, COSEE Florida (the Florida Center for Ocean Sciences Education Excellence) has provided individualized content and editorial `coaching' on Broader Impacts for Florida scientists and educators submitting proposals to NSF. As of September 2015, 32% of the plans prepared with our guidance have been associated with projects that have received support. This presentation will review 1) the current BI guidance provided by NSF in the 2012 and subsequent editions of the Grant Proposal Guide, 2) the administrative process used by COSEE Florida to identify and assist scientists in understanding these changes and preparing fundable BI plans, 3) the characteristics of submitted plans in terms of type of plan, PI career stage and demographics 4) `lessons learned' about plan strengths and weaknesses and 5) the products developed (or currently under development) as COSEE Florida legacy documents to guide current and future scientists in addressing the Broader Impacts criterion. Resources developed by other Centers in the national COSEE network and the new National Alliance for Broader Impacts (NABI) will also be described.

  1. Regional Differences in Communication Process and Outcomes of Requests for Solid Organ Donation.

    Science.gov (United States)

    Traino, H M; Molisani, A J; Siminoff, L A

    2017-06-01

    Although federal mandate prohibits the allocation of solid organs for transplantation based on "accidents of geography," geographic variation of transplantable organs is well documented. This study explores regional differences in communication in requests for organ donation. Administrative data from nine partnering organ procurement organizations and interview data from 1339 family decision makers (FDMs) were compared across eight geographically distinct US donor service areas (DSAs). Authorization for organ donation ranged from 60.4% to 98.1% across DSAs. FDMs from the three regions with the lowest authorization rates reported the lowest levels of satisfaction with the time spent discussing donation and with the request process, discussion of the least donation-related topics, the highest levels of pressure to donate, and the least comfort with the donation decision. Organ procurement organization region predicted authorization (odds ratios ranged from 8.14 to 0.24), as did time spent discussing donation (OR = 2.11), the number of donation-related topics discussed (OR = 1.14), and requesters' communication skill (OR = 1.14). Standardized training for organ donation request staff is needed to ensure the highest quality communication during requests, optimize rates of family authorization to donation in all regions, and increase the supply of organs available for transplantation. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  2. A Comparison of the Request Process and Outcomes in Adult and Pediatric Organ Donation

    Science.gov (United States)

    Siminoff, Laura A.; Molisani, Anthony J.

    2015-01-01

    BACKGROUND AND OBJECTIVES: Although existing studies suggest that factors affecting families’ decisions regarding pediatric organ donation mirror those for adult patients, health professionals working in this area maintain that pediatric and adult decision-makers differ in significant ways. This study compared the request process, experiences, and authorization decisions between family decision-makers (FDMs) of adult and pediatric donors and nondonors. METHODS: Perceptions of the donation request were collected via telephone interviews with 1601 FDMs approached by staff from 9 US organ procurement organizations (OPOs). Authorization regarding donation (ie, authorized/refused) was obtained from FDM reports and verified by using OPO records. Tests of association were used to estimate differences between FDMs of adult and pediatric patients. A logistic regression analysis was conducted to identify variables predicting FDM authorization. RESULTS: FDMs of children were significantly more likely to authorize donation than were FDMs of adults (89.7% vs 83.2%; χ2 = 6.2, P = .01). Differences were found between pediatric and adult families’ initial feelings toward donation, donation-related topics discussed, communication behaviors and techniques used, perceptions of the request, and receipt and preference of grief information. The likelihood of FDM authorization increased with the number of topics discussed and communication skills employed during requests. Authorization was not predicted by patient age (ie, adult versus pediatric). CONCLUSIONS: FDMs of children are willing to donate and experience no more psychological distress from the request for donation than do FDMs of adults. Communication emerged as a critical factor of family authorization, reinforcing its importance in requests for donation. PMID:26034251

  3. Outcomes from the Delphi process of the Thoracic Robotic Curriculum Development Committee.

    Science.gov (United States)

    Veronesi, Giulia; Dorn, Patrick; Dunning, Joel; Cardillo, Giuseppe; Schmid, Ralph A; Collins, Justin; Baste, Jean-Marc; Limmer, Stefan; Shahin, Ghada M M; Egberts, Jan-Hendrik; Pardolesi, Alessandro; Meacci, Elisa; Stamenkovic, Sasha; Casali, Gianluca; Rueckert, Jens C; Taurchini, Mauro; Santelmo, Nicola; Melfi, Franca; Toker, Alper

    2018-06-01

    As the adoption of robotic procedures becomes more widespread, additional risk related to the learning curve can be expected. This article reports the results of a Delphi process to define procedures to optimize robotic training of thoracic surgeons and to promote safe performance of established robotic interventions as, for example, lung cancer and thymoma surgery. In June 2016, a working panel was spontaneously created by members of the European Society of Thoracic Surgeons (ESTS) and European Association for Cardio-Thoracic Surgery (EACTS) with a specialist interest in robotic thoracic surgery and/or surgical training. An e-consensus-finding exercise using the Delphi methodology was applied requiring 80% agreement to reach consensus on each question. Repeated iterations of anonymous voting continued over 3 rounds. Agreement was reached on many points: a standardized robotic training curriculum for robotic thoracic surgery should be divided into clearly defined sections as a staged learning pathway; the basic robotic curriculum should include a baseline evaluation, an e-learning module, a simulation-based training (including virtual reality simulation, Dry lab and Wet lab) and a robotic theatre (bedside) observation. Advanced robotic training should include e-learning on index procedures (right upper lobe) with video demonstration, access to video library of robotic procedures, simulation training, modular console training to index procedure, transition to full-procedure training with a proctor and final evaluation of the submitted video to certified independent examiners. Agreement was reached on a large number of questions to optimize and standardize training and education of thoracic surgeons in robotic activity. The production of the content of the learning material is ongoing.

  4. Motivation to change and perceptions of the admission process with respect to outcome in adolescent anorexia nervosa.

    Science.gov (United States)

    Hillen, Simona; Dempfle, Astrid; Seitz, Jochen; Herpertz-Dahlmann, Beate; Bühren, Katharina

    2015-07-02

    In patients with anorexia nervosa (AN), there is evidence that readiness to change is an important predictor of outcome with respect to weight gain and improvement in eating disorder psychopathology. In particular, young patients are characterized by a low level of motivation for recovery and perceive more coercion at hospitalization. Thus, a better understanding of the variables that influence readiness to change and perception of the admission process in adolescent AN may help to support patients in initiating change and staying motivated for treatment. In 40 adolescent patients diagnosed with AN according to DSM-IV criteria, we assessed in a prospective clinical cohort study the motivation to change using the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) at admission to inpatient treatment, in week 9 after admission and at discharge. Additional variables were assessed, including depressive symptoms (Beck Depression Inventory, BDI), eating disorder-specific psychopathology (Eating Disorder Inventory, EDI-2), body mass index (BMI) and the percentage of expected body weight (%EBW). The patients' perceptions of the admission process and their perceived need for hospitalization were assessed using a self-report scale developed by Guarda et al. (2007). Younger patients perceived more coercion than older patients did. Low %EBW and more severe eating disorder-specific psychopathology were associated with a greater perceived need for hospitalization. Moreover, low %EBW at admission and a longer duration of illness were accompanied by a greater motivation to change at admission, whereas more severe eating disorder psychopathology was associated with a low motivation to change. The motivation to change increased significantly between admission and discharge. Patients with a greater motivation to change at admission exhibited a higher weekly weight gain during treatment but did not show better outcome in eating disorder-specific psychopathology and depression

  5. James Cook University's rurally orientated medical school selection process: quality graduates and positive workforce outcomes.

    Science.gov (United States)

    Ray, Robin A; Woolley, Torres; Sen Gupta, Tarun

    2015-01-01

    , times that of graduates having a metropolitan/inner regional hometown, while at PGY 9 the PORs had increased to 4.2 and 9.5, respectively. Bonded medical place students showed many similar trends to rural students in both their pre-medical school and undergraduate performance indicators but lower engagement in rural practice in the 5 years of data available. Some significant differences were noted between rural and remote origin students and metropolitan or inner regional origin students in terms of academic achievement in the first 3 years of the course and length of time taken to complete the course. However, this group of rural and remote-origin students seems to do just as well in the exams in the clinical years (years 4-6) and are much more likely to practise in rural and remote areas. These data suggest that JCU's selection process favouring rural origin applicants does not compromise academic standards, but does produce graduates whose patterns of practice accord with the mission of the school.

  6. Early preschool processing abilities predict subsequent reading outcomes in bilingual Spanish-Catalan children with Specific Language Impairment (SLI).

    Science.gov (United States)

    Aguilar-Mediavilla, Eva; Buil-Legaz, Lucía; Pérez-Castelló, Josep A; Rigo-Carratalà, Eduard; Adrover-Roig, Daniel

    2014-01-01

    Children with Specific Language Impairment (SLI) have severe language difficulties without showing hearing impairments, cognitive deficits, neurological damage or socio-emotional deprivation. However, previous studies have shown that children with SLI show some cognitive and literacy problems. Our study analyses the relationship between preschool cognitive and linguistic abilities and the later development of reading abilities in Spanish-Catalan bilingual children with SLI. The sample consisted of 17 bilingual Spanish-Catalan children with SLI and 17 age-matched controls. We tested eight distinct processes related to phonological, attention, and language processing at the age of 6 years and reading at 8 years of age. Results show that bilingual Spanish-Catalan children with SLI show significantly lower scores, as compared to typically developing peers, in phonological awareness, phonological memory, and rapid automatized naming (RAN), together with a lower outcome in tasks measuring sentence repetition and verbal fluency. Regarding attentional processes, bilingual Spanish-Catalan children with SLI obtained lower scores in auditory attention, but not in visual attention. At the age of 8 years Spanish-Catalan children with SLI had lower scores than their age-matched controls in total reading score, letter identification (decoding), and in semantic task (comprehension). Regression analyses identified both phonological awareness and verbal fluency at the age of 6 years to be the best predictors of subsequent reading performance at the age of 8 years. Our data suggest that language acquisition problems and difficulties in reading acquisition in bilingual children with SLI might be related to the close interdependence between a limitation in cognitive processing and a deficit at the linguistic level. After reading this article, readers will be able to: identify their understanding of the relation between language difficulties and reading outcomes; explain how processing

  7. Variations in structures, processes and outcomes of community mental health teams for older people: a systematic review of the literature.

    Science.gov (United States)

    Abendstern, M; Harrington, V; Brand, C; Tucker, S; Wilberforce, M; Challis, D

    2012-01-01

    In the UK and elsewhere, specialist community mental health teams (CMHTs) are central to the provision of comprehensive services for older people with mental ill health. Recent guidance documents suggest a core set of attributes that such teams should encompass. This article reports on a systematic literature review undertaken to collate existing evidence regarding the structures and processes of CMHTs for older people and to evaluate evidence linking approaches to effectiveness. Relevant publications were identified via systematic searches, both electronic and manual. Searches were limited to the UK for descriptions of organisation and practice but included international literature where comparisons between different CMHT arrangements were evaluated. Empirical, peer-reviewed studies from 1989 onward were included, extended to non peer-reviewed nationally or regionally representative reports, published after 1998, for the descriptive element. Forty-five studies met inclusion criteria of which seven provided comparative outcome data. All but one were UK based. The most robust evidence related to research conducted in exemplar teams. Limited evidence was found regarding the effectiveness of many of the core attributes recommended in policy directives although their presence was reported in much of the literature. The contrast between presentation and evaluation of attributes is stark. Whilst some gaps can be filled from related fields, further research is required that moves beyond description to evaluation of the impact of team design on service user outcomes in order to inform future policy directives and practice guidance. A framework for an evidence-based model of CMHTs for older people is provided.

  8. Nurse-led action research project for expanding nurses′ role in patient education in Iran: Process, structure, and outcomes

    Directory of Open Access Journals (Sweden)

    Parvaneh Khorasani

    2015-01-01

    Full Text Available Background: Patient education is among the lowest met need of patients in Iran; therefore, expansion of that role can result in greater professional accountability. This study aimed to explain the practical science of the process, structure, and outcomes of a nurse-led action research project to expand the nurses′ role in patient education in Iran. Materials and Methods: This study was part of a participatory action research. Daily communications and monthly joint meetings were held from January 2012 to February 2014 for planning and management. These were based on the research protocol, and the conceptual framework included the Mobilizing for Action through Planning and Partnerships process by means of Leadership for Change skills. Data were produced and gathered through participant observations. Administrative data included project records, official documents, artifacts, news, and reports, which were analyzed through qualitative content analysis. Results: A participatory project was established with three groups of participants organized from both academic and clinical fields. These consisted of a "core research support team," "two steering committees," and community representatives of clients and professionals as "feedback groups." A seven-stage process, named the "Nurse Educators: Al-Zahra Role Expansion Action Research" (NEAREAR process, resulted from the project, in which strategic issues were gradually developed and implemented through 32 action plans and quality improvement cycles of action research. Audits and supervision evaluations showed meaningful changes in capacity building components. Conclusions: A nurse-led ad hoc structure with academic-clinical partnerships and strategic management process was suggested as a possible practical model for expanding nurses′ educational role in similar contexts. Implications and practical science introduced in this action research could also be applicable for top managers and health system

  9. Nurse-led action research project for expanding nurses’ role in patient education in Iran: Process, structure, and outcomes

    Science.gov (United States)

    Khorasani, Parvaneh; Rassouli, Maryam; Parvizy, Soroor; Zagheri-Tafreshi, Mansoureh; Nasr-Esfahani, Mahmood

    2015-01-01

    Background: Patient education is among the lowest met need of patients in Iran; therefore, expansion of that role can result in greater professional accountability. This study aimed to explain the practical science of the process, structure, and outcomes of a nurse-led action research project to expand the nurses’ role in patient education in Iran. Materials and Methods: This study was part of a participatory action research. Daily communications and monthly joint meetings were held from January 2012 to February 2014 for planning and management. These were based on the research protocol, and the conceptual framework included the Mobilizing for Action through Planning and Partnerships process by means of Leadership for Change skills. Data were produced and gathered through participant observations. Administrative data included project records, official documents, artifacts, news, and reports, which were analyzed through qualitative content analysis. Results: A participatory project was established with three groups of participants organized from both academic and clinical fields. These consisted of a “core research support team,” “two steering committees,” and community representatives of clients and professionals as “feedback groups.” A seven-stage process, named the “Nurse Educators: Al-Zahra Role Expansion Action Research” (NEAREAR) process, resulted from the project, in which strategic issues were gradually developed and implemented through 32 action plans and quality improvement cycles of action research. Audits and supervision evaluations showed meaningful changes in capacity building components. Conclusions: A nurse-led ad hoc structure with academic–clinical partnerships and strategic management process was suggested as a possible practical model for expanding nurses’ educational role in similar contexts. Implications and practical science introduced in this action research could also be applicable for top managers and health system

  10. Nurse-led action research project for expanding nurses' role in patient education in Iran: Process, structure, and outcomes.

    Science.gov (United States)

    Khorasani, Parvaneh; Rassouli, Maryam; Parvizy, Soroor; Zagheri-Tafreshi, Mansoureh; Nasr-Esfahani, Mahmood

    2015-01-01

    Patient education is among the lowest met need of patients in Iran; therefore, expansion of that role can result in greater professional accountability. This study aimed to explain the practical science of the process, structure, and outcomes of a nurse-led action research project to expand the nurses' role in patient education in Iran. This study was part of a participatory action research. Daily communications and monthly joint meetings were held from January 2012 to February 2014 for planning and management. These were based on the research protocol, and the conceptual framework included the Mobilizing for Action through Planning and Partnerships process by means of Leadership for Change skills. Data were produced and gathered through participant observations. Administrative data included project records, official documents, artifacts, news, and reports, which were analyzed through qualitative content analysis. A participatory project was established with three groups of participants organized from both academic and clinical fields. These consisted of a "core research support team," "two steering committees," and community representatives of clients and professionals as "feedback groups." A seven-stage process, named the "Nurse Educators: Al-Zahra Role Expansion Action Research" (NEAREAR) process, resulted from the project, in which strategic issues were gradually developed and implemented through 32 action plans and quality improvement cycles of action research. Audits and supervision evaluations showed meaningful changes in capacity building components. A nurse-led ad hoc structure with academic-clinical partnerships and strategic management process was suggested as a possible practical model for expanding nurses' educational role in similar contexts. Implications and practical science introduced in this action research could also be applicable for top managers and health system policy makers in a wider range of practice.

  11. Using Systems Theory to Examine Patient and Nurse Structures, Processes, and Outcomes in Centralized and Decentralized Units.

    Science.gov (United States)

    Real, Kevin; Fay, Lindsey; Isaacs, Kathy; Carll-White, Allison; Schadler, Aric

    2018-01-01

    This study utilizes systems theory to understand how changes to physical design structures impact communication processes and patient and staff design-related outcomes. Many scholars and researchers have noted the importance of communication and teamwork for patient care quality. Few studies have examined changes to nursing station design within a systems theory framework. This study employed a multimethod, before-and-after, quasi-experimental research design. Nurses completed surveys in centralized units and later in decentralized units ( N = 26 pre , N = 51 post ). Patients completed surveys ( N = 62 pre ) in centralized units and later in decentralized units ( N = 49 post ). Surveys included quantitative measures and qualitative open-ended responses. Patients preferred the decentralized units because of larger single-occupancy rooms, greater privacy/confidentiality, and overall satisfaction with design. Nurses had a more complex response. Nurses approved the patient rooms, unit environment, and noise levels in decentralized units. However, they reported reduced access to support spaces, lower levels of team/mentoring communication, and less satisfaction with design than in centralized units. Qualitative findings supported these results. Nurses were more positive about centralized units and patients were more positive toward decentralized units. The results of this study suggest a need to understand how system components operate in concert. A major contribution of this study is the inclusion of patient satisfaction with design, an important yet overlooked fact in patient satisfaction. Healthcare design researchers and practitioners may consider how changing system interdependencies can lead to unexpected changes to communication processes and system outcomes in complex systems.

  12. When Regional Innovation Policies Meet Policy Rationales and Evidence:

    DEFF Research Database (Denmark)

    Borrás, Susana; Jordana, Jacint

    regions, and to understand how rationales and evidence can be translated into policy-making. To this purpose, this paper develops a framework to study the extent to which regional innovation policies have changed during the past few years. Since the mid-2000s there has been an important development......In spite of recent advancements regarding regional innovation policy rationales and evidence, there are few analyses about the actual features of existing regional innovation policies. Nevertheless, a policy analysis perspective is important in order to recognise their distinctive patterns across...... of innovation policy rationales, advocating for more specialisation; likewise, greater data availability at the regional level has allowed more sophisticated assessment of innovation performance. Finally, the crisis since 2008 has had ravaging effects in some regions, with job losses and severe economic...

  13. When Regional Innovation Policies Meet Policy Rationales and Evidence

    DEFF Research Database (Denmark)

    Borrás, Susana; Jordana, Jacint

    2016-01-01

    regions, and to understand how rationales and evidence can be translated into policy-making. To this purpose, this paper develops a framework to study the extent to which regional innovation policies have changed during the past few years. Since the mid-2000s, there has been an important development......In spite of recent advancements regarding regional innovation policy rationales and evidence, there are few analyses about the actual features of existing regional innovation policies. Nevertheless, a policy analysis perspective is important in order to recognize their distinctive patterns across...... of innovation policy rationales, advocating for more specialization; likewise, greater data availability at the regional level has allowed more sophisticated assessment of innovation performance. Finally, the crisis since 2008 has had ravaging effects in some regions, with job losses and severe economic...

  14. Engagement with the auditory processing system during targeted auditory cognitive training mediates changes in cognitive outcomes in individuals with schizophrenia.

    Science.gov (United States)

    Biagianti, Bruno; Fisher, Melissa; Neilands, Torsten B; Loewy, Rachel; Vinogradov, Sophia

    2016-11-01

    Individuals with schizophrenia who engage in targeted cognitive training (TCT) of the auditory system show generalized cognitive improvements. The high degree of variability in cognitive gains maybe due to individual differences in the level of engagement of the underlying neural system target. 131 individuals with schizophrenia underwent 40 hours of TCT. We identified target engagement of auditory system processing efficiency by modeling subject-specific trajectories of auditory processing speed (APS) over time. Lowess analysis, mixed models repeated measures analysis, and latent growth curve modeling were used to examine whether APS trajectories were moderated by age and illness duration, and mediated improvements in cognitive outcome measures. We observed significant improvements in APS from baseline to 20 hours of training (initial change), followed by a flat APS trajectory (plateau) at subsequent time-points. Participants showed interindividual variability in the steepness of the initial APS change and in the APS plateau achieved and sustained between 20 and 40 hours. We found that participants who achieved the fastest APS plateau, showed the greatest transfer effects to untrained cognitive domains. There is a significant association between an individual's ability to generate and sustain auditory processing efficiency and their degree of cognitive improvement after TCT, independent of baseline neurocognition. APS plateau may therefore represent a behavioral measure of target engagement mediating treatment response. Future studies should examine the optimal plateau of auditory processing efficiency required to induce significant cognitive improvements, in the context of interindividual differences in neural plasticity and sensory system efficiency that characterize schizophrenia. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  15. Core outcome sets for research and clinical practice

    NARCIS (Netherlands)

    Chiarotto, Alessandro; Ostelo, Raymond W.; Turk, Dennis C.; Buchbinder, Rachelle; Boers, Maarten

    2017-01-01

    Background This masterclass introduces the topic of core outcome sets, describing rationale and methods for developing them, and providing some examples that are relevant for clinical research and practice. Method A core outcome set is a minimum consensus-based set of outcomes that should be

  16. Brief report: identity processes in Filipino late adolescents and young adults: parental influences and mental health outcomes.

    Science.gov (United States)

    Pesigan, Ivan Jacob Agaloos; Luyckx, Koen; Alampay, Liane Peña

    2014-07-01

    This study focused on a process-oriented approach to identity formation using a sample of Filipino late adolescents and young adults (17-30 years; N = 779). Indirect relations between parenting and mental health via identity formation processes were examined. Two parenting dimensions (psychological control and support), two types of mental health outcomes (depression and psychological well-being), and five identity dimensions (commitment making (CM), identification with commitment (IC), exploration in breadth (EB), exploration in depth (ED), and ruminative exploration (RE)) were assessed. Recursive path analysis showed indirect relations between parenting and mental health via EB, ED, RE, and IC. Model differences between late adolescents (17-21 year olds) and young adults (22-30 year olds) were examined using multigroup path analysis. Results showed that the direct effect of psychological control on RE, and its indirect effect on depression through RE differed between the age groups. Implications and suggestions for future research are provided. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  17. Resilient family processes, personal reintegration, and subjective well-being outcomes for military personnel and their family members.

    Science.gov (United States)

    Clark, Malissa A; O'Neal, Catherine W; Conley, Kate M; Mancini, Jay A

    2018-01-01

    Deployment affects not just the service members, but also their family members back home. Accordingly, this study examined how resilient family processes during a deployment (i.e., frequency of communication and household management) were related to the personal reintegration of each family member (i.e., how well each family member begins to "feel like oneself again" after a deployment), as well as several indicators of subjective well-being. Drawing from the family attachment network model (Riggs & Riggs, 2011), the present study collected survey data from 273 service members, their partners, and their adolescent children. Resilient family processes during the deployment itself (i.e., frequency of communication, household management), postdeployment positive and negative personal reintegration, and several indicators of well-being were assessed. Frequency of communication was related to personal reintegration for service members, while household management was related to personal reintegration for nondeployed partners; both factors were related to personal reintegration for adolescents. Negative and positive personal reintegration related to a variety of subjective well-being outcomes for each individual family member. Interindividual (i.e., crossover) effects were also found, particularly between adolescents and nondeployed partners. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  18. Feasibility, Process, and Outcomes of Cardiovascular Clinical Trial Data Sharing: A Reproduction Analysis of the SMART-AF Trial.

    Science.gov (United States)

    Gay, Hawkins C; Baldridge, Abigail S; Huffman, Mark D

    2017-12-01

    Data sharing is as an expanding initiative for enhancing trust in the clinical research enterprise. To evaluate the feasibility, process, and outcomes of a reproduction analysis of the THERMOCOOL SMARTTOUCH Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation (SMART-AF) trial using shared clinical trial data. A reproduction analysis of the SMART-AF trial was performed using the data sets, data dictionary, case report file, and statistical analysis plan from the original trial accessed through the Yale Open Data Access Project using the SAS Clinical Trials Data Transparency platform. SMART-AF was a multicenter, single-arm trial evaluating the effectiveness and safety of an irrigated, contact force-sensing catheter for ablation of drug refractory, symptomatic paroxysmal atrial fibrillation in 172 participants recruited from 21 sites between June 2011 and December 2011. Analysis of the data was conducted between December 2016 and April 2017. Effectiveness outcomes included freedom from atrial arrhythmias after ablation and proportion of participants without any arrhythmia recurrence over the 12 months of follow-up after a 3-month blanking period. Safety outcomes included major adverse device- or procedure-related events. The SMART AF trial participants' mean age was 58.7 (10.8) years, and 72% were men. The time from initial proposal submission to final analysis was 11 months. Freedom from atrial arrhythmias at 12 months postprocedure was similar compared with the primary study report (74.0%; 95% CI, 66.0-82.0 vs 76.4%; 95% CI, 68.7-84.1). The reproduction analysis success rate was higher than the primary study report (65.8%; 95% CI 56.5-74.2 vs 75.6%; 95% CI, 67.2-82.5). Adverse events were minimal and similar between the 2 analyses, but contact force range or regression models could not be reproduced. The feasibility of a reproduction analysis of the SMART-AF trial was demonstrated through an academic data-sharing platform. Data sharing can be

  19. Multidisciplinary Team Meetings appear to be effective in Inflammatory Bowel Disease Management: An audit of process and outcomes.

    Science.gov (United States)

    Ferman, Mutaz; Lim, Amanda H; Hossain, Monowar; Siow, Glenn W; Andrews, Jane M

    2018-05-14

    Multidisciplinary team meetings (MDTMs) have proven efficacy in cancer management. Whilst widely implemented in inflammatory bowel disease (IBD) care, their value is yet to be investigated. We reviewed the performance of MDTMs for IBD patients. Retrospective review of MDTMs from March 2013 to July 2016. Each patient's first MDTM was considered. Data collected included: report production and location, disease factors, recommendation(s), implementation and barriers to implementation. The MDTM process was considered successful when at least top-level recommendations were implemented within 6 months. MDTM attendance included IBD gastroenterologist, surgeons, radiologist, nurses, dieticians, psychologists and clinical trial staff. Initial MDTM encounters for 166 patients were reviewed: 86 females; mean age 40 years; 140 (84.3%) with Crohn's disease; mean disease duration 10.8 years (interquartile range 15 years). Electronic reports were filed for all patients; hard copies in 84%. In 151/166 episodes, all (n=127) or top-line (n=24) recommendations were implemented, although there was a delay beyond 6 months in 5. Of 146 patients with a successful MDTM, 85 (58.2%) were in clinical remission at last review (median follow-up 27 months). Amongst patients with unsuccessful MDTMs (n=13), only 2 (15.4%) were in clinical remission at follow-up. Barriers to implementation included patients declining recommendations and loss to follow-up. The majority of MDTM encounters were successful from both a process and clinical outcome perspective. System opportunities to improve the process include ensuring 100% reports are available and addressing implementation delays. Patient factors to address include improved engagement and understanding reasons for declining recommendations. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. HAMMLAB 1999 experimental control room: design - design rationale - experiences

    International Nuclear Information System (INIS)

    Foerdestroemmen, N. T.; Meyer, B. D.; Saarni, R.

    1999-01-01

    A presentation of HAMMLAB 1999 experimental control room, and the accumulated experiences gathered in the areas of design and design rationale as well as user experiences. It is concluded that HAMMLAB 1999 experimental control room is a realistic, compact and efficient control room well suited as an Advanced NPP Control Room (ml)

  1. Building "Applied Linguistic Historiography": Rationale, Scope, and Methods

    Science.gov (United States)

    Smith, Richard

    2016-01-01

    In this article I argue for the establishment of "Applied Linguistic Historiography" (ALH), that is, a new domain of enquiry within applied linguistics involving a rigorous, scholarly, and self-reflexive approach to historical research. Considering issues of rationale, scope, and methods in turn, I provide reasons why ALH is needed and…

  2. Learning Rationales and Virtual Reality Technology in Education.

    Science.gov (United States)

    Chiou, Guey-Fa

    1995-01-01

    Defines and describes virtual reality technology and differentiates between virtual learning environment, learning material, and learning tools. Links learning rationales to virtual reality technology to pave conceptual foundations for application of virtual reality technology education. Constructivism, case-based learning, problem-based learning,…

  3. Rationale of Early Adopters of Fossil Fuel Divestment

    Science.gov (United States)

    Beer, Christopher Todd

    2016-01-01

    Purpose: This research uses the social science perspectives of institutions, ecological modernization and social movements to analyze the rationale used by the early-adopting universities of fossil fuel divestment in the USA. Design/methodology/approach: Through analysis of qualitative data from interviews with key actors at the universities that…

  4. Karl Popper and Jean Piaget: A Rationale for Constructivism

    Science.gov (United States)

    Harlow, Steve; Cummings, Rhoda; Aberasturi, Suzanne M.

    2006-01-01

    The current faddish use of the term constructivism has taken on as many different definitions as the number of people attempting to define it. This essay clarifies the meaning of constructivism through an examination of Karl Popper's and Jean Piaget's theories. The authors provide a rationale for the use of Popper's paradigm of "Three Worlds" and…

  5. Oral Health Promotion in Schools: Rationale and Evaluation

    Science.gov (United States)

    Kizito, Alex; Caitlin, Meredith; Wang, Yili; Kasangaki, Arabat; Macnab, Andrew J.

    2014-01-01

    Purpose: The purpose of this paper is to explain the rationale and potential for the WHO health promoting schools (HPS) to improve children's oral health, and describe validated quantitative methodologies and qualitative approaches to measure program impact. Design/Methodology/Approach: Critical discussion of the impact of poor oral health and…

  6. Rationale for the Cultural Construction of School Mental Health Programming

    Science.gov (United States)

    Arora, Prerna G.; Nastasi, Bonnie K.; Leff, Stephen S.

    2017-01-01

    The implementation of evidence-based psychological programming to meet the needs of a global population has been impeded by the translation of theories and research findings across populations and settings without due consideration of cultural factors. The purpose of this article is to discuss the rationale for use of partnership-based methods in…

  7. "ComPost": A Writing Program Newsletter and Its Rationale.

    Science.gov (United States)

    Hall, Dennis R.

    1993-01-01

    Discusses the development and rationale of "ComPost," a weekly newsletter of the Composition Program at the University of Louisville. Suggests that a vehicle like ComPost can promote the communications that contribute to accomplishing collegiality and genuine program consensus. (RS)

  8. Invitation to the Birthday Party: Rationale and Description

    Science.gov (United States)

    Ginsburg, Herbert P.; Pappas, Sandra

    2016-01-01

    Educators in many countries around the world have a strong interest in improving early childhood mathematics education, one component of which is formative assessment. Unlike summative assessment, this approach can provide teachers with information useful for understanding and teaching individual children. This paper describes the rationale for…

  9. The rationale of scored tablets as dosage form.

    NARCIS (Netherlands)

    Rodenhuis, N.; Smet, P.A.G.M. de; Barends, D.M.

    2004-01-01

    The aim of the study was to get insight into the rationale of scored tablets. This was pursued by studying patient's reasons for subdividing ("breaking") scored and unscored tablets. Patients who picked up their prescriptions in 5 community pharmacies in The Netherlands were questioned. Two-hundred

  10. Genomewide Association Studies: History, Rationale, and Prospects for Psychiatric Disorders

    NARCIS (Netherlands)

    Cichon, S.; Craddock, N.; Daly, M.J.; Faraone, S.V.; Gejman, P.V.; Kelsoe, J.; Lehner, T.; Levinson, D.F.; Moran, A.P.; Sklar, P.; Sullivan, P.F.; Boomsma, D.I.; de Geus, E.J.C.; Posthuma, D.; Willemsen, G.

    2009-01-01

    Objective: The authors conducted a review of the history and empirical basis of genomewide association studies (GWAS), the rationale for GWAS of psychiatric disorders, results to date, limitations, and plans for GWAS meta-analyses. Method: A literature review was carried out, power and other issues

  11. Genomewide association studies: history, rationale, and prospects for psychiatric disorders.

    NARCIS (Netherlands)

    Franke, B.; Buitelaar, J.K.; Cichon, S.; Craddock, N.; Daly, M.; Faraone, S.V.; Gejman, P.V.; Kelsoe, J.; Lehner, T.; Levinson, D.F.; Moran, A.; Sklar, P.; Sullivan, P.F.

    2009-01-01

    OBJECTIVE: The authors conducted a review of the history and empirical basis of genomewide association studies (GWAS), the rationale for GWAS of psychiatric disorders, results to date, limitations, and plans for GWAS meta-analyses. METHOD: A literature review was carried out, power and other issues

  12. Meeting a Moral Imperative: A Rationale for Teaching the Holocaust

    Science.gov (United States)

    Lindquist, David H.

    2011-01-01

    A primary rationale for studying the Holocaust (Shoah) involves the opportunity to consider the moral implications that can be drawn from examining the event. Studying the Shoah forces students to consider what it means to be human and humane by examining the full continuum of individual behavior, from "ultimate evil" to "ultimate good". This…

  13. Rationales behind the choice of administration form with fentanyl

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Møldrup, Claus; Christrup, Lona

    2010-01-01

    BACKGROUND AND AIM: The aim of this study was to describe the rationale behind the choice of fentanyl administration forms among Danish general practitioners (GPs). METHODS: Thirty-eight Danish GPs were contacted via an Internet survey system to perform a Delphi survey. In the brainstorming phase...

  14. An information economic rationale for cooperatives

    DEFF Research Database (Denmark)

    Bogetoft, Peter

    2005-01-01

    We consider how to organise the processing and marketing of an agricultural product when farming costs are known only by the individual farmers. We show that when marginal costs are uncorrelated, the market for final goods is competitive, and the market for processing is non-competitive, the soci......-competitive, the socially optimal production levels are sustained by a cooperative and a cooperative only. We show also that the cooperative form is particularly useful when the cost uncertainty is large and the net average revenue product is small....

  15. The prediction of breast cancer biopsy outcomes using two CAD approaches that both emphasize an intelligible decision process

    International Nuclear Information System (INIS)

    Elter, M.; Schulz-Wendtland, R.; Wittenberg, T.

    2007-01-01

    Mammography is the most effective method for breast cancer screening available today. However, the low positive predictive value of breast biopsy resulting from mammogram interpretation leads to approximately 70% unnecessary biopsies with benign outcomes. To reduce the high number of unnecessary breast biopsies, several computer-aided diagnosis (CAD) systems have been proposed in the last several years. These systems help physicians in their decision to perform a breast biopsy on a suspicious lesion seen in a mammogram or to perform a short term follow-up examination instead. We present two novel CAD approaches that both emphasize an intelligible decision process to predict breast biopsy outcomes from BI-RADS findings. An intelligible reasoning process is an important requirement for the acceptance of CAD systems by physicians. The first approach induces a global model based on decison-tree learning. The second approach is based on case-based reasoning and applies an entropic similarity measure. We have evaluated the performance of both CAD approaches on two large publicly available mammography reference databases using receiver operating characteristic (ROC) analysis, bootstrap sampling, and the ANOVA statistical significance test. Both approaches outperform the diagnosis decisions of the physicians. Hence, both systems have the potential to reduce the number of unnecessary breast biopsies in clinical practice. A comparison of the performance of the proposed decision tree and CBR approaches with a state of the art approach based on artificial neural networks (ANN) shows that the CBR approach performs slightly better than the ANN approach, which in turn results in slightly better performance than the decision-tree approach. The differences are statistically significant (p value <0.001). On 2100 masses extracted from the DDSM database, the CRB approach for example resulted in an area under the ROC curve of A(z)=0.89±0.01, the decision-tree approach in A(z)=0.87±0

  16. Effectiveness of Telebehavioral Health Program Nurse Case Managers (NCM): Data Collection Tools and the Process for NCM-Sensitive Outcome Measures.

    Science.gov (United States)

    Carlson, Judy; Cohen, Roslyn; Bice-Stephens, Wynona

    2014-01-01

    As a part of our nation's pursuit of improvements in patient care outcomes, continuity of care, and cost containment, the case manager has become a vital member on interdisciplinary teams and in health care agencies. Telebehavioral health programs, as a relatively new method of delivering behavioral health care, have recently begun to incorporate case management into their multidisciplinary teams. To determine the efficacy and efficiency of healthcare programs, program managers are charged with the determination of the outcomes of the care rendered to patient populations. However, programs that use telehealth methods to deliver care have unique structures in place that impact ability to collect outcome data. A military medical center that serves the Pacific region developed surveys and processes to distribute, administer, and collect information about a telehealth environment to obtain outcome data for the nurse case manager. This report describes the survey development and the processes created to capture nurse case manager outcomes. Additionally, the surveys and processes developed in this project for measuring outcomes may be useful in other settings and disciplines.

  17. Evaluating web-based cognitive-affective remediation in recent trauma survivors: study rationale and protocol.

    Science.gov (United States)

    Fine, Naomi B; Achituv, Michal; Etkin, Amit; Merin, Ofer; Shalev, Arieh Y

    2018-01-01

    Background : The immediate aftermath of traumatic events is a period of enhanced neural plasticity, following which some survivors remain with post-traumatic stress disorder (PTSD) whereas others recover. Evidence points to impairments in emotional reactivity, emotion regulation, and broader executive functions as critically contributing to PTSD. Emerging evidence further suggests that the neural mechanisms underlying these functions remain plastic in adulthood and that targeted retraining of these systems may enhance their efficiency and could reduce the likelihood of developing PTSD. Administering targeted neurocognitive training shortly after trauma exposure is a daunting challenge. This work describes a study design addressing that challenge. The study evaluated the direct effects of cognitive remediation training on neurocognitive mechanisms that hypothetically underlay PTSD, and the indirect effect of this intervention on emerging PTSD symptoms. Method : We describe a study rationale, design, and methodological choices involving: (a) participants' enrolment; (b) implementation and management of a daily self-administered, web-based intervention; (c) reliable, timely screening and assessment of treatment of eligible survivors; and (d) defining control conditions and outcome measures. We outline the rationale of choices made regarding study sample, timing of intervention, measurements, monitoring participants' adherence, and ways to harmonize and retain interviewers' fidelity and mitigate eventual burnout by repeated contacts with recently traumatized survivors. Conclusion : Early web-based interventions targeting causative mechanisms of PTSD can be informed by the model presented in this paper.

  18. Patient-focused goal planning process and outcome after spinal cord injury rehabilitation: quantitative and qualitative audit.

    Science.gov (United States)

    Byrnes, Michelle; Beilby, Janet; Ray, Patricia; McLennan, Renee; Ker, John; Schug, Stephan

    2012-12-01

    To evaluate the process and outcome of a multidisciplinary inpatient goal planning rehabilitation programme on physical, social and psychological functioning for patients with spinal cord injury. Clinical audit: quantitative and qualitative analyses. Specialist spinal injury unit, Perth, Australia. Consecutive series of 100 newly injured spinal cord injury inpatients. MAIN MEASURE(S): The Needs Assessment Checklist (NAC), patient-focused goal planning questionnaire and goal planning progress form. The clinical audit of 100 spinal cord injured patients revealed that 547 goal planning meetings were held with 8531 goals stipulated in total. Seventy-five per cent of the goals set at the first goal planning meeting were achieved by the second meeting and the rate of goal achievements at subsequent goal planning meetings dropped to 56%. Based on quantitative analysis of physical, social and psychological functioning, the 100 spinal cord injury patients improved significantly from baseline to discharge. Furthermore, qualitative analysis revealed benefits consistently reported by spinal cord injury patients of the goal planning rehabilitation programme in improvements to their physical, social and psychological adjustment to injury. The findings of this clinical audit underpin the need for patient-focused goal planning rehabilitation programmes which are tailored to the individual's needs and involve a comprehensive multidisciplinary team.

  19. Risk-taking attitudes and their association with process and outcomes of cardiac care: a cohort study

    Directory of Open Access Journals (Sweden)

    Knudtson Merril L

    2009-08-01

    Full Text Available Abstract Background Prior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata. One potential contributing factor to such differences is the personality traits of individuals within these strata. We examined the association between risk-taking attitudes and cardiac patients' clinical and demographic characteristics, the likelihood of undergoing invasive cardiac procedures and survival. Methods We studied a large inception cohort of patients who underwent cardiac catheterization between July 1998 and December 2001. Detailed clinical and demographic data were collected at time of cardiac catheterization and through a mailed survey one year post-catheterization. The survey included three general risk attitude items from the Jackson Personality Inventory. Patients' (n = 6294 attitudes toward risk were categorized as risk-prone versus non-risk-prone and were assessed for associations with baseline clinical and demographic characteristics, treatment received (i.e., medical therapy, coronary artery bypass graft (CABG surgery, percutaneous coronary intervention (PCI, and survival (to December 2005. Results 2827 patients (45% were categorized as risk-prone. Having risk-prone attitudes was associated with younger age (p Conclusion These exploratory findings suggest that patient attitudes toward risk taking may contribute to some of the documented differences in use of invasive cardiac procedures. An awareness of these associations could help healthcare providers as they counsel patients regarding cardiac care decisions.

  20. Status of the structure, process and outcoms of pharmaceutical care to HIV patient in Spain. Origen study

    Directory of Open Access Journals (Sweden)

    R. Morillo-Verdugo

    2014-03-01

    Full Text Available Objectives: To describe the structure, process and outcomes with which hospital pharmacist performs health care activity, teaching and research about Pharmaceutical Care (PC in HIV patients in Spain. Methods: Observational, cross-sectional and multicenter study carried out between November 2011-February 2012 in spanish hospitals. The inclusion criteria were: hospitals pharmacy services that dispensed antiretroviral medication to HIV patients. The questionnaire had 41 questions structured in 9 groups: hospital type and person conducting the survey, structure and resources, health care activities, interventions, communication with the rest of the multidisciplinary team, adherence, and quality records, management and pharmacoeconomy and teaching and research. Descriptive analysis was performed. To analyze the existence of statistically significant relationships, we applied fisher test, chi-square or logistic regression Results: 86 hospitals completed the survey. In 93%, PC consultation was not classified by pathologies. 27.9% provided continuing PC to all patients. Adherence was determined regularly or when pharmacist suspected poor adherence (57.5 %. 20% of hospital s teaching had a program that allowed a high level of training in PC to HIV patient. 52,3% of participating centers had published scientific articles related to HIV. Conclusions: Pharmaceutical care to HIV patients in Spain need to adapt to a new situation. For this, hospital pharmacists have to consider several issues such as chronicity, comorbidity, incorporation of new technologies and the stratification of patients in order to make it more efficient.

  1. The structure, processes, and outcomes of Banner Health's corporate-wide strategy to improve health care quality.

    Science.gov (United States)

    Kirkman-Liff, Bradford

    2004-01-01

    Banner Health consists of 19 hospitals, 6 long-term care centers and a number of family health clinics, home care programs, and home medical equipment providers in 9 Western and Midwestern states. Banner Health has developed an integrated organization-wide effort called Care Management to simultaneously address quality and safety, reduce patient errors, and measure and report performance, outcomes, and patient satisfaction, while controlling costs through utilization management, care coordination, and performance improvement. Eleven functional areas were identified and more than 36 cross-functional and cross-facility work groups have been created. These work groups use a deliberate process in which knowledge is created, reviewed, synthesized, distributed, taught, and implemented within the system. Key lessons after the first 2 years of this effort are as follows: information sharing and collegial support can be established within newly merged organizations; there must be continued enhancement of both the accuracy and timeliness of data; the ability of health care professionals to understand and use sophisticated statistical tools has increased; a variety of methods should be used to distribute the knowledge products; and the strategy to have functional teams and work groups develop systemwide policies and toolkits but leave implementation to facility employees has worked relatively well.

  2. Process and outcome measures of quality of care at the diabetes outpatient clinic, University College Hospital, Ibadan.

    Science.gov (United States)

    Adeleye, J O; Kuti, M A

    2017-02-01

    The study aims to assess the quality of care provided at a diabetes outpatient clinic of a tertiary hospital in Nigeria using quality indicators approved by the National Diabetes Quality Improvement Alliance (NDQIA). The medical records of patients who had visited the clinic at least two times within a 12 months period preceding the index visit were reviewed during a 5 month period. Process measure indicators, approved by the NDQIA (evaluating the functioning of the clinic) and outcome measures, published by the American Diabetes Association, (evaluating the health status of the attending patients) were retrieved from the medical records. The 332 records reviewed showed that the most consistently performed process measures were blood pressure and weight measurement (>90%). Foot examination was done infrequently (10.5%). Less than 50% had at least an annual low-density lipoprotein cholesterol (LDL-C) and hemoglobin A1c testing done. The mean (standard deviation) HbA1C (%), LDL-C (mg/dL) systolic blood pressure (SBP) (mmHg), and diastolic blood pressure (DBP) (mmHg) were 7.6 (2.0), 107.3 (31.5), 134.3 (20.8), 79.5 (11.0), respectively. HbA1C >8.0%, LDL-C >130 mg/dL, SBP >130 mmHg, and DBP >90 mmHg) were observed in 34.8%, 21.1%, 40.4%, and 23.8%, respectively. Although the organization of the outpatient services allowed for good performance with regards to "free" services such as blood pressure and weight measurement, it performed suboptimally for foot examinations. Performance indicators that required payment were consistently underperformed. Regular assessment of the quality of care may help in the identification of opportunities for improvement in the organization and delivery of care.

  3. Can modeling of HIV treatment processes improve outcomes? Capitalizing on an operations research approach to the global pandemic

    Directory of Open Access Journals (Sweden)

    Hollingsworth Eric B

    2008-08-01

    Full Text Available Abstract Background Mathematical modeling has been applied to a range of policy-level decisions on resource allocation for HIV care and treatment. We describe the application of classic operations research (OR techniques to address logistical and resource management challenges in HIV treatment scale-up activities in resource-limited countries. Methods We review and categorize several of the major logistical and operational problems encountered over the last decade in the global scale-up of HIV care and antiretroviral treatment for people with AIDS. While there are unique features of HIV care and treatment that pose significant challenges to effective modeling and service improvement, we identify several analogous OR-based solutions that have been developed in the service, industrial, and health sectors. Results HIV treatment scale-up includes many processes that are amenable to mathematical and simulation modeling, including forecasting future demand for services; locating and sizing facilities for maximal efficiency; and determining optimal staffing levels at clinical centers. Optimization of clinical and logistical processes through modeling may improve outcomes, but successful OR-based interventions will require contextualization of response strategies, including appreciation of both existing health care systems and limitations in local health workforces. Conclusion The modeling techniques developed in the engineering field of operations research have wide potential application to the variety of logistical problems encountered in HIV treatment scale-up in resource-limited settings. Increasing the number of cross-disciplinary collaborations between engineering and public health will help speed the appropriate development and application of these tools.

  4. Design and rationale for the PREVAIL study

    DEFF Research Database (Denmark)

    Klausen, Susanne Hwiid; Mikkelsen, Ulla Ramer; Hirth, Asle

    2012-01-01

    to participate in physical activity are in the process of being enrolled by invitation after informed consent. Physical fitness is measured as the maximal oxygen uptake (Vo(2)) at baseline and after 12 months by an assessor blinded to the randomization group. After baseline testing, the patients are 1......:1 randomized to an intervention group or a control group. Individually fully automated tailored e-Health encouragements--SMS, Internet, and mobile applications--aimed at increasing physical activity are delivered to the participants in the intervention group once a week. The Bandura's Social Cognitive Theory...

  5. The Strathclyde Evaluation of Children's Active Travel (SE-CAT: study rationale and methods

    Directory of Open Access Journals (Sweden)

    McMinn David

    2011-12-01

    Full Text Available Abstract Background The school commute is a prime opportunity to increase children's physical activity levels. However, active commuting has decreased over the past 40 years. Strategies that increase walking to school are therefore needed. Travelling Green (TG is a school-based active travel resource aimed at increasing children's walking to school. The resource consists of a curriculum-based program of lessons and goal setting activities. A previous study found that children who received the TG intervention increased self-reported distance travelled to school by active modes and reduced the distance travelled by inactive modes. This study was limited by self-reported outcome measures, a small sample, and no follow-up measures. A more robust evaluation of TG is required to address these limitations. This paper describes the rationale and methods for such an evaluation of Travelling Green, and describes the piloting of various active commuting measures in primary school children. Methods/Design Measures of active commuting were piloted in a sample of 26 children (aged 8-9 years over one school week. These measures were subsequently used in an 18-month quasi-experimental design to evaluate the effect of TG on commuting behaviour. Participants were 166 children (60% male aged 8-9 years from 5 primary schools. Two schools (n = 79 children received TG in September/October 2009. Three schools (n = 87 children acted as a comparison group, and subsequently received TG at a later date. Physical activity was measured using Actigraph GT1M accelerometers. Personal and environmental determinants of active commuting were measured via parent and child questionnaires, as were factors related to the Theory of Planned Behaviour and the construct of habit. Measures were taken pre- and post-intervention and at 5 and 12 months follow-up. Discussion The piloted protocol was practical and feasible and piloted measures were reliable and valid. All study data, including

  6. Collaborative Care for patients with severe borderline and NOS personality disorders: A comparative multiple case study on processes and outcomes

    Directory of Open Access Journals (Sweden)

    Koekkoek Bauke

    2011-06-01

    Full Text Available Abstract Background Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer access to psychotherapy a Collaborative Care Program (CCP is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP's as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. Methods/design Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the 'black box' of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. Discussion The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen

  7. Comparison and Evaluation of Learning Outcomes from an International Perspective: Development of a Best-Practice Process

    Science.gov (United States)

    Elmgren, Maja; Ho, Felix; Åkesson, Eva; Schmid, Siegbert; Towns, Marcy

    2015-01-01

    Chemistry education focused on learning outcomes is increasingly practiced, providing new opportunities for international comparisons. The interest in intended learning outcomes and constructive alignment has grown in many parts of the world due to both research in higher education and political decisions. In an International Union of Pure and…

  8. Implementation of a Proposed Model of a Constructivist Teaching-Learning Process – A Step Towards an Outcome Based Education in Chemistry Laboratory Instruction

    Directory of Open Access Journals (Sweden)

    Dr. Paz B. Reyes

    2013-12-01

    Full Text Available This study implemented the proposed model of a constructivist teachinglearning process and determined the extent by which the students manifested the institutional learning outcomes which include competency, credibility, commitment and collaboration. It also investigated if there was an improvement in the learning outcomes after the implementation of the constructivist teachinglearning process and determined the students’ acceptance of the constructivist teaching-learning process. Towards the end a plan of action was proposed to enhance the students’ manifestation of the institutional learning outcomes. It made use of the qualitative- quantitative method particularly the descriptive design. The results of the study revealed that the students manifest competency, credibility, commitment and collaboration as they accept positively the constructivist teaching-learning process in their chemistry laboratory subject. It can be deduced from the findings that the constructivist teaching-learning process improved the learning outcomes of the students. The use of the proposed plan of action is recommended for an effective chemistry laboratory instruction.

  9. Tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign trial: Rationale and design.

    Science.gov (United States)

    Liu, Liping; Wang, Yilong; Meng, Xia; Li, Na; Tan, Ying; Nie, Ximing; Liu, Dacheng; Zhao, Xingquan

    2017-04-01

    Rationale Acute intracerebral hemorrhage inflicts a high-economic and -health burden. Computed tomography angiography spot sign is a predictor of hematoma expansion, is associated with poor clinical outcome and is an important stratifying variable for patients treated with haemostatic therapy. Aims We aim to compare the effect of treatment with tranexamic acid to placebo for the prevention of hemorrhage growth in patients with high-risk acute intracerebral hemorrhage with a positive spot sign. Design The tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign (TRAIGE) is a prospective, multicenter, placebo-controlled, double-blind, investigator-led, randomized clinical trial that will include an estimated 240 participants. Patients with intracerebral hemorrhage demonstrating symptom onset within 8 h and with the spot sign as a biomarker for ongoing hemorrhage, and no contraindications for antifibrinolytic therapy, will be enrolled to receive either tranexamic acid or placebo. The primary outcome measure is the presence of hemorrhage growth defined as an increase in intracerebral hemorrhage volume >33% or >6 ml from baseline to 24 ± 2 h. The secondary outcomes include safety and clinical outcomes. Conclusion The TRAIGE trial evaluates the efficacy of haemostatic therapy with tranexamic acid in the prevention of hemorrhage growth among high-risk patients with acute intracerebral hemorrhage.

  10. Long-term effect of fee-for-service-based reimbursement cuts on processes and outcomes of care for stroke: interrupted time-series study from Taiwan.

    Science.gov (United States)

    Tung, Yu-Chi; Chang, Guann-Ming; Cheng, Shou-Hsia

    2015-01-01

    As healthcare spending continues to increase, reimbursement cuts have become 1 type of healthcare reform to contain costs. Little is known about the long-term impact of cuts in reimbursement, especially under a global budget cap with fee-for-service (FFS) reimbursement, on processes and outcomes of care. The FFS-based reimbursement cuts have been implemented since July 2002 in Taiwan. We examined the long-term association of FFS-based reimbursement cuts with trends in processes and outcomes of care for stroke. We analyzed all 411,487 patients with stroke admitted to general acute care hospitals in Taiwan during the period 1997 to 2010 through Taiwan's National Health Insurance Research Database. We used a quasi-experimental design with quarterly measures of healthcare utilization and outcomes and used segmented autoregressive integrated moving average models for the analysis. After accounting for secular trends and other confounders, the implementation of the FFS-based reimbursement cuts was associated with trend changes in computed tomography/magnetic resonance imaging scanning (0.31% per quarter; P=0.013), antiplatelet/anticoagulant use (-0.20% per quarter; Pprocesses and outcomes of care over time. However, the reimbursement cuts from the FFS-based global budget cap are associated with trend changes in processes and outcomes of care for stroke. The FFS-based reimbursement cuts may have long-term positive and negative associations with stroke care. © 2014 American Heart Association, Inc.

  11. Rationale for and protocol of a multi-national population-based bacteremia surveillance collaborative

    Directory of Open Access Journals (Sweden)

    Church Deirdre L

    2009-07-01

    Full Text Available Abstract Background Bloodstream infections are frequent causes of human illness and cause major morbidity and death. In order to best define the epidemiology of these infections and to track changes in occurrence, adverse outcome, and resistance rates over time, population based methodologies are optimal. However, few population-based surveillance systems exist worldwide, and because of differences in methodology inter-regional comparisons are limited. In this report we describe the rationale and propose first practical steps for developing an international collaborative approach to the epidemiologic study and surveillance for bacteremia. Findings The founding collaborative participants represent six regions in four countries in three continents with a combined annual surveillance population of more than 8 million residents. Conclusion Future studies from this collaborative should lead to a better understanding of the epidemiology of bloodstream infections.

  12. Organ Donation in the 50+ Age Demographic: Survey Results on Decision Rationale and Information Preferences.

    Science.gov (United States)

    Tartaglia, Alexander; Dodd-McCue, Diane; Myer, Kevin A; Mullins, Andrew

    2016-09-01

    The rate of organ donation by older potential donors is significantly declining even though recent studies show positive clinical outcomes with organs transplanted from older donors. This study examined the 50+ age demographic to identify the rationale for donation decisions, preferred media methods of donation information delivery, and responsiveness to an age-tailored donation message. Results from 579 surveys, 87% from the 50+ age demographic, found respondents prone to self-select themselves as medically ineligible based on current medication and health status, even though they might be medically suitable donors. Their incentive to pursue additional information on donation is limited except when motivated by personal accounts within their families and communities. In addition, even when computer literate, they continue to favor the printed or spoken word for donation information delivery. The results suggest an opportunity for those working with older adults to develop more personalized, localized donation education programs targeting this age demographic. © The Author(s) 2014.

  13. Galaxy Evolution Spectroscopic Explorer: Scientific Rationale

    Science.gov (United States)

    Heap, Sara; Ninkov, Zoran; Robberto, Massimo; Hull, Tony; Purves, Lloyd

    2016-01-01

    GESE is a mission concept consisting of a 1.5-m space telescope and UV multi-object slit spectrograph designed to help understand galaxy evolution in a critical era in the history of the universe, where the rate of star-formation stopped increasing and started to decline. To isolate and identify the various processes driving the evolution of these galaxies, GESE will obtain rest-frame far-UV spectra of 100,000 galaxies at redshifts, z approximately 1-2. To obtain such a large number of spectra, multiplexing over a wide field is an absolute necessity. A slit device such as a digital micro-mirror device (DMD) or a micro-shutter array (MSA) enables spectroscopy of a hundred or more sources in a single exposure while eliminating overlapping spectra of other sources and blocking unwanted background like zodiacal light. We find that a 1.5-m space telescope with a MSA slit device combined with a custom orbit enabling long, uninterrupted exposures (approximately 10 hr) are optimal for this spectroscopic survey. GESE will not be operating alone in this endeavor. Together with x-ray telescopes and optical/near-IR telescopes like Subaru/Prime Focus Spectrograph, GESE will detect "feedback" from young massive stars and massive black holes (AGN's), and other drivers of galaxy evolution.

  14. Does Adipose-derived Stromal Cell Adjuvant Therapy for Fragmented Medial Coronoid Process in Dogs Influence Outcome? A Pilot Project

    Directory of Open Access Journals (Sweden)

    Kristina M Kiefer

    2016-11-01

    Full Text Available Objective: The primary objective of this study was to identify adverse events associated with multiple intra-articular injections of adipose stromal cell (ASC therapy and secondarily to objectively assess the therapeutic effect of ASC therapy for treatment of fragmented medial coronoid process (FMCP in dogs when used as an adjuvant to standard of care (SOC treatment. Background: Preliminary trials assessing autologous ASC therapy to treat osteoarthritis indicate a positive impact on clinical signs, but assessment of donated, allogeneic ASC therapy is lacking.Evidentiary value: This prospective, randomised, controlled trial in dogs (n=30 provides objective evidence for clinical practitioners regarding ASC therapy in a naturally occurring osteoarthritic disease model.Methods: Dogs diagnosed with FMCP and osteoarthritis were enrolled. All dogs had arthroscopic fragment removal and proximal ulnar osteotomy (PUO and were assigned into three groups (n=10/group: 1 control group with no further treatment beyond the PUO and fragment removal (SOC, 2 PUO + autologous ASCs and 3 PUO+ allogeneic ASCs. Each dog had force platform gait analysis, Canine Brief Pain Inventory (CBPI questionnaires, and delayed gadolinium enhanced magnetic resonance imaging scores prior to and six months after therapeutic intervention.Results: No serious adverse events were reported in any participant. 3/10 dogs in the control group, 3/10 autologous ASC group and 7/10 allogeneic ASC group participants were assessed as successful outcomes.Conclusion: This study provides preliminary safety data for the use of intra-articular allogeneic ASC therapy to treat osteoarthritis, and justification for larger clinical studies.Application: Clinical practitioners considering ASC therapy within their practice are provided with additional evidence of autologous ASC therapy for osteoarthritis. Researchers committed to developing and generating effective ASC therapies are provided with safety

  15. A Scotland-wide pilot programme of smoking cessation services for young people: process and outcome evaluation.

    Science.gov (United States)

    Gnich, Wendy; Sheehy, Christine; Amos, Amanda; Bitel, Mark; Platt, Stephen

    2008-11-01

    To conduct an independent, external evaluation of a Scotland-wide youth cessation pilot programme, focusing upon service uptake and effectiveness. National Health Service (NHS) Health Scotland and Action on Smoking and Health (ASH) Scotland funded a 3-year (2002-2005) national pilot programme comprising eight projects which aimed to engage with and support young smokers (aged 12-25 years) to quit. Process evaluation was undertaken via detailed case studies comprising qualitative interviews, observation and documentary analysis. Outcomes were assessed by following project participants (n=470 at baseline) at 3 and 12 months and measuring changes in smoking behaviour, including carbon monoxide (CO)-validated quit status. Recruitment proved difficult. Considerable time and effort were needed to attract young smokers. Advertising and recruitment had to be tailored to project settings and educational activities proved essential to raise the profile of smoking as an issue. Thirty-nine participants [8.6%, 95% confidence interval (CI) 5.0-11.2%] were CO-validated quitters at 3 months and 11 of these (2.4%, 95% CI 1.90-3.8%) were also validated quitters at 12 months. Older participants were more likely to be abstinent at 3 months. The overall quit rate was disappointing. As a result of low participant numbers, it was impossible to draw conclusions about the relative effectiveness of different project approaches. These findings give little support to the case for developing dedicated youth cessation services in Scotland. They also highlight the difficulties of undertaking 'real-world' evaluations of pilot youth cessation projects. More action is needed to develop environments which enhance young smokers' motivation to quit and their ability to sustain quit attempts.

  16. Supporting awareness in creative group work by exposing design rationale

    Directory of Open Access Journals (Sweden)

    Umer Farooq

    2011-01-01

    Full Text Available When creativity is taken as a long-term, complex, and collaborative activity, support for awareness is required for group members to monitor the development of ideas, track how these ideas became narrowed, and understand how alternatives are being implemented and integrated by colleagues. In this paper, we investigate the effects of exposing design rationale to convey awareness, specifically activity awareness, in group creativity. Through evaluating a prototype, we investigate status updates that convey design rationale, and to what consequences, in small groups in fully distributed collaboration. We found that status updates are used for a variety of purposes and that participants’ comments on their collaborators’ status updates provided feedback. Overall, results suggest that participants’ awareness about their collaborators’ future plans increased over time. Majority of participants found the status updates useful, particularly those with higher metacognitive knowledge. Based on our results, two design strategies for activity awareness are proposed.

  17. Rationale for single molecule detection by means of Raman spectroscopy

    International Nuclear Information System (INIS)

    Gaponenko, S.V.; Guzatov, D.V.

    2009-01-01

    A consistent quantum electrodynamical description is proposed of Raman scattering of light by a molecule in a medium with a modified photon density of states. Enhanced local density of states near a metal nanobody is shown to increase a scattering rate by several orders of magnitude, thus providing a rationale for experimental detection of single molecules by means of Raman spectroscopy. For an ellipsoidal particle 10 14 -fold enhancement of the Raman scattering cross-section is obtained. (authors)

  18. Physics rationale for the engineering specifications for ZTH

    International Nuclear Information System (INIS)

    Dimarco, J.N.

    1987-01-01

    This report presents the physics rationale that established the engineering design of ZTH. The physics criteria are given and the implications regarding the engineering design are presented. Experimental and theoretical background evidence is given in support of the criteria but the justification is left to other reports and peer reviews. The physics criteria discussed here are limited to the ones deemed to be of highest engineering priority. 32 refs., 9 figs

  19. The rationale for early intervention in schizophrenia and related disorders

    DEFF Research Database (Denmark)

    Nordentoft, Merete; Jeppesen, Pia; Petersen, Lone

    2009-01-01

    , adherence to treatment, comorbid drug abuse, relapse and readmission. Some benefits persist after cessation of the intervention. Conclusions: Early intervention in schizophrenia is justified to reduce the negative personal and social impact of prolonged periods of untreated symptoms. Furthermore, phase......Abstract Aim: To examine the rationale and evidence supporting an early intervention approach in schizophrenia. Methods: A selective literature review was conducted. Results: During the onset of schizophrenia, there is often a significant delay between the emergence of psychotic symptoms...

  20. Sampling in Qualitative Research: Rationale, Issues, and Methods

    OpenAIRE

    LUBORSKY, MARK R.; RUBINSTEIN, ROBERT L.

    1995-01-01

    In gerontology the most recognized and elaborate discourse about sampling is generally thought to be in quantitative research associated with survey research and medical research. But sampling has long been a central concern in the social and humanistic inquiry, albeit in a different guise suited to the different goals. There is a need for more explicit discussion of qualitative sampling issues. This article will outline the guiding principles and rationales, features, and practices of sampli...

  1. Petrosal sinus sampling: technique and rationale.

    Science.gov (United States)

    Miller, D L; Doppman, J L

    1991-01-01

    Bilateral simultaneous sampling of the inferior petrosal sinuses is an extremely sensitive, specific, and accurate test for diagnosing Cushing disease and distinguishing between that entity and the ectopic ACTH syndrome. It is also valuable for lateralizing small hormone-producing adenomas within the pituitary gland. The inferior petrosal sinuses connect the cavernous sinuses with the ipsilateral internal jugular veins. The anatomy of the anastomoses between the inferior petrosal sinus, the internal jugular vein, and the venous plexuses at the base of the skull varies, but it is almost always possible to catheterize the inferior petrosal sinus. In addition, variations in size and anatomy are often present between the two inferior petrosal sinuses in a patient. Advance preparation is required for petrosal sinus sampling. Teamwork is a critical element, and each member of the staff should know what he or she will be doing during the procedure. The samples must be properly labeled, processed, and stored. Specific needles, guide wires, and catheters are recommended for this procedure. The procedure is performed with specific attention to the three areas of potential technical difficulty: catheterization of the common femoral veins, crossing the valve at the base of the left internal jugular vein, and selective catheterization of the inferior petrosal sinuses. There are specific methods for dealing with each of these areas. The sine qua non of correct catheter position in the inferior petrosal sinus is demonstration of reflux of contrast material into the ipsilateral cavernous sinus. Images must always be obtained to document correct catheter position. Special attention must be paid to two points to prevent potential complications: The patient must be given an adequate dose of heparin, and injection of contrast material into the inferior petrosal sinuses and surrounding veins must be done gently and carefully. When the procedure is performed as outlined, both inferior

  2. Getting to Yes at the Beach or in the Office? : The Role of Location Formality and Negotiation Type on Negotiation Process and Outcomes

    NARCIS (Netherlands)

    Hong, Alain; van der Wijst, Per

    2017-01-01

    The negotiation location plays an important role in negotiations. The present study examined to what extent the negotiation process and outcomes are influenced by the formality of the location and negotiation type. It was hypothesized that negotiations in a beach setting would yield better

  3. Quality of data entry using single entry, double entry and automated forms processing--an example based on a study of patient-reported outcomes

    DEFF Research Database (Denmark)

    Paulsen, Aksel; Overgaard, Søren; Lauritsen, Jens Martin

    2012-01-01

    The clinical and scientific usage of patient-reported outcome measures is increasing in the health services. Often paper forms are used. Manual double entry of data is defined as the definitive gold standard for transferring data to an electronic format, but the process is laborious. Automated...

  4. From Covert Processes to Overt Outcomes of Refutation Text Reading: The Interplay of Science Text Structure and Working Memory Capacity through Eye Fixations

    Science.gov (United States)

    Ariasi, Nicola; Mason, Lucia

    2014-01-01

    This study extends current research on the refutation text effect by investigating it in learners with different levels of working memory capacity. The purpose is to outline the link between online processes (revealed by eye fixation indices) and off-line outcomes in these learners. In science education, unlike a standard text, a refutation text…

  5. Modelling self-efficacy, self-regulation, self-directed learning and career processes of adult professionals and relations with learning outcomes and labour market success

    NARCIS (Netherlands)

    Bijker, Monique; Van der Klink, Marcel; Boshuizen, Els

    2010-01-01

    Bijker, M. M., Van der Klink, M. R., & Boshuizen, H. P. A. (2010, 25-27 August). Modelling self-efficacy, self-regulation, self-directed learning and career processes of adult professionals and relations with learning outcomes and labour market success. Paper presented at the 5th EARLI-SIG14

  6. Exploration, Development, and Validation of Patient-reported Outcomes in Antineutrophil Cytoplasmic Antibody–associated Vasculitis Using the OMERACT Process

    Science.gov (United States)

    Robson, Joanna C.; Milman, Nataliya; Tomasson, Gunnar; Dawson, Jill; Cronholm, Peter F.; Kellom, Katherine; Shea, Judy; Ashdown, Susan; Boers, Maarten; Boonen, Annelies; Casey, George C.; Farrar, John T.; Gebhart, Don; Krischer, Jeffrey; Lanier, Georgia; McAlear, Carol A.; Peck, Jacqueline; Sreih, Antoine G.; Tugwell, Peter; Luqmani, Raashid A.; Merkel, Peter A.

    2016-01-01

    Objective Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of linked multisystem life- and organ-threatening diseases. The Outcome Measures in Rheumatology (OMERACT) vasculitis working group has been at the forefront of outcome development in the field and has achieved OMERACT endorsement of a core set of outcomes for AAV. Patients with AAV report as important some manifestations of disease not routinely collected through physician-completed outcome tools; and they rate common manifestations differently from investigators. The core set includes the domain of patient-reported outcomes (PRO). However, PRO currently used in clinical trials of AAV do not fully characterize patients’ perspectives on their burden of disease. The OMERACT vasculitis working group is addressing the unmet needs for PRO in AAV. Methods Current activities of the working group include (1) evaluating the feasibility and construct validity of instruments within the PROMIS (Patient-Reported Outcome Measurement Information System) to record components of the disease experience among patients with AAV; (2) creating a disease-specific PRO measure for AAV; and (3) applying The International Classification of Functioning, Disability and Health to examine the scope of outcome measures used in AAV. Results The working group has developed a comprehensive research strategy, organized an investigative team, included patient research partners, obtained peer-reviewed funding, and is using a considerable research infrastructure to complete these interrelated projects to develop evidence-based validated outcome instruments that meet the OMERACT filter of truth, discrimination, and feasibility. Conclusion The OMERACT vasculitis working group is on schedule to achieve its goals of developing validated PRO for use in clinical trials of AAV. (First Release September 1 2015; J Rheumatol 2015;42:2204–9; doi:10.3899/jrheum.141143) PMID:26329344

  7. Bariatric surgery in adolescents: what's the rationale? What's rational?

    Science.gov (United States)

    Austin, Heather; Smith, Kevin C; Ward, Wendy L

    2012-06-01

    Rates of obesity in adolescents continue to rise, and available lifestyle and pharmacological interventions have had limited success in reducing excess weight and risk for comorbid health issues. However, ongoing health risks, psychosocial issues, and increased risk of mortality place these adolescents in jeopardy and warrant ongoing investigation for available treatments. Bariatric surgery for adults has had positive medical and psychological outcomes. However, bariatric surgery is a relatively new option for adolescents. Initial findings suggest positive results for excess weight loss and psychosocial improvements, but not without possible risks. Selection of appropriate candidates is essential in the process, specifically considering developmental maturity, family support, and resultant disease burden without surgery. Surgery is not a panacea for the obesity epidemic. Outcome studies are limited and long-term results are unknown, but for extremely obese adolescents, bariatric surgery is promising and should be considered a viable option for appropriate adolescent candidates.

  8. The role of psycho-education in improving outcome at a general ...

    African Journals Online (AJOL)

    rationale was to evaluate the effect of psychoeducation in a ... one of the outcome measures was compliance with .... closer routes to care such as traditional healers or local .... psychoeducation model, the content of which we believed.

  9. Relationships between structure, process and outcome to assess quality of integrated chronic disease management in a rural South African setting: applying a structural equation model.

    Science.gov (United States)

    Ameh, Soter; Gómez-Olivé, Francesc Xavier; Kahn, Kathleen; Tollman, Stephen M; Klipstein-Grobusch, Kerstin

    2017-03-23

    South Africa faces a complex dual burden of chronic communicable and non-communicable diseases (NCDs). In response, the Integrated Chronic Disease Management (ICDM) model was initiated in primary health care (PHC) facilities in 2011 to leverage the HIV/ART programme to scale-up services for NCDs, achieve optimal patient health outcomes and improve the quality of medical care. However, little is known about the quality of care in the ICDM model. The objectives of this study were to: i) assess patients' and operational managers' satisfaction with the dimensions of ICDM services; and ii) evaluate the quality of care in the ICDM model using Avedis Donabedian's theory of relationships between structure (resources), process (clinical activities) and outcome (desired result of healthcare) constructs as a measure of quality of care. A cross-sectional study was conducted in 2013 in seven PHC facilities in the Bushbuckridge municipality of Mpumalanga Province, north-east South Africa - an area underpinned by a robust Health and Demographic Surveillance System (HDSS). The patient satisfaction questionnaire (PSQ-18), with measures reflecting structure/process/outcome (SPO) constructs, was adapted and administered to 435 chronic disease patients and the operational managers of all seven PHC facilities. The adapted questionnaire contained 17 dimensions of care, including eight dimensions identified as priority areas in the ICDM model - critical drugs, equipment, referral, defaulter tracing, prepacking of medicines, clinic appointments, waiting time, and coherence. A structural equation model was fit to operationalise Donabedian's theory, using unidirectional, mediation, and reciprocal pathways. The mediation pathway showed that the relationships between structure, process and outcome represented quality systems in the ICDM model. Structure correlated with process (0.40) and outcome (0.75). Given structure, process correlated with outcome (0.88). Of the 17 dimensions of care in

  10. The anticipation and outcome phases of reward and loss processing: A neuroimaging meta-analysis of the monetary incentive delay task.

    Science.gov (United States)

    Oldham, Stuart; Murawski, Carsten; Fornito, Alex; Youssef, George; Yücel, Murat; Lorenzetti, Valentina

    2018-04-25

    The processing of rewards and losses are crucial to everyday functioning. Considerable interest has been attached to investigating the anticipation and outcome phases of reward and loss processing, but results to date have been inconsistent. It is unclear if anticipation and outcome of a reward or loss recruit similar or distinct brain regions. In particular, while the striatum has widely been found to be active when anticipating a reward, whether it activates in response to the anticipation of losses as well remains ambiguous. Furthermore, concerning the orbitofrontal/ventromedial prefrontal regions, activation is often observed during reward receipt. However, it is unclear if this area is active during reward anticipation as well. We ran an Activation Likelihood Estimation meta-analysis of 50 fMRI studies, which used the Monetary Incentive Delay Task (MIDT), to identify which brain regions are implicated in the anticipation of rewards, anticipation of losses, and the receipt of reward. Anticipating rewards and losses recruits overlapping areas including the striatum, insula, amygdala and thalamus, suggesting that a generalised neural system initiates motivational processes independent of valence. The orbitofrontal/ventromedial prefrontal regions were recruited only during the reward outcome, likely representing the value of the reward received. Our findings help to clarify the neural substrates of the different phases of reward and loss processing, and advance neurobiological models of these processes. © 2018 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

  11. The association between hypertension-specific care management processes and blood pressure outcomes in US-based physician organizations.

    Science.gov (United States)

    Wong, Ken; Smalarz, Amy; Wu, Ning; Boulanger, Luke; Wogen, Jenifer

    2011-01-01

    Care management processes (CMP) may be implemented in health systems to improve chronic disease quality of care. The objective of this study was to assess the relationship between the presence of hypertension-specific CMP and blood pressure (BP) control among hypertensive patients within selected physician organizations in the USA-modified version of the Physician Practice Connection Readiness Survey (PPC-RS), developed by The National Committee for Quality Assurance (NCQA), was administered to chief medical officers at 28 US-based physician organizations in 2010. Hypertension-specific survey items were added to the PPC-RS and focused on medication fill compliance, chronic disease management, and patient self-management. Demographic and clinical cross-sectional data from a random sample of 300 hypertensive patients age 18 years or older were collected at each site. Physician site and patient characteristics were reported. Regression models were used to assess the relationship between hypertension-specific physician practices and patient BP control. Eligible patients had at least a 1-year history of care with the physician organization and had an encounter within the past year of data collection. Of the 28 participating sites, most had electronic medical records that handle total functionality (71.4%) and had more than 50 staff members (78.6%). Across all sites, approximately 61% of patients had controlled BP. Regression analyses found that practices that used physician education as an effort to improve medication fill compliance demonstrated improvement in BP control (changes in systolic BP: beta coefficient = -1.366, P = .034; changes in diastolic BP: beta coefficient = -0.859, P = .056). The use of a systematic process to screen or assess patients for hypertension as a risk factor was also found to be associated with improvements in BP control (changes in diastolic BP: beta coefficient = -0.860, P = .006). In addition, physician practices that maintained a list

  12. Computerized clinical decision support systems for primary preventive care: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes.

    Science.gov (United States)

    Souza, Nathan M; Sebaldt, Rolf J; Mackay, Jean A; Prorok, Jeanette C; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

    2011-08-03

    Computerized clinical decision support systems (CCDSSs) are claimed to improve processes and outcomes of primary preventive care (PPC), but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs) assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63%) RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34%) trials assessed patient outcomes, and four (29%) reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15%) and two (5%) trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Evidence supports the effectiveness of CCDSSs for screening and

  13. Computerized clinical decision support systems for primary preventive care: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

    Directory of Open Access Journals (Sweden)

    Wilczynski Nancy L

    2011-08-01

    Full Text Available Abstract Background Computerized clinical decision support systems (CCDSSs are claimed to improve processes and outcomes of primary preventive care (PPC, but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63% RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34% trials assessed patient outcomes, and four (29% reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15% and two (5% trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Conclusions

  14. Evaluation of the short- and long-term safety and therapy outcomes of the everolimus-eluting bioresorbable vascular scaffold system in patients with coronary artery stenosis: Rationale and design of the German–Austrian ABSORB RegIstRy (GABI-R)

    Energy Technology Data Exchange (ETDEWEB)

    Nef, Holger, E-mail: holger.nef@innere.med.uni-giessen.de [University of Giessen, Medizinische Klinik I, Department of Cardiology, Giessen (Germany); Wiebe, Jens [University of Giessen, Medizinische Klinik I, Department of Cardiology, Giessen (Germany); Achenbach, Stefan [University of Erlangen, Medizinische Klinik II, Department of Cardiology, Erlangen (Germany); Münzel, Thomas [Department of Medicine II, University Medical Center, Johannes Gutenberg University Mainz, Mainz (Germany); Naber, Christoph [Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen (Germany); Richardt, Gert [Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg (Germany); Mehilli, Julinda [Department of Cardiology, Klinikum Großhadern, Ludwig- Maximilian Universität, Munich (Germany); Wöhrle, Jochen [Department of Internal Medicine II, University of Ulm, Ulm (Germany); Neumann, Till; Biermann, Janine [University of Essen, Department of Cardiology, Essen (Germany); Zahn, Ralf [Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen (Germany); Kastner, Johannes [Department of Cardiology, University of Vienna Medical School, Vienna (Austria); Schmermund, Axel [CCB, Cardioangiologisches Centrum Bethanien, Frankfurt (Germany); Pfannebecker, Thomas [Abbott Vascular Deutschland GmbH, Wetzlar (Germany); Schneider, Steffen; Limbourg, Tobias [Institut für Herzinfarktforschung, Ludwigshafen (Germany); Hamm, Christian W. [University of Giessen, Medizinische Klinik I, Department of Cardiology, Giessen (Germany); Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim (Germany)

    2016-01-15

    Background: Third-generation drug-eluting metal stents are the gold standard for treatment of coronary artery disease. The permanent metallic caging of the vessel, however, can result in limited vasomotion, chronic inflammation, and late expansive remodeling, conditions that can lead to late and very late stent thrombosis. The development of bioresorbable scaffolds (BRSs) promises advantages over metal stents due to complete biodegradation within 2–4 years. Theoretically, since vessel scaffolding is temporary and no permanent implant remains in the vessel, BRSs, as opposed to metal stents, once degraded would no longer be potential triggers for stent-related adverse events or side effects. Methods/design: The short- and long-term outcome after implantation of an everolimus-eluting, poly-L-lactic acid-based bioresorbable scaffold system (ABSORB, Abbott Vascular, Santa Clara, CA, USA) in the world-wide greatest all-comers cohort will be evaluated in the prospective, non-interventional, multicenter German–Austrian ABSORB RegIstRy (GABI-R). GABI-R will include over 5000 patients from about 100 study sites in Austria and Germany. Safety endpoints such as cardiac death, myocardial infarction, and clinically driven percutaneous or surgical target lesion and vessel revascularization will be evaluated during hospitalization and in the follow-up period (minimum of 5 years). Conclusion: Although two randomized controlled trials and several registries have documented safety and efficacy as well as non-inferiority of this everolimus-eluting ABSORB device compared with drug-eluting metal stents, the current knowledge regarding clinical application, treatment success, and long-term safety of using this BRS in daily routine is limited. Thus, the goal of GABI-R is to address this lack of information. - Highlights: • The GABI-R addresses a lack of data about bioresorbable scaffolds in daily practice. • 5000 patients with minimal in- and exclusion criteria at 100 sites will

  15. Evaluation of the short- and long-term safety and therapy outcomes of the everolimus-eluting bioresorbable vascular scaffold system in patients with coronary artery stenosis: Rationale and design of the German–Austrian ABSORB RegIstRy (GABI-R)

    International Nuclear Information System (INIS)

    Nef, Holger; Wiebe, Jens; Achenbach, Stefan; Münzel, Thomas; Naber, Christoph; Richardt, Gert; Mehilli, Julinda; Wöhrle, Jochen; Neumann, Till; Biermann, Janine; Zahn, Ralf; Kastner, Johannes; Schmermund, Axel; Pfannebecker, Thomas; Schneider, Steffen; Limbourg, Tobias; Hamm, Christian W.

    2016-01-01

    Background: Third-generation drug-eluting metal stents are the gold standard for treatment of coronary artery disease. The permanent metallic caging of the vessel, however, can result in limited vasomotion, chronic inflammation, and late expansive remodeling, conditions that can lead to late and very late stent thrombosis. The development of bioresorbable scaffolds (BRSs) promises advantages over metal stents due to complete biodegradation within 2–4 years. Theoretically, since vessel scaffolding is temporary and no permanent implant remains in the vessel, BRSs, as opposed to metal stents, once degraded would no longer be potential triggers for stent-related adverse events or side effects. Methods/design: The short- and long-term outcome after implantation of an everolimus-eluting, poly-L-lactic acid-based bioresorbable scaffold system (ABSORB, Abbott Vascular, Santa Clara, CA, USA) in the world-wide greatest all-comers cohort will be evaluated in the prospective, non-interventional, multicenter German–Austrian ABSORB RegIstRy (GABI-R). GABI-R will include over 5000 patients from about 100 study sites in Austria and Germany. Safety endpoints such as cardiac death, myocardial infarction, and clinically driven percutaneous or surgical target lesion and vessel revascularization will be evaluated during hospitalization and in the follow-up period (minimum of 5 years). Conclusion: Although two randomized controlled trials and several registries have documented safety and efficacy as well as non-inferiority of this everolimus-eluting ABSORB device compared with drug-eluting metal stents, the current knowledge regarding clinical application, treatment success, and long-term safety of using this BRS in daily routine is limited. Thus, the goal of GABI-R is to address this lack of information. - Highlights: • The GABI-R addresses a lack of data about bioresorbable scaffolds in daily practice. • 5000 patients with minimal in- and exclusion criteria at 100 sites will

  16. Design of a study on suboptimal cognitive acts in the diagnostic process, the effect on patient outcomes and the influence of workload, fatigue and experience of physician

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit

    2009-04-01

    Full Text Available Abstract Background Diagnostic error is an important error type since diagnostic adverse events are regularly judged as being preventable and the consequences are considered to be severe. Existing research often focuses on either diagnostic adverse events or on the errors in diagnostic reasoning. Whether and when an incorrect diagnostic process results in adverse outcomes has not been studied extensively. The present paper describes the design of a study that aims to study the relationship between a suboptimal diagnostic process and patient outcomes. In addition, the role of personal and circumstantial factors on the quality of the diagnostic process will be examined. Methods/Design The research questions were addressed using several data sources. First, the differential diagnosis was assessed concurrently to the diagnostic process. Second, the patient records of 248 patients suffering from shortness of breath were reviewed by expert internists in order to reveal suboptimal cognitive acts and (potential consequences for the patient. The suboptimal cognitive acts were discussed with the treating physicians and classified with the taxonomy of unsafe acts. Third, workload, fatigue and work experience were measured during the physicians work. Workload and fatigue were measured during the physicians shift using the NASA tlx questionnaire on a handheld computer. Physicians participating in the study also answered questions about their work experience. Discussion The design used in this study provides insight into the relationship between suboptimal cognitive acts in the diagnostic process and possible consequences for the patient. Suboptimal cognitive acts in the diagnostic process and its causes can be revealed. Additional measurements of workload, fatigue and experience allow examining the influence of these factors on the diagnostic process. In conclusion, the present design provides a method with which insights in weaknesses of the diagnostic

  17. Impact of red and processed meat and fibre intake on treatment outcomes among patients with chronic inflammatory diseases

    DEFF Research Database (Denmark)

    Christensen, Robin; Heitmann, Berit L; Andersen, Karina Winther

    2018-01-01

    will be assessed using patient-reported outcome measures, clinical assessments of disease activity, quality of life and lifestyle, in addition to registry data on comorbidity and concomitant medication(s). In accordance with current Danish standards, follow-up will be conducted 14-16 weeks after treatment...

  18. Therapeutic Alliance and Treatment Adherence in Two Interventions for Bulimia Nervosa: A Study of Process and Outcome

    Science.gov (United States)

    Loeb, Katharine L.; Wilson, G. Terence; Labouvie, Erich; Pratt, Elizabeth M.; Hayaki, Jumi; Walsh, B. Timothy; Agras, W. Stewart; Fairburn, Christopher G.

    2005-01-01

    The relationship between therapeutic alliance, therapist adherence to treatment protocol, and outcome was analyzed in a randomized trial of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy for bulimia nervosa. Independent observers rated audiotapes of full-length therapy sessions. Purging frequency was the primary outcome…

  19. Adapting an Outcome-Based Education Development Process to Meet Near Real-Time Challenges to Sustainable Agricultural Production

    Science.gov (United States)

    Halbleib, Mary L.; Jepson, Paul C.

    2015-01-01

    Purpose: This paper examines the benefits of using an outcome-based education (OBE) method within agricultural extension outreach programmes for professional and farmer audiences. Design/Methodology/Approach: The method is elaborated through two practical examples, which show that focused, short-duration programmes can produce meaningful skill…

  20. A Follow-Up Study of Relational Processes and Consultation Outcomes for Students with Attention Deficit Hyperactivity Disorder

    Science.gov (United States)

    Erchul, William P.; DuPaul, George J.; Bennett, Megan S.; Grissom, Priscilla F.; Jitendra, Asha K.; Tresco, Katy E.; Volpe, Robert J.; Vile Junod, Rosemary E.; Flammer-Rivera, Lizette M.; Mannella, Mark C.

    2009-01-01

    The purpose of this study was to link consultant and teacher verbal interaction patterns to consultation outcomes. Participants were 4 consultants, 20 teachers, and 20 elementary school students with attention deficit hyperactivity disorder. Audiotaped Problem Analysis Interviews (PAIs) from Project PASS (Promoting Academic Success in Students)…

  1. Multi-level prediction of short-term outcome of depression : non-verbal interpersonal processes, cognitions and personality traits

    NARCIS (Netherlands)

    Geerts, E; Bouhuys, N

    1998-01-01

    It was hypothesized that personality factors determine the short-term outcome of depression, and that they may do this via non-verbal interpersonal interactions and via cognitive interpretations of non-verbal behaviour. Twenty-six hospitalized depressed patients entered the study. Personality

  2. Young drivers' responses to anti-speeding advertisements: Comparison of self-report and objective measures of persuasive processing and outcomes.

    Science.gov (United States)

    Kaye, Sherrie-Anne; Lewis, Ioni; Algie, Jennifer; White, Melanie J

    2016-05-18

    Self-report measures are typically used to assess the effectiveness of road safety advertisements. However, psychophysiological measures of persuasive processing (i.e., skin conductance response [SCR]) and objective driving measures of persuasive outcomes (i.e., in-vehicle Global Positioning System [GPS] devices) may provide further insights into the effectiveness of these advertisements. This study aimed to explore the persuasive processing and outcomes of 2 anti-speeding advertisements by incorporating both self-report and objective measures of speeding behavior. In addition, this study aimed to compare the findings derived from these different measurement approaches. Young drivers (N = 20, M age = 21.01 years) viewed either a positive or negative emotion-based anti-speeding television advertisement. While viewing the advertisement, SCR activity was measured to assess ad-evoked arousal responses. The RoadScout GPS device was then installed in participants' vehicles for 1 week to measure on-road speed-related driving behavior. Self-report measures assessed persuasive processing (emotional and arousal responses) and actual driving behavior. There was general correspondence between the self-report measures of arousal and the SCR and between the self-report measure of actual driving behavior and the objective driving data (as assessed via the GPS devices). This study provides insights into how psychophysiological and GPS devices could be used as objective measures in conjunction with self-report measures to further understand the persuasive processes and outcomes of emotion-based anti-speeding advertisements.

  3. [Cleaning and disinfection in nursing homes. Data on quality of structure, process and outcome in nursing homes in Frankfurt am Main, Germany, 2011].

    Science.gov (United States)

    Heudorf, U; Gasteyer, S; Samoiski, Y; Voigt, K

    2012-08-01

    Due to the Infectious Disease Prevention Act, public health services in Germany are obliged to check the infection prevention in hospitals and other medical facilities as well as in nursing homes. In Frankfurt/Main, Germany, standardized control visits have been performed for many years. In 2011 focus was laid on cleaning and disinfection of surfaces. All 41 nursing homes were checked according to a standardized checklist covering quality of structure (i.e. staffing, hygiene concept), quality of process (observation of the cleaning processes in the homes) and quality of output, which was monitored by checking the cleaning of fluorescent marks which had been applied some days before and should have been removed via cleaning in the following days before the final check. In more than two thirds of the homes, cleaning personnel were salaried, in one third external personnel were hired. Of the homes 85% provided service clothing and all of them offered protective clothing. All homes had established hygiene and cleaning concepts, however, in 15% of the homes concepts for the handling of Norovirus and in 30% concepts for the handling of Clostridium difficile were missing. Regarding process quality only half of the processes observed, i.e. cleaning of hand contact surfaces, such as handrails, washing areas and bins, were correct. Only 44% of the cleaning controls were correct with enormous differences between the homes (0-100%). The correlation between quality of process and quality of output was significant. There was good quality of structure in the homes but regarding quality of process and outcome there was great need for improvement. This was especially due to faults in communication and coordination between cleaning personnel and nursing personnel. Quality outcome was neither associated with the number of the places for residents nor with staffing. Thus, not only quality of structure but also quality of process and outcome should be checked by the public health

  4. Operationalizing "trance". I: Rationale and research using a psychophenomenological approach.

    Science.gov (United States)

    Pekala, R J; Kumar, V K

    2000-10-01

    Despite the popularity of the term "trance" among clinicians to describe the subjective effects associated with being hypnotized, heretofore there has been no means to operationalize that definition. The authors present a rationale and psychophenomenological method to operationalize the term "trance" in terms of (a) hypnotic depth, a quantitative measure of subjective trance assessed via a pHGS (predicted Harvard Group Scale) score, derived from regression analysis, and (b) "trance typology profiles," a qualitative differentiation of empirically derived (via cluster and discriminant analyses) categories of subjective trance experiences. The authors then discuss theoretical and clinical implications of this psychophenomenological approach for developing an operational definition of the concept of trance.

  5. Exploration in Ways and Rationales of Designing A Desirable Webquest

    Institute of Scientific and Technical Information of China (English)

    覃靓

    2017-01-01

    WebQuest is an advanced tool which could provide the significant scaffolding to support instructors through incorpo-rating learning objects within systematic designs of learning activities. The focus of this article is to explore how a Webquest is designed reasonably and what rationales are implied in such a design through a case study of Webquest design for a group of ESL/EFL learners in Grade 12. The result indicates that a Webquest which is guided by the principles of constructivist problem solving, social interaction and scaffolding learning can be regarded as a desirable Webquest.

  6. Plato's Cosmic Theology: A Rationale for a Polytheistic Astrology?

    Science.gov (United States)

    Henriques, André

    2015-05-01

    Plato's cosmology influenced classical astronomy and religion, but was in turn influenced by the polytheistic context of its time. Throughout his texts, including the cosmological treatise Timaeus, and the discussions on the soul in the Phaedrus, Plato (c.428-c.348 BC) established what can be generalised as Platonic cosmological thought. An understanding of the philosophical and mythical levels of Platonic thought can provide a rationale for polytheistic and astrological worldviews, pointing to some cosmological continuity, alongside major shifts, from ancient Greek religion to the astrological thought of ancient astronomers such as Claudius Ptolemy.

  7. Rationale of physical rehabilitation of patients with violation coronary circulation

    Directory of Open Access Journals (Sweden)

    Anvar Morad Pour Heidari Roudberi

    2013-09-01

    Full Text Available The aim of the study is to examine the risk factors that lead to the violation of the coronary circulation. Rationale for the use of physical rehabilitation to restore optimal hemodynamics in the myocardium. Considered views on the causes of the high mortality rate of the population of Ukraine of cardiovascular disease. It is shown that the main cause of death is coronary heart disease. Suggested that the major risk factors for coronary heart disease is high cholesterol, hypertension and obesity. Proposed to use exercise therapy, dosage walking, psychotherapy, autogenic training and diet therapy in rehabilitation program patients with impaired coronary circulation.

  8. Critique of rationale for transmutation of nuclear waste

    International Nuclear Information System (INIS)

    Smith, C.F.; Cohen, J.J.

    1980-07-01

    It has been suggested that nuclear transmutation could be used in the elimination or reduction of hazards from radioactive wastes. The rationale for this suggestion is the subject of this paper. The objectives of partitioning-transmutation are described. The benefits are evaluated. The author concludes that transmutation would appear at best to offer the opportunity of reducing an already low risk. This would not seem to be justifiable considering the cost. If non-radiological risks are considered, there is a negative total benefit

  9. Effects of performance feedback and coaching on the problem-solving process: Improving the integrity of implementation and enhancing student outcomes

    Science.gov (United States)

    Lundahl, Allison A.

    Schools implementing Response to Intervention (RtI) procedures frequently engage in team problem-solving processes to address the needs of students who require intensive and individualized services. Because the effectiveness of the problem-solving process will impact the overall success of RtI systems, the present study was designed to learn more about how to strengthen the integrity of the problem-solving process. Research suggests that school districts must ensure high quality training and ongoing support to enhance the effectiveness, acceptability, and sustainability of the problem-solving process within an RtI model; however, there is a dearth of research examining the effectiveness of methods to provide this training and support. Consequently, this study investigated the effects of performance feedback and coaching strategies on the integrity with which teams of educators conducted the problem-solving process in schools. In addition, the relationships between problem-solving integrity, teacher acceptability, and student outcomes were examined. Results suggested that the performance feedback increased problem-solving procedural integrity across two of the three participating schools. Conclusions about the effectiveness of the (a) coaching intervention and (b) interventions implemented in the third school were inconclusive. Regression analyses indicated that the integrity with which the teams conducted the problem-solving process was a significant predictor of student outcomes. However, the relationship between problem-solving procedural integrity and teacher acceptability was not statistically significant.

  10. The relationship between time perspective and self-regulatory processes, abilities and outcomes: a protocol for a meta-analytical review.

    Science.gov (United States)

    Baird, Harriet M; Webb, Thomas L; Martin, Jilly; Sirois, Fuschia M

    2017-07-05

    Both theoretical and empirical evidence suggests that time perspective is likely to influence self-regulatory processes and outcomes. Despite the theoretical and practical significance of such relations, the relationship between time perspective and self-regulatory processes and outcomes across different measures, samples and life domains, including health, has yet to be explored. The proposed review will develop a taxonomy for classifying measures according to the self-regulatory process, ability or outcome that they are likely to reflect. Electronic scientific databases will be searched, along with relevant conference abstract booklets and citation lists. Additionally, a call for unpublished data will be submitted to relevant bodies. To be eligible for inclusion, studies must include a measure of time perspective and a measure of at least one self-regulatory process, ability and/ or outcome. Eligibility will not be restricted by publication date, language, type of sample or setting. The bivariate correlations will be extracted (or calculated) and submitted to a random-effects meta-analysis. The sample-weighted average effect size, heterogeneity, risk of bias and publication bias will be calculated, and the effects of categorical and continuous moderator variables on the effect sizes will be determined. The proposed meta-analysis will synthesise previously conducted research; thus, ethical approval is not required. The findings will be submitted for publication in an international peer-reviewed journal and reported as part of the first author’s PhD thesis. The findings will also be disseminated to the research community and, where appropriate, to other interested parties through presentations at relevant academic and non-academic conferences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Rationale and design: telepsychology service delivery for depressed elderly veterans

    Directory of Open Access Journals (Sweden)

    Richardson Lisa K

    2009-04-01

    Full Text Available Abstract Background Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health" represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1 utility to address existing problematic access to care for rural residents; (2 capacity to reduce stigma associated with traditional mental health care; and (3 utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas. Methods We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology" or traditional face-to-face services ("Same-Room". Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room. Two-hundred twenty-four (224 male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1 clinical outcomes (symptom severity, social functioning; (2 process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout; and (3 economic outcomes (cost and resource use. Discussion Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective

  12. The Association of State Legal Mandates for Data Submission of Central Line-associated Blood Stream Infections in Neonatal Intensive Care Units with Process and Outcome Measures

    Science.gov (United States)

    Zachariah, Philip; Reagan, Julie; Furuya, E. Yoko; Dick, Andrew; Liu, Hangsheng; Herzig, Carolyn T.A; Pogorzelska-Maziarz, Monika; Stone, Patricia W.; Saiman, Lisa

    2014-01-01

    Objective To determine the association between state legal mandates for data submission of central line-associated blood stream infections (CLABSIs) in neonatal intensive care units (NICUs) with process/outcome measures. Design Cross-sectional study. Participants National sample of level II/III and III NICUs participating in National Healthcare Safety Network (NHSN) surveillance. Methods State mandates for data submission of CLABSIs in NICUs in place by 2011 were compiled and verified with state healthcare-associated infection coordinators. A web-based survey of infection control departments in October 2011 assessed CLABSI prevention practices i.e. compliance with checklist and bundle components (process measures) in ICUs including NICUs. Corresponding 2011 NHSN NICU CLABSI rates (outcome measures) were used to calculate Standardized Infection Ratios (SIR). The association between mandates and process/outcome measures was assessed by multivariable logistic regression. Results Among 190 study NICUs, 107 (56.3%) NICUs were located in states with mandates, with mandates in place for 3 or more years for half. More NICUs in states with mandates reported ≥95% compliance to at least one CLABSI prevention practice (52.3% – 66.4%) than NICUs in states without mandates (28.9% – 48.2%). Mandates were predictors of ≥95% compliance with all practices (OR 2.8; 95% CI 1.4–6.1). NICUs in states with mandates reported lower mean CLABSI rates in the prevention practices but not with lower CLABSI rates. PMID:25111921

  13. What's to Be Done About Laboratory Quality? Process Indicators, Laboratory Stewardship, the Outcomes Problem, Risk Assessment, and Economic Value: Responding to Contemporary Global Challenges.

    Science.gov (United States)

    Meier, Frederick A; Badrick, Tony C; Sikaris, Kenneth A

    2018-02-17

    For 50 years, structure, process, and outcomes measures have assessed health care quality. For clinical laboratories, structural quality has generally been assessed by inspection. For assessing process, quality indicators (QIs), statistical monitors of steps in the clinical laboratory total testing, have proliferated across the globe. Connections between structural and process laboratory measures and patient outcomes, however, have rarely been demonstrated. To inform further development of clinical laboratory quality systems, we conducted a selective but worldwide review of publications on clinical laboratory quality assessment. Some QIs, like seven generic College of American Pathologists Q-Tracks monitors, have demonstrated significant process improvement; other measures have uncovered critical opportunities to improve test selection and result management. The College of Pathologists of Australasia Key Indicator Monitoring and Management System has deployed risk calculations, introduced from failure mode effects analysis, as surrogate measures for outcomes. Showing economic value from clinical laboratory testing quality is a challenge. Clinical laboratories should converge on fewer (7-14) rather than more (21-35) process monitors; monitors should cover all steps of the testing process under laboratory control and include especially high-risk specimen-quality QIs. Clinical laboratory stewardship, the combination of education interventions among clinician test orderers and report consumers with revision of test order formats and result reporting schemes, improves test ordering, but improving result reception is more difficult. Risk calculation reorders the importance of quality monitors by balancing three probabilities: defect frequency, weight of potential harm, and detection difficulty. The triple approach of (1) a more focused suite of generic consensus quality indicators, (2) more active clinical laboratory testing stewardship, and (3) integration of formal

  14. A randomised trial of the Flinders Program to improve patient self-management competencies in a range of chronic conditions: study rationale and protocol

    Directory of Open Access Journals (Sweden)

    Malcolm W. Battersby

    2010-03-01

    Full Text Available BackgroundSupporting self management is seen as an important healthservice strategy in dealing with the large and increasing healthburden of chronic conditions. Several types of selfmanagementprograms are available. Evidence to datesuggests that disease-specific and lay-led self managementprograms provide only part of the support needed forimproved outcomes. The Flinders Program is promising as ageneric self management intervention, which can becombined with targeted disease-specific and lay-ledinterventions, but it has yet to be evaluated for a range ofchronic conditions using a rigorous controlled trial design. Thispaper gives the rationale for a randomised controlled trial andprocess evaluation of the Flinders Program of chroniccondition self-management in community practice, and detailsand justifies the design of such a study.MethodThe design for a randomised trial and associated processevaluation, suited to evaluation of a complex and behaviouralintervention as it is applied in actual practice, is presented andjustified.ConclusionA randomised trial of the Flinders Program is required and afunctional design is presented. Results from this trial,currently underway, will test the effectiveness of the FlindersProgram in improving patient competencies in selfmanagementof chronic conditions in practice conditions.A process evaluation alongside the trial will exploresystem, provider and patient factors associated withgreater and lesser Program effectiveness.

  15. Rationale for statistical characteristics of road safety parameters

    Directory of Open Access Journals (Sweden)

    Dormidontova Tatiana

    2017-01-01

    Full Text Available When making engineering decisions at the stage of designing auto-roads and man-made structures it is necessary to take into account the statistical variability of physical and mechanical characteristics of the used materials as well as the different effects on the structures. Thus the rationale for the statistical characteristics of the parameters that determine the reliability of roads and man-made engineering facilities is of particular importance.There are many factors to be considered while designing roads, such as natural climatic factors, the accidental effects of the operating loads, the strength and deformation characteristics of the materials, the geometric parameters of the structure, etc. which affect the strength characteristics of roads and man-made structures. The rationale for statistical characteristics of the parameters can help an engineer assess the reliability of the decision and the economic risk, as well as avoid making mistakes in the design of roads and man-made structures.However, some statistical characteristics of the parameters that define the reliability of a road and man-made structures play a key role in the design. These are the visibility distance in daytime for the peak curve, variation coefficient of radial acceleration, the reliability of visibility distance and other parameters.

  16. An anthology: Rationale for a US ballistic missile defense (1969 - 1984)

    Science.gov (United States)

    Tircuit, E. C.

    1985-04-01

    This anthology is a selection and short synopsis of representative articles on the rationale for a US ballistic missile defense (BMD). Unclassified articles and documents were reviewed and analyzed to identify and include nine representative articles in the anthology. The anthology reduces the search for quality material on the subject and documents the fundamental rationale for a BMD. The author concluded that the fundamental rationale for a US BMD is to deter nuclear war. In addition, specific rationale for a US BMD is provided in the anthology. Finally, an extensive bibliography is included in the anthology to enhance further research on the subject.

  17. Design and rationale for examining neuroimaging genetics in ischemic stroke: The MRI-GENIE study.

    Science.gov (United States)

    Giese, Anne-Katrin; Schirmer, Markus D; Donahue, Kathleen L; Cloonan, Lisa; Irie, Robert; Winzeck, Stefan; Bouts, Mark J R J; McIntosh, Elissa C; Mocking, Steven J; Dalca, Adrian V; Sridharan, Ramesh; Xu, Huichun; Frid, Petrea; Giralt-Steinhauer, Eva; Holmegaard, Lukas; Roquer, Jaume; Wasselius, Johan; Cole, John W; McArdle, Patrick F; Broderick, Joseph P; Jimenez-Conde, Jordi; Jern, Christina; Kissela, Brett M; Kleindorfer, Dawn O; Lemmens, Robin; Lindgren, Arne; Meschia, James F; Rundek, Tatjana; Sacco, Ralph L; Schmidt, Reinhold; Sharma, Pankaj; Slowik, Agnieszka; Thijs, Vincent; Woo, Daniel; Worrall, Bradford B; Kittner, Steven J; Mitchell, Braxton D; Rosand, Jonathan; Golland, Polina; Wu, Ona; Rost, Natalia S

    2017-10-01

    To describe the design and rationale for the genetic analysis of acute and chronic cerebrovascular neuroimaging phenotypes detected on clinical MRI in patients with acute ischemic stroke (AIS) within the scope of the MRI-GENetics Interface Exploration (MRI-GENIE) study. MRI-GENIE capitalizes on the existing infrastructure of the Stroke Genetics Network (SiGN). In total, 12 international SiGN sites contributed MRIs of 3,301 patients with AIS. Detailed clinical phenotyping with the web-based Causative Classification of Stroke (CCS) system and genome-wide genotyping data were available for all participants. Neuroimaging analyses include the manual and automated assessments of established MRI markers. A high-throughput MRI analysis pipeline for the automated assessment of cerebrovascular lesions on clinical scans will be developed in a subset of scans for both acute and chronic lesions, validated against gold standard, and applied to all available scans. The extracted neuroimaging phenotypes will improve characterization of acute and chronic cerebrovascular lesions in ischemic stroke, including CCS subtypes, and their effect on functional outcomes after stroke. Moreover, genetic testing will uncover variants associated with acute and chronic MRI manifestations of cerebrovascular disease. The MRI-GENIE study aims to develop, validate, and distribute the MRI analysis platform for scans acquired as part of clinical care for patients with AIS, which will lead to (1) novel genetic discoveries in ischemic stroke, (2) strategies for personalized stroke risk assessment, and (3) personalized stroke outcome assessment.

  18. The PROgnostic Value of unrequested Information in Diagnostic Imaging (PROVIDI) Study: rationale and design

    International Nuclear Information System (INIS)

    Gondrie, M. J. A.; Mali, W. P. Th. M.; Buckens, C. F. M.; Jacobs, P. C. A.; Grobbee, D. E.; Graaf, Y van der

    2010-01-01

    We describe the rationale for a new study examining the prognostic value of unrequested findings in diagnostic imaging. The deployment of more advanced imaging modalities in routine care means that such findings are being detected with increasing frequency. However, as the prognostic significance of many types of unrequested findings is unknown, the optimal response to such findings remains uncertain and in many cases an overly defensive approach is adopted, to the detriment of patient-care. Additionally, novel and promising image findings that are newly available on many routine scans cannot be used to improve patient care until their prognostic value is properly determined. The PROVIDI study seeks to address these issues using an innovative multi-center case-cohort study design. PROVIDI is to consist of a series of studies investigating specific, selected disease entities and clusters. Computed Tomography images from the participating hospitals are reviewed for unrequested findings. Subsequently, this data is pooled with outcome data from a central population registry. Study populations consist of patients with endpoints relevant to the (group of) disease(s) under study along with a random control sample from the cohort. This innovative design allows PROVIDI to evaluate selected unrequested image findings for their true prognostic value in a series of manageable studies. By incorporating unrequested image findings and outcomes data relevant to patients, truly meaningful conclusions about the prognostic value of unrequested and emerging image findings can be reached and used to improve patient-care.

  19. Apixaban for treatment of embolic stroke of undetermined source (ATTICUS randomized trial): Rationale and study design.

    Science.gov (United States)

    Geisler, Tobias; Poli, Sven; Meisner, Christoph; Schreieck, Juergen; Zuern, Christine S; Nägele, Thomas; Brachmann, Johannes; Jung, Werner; Gahn, Georg; Schmid, Elisabeth; Bäezner, Hansjörg; Keller, Timea; Petzold, Gabor C; Schrickel, Jan-Wilko; Liman, Jan; Wachter, Rolf; Schön, Frauke; Schabet, Martin; Lindner, Alfred; Ludolph, Albert C; Kimmig, Hubert; Jander, Sebastian; Schlegel, Uwe; Gawaz, Meinrad; Ziemann, Ulf

    2017-12-01

    Rationale Optimal secondary prevention of embolic stroke of undetermined source is not established. The current standard in these patients is acetylsalicylic acid, despite high prevalence of yet undetected paroxysmal atrial fibrillation. Aim The ATTICUS randomized trial is designed to determine whether the factor Xa inhibitor apixaban administered within 7 days after embolic stroke of undetermined source, is superior to acetylsalicylic acid for prevention of new ischemic lesions documented by brain magnetic resonance imaging within 12 months after index stroke. Design Prospective, randomized, blinded, parallel-group, open-label, German multicenter phase III trial in approximately 500 patients with embolic stroke of undetermined source. A key inclusion criterion is the presence or the planned implantation of an insertable cardiac monitor. Patients are 1:1 randomized to apixaban or acetylsalicylic acid and treated for a 12-month period. It is an event-driven trial aiming for core-lab adjudicated primary outcome events. Study outcomes The primary outcome is the occurrence of at least one new ischemic lesion identified by axial T2-weighted FLAIR magnetic resonance imaging and/or axial DWI magnetic resonance imaging at 12 months when compared with the baseline magnetic resonance imaging. Key secondary outcomes are the combination of recurrent ischemic strokes, hemorrhagic strokes, systemic embolism; combination of MACE including recurrent stroke, myocardial infarction, and cardiovascular death and combination of major and clinically relevant non-major bleeding defined according to ISTH, and change of cognitive function and quality of life (EQ-5D, Stroke Impact Scale). Discussion Embolic stroke of undetermined source is caused by embolic disease and associated with a high risk of recurrent ischemic strokes and clinically silent cerebral ischemic lesions. ATTICUS will investigate the impact of atrial fibrillation detected by insertable cardiac monitor and the effects of

  20. From European Identity and Media Imperialism to Public Diplomacy: The Changing Rationale Behind Euronews

    Directory of Open Access Journals (Sweden)

    Eva Polonska-Kimunguyi

    2012-11-01

    Full Text Available Euronews can be regarded as Europe’s most experimental and successful pan-national broadcaster. It is increasingly international in its organisation and output. The issues covered no longer concentrate on Europe. ‘Going global’ is the channel’s new motto. This paper outlines the changing rationale behind the creation of Euronews. It starts by discussing the American cultural imperialism of the 1970s and 1980s and the way it ignited European responses and counter-measures. It subsequently examines the politics of pan-national identity building in Europe and media’s role in the process. Finally, it demonstrates how Euronews has transformed itself into an instrument of the European Union’s transnational public diplomacy.

  1. Rationale and methods of discovering hormetins as drugs for healthy ageing

    DEFF Research Database (Denmark)

    Rattan, Suresh I S

    2012-01-01

    hormetins. Areas covered: Almost fifty years of modern biogerontolgical research has established a clear framework regarding the biological basis of aging and longevity, and it is now generally accepted that aging occurs in spite of the presence of complex pathways of maintenance, repair and defence...... development based in the ideas of hormesis and by following the strategy described here is a skin care cosmetic. Expert opinion: As a biomedical issue, the biological process of aging underlies several major diseases, and although the optimal treatment of every disease, irrespective of age, is a social......Introduction: Mild stress-induced hormesis is becoming increasingly attractive as an aging interventional strategy, and is leading to the discovery of hormesis-inducing compounds called homretins. This review gives the background, rationale and approaches for screening, testing and developing novel...

  2. Predicting sugar-sweetened behaviours with theory of planned behaviour constructs: Outcome and process results from the SIPsmartER behavioural intervention

    Science.gov (United States)

    Zoellner, Jamie M.; Porter, Kathleen J.; Chen, Yvonnes; Hedrick, Valisa E.; You, Wen; Hickman, Maja; Estabrooks, Paul A.

    2017-01-01

    Objective Guided by the theory of planned behaviour (TPB) and health literacy concepts, SIPsmartER is a six-month multicomponent intervention effective at improving SSB behaviours. Using SIPsmartER data, this study explores prediction of SSB behavioural intention (BI) and behaviour from TPB constructs using: (1) cross-sectional and prospective models and (2) 11 single-item assessments from interactive voice response (IVR) technology. Design Quasi-experimental design, including pre- and post-outcome data and repeated-measures process data of 155 intervention participants. Main Outcome Measures Validated multi-item TPB measures, single-item TPB measures, and self-reported SSB behaviours. Hypothesised relationships were investigated using correlation and multiple regression models. Results TPB constructs explained 32% of the variance cross sectionally and 20% prospectively in BI; and explained 13–20% of variance cross sectionally and 6% prospectively. Single-item scale models were significant, yet explained less variance. All IVR models predicting BI (average 21%, range 6–38%) and behaviour (average 30%, range 6–55%) were significant. Conclusion Findings are interpreted in the context of other cross-sectional, prospective and experimental TPB health and dietary studies. Findings advance experimental application of the TPB, including understanding constructs at outcome and process time points and applying theory in all intervention development, implementation and evaluation phases. PMID:28165771

  3. Structure, process, and annual ICU mortality across 69 centers: United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.

    Science.gov (United States)

    Checkley, William; Martin, Greg S; Brown, Samuel M; Chang, Steven Y; Dabbagh, Ousama; Fremont, Richard D; Girard, Timothy D; Rice, Todd W; Howell, Michael D; Johnson, Steven B; O'Brien, James; Park, Pauline K; Pastores, Stephen M; Patil, Namrata T; Pietropaoli, Anthony P; Putman, Maryann; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Sevransky, Jonathan E

    2014-02-01

    Hospital-level variations in structure and process may affect clinical outcomes in ICUs. We sought to characterize the organizational structure, processes of care, use of protocols, and standardized outcomes in a large sample of U.S. ICUs. We surveyed 69 ICUs about organization, size, volume, staffing, processes of care, use of protocols, and annual ICU mortality. ICUs participating in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Sixty-nine intensivists completed the survey. We characterized structure and process variables across ICUs, investigated relationships between these variables and annual ICU mortality, and adjusted for illness severity using Acute Physiology and Chronic Health Evaluation II. Ninety-four ICU directors were invited to participate in the study and 69 ICUs (73%) were enrolled, of which 25 (36%) were medical, 24 (35%) were surgical, and 20 (29%) were of mixed type, and 64 (93%) were located in teaching hospitals with a median number of five trainees per ICU. Average annual ICU mortality was 10.8%, average Acute Physiology and Chronic Health Evaluation II score was 19.3, 58% were closed units, and 41% had a 24-hour in-house intensivist. In multivariable linear regression adjusted for Acute Physiology and Chronic Health Evaluation II and multiple ICU structure and process factors, annual ICU mortality was lower in surgical ICUs than in medical ICUs (5.6% lower [95% CI, 2.4-8.8%]) or mixed ICUs (4.5% lower [95% CI, 0.4-8.7%]). We also found a lower annual ICU mortality among ICUs that had a daily plan of care review (5.8% lower [95% CI, 1.6-10.0%]) and a lower bed-to-nurse ratio (1.8% lower when the ratio decreased from 2:1 to 1.5:1 [95% CI, 0.25-3.4%]). In contrast, 24-hour intensivist coverage (p = 0.89) and closed ICU status (p = 0.16) were not associated with a lower annual ICU mortality. In a sample of 69 ICUs, a daily plan of care review and a lower bed-to-nurse ratio were both associated with a

  4. A qualitative analysis of teacher design teams: In-depth insights into their process and links with their outcomes

    NARCIS (Netherlands)

    Binkhorst, F.; Poortman, C. L.; van Joolingen, W.R.

    2017-01-01

    Abstract Teacher Design Teams (TDTs) are professional learning communities in which teachers collaborate to (re)design innovative educational materials. TDTs can contribute to teachers’ professional growth. Furthermore, engaging teachers in the design process could create ownership, increasing the

  5. A qualitative analysis of teacher design teams : In-depth insights into their process and links with their outcomes

    NARCIS (Netherlands)

    Binkhorst, Floor; Poortman, Cindy L.; van Joolingen, Wouter

    2017-01-01

    Teacher Design Teams (TDTs) are professional learning communities in which teachers collaborate to (re)design innovative educational materials. TDTs can contribute to teachers’ professional growth. Furthermore, engaging teachers in the design process could create ownership, increasing the likelihood

  6. A transactional framework for pediatric rehabilitation: shifting the focus to situated contexts, transactional processes, and adaptive developmental outcomes.

    Science.gov (United States)

    King, Gillian; Imms, Christine; Stewart, Debra; Freeman, Matt; Nguyen, Tram

    2018-07-01

    A paradigm shift is taking place in pediatric rehabilitation research, practice, and policy - a shift towards the real-life contexts of clients rather than requiring clients to navigate the world of pediatric rehabilitation. This article proposes a conceptual framework to bring about a broader awareness of clients' lives and transactional processes of change over the life course. The framework draws attention to transactional processes by which individuals, situated in life contexts, change and adapt over the life course and, in turn, influence their contextual settings and broader environments. This framework is based on (a) basic tenets derived from foundational theories taking a life course perspective to change, and (b) transactional processes identified from relevant pediatric rehabilitation models that bring these foundational theories into the pediatric rehabilitation sphere. The framework identifies three types of transactional processes relevant to pediatric rehabilitation: facilitative, resiliency, and socialization processes. These processes describe how contexts and people mutually influence each other via opportunities and situated experiences, thus facilitating capacity, adaptation to adversity, and socialization to new roles and life transitions. The utility of the framework is considered for research, practice, service organizations, and policy. Implications for Rehabilitation The framework supports practitioners going beyond person and environment as separate entities, to provide services to the "situated person" in real-life contexts The framework shifts the focus from "body structures/functions" and "person in activity" to "person in changing and challenging life contexts" Working from a transactional perspective, practitioner-client conversations will change; practitioners will view client situations through a lens of opportunities and experiences, assess client experiences in real-life contexts, and strive to create context-based therapy

  7. #RecruitmentSocialMedia : How Swedish organizations can utilize the beneficial outcomes of using social media in the recruitment process

    OpenAIRE

    Chan, Eddie; Kjellberg, Annie

    2017-01-01

    Due to changes in the labour market, organizations need to adjust and change their attitude towards the recruitment process. The traditional way of recruiting will eventually disappear and the use of social media will play an important part in recruiting. The recruitment process is a set of actions created by the organization and consists of: Recruitment Objectives, Strategy Development, Recruitment Activities, Intervening Job Applicant Variables and Recruitment Results. The use of social med...

  8. Impact of red and processed meat and fibre intake on treatment outcomes among patients with chronic inflammatory diseases

    DEFF Research Database (Denmark)

    Christensen, Robin; Heitmann, Berit L; Andersen, Karina Winther

    2018-01-01

    INTRODUCTION: Chronic inflammatory diseases (CIDs) are frequently treated with biological medications, specifically tumour necrosis factor inhibitors (TNFi)). These medications inhibit the pro-inflammatory molecule TNF alpha, which has been strongly implicated in the aetiology of these diseases. Up...... with inflammatory bowel disease (Crohn's disease and ulcerative colitis), rheumatic disorders (rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis), inflammatory skin diseases (psoriasis, hidradenitis suppurativa) and non-infectious uveitis. At baseline (pretreatment), patient characteristics...... will be assessed using patient-reported outcome measures, clinical assessments of disease activity, quality of life and lifestyle, in addition to registry data on comorbidity and concomitant medication(s). In accordance with current Danish standards, follow-up will be conducted 14-16 weeks after treatment...

  9. Therapy Processes and Outcomes of Psychological Interventions for Women Diagnosed with Gynecological Cancers: A Test of the Generic Process Model of Psychotherapy

    Science.gov (United States)

    Manne, Sharon; Winkel, Gary; Zaider, Talia; Rubin, Stephen; Hernandez, Enrique; Bergman, Cynthia

    2010-01-01

    Objective: Little attention has been paid to the role of nonspecific therapy processes in the efficacy of psychological interventions for individuals diagnosed with cancer. The goal of the current study was to examine the three constructs from the generic model of psychotherapy (GMP): therapeutic alliance, therapeutic realizations, and therapeutic…

  10. Anonymous living liver donation: donor profiles and outcomes.

    Science.gov (United States)

    Reichman, T W; Fox, A; Adcock, L; Wright, L; Abbey, S E; Levy, G; Grant, D R

    2010-09-01

    There are no published series of the assessment process, profiles and outcomes of anonymous, directed or nondirected live liver donation. The outcomes of 29 consecutive potential anonymous liver donors at our center were assessed. We used our standard live liver assessment process, augmented with the following additional acceptance criteria: a logical rationale for donation, a history of social altruism, strong social supports and a willingness to maintain confidentiality of patient information. Seventeen potential donors were rejected and 12 donors were ultimately accepted (six male, six female). All donors were strongly motivated by a desire and sense of responsibility to help others. Four donations were directed toward recipients who undertook media appeals. The donor operations included five left lateral segmentectomies and seven right hepatectomies. The overall donor morbidity was 40% with one patient having a transient Clavien level 3 complication (a pneumothorax). All donors are currently well. None expressed regret about their decision to donate, and all volunteered the opinion that donation had improved their lives. The standard live liver donor assessment process plus our additional requirements appears to provide a robust assessment process for the selection of anonymous live liver donors. Acceptance of anonymous donors enlarges the donor liver pool. © 2010 The Authors Journal compilation © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

  11. Renal Denervation for Chronic Heart Failure: Background and Pathophysiological Rationale.

    Science.gov (United States)

    Böhm, Michael; Ewen, Sebastian; Mahfoud, Felix

    2017-01-01

    The activation of the sympathetic nervous system is associated with cardiovascular hospitalizations and death in heart failure. Renal denervation has been shown to effectively reduce sympathetic overdrive in certain patients with uncontrolled hypertension. Pilot trials investigating renal denervation as a potential treatment approach for heart failure were initiated. Heart failure comorbidities like obstructive sleep apnea, metabolic syndrome and arrhythmias could also be targets for renal denervation, because these occurrences are also mediated by the activation of the sympathetic nervous system. Therefore, renal denervation in heart failure is worthy of further investigation, although its effectiveness still has to be proven. Herein, we describe the pathophysiological rationale and the effect of renal denervation on surrogates of the heart failure syndrome.

  12. Renal Denervation for Chronic Heart Failure: Background and Pathophysiological Rationale

    Science.gov (United States)

    Ewen, Sebastian; Mahfoud, Felix

    2017-01-01

    The activation of the sympathetic nervous system is associated with cardiovascular hospitalizations and death in heart failure. Renal denervation has been shown to effectively reduce sympathetic overdrive in certain patients with uncontrolled hypertension. Pilot trials investigating renal denervation as a potential treatment approach for heart failure were initiated. Heart failure comorbidities like obstructive sleep apnea, metabolic syndrome and arrhythmias could also be targets for renal denervation, because these occurrences are also mediated by the activation of the sympathetic nervous system. Therefore, renal denervation in heart failure is worthy of further investigation, although its effectiveness still has to be proven. Herein, we describe the pathophysiological rationale and the effect of renal denervation on surrogates of the heart failure syndrome. PMID:28154583

  13. Soft Power as a Policy Rationale for International Education in the UK: A Critical Analysis

    Science.gov (United States)

    Lomer, Sylvie

    2017-01-01

    This article presents the results of a textual analysis conducted on policy discourses on international students in the UK between 1999 and 2013. A number of rationales for and against increasing their numbers have been made, which have largely remained consistent over changing political administrations. One key rationale is that international…

  14. Enhancing Learning Outcomes through Experiential Learning: Using Open-Source Systems to Teach Enterprise Systems and Business Process Management

    Science.gov (United States)

    Jewer, Jennifer; Evermann, Joerg

    2015-01-01

    Enterprise systems and business process management are the two key information technologies to integrate the functions of a modern business into a coherent and efficient system. While the benefits of these systems are easy to describe, students, especially those without business experience, have difficulty appreciating how these systems are used…

  15. Research on Interventions for Adolescents with Learning Disabilities: A Meta-Analysis of Outcomes Related to Higher-Order Processing.

    Science.gov (United States)

    Swanson, H. Lee

    2001-01-01

    Details meta-analysis of 58 intervention studies related to higher-order processing (i.e., problem solving) for adolescents with learning disabilities. Discusses factors that increased effect sizes: (1) measures of metacognition and text understanding; (2) instruction including advanced organizers, new skills, and extended practice; and (3)…

  16. Will Mobile Diabetes Education Teams (MDETs in primary care improve patient care processes and health outcomes? Study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Gucciardi Enza

    2012-09-01

    Full Text Available Abstract Background There is evidence to suggest that delivery of diabetes self-management support by diabetes educators in primary care may improve patient care processes and patient clinical outcomes; however, the evaluation of such a model in primary care is nonexistent in Canada. This article describes the design for the evaluation of the implementation of Mobile Diabetes Education Teams (MDETs in primary care settings in Canada. Methods/design This study will use a non-blinded, cluster-randomized controlled trial stepped wedge design to evaluate the Mobile Diabetes Education Teams' intervention in improving patient clinical and care process outcomes. A total of 1,200 patient charts at participating primary care sites will be reviewed for data extraction. Eligible patients will be those aged ≥18, who have type 2 diabetes and a hemoglobin A1c (HbA1c of ≥8%. Clusters (that is, primary care sites will be randomized to the intervention and control group using a block randomization procedure within practice size as the blocking factor. A stepped wedge design will be used to sequentially roll out the intervention so that all clusters eventually receive the intervention. The time at which each cluster begins the intervention is randomized to one of the four roll out periods (0, 6, 12, and 18 months. Clusters that are randomized into the intervention later will act as the control for those receiving the intervention earlier. The primary outcome measure will be the difference in the proportion of patients who achieve the recommended HbA1c target of ≤7% between intervention and control groups. Qualitative work (in-depth interviews with primary care physicians, MDET educators and patients; and MDET educators’ field notes and debriefing sessions will be undertaken to assess the implementation process and effectiveness of the MDET intervention. Trial registration ClinicalTrials.gov NCT01553266

  17. Impact of e-alert for detection of acute kidney injury on processes of care and outcomes: protocol for a systematic review and meta-analysis.

    Science.gov (United States)

    Lachance, Philippe; Villeneuve, Pierre-Marc; Wilson, Francis P; Selby, Nicholas M; Featherstone, Robin; Rewa, Oleksa; Bagshaw, Sean M

    2016-05-05

    Acute kidney injury (AKI) is a common complication in hospitalised patients. It imposes significant risk for major morbidity and mortality. Moreover, patients suffering an episode of AKI consume considerable health resources. Recently, a number of studies have evaluated the implementation of automated electronic alerts (e-alerts) configured from electronic medical records (EMR) and clinical information systems (CIS) to warn healthcare providers of early or impending AKI in hospitalised patients. The impact of e-alerts on care processes, patient outcomes and health resource use, however, remains uncertain. We will perform a systematic review to describe and appraise e-alerts for AKI, and evaluate their impact on processes of care, clinical outcomes and health services use. In consultation with a research librarian, a search strategy will be developed and electronic databases (ie, MEDLINE, EMBASE, CINAHL, Cochrane Library and Inspec via Engineering Village) searched. Selected grey literature sources will also be searched. Search themes will focus on e-alerts and AKI. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. The primary analysis will be narrative; however, where feasible, pooled analysis will be performed. Each e-alert will be described according to trigger, type of alert, target recipient and degree of intrusiveness. Pooled effect estimates will be described, where applicable. Our systematic review will synthesise the literature on the value of e-alerts to detect AKI, and their impact on processes, patient-centred outcomes and resource use, and also identify key knowledge gaps and barriers to implementation. This is a fundamental step in a broader research programme aimed to understand the ideal structure of e-alerts, target population and methods for implementation, to derive benefit. Research ethics approval is not required for this review. CRD42016033033. Published by the BMJ Publishing Group Limited

  18. Hierarchical Bayesian analysis of outcome- and process-based social preferences and beliefs in Dictator Games and sequential Prisoner's Dilemmas.

    Science.gov (United States)

    Aksoy, Ozan; Weesie, Jeroen

    2014-05-01

    In this paper, using a within-subjects design, we estimate the utility weights that subjects attach to the outcome of their interaction partners in four decision situations: (1) binary Dictator Games (DG), second player's role in the sequential Prisoner's Dilemma (PD) after the first player (2) cooperated and (3) defected, and (4) first player's role in the sequential Prisoner's Dilemma game. We find that the average weights in these four decision situations have the following order: (1)>(2)>(4)>(3). Moreover, the average weight is positive in (1) but negative in (2), (3), and (4). Our findings indicate the existence of strong negative and small positive reciprocity for the average subject, but there is also high interpersonal variation in the weights in these four nodes. We conclude that the PD frame makes subjects more competitive than the DG frame. Using hierarchical Bayesian modeling, we simultaneously analyze beliefs of subjects about others' utility weights in the same four decision situations. We compare several alternative theoretical models on beliefs, e.g., rational beliefs (Bayesian-Nash equilibrium) and a consensus model. Our results on beliefs strongly support the consensus effect and refute rational beliefs: there is a strong relationship between own preferences and beliefs and this relationship is relatively stable across the four decision situations. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. The Effect of Guided Inquiry Learning with Mind Map to Science Process Skills and Learning Outcomes of Natural Sciences

    OpenAIRE

    Hilman .

    2015-01-01

    Pengaruh Pembelajaran Inkuiri Terbimbing dengan Mind Map terhadap Keterampilan Proses Sains dan Hasil Belajar IPA   Abstract: Science learning in junior high school aims to enable students conducts scientific inquiry, improves knowledge, concepts, and science skills. Organization materials for students supports learning process so that needs to be explored techniques that allows students to enable it. This study aimed to determine the effect of guided inquiry learning with mind map on...

  20. Rationale and Design of the Women and Inclusion in Academic Medicine Study.

    Science.gov (United States)

    Hill, Emorcia V; Wake, Michael; Carapinha, René; Normand, Sharon-Lise; Wolf, Robert E; Norris, Keith; Reede, Joan Y

    2016-04-21

    Women of color (WOC) (African American, Hispanic, Native American/Alaskan Native, and Asian American) faculty remain disproportionately underrepresented among medical school faculty and especially at senior ranks compared with White female faculty. The barriers or facilitators to the career advancement of WOC are poorly understood. The Women and Inclusion in Academic Medicine (WIAM) study was developed to characterize individual, institutional and sociocultural factors that influence the entry, progression and persistence, and advancement of women faculty in academic medical careers with a focus on WOC. Using a purposive sample of 13 academic medical institutions, we collected qualitative interview data from 21 WOC junior faculty and quantitative data from 3,127 (38.9% of 8,053 eligible women) respondents via an online survey. To gather institutional data, we used an online survey and conducted 23 key administrative informant interviews from the 13 institutions. Grounded theory methodology will be used to analyze qualitative data. Multivariable analysis including hierarchical linear modeling will be used to investigate outcomes, such as the inclusiveness of organizational gender climate and women faculty's intent to stay. We describe the design, methods, rationale and limitations of one of the largest and most comprehensive studies of women faculty in academic medicine with a focus on WOC. This study will enhance our understanding of challenges that face women, and, especially WOC, faculty in academic medicine and will provide solutions at both the individual and institutional levels.

  1. Rationale and Description of Right Ventricle-Protective Ventilation in ARDS.

    Science.gov (United States)

    Paternot, Alexis; Repessé, Xavier; Vieillard-Baron, Antoine

    2016-10-01

    Pulmonary vascular dysfunction is associated with ARDS and leads to increased right-ventricular afterload and eventually right-ventricular failure, also called acute cor pulmonale. Interest in acute cor pulmonale and its negative impact on outcome in patients with ARDS has grown in recent years. Right-ventricular function in these patients should be closely monitored, and this is helped by the widespread use of echocardiography in intensive care units. Because mechanical ventilation may worsen right-ventricular failure, the interaction between the lungs and the right ventricle appears to be a key factor in the ventilation strategy. In this review, a rationale for a right ventricle-protective ventilation approach is provided, and such a strategy is described, including the reduction of lung stress (ie, the limitation of plateau pressure and driving pressure), the reduction of PaCO2 , and the improvement of oxygenation. Prone positioning seems to be a crucial part of this strategy by protecting both the lungs and the right ventricle, resulting in increased survival of patients with ARDS. Further studies are required to validate the positive impact on prognosis of right ventricle-protective mechanical ventilation. Copyright © 2016 by Daedalus Enterprises.

  2. The dissociative subtype of posttraumatic stress disorder: rationale, clinical and neurobiological evidence, and implications.

    Science.gov (United States)

    Lanius, Ruth A; Brand, Bethany; Vermetten, Eric; Frewen, Paul A; Spiegel, David

    2012-08-01

    Clinical and neurobiological evidence for a dissociative subtype of posttraumatic stress disorder (PTSD) has recently been documented. A dissociative subtype of PTSD is being considered for inclusion in the forthcoming Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) to address the symptoms of depersonalization and derealization found among a subset of patients with PTSD. This article reviews research related to the dissociative subtype including antecedent, concurrent, and predictive validators as well as the rationale for recommending the dissociative subtype. The relevant literature pertaining to the dissociative subtype of PTSD was reviewed. Latent class analyses point toward a specific subtype of PTSD consisting of symptoms of depersonalization and derealization in both veteran and civilian samples of PTSD. Compared to individuals with PTSD, those with the dissociative subtype of PTSD also exhibit a different pattern of neurobiological response to symptom provocation as well as a differential response to current cognitive behavioral treatment designed for PTSD. We recommend that consideration be given to adding a dissociative subtype of PTSD in the revision of the DSM. This facilitates more accurate analysis of different phenotypes of PTSD, assist in treatment planning that is informed by considering the degree of patients' dissociativity, will improve treatment outcome, and will lead to much-needed research about the prevalence, symptomatology, neurobiology, and treatment of individuals with the dissociative subtype of PTSD. © 2012 Wiley Periodicals, Inc.

  3. The Mediterranean healthy eating, ageing, and lifestyle (MEAL) study: rationale and study design.

    Science.gov (United States)

    Grosso, Giuseppe; Marventano, Stefano; D'Urso, Maurizio; Mistretta, Antonio; Galvano, Fabio

    2017-08-01

    There is accumulating evidence suggesting that Mediterranean lifestyles, including nutrition and sleeping patterns as well as social integration, may play a role in reducing age-related diseases. However, the literature is mostly deficient of evidence provided by Italian Mediterranean islands that more closely adhered to the originally described lifestyles. In this paper, we described the rationale and the study design of the Mediterranean healthy Eating, Ageing, and Lifestyle (MEAL) study, a prospective population-based cohort established in Sicily, southern Italy. The main exposures investigated are classical determinants of health, including demographic, nutritional habits, smoking and physical activity status, as well as eating-related behaviors, sleeping habits, sun exposure, social resources, and perceived stress. Anthropometric measurements will be collected. The main outcomes included depression, quality of life, and, after the follow-up period, also cardiovascular disease and cancer. The MEAL study may provide important data to increase our knowledge regarding the prevalence, incidence, and risk factors of age-related disorders in the Mediterranean region.

  4. Structures, processes and outcomes of the Aussie Heart Guide Program: A nurse mentor supported, home based cardiac rehabilitation program for rural patients with acute coronary syndrome.

    Science.gov (United States)

    Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

    2018-03-01

    Cardiac rehabilitation has a number of benefits for patients, yet participation in it is sub-optimal, especially in regional Australia. Innovative models of cardiac rehabilitation are needed to improve participation. Providing nurse mentors to support patients transitioning from hospital to home represents a new model of service delivery in Australia. To explore the impact of a home-based cardiac rehabilitation program in assisting patients to recover from Acute Coronary Syndrome and meeting the expectations of nurse mentors delivering the program. This case study was underpinned by the structure, process and outcomes model and occurred in three Australian hospitals 2008-2011. Thirteen patients recovering from acute coronary syndrome were interviewed by telephone and seven nurse mentors completed a survey after completing the program. Mentor perceptions concerning the structures of the home-based CR program included the timely recruitment of patients, mentor training to operationalise the program, commitment to development of the mentor role, and the acquisition of knowledge and skills about cognitive behavioural therapy and patient centred care. Processes included the therapeutic relationship between mentors and patients, suitability of the program and the promotion of healthier lifestyle behaviours. Outcomes identified that patients were satisfied with the program's audiovisual resources, and the level of support and guidance provided by their nurse mentors. Mentors believed that the program was easy to use in terms of its delivery. Patients believed the program assisted their recovery and were satisfied with the information, guidance and support received from mentors. There were positive signs that the program influenced patients' decisions to change unhealthy lifestyle behaviours. Outcomes highlighted both rewards and barriers associated with mentoring patients in their homes by telephone. Experience gained from developing a therapeutic relationship with

  5. Improving therapeutic outcomes in autism spectrum disorders: Enhancing social communication and sensory processing through the use of interactive robots.

    Science.gov (United States)

    Sartorato, Felippe; Przybylowski, Leon; Sarko, Diana K

    2017-07-01

    For children with autism spectrum disorders (ASDs), social robots are increasingly utilized as therapeutic tools in order to enhance social skills and communication. Robots have been shown to generate a number of social and behavioral benefits in children with ASD including heightened engagement, increased attention, and decreased social anxiety. Although social robots appear to be effective social reinforcement tools in assistive therapies, the perceptual mechanism underlying these benefits remains unknown. To date, social robot studies have primarily relied on expertise in fields such as engineering and clinical psychology, with measures of social robot efficacy principally limited to qualitative observational assessments of children's interactions with robots. In this review, we examine a range of socially interactive robots that currently have the most widespread use as well as the utility of these robots and their therapeutic effects. In addition, given that social interactions rely on audiovisual communication, we discuss how enhanced sensory processing and integration of robotic social cues may underlie the perceptual and behavioral benefits that social robots confer. Although overall multisensory processing (including audiovisual integration) is impaired in individuals with ASD, social robot interactions may provide therapeutic benefits by allowing audiovisual social cues to be experienced through a simplified version of a human interaction. By applying systems neuroscience tools to identify, analyze, and extend the multisensory perceptual substrates that may underlie the therapeutic benefits of social robots, future studies have the potential to strengthen the clinical utility of social robots for individuals with ASD. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Predicting sugar-sweetened behaviours with theory of planned behaviour constructs: Outcome and process results from the SIPsmartER behavioural intervention.

    Science.gov (United States)

    Zoellner, Jamie M; Porter, Kathleen J; Chen, Yvonnes; Hedrick, Valisa E; You, Wen; Hickman, Maja; Estabrooks, Paul A

    2017-05-01

    Guided by the theory of planned behaviour (TPB) and health literacy concepts, SIPsmartER is a six-month multicomponent intervention effective at improving SSB behaviours. Using SIPsmartER data, this study explores prediction of SSB behavioural intention (BI) and behaviour from TPB constructs using: (1) cross-sectional and prospective models and (2) 11 single-item assessments from interactive voice response (IVR) technology. Quasi-experimental design, including pre- and post-outcome data and repeated-measures process data of 155 intervention participants. Validated multi-item TPB measures, single-item TPB measures, and self-reported SSB behaviours. Hypothesised relationships were investigated using correlation and multiple regression models. TPB constructs explained 32% of the variance cross sectionally and 20% prospectively in BI; and explained 13-20% of variance cross sectionally and 6% prospectively. Single-item scale models were significant, yet explained less variance. All IVR models predicting BI (average 21%, range 6-38%) and behaviour (average 30%, range 6-55%) were significant. Findings are interpreted in the context of other cross-sectional, prospective and experimental TPB health and dietary studies. Findings advance experimental application of the TPB, including understanding constructs at outcome and process time points and applying theory in all intervention development, implementation and evaluation phases.

  7. The use of outcome and process indicators to incentivize integrated care for frail older people: a case study of primary care services in Sweden

    Directory of Open Access Journals (Sweden)

    Anders Lars Anell

    2014-12-01

    Full Text Available Background: A number of reforms have been implemented in Swedish health care to support integrated care for frail older people and to reduce utilization of hospital care by this group. Outcomes and process indicators have been used in pay-for-performance (P4P schemes by both national and local governments to support developments.Objective: To analyse limitations in the use of outcome and process indicators to incentivize integrated care for elderly patients with significant health care needs in the context of primary care.Method: Data were collected from the Region Skåne county council. Eight primary care providers and associated community services were compared in a ranking exercise based on information from interviews and registered data. Registered data from 150 primary care providers were analysed in regression models.Results and conclusion: Both the ranking exercise and regression models revealed important problems related to risk-adjustment, attribution, randomness and measurement fixation when using indicators in P4P schemes and for external accountability purposes. Instead of using indicators in incentive schemes targeting individual providers, indicators may be used for diagnostic purposes and to support development of new knowledge, targeting local systems that move beyond organizational boundaries.

  8. [Quality of care in nursing homes: a review of literature regarding structure, process and outcome indicators related to the risk of malnutrition].

    Science.gov (United States)

    Lorini, C; Mencacci, M; Bonaccorsi, G

    2012-01-01

    The admissions and the demands for entering nursing homes (NHs) are gradually increasing. Focusing on the quality of care in NHs, the risk of protein- calorie malnutrition has a key role. The purpose of this paper is to select and describe structure, process of care and outcome indicators, as well as individual risk factors (confounders), related to malnutrition in NHs. We have analyzed scientific articles found in MEDLINE, published from 2000 to 2011, identified through four different string selections. 505 articles have been collected, 17 of whom were chosen because they included specific malnutrition indicators in the framework of quality of care indicators. Three papers specifically deal with malnutrition as one of the elements of the quality of care in NHs linked to structure, processes and outcome. From this review, it clearly emerges that scientific articles addressing malnutrition as one of the requirements of healthcare quality in NHs are scarce, compared with a rather large number of publications concerning the prevalence and/or the description of interventions related to--and made to solve or reduce--malnutrition already in place. It is therefore necessary to spread the culture and the approach of nutritional risk analysis within the systems aimed at evaluating the quality of care in NHs, by selecting and monitoring appropriate malnutrition indicators.

  9. The effects of urgency to reach agreement on the process and outcome of multi-party natural resource negotiations

    Science.gov (United States)

    Lamb, B.L.; Taylor, J.G.; Burkardt, N.; Gillette, S.C.

    2005-01-01

    We studied seven hydropower license consultations to examine the role of a sense of urgency to reach agreement. Hydropower licensing consultations were studied because the statutory requirement for consultation encourages negotiation, all such consultations are similar, and a negotiated settlement is not a foregone result. Cases selected for analysis met screening criteria. Structured interviews were conducted with participants after the negotiations had been concluded. Respondent recollections were checked against the documentary record. A sense of urgency to reach agreement was a significant factor in the completion of these negotiations; where there was no shared sense of urgency, purposeful delay adversely affected the negotiations. Although a sense of urgency was experienced by at least one party in each case, only a shared sense of urgency at the end of the process proved significant. Delay did not prevent ultimate agreement but a shared sense of urgency brought speedier agreement and greater satisfaction with the negotiation.

  10. A Conceptual Model for Assessing Quality of Care for Patients Boarding in the Emergency Department: Structure-Process-Outcome

    Science.gov (United States)

    Liu, Shan W.; Singer, Sara J.; Sun, Benjamin C.; Camargo, Carlos A.

    2013-01-01

    Many believe that the “boarding” of emergency department (ED) patients awaiting inpatient beds compromises quality of care. To better study the quality of care of boarded patients, one should identify and understand the mechanisms accounting for any potential differences in care. This paper present a conceptual boarding “structure-process-outcome” model to help assess quality of care provided to boarded patients, and to aid in recognizing potential solutions to improve that quality, if it is deficient. The goal of the conceptual model is to create a practical framework on which a research and policy agenda can be based to measure and improve quality of care for boarded patients. PMID:21496148

  11. Integrating Information Literacy and Evidence-Based Medicine Content within a New School of Medicine Curriculum: Process and Outcome.

    Science.gov (United States)

    Muellenbach, Joanne M; Houk, Kathryn M; E Thimons, Dana; Rodriguez, Bredny

    2018-01-01

    This column describes a process for integrating information literacy (IL) and evidence-based medicine (EBM) content within a new school of medicine curriculum. The project was a collaborative effort among health sciences librarians, curriculum deans, directors, and faculty. The health sciences librarians became members of the curriculum committees, developed a successful proposal for IL and EBM content within the curriculum, and were invited to become course instructors for Analytics in Medicine. As course instructors, the librarians worked with the other faculty instructors to design and deliver active learning class sessions based on a flipped classroom approach using a proprietary Information Mastery curriculum. Results of this collaboration may add to the knowledge base of attitudes and skills needed to practice as full faculty partners in curricular design and instruction.

  12. Ethical and policy issues in cluster randomized trials: rationale and design of a mixed methods research study

    Directory of Open Access Journals (Sweden)

    Chaudhry Shazia H

    2009-07-01

    Full Text Available Abstract Background Cluster randomized trials are an increasingly important methodological tool in health research. In cluster randomized trials, intact social units or groups of individuals, such as medical practices, schools, or entire communities – rather than individual themselves – are randomly allocated to intervention or control conditions, while outcomes are then observed on individual cluster members. The substantial methodological differences between cluster randomized trials and conventional randomized trials pose serious challenges to the current conceptual framework for research ethics. The ethical implications of randomizing groups rather than individuals are not addressed in current research ethics guidelines, nor have they even been thoroughly explored. The main objectives of this research are to: (1 identify ethical issues arising in cluster trials and learn how they are currently being addressed; (2 understand how ethics reviews of cluster trials are carried out in different countries (Canada, the USA and the UK; (3 elicit the views and experiences of trial participants and cluster representatives; (4 develop well-grounded guidelines for the ethical conduct and review of cluster trials by conducting an extensive ethical analysis and organizing a consensus process; (5 disseminate the guidelines to researchers, research ethics boards (REBs, journal editors, and research funders. Methods We will use a mixed-methods (qualitative and quantitative approach incorporating both empirical and conceptual work. Empirical work will include a systematic review of a random sample of published trials, a survey and in-depth interviews with trialists, a survey of REBs, and in-depth interviews and focus group discussions with trial participants and gatekeepers. The empirical work will inform the concurrent ethical analysis which will lead to a guidance document laying out principles, policy options, and rationale for proposed guidelines. An

  13. Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach.

    Science.gov (United States)

    Brendryen, Håvar; Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny

    2013-01-23

    Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. The descriptions of the treatment

  14. Factors Influencing the Decision-Making Process and Long-Term Interpersonal Outcomes for Parents Who Undergo Preimplantation Genetic Diagnosis for Fanconi Anemia: a Qualitative Investigation.

    Science.gov (United States)

    Haude, K; McCarthy Veach, P; LeRoy, B; Zierhut, H

    2017-06-01

    Fanconi anemia (FA) is characterized by congenital malformations, progressive bone marrow failure, and predisposition to malignancy. Hematopoietic stem cell transplantation is used to treat FA, and best results are attained with sibling donors who are human leukocyte antigen (HLA) identical matches. Preimplantation genetic diagnosis (PGD) offers parents of an affected child the opportunity to have an unaffected child who is an HLA match. While some research has investigated parents' experiences during the PGD process, no published studies specifically address factors influencing their decision-making process and long-term interpersonal outcomes. The aims of this study are to: (1) examine parents' expectations and the influence of media, bioethics, and religion on their decision to undergo PGD; (2) examine parents' social support and emotional experiences during their PGD process; and (3) characterize long-term effects of PGD on relationship dynamics (partner, family, friends), others' attitudes, and parental regret. Nine parents participated in semi-structured interviews. Thematic analysis revealed their decision to use PGD was variously influenced by media, bioethics, and religion, in particular, affecting parents' initial confidence levels. Moreover, the PGD process was emotionally complex, with parents desiring varying amounts and types of support from different sources at different times. Parents reported others' attitudes towards them were similar or no different than before PGD. Parental regret regarding PGD was negligible. Results of this study will promote optimization of long-term care for FA families.

  15. A review and rationale for studying the cardiovascular effects of drinking water arsenic in women of reproductive age

    International Nuclear Information System (INIS)

    Kwok, Richard K.

    2007-01-01

    Drinking water arsenic has been shown to be associated with a host of adverse health outcomes at exposure levels > 300 μg of As/L. However, the results are not consistent at exposures below this level. We have reviewed selected articles that examine the effects of drinking water arsenic on cardiovascular outcomes and present a rationale for studying these effects on women of reproductive age, and also over the course of pregnancy when they would potentially be more susceptible to adverse cardiovascular and reproductive outcomes. It is only recently that reproductive effects have been linked to drinking water arsenic. However, there is a paucity of information about the cardiovascular effects of drinking water arsenic on women of reproductive age. Under the cardiovascular challenge of pregnancy, we hypothesize that women with a slightly elevated exposure to drinking water arsenic may exhibit adverse cardiovascular outcomes at higher rates than in the general population. Studying sensitive clinical and sub-clinical indicators of disease in susceptible sub-populations may yield important information about the potentially enormous burden of disease related to low-level drinking water arsenic exposure

  16. Not just another multi-professional course! Part 1. Rationale for a transformative curriculum.

    Science.gov (United States)

    Duncan, Madeleine; Alperstein, Melanie; Mayers, Pat; Olckers, Lorna; Gibbs, Trevor

    2006-02-01

    Undergraduate inter- and multi-professional education has traditionally aimed to develop health professionals who are able to collaborate effectively in comprehensive healthcare delivery. The respective professions learn from and about each other through comparisons of roles, responsibilities, powers, duties and perspectives in order to promote integrated service. Described here is the educational rationale of a multi-professional course with a difference; one that injects value to undergraduate health professional education through the development of critical cross-field knowledge, skills and attitudes that unite rather than differentiate professions. The aim of this course, offered at the Faculty of Health Sciences, University of Cape Town, is to lay an integrated, pan-professional foundation for the advancement of collective commitment to and understanding of national health and social development objectives such as primary health care, human rights and professionalism. Pan-professional refers to curriculum content that is core and of critical relevance to all participating professions. What is learned, how it is learned, how learning is facilitated and how it is applied, has been co-constructed by a multi-professional design team representing a range of health professions (audiology, medicine, occupational therapy, nursing, physiotherapy and speech therapy) and academic disciplines (anthropology, sociology, psychology, history, African studies and social development, information technology and language literacy). Education specialists facilitate the ongoing design process ensuring that the structure and content of the curriculum complies with contemporary adult learning principles and national higher education imperatives. Designing the original curriculum required the deconstruction of intra-professional and disciplinary canons of knowledge and ways of 'doing things' in order to identify and develop shared interpretations of critical epistemology and axiology

  17. Achieving Both Creativity And Rationale: Reuse In Design With Images And Claims

    Directory of Open Access Journals (Sweden)

    D. Scott McCrickard

    2011-01-01

    Full Text Available Although designers often try to create novel designs, many designs are based on previous work. In this paper we argue for the reuse of rationale, in the form of claims, as a central activity in design, and explore how this can be used to inspire creativity. We present a design activity in which images and claims are reused to create a storyboard and illustrate how creativity and rationale complement each other. Our work serves to demonstrate that an appropriate design activity can be used to leverage creativity with the use of rationale.

  18. The Living Donor Lost Wages Trial: Study Rationale and Protocol.

    Science.gov (United States)

    Rodrigue, James R; Fleishman, Aaron; Carroll, Michaela; Evenson, Amy R; Pavlakis, Martha; Mandelbrot, Didier A; Baliga, Prabhakar; Howard, David H; Schold, Jesse D

    2018-03-01

    This paper describes the background, rationale, and design of an NIH-funded, single-center study to test the impact of offering reimbursement for donor lost wages incurred during the post-nephrectomy recovery period on the live donor kidney transplant (LDKT) rate in newly evaluated kidney transplant candidates, to examine whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and to determine whether higher reimbursement amounts lead to higher LDKT rates. LDKT is the optimal treatment for renal failure. However, living kidney donation has declined in the past decade, particularly among men, younger adults, blacks, and low-income adults. There is evidence that donation-related costs may deter both transplant candidates and potential donors from considering LDKT. Lost wages is a major source of financial loss for some living donors and, unlike travel and lodging expenses, is not reimbursed by financial assistance programs. The study addresses the transplant community's call to reduce the financial burden of living donation and examine its impact on LDKT rates. Findings have the potential to influence policy, clinical practice, LDKT access, and income-related and racial disparities in LDKT and living donation.

  19. Maxillary advancement for mandibular prognathism: indications and rationale.

    Science.gov (United States)

    Rosen, H M

    1991-05-01

    The surgical correction of mandibular prognathism has traditionally involved posterior repositioning of the mandibular body. This treatment approach corrects the skeletal disproportion at the expense of reducing facial skeletal volume and can unpredictably result in inadequately supported soft tissues with loss of skeletal definition. In an effort to avoid these sequelae of mandibular reduction, 18 patients diagnosed as having mandibular prognathism were treated with maxillary advancement surgery at the Le Fort I level. Mean patient SNB angle was 85.2 degrees, as compared with a normal 79 +/- 3 degrees. Maxillae were documented to be in normal position relative to both cranial base and Frankfort horizontal. The mean maxillary advancement was 6.9 mm, with a range of 4.5 to 8.8 mm. All patients required genioplasty to reduce vertical chin height and/or to laterally shift the chin. At the time of follow-up (mean 16.2 months), all patients retained cephalometric data suggestive of enlarged mandibles and excessive anterior facial divergence. However, maxillomandibular harmony and facial convexity had been restored without sacrificing skeletal volume. Treatment results demonstrated these faces to be skeletally well proportioned despite lower face protrusion that was beyond "normal." Postoperative appearances were characterized by a well-supported soft-tissue envelope and a highlighted skeletal foundation, creating angular, well-defined lower faces. These findings support the credibility of maxillary advancement as the procedure of choice in selected individuals with mandibular prognathism. Indications and an aesthetic rationale for this surgical approach are presented.

  20. Photometry in the workplace: the rationale for a new method.

    Science.gov (United States)

    Piccoli, B; Soci, G; Zambelli, P L; Pisaniello, D

    2004-01-01

    The assessment of lighting conditions in workplaces has traditionally focused on the measurement of illuminance. The rationale for a new method for the detailed evaluation of natural and artificial light in 'near work' situations, involving the assessment of luminance, is described. The procedure comprises four successive phases: (1) identify object/images observed during work tasks; (2) outline the area of the operator's visual field where gaze is predominantly directed; (3) measure luminances in the visual field, pin-pointing all sources of primary and secondary luminance, and constructing iso-luminance maps; and (4) compare luminance ratios. The procedure was illustrated using the common example of near work in an office environment. Illuminance was found to be inadequate to evaluate the effects of natural and artificial environmental light in the workplace. This is due to the fact that the luxmeter is designed to integrate the light detected over a large angle, whereas in near work the operator's retina is mainly stimulated by light originating from objects/images placed in the occupational visual field. A detailed measurement of luminance within the occupational visual field is consistent with ocular anatomy and physiology, and can be used as part of a risk assessment for visual disturbances and to rationalize lighting at workstations.

  1. Comparative quality measures of emergency care: an outcome cockpit proposal to survey clinical processes in real life

    Directory of Open Access Journals (Sweden)

    Burgemeister S

    2017-10-01

    Full Text Available Susanne Burgemeister,1 Alexander Kutz,1 Antoinette Conca,2 Thomas Holler,3 Sebastian Haubitz,1 Andreas Huber,4 Ulrich Buergi,5 Beat Mueller,1 Philipp Schuetz1 1University Department of Internal Medicine, Medical Faculty of the University of Basel, Kantonsspital Aarau, Basel, 2Department of Clinical Nursing Science, 3Department of Controlling and Quality Management, 4Department of Laboratory Medicine, 5Emergency Department, Kantonsspital Aarau, Aarau, Switzerland Background: Benchmarking of real-life quality of care may improve evaluation and comparability of emergency department (ED care. We investigated process management variables for important medical diagnoses in a large, well-defined cohort of ED patients and studied predictors for low quality of care. Methods: We prospectively included consecutive medical patients with main diagnoses of community-acquired pneumonia, urinary tract infection (UTI, myocardial infarction (MI, acute heart failure, deep vein thrombosis, and COPD exacerbation and followed them for 30 days. We studied predictors for alteration in ED care (treatment times, satisfaction with care, readmission rates, and mortality by using multivariate regression analyses.Results: Overall, 2986 patients (median age 72 years, 57% males were included. The median time to start treatment was 72 minutes (95% CI: 23 to 150, with a median length of ED stay (ED LOS of 256 minutes (95% CI: 166 to 351. We found delayed treatment times and longer ED LOS to be independently associated with main medical admission diagnosis and time of day on admission (shortest times for MI and longest times for UTI. Time to first physician contact (–0.01 hours, 95% CI: –0.03 to –0.02 and ED LOS (–0.01 hours, 95% CI: –0.02 to –0.04 were main predictors for patient satisfaction. Conclusion: Within this large cohort of consecutive patients seeking ED care, we found time of day on admission to be an important predictor for ED timeliness, which again

  2. Relationships between consumption of ultra-processed foods, gestational weight gain and neonatal outcomes in a sample of US pregnant women

    Directory of Open Access Journals (Sweden)

    Karthik W. Rohatgi

    2017-12-01

    Full Text Available Background An increasingly large share of diet comes from ultra-processed foods (UPFs, which are assemblages of food substances designed to create durable, convenient and palatable ready-to-eat products. There is increasing evidence that high UPF consumption is indicative of poor diet and is associated with obesity and metabolic disorders. This study sought to examine the relationship between percent of energy intake from ultra-processed foods (PEI-UPF during pregnancy and maternal gestational weight gain, maternal lipids and glycemia, and neonatal body composition. We also compared the PEI-UPF indicator against the US government’s Healthy Eating Index-2010 (HEI-2010. Methods Data were used from a longitudinal study performed in 2013–2014 at the Women’s Health Center and Obstetrics & Gynecology Clinic in St. Louis, MO, USA. Subjects were pregnant women in the normal and obese weight ranges, as well as their newborns (n = 45. PEI-UPF and the Healthy Eating Index-2010 (HEI-2010 were calculated for each subject from a one-month food frequency questionnaire (FFQ. Multiple regression (ANCOVA-like analysis was used to analyze the relationship between PEI-UPF or HEI-2010 and various clinical outcomes. The ability of these dietary indices to predict clinical outcomes was also compared with the predictive abilities of total energy intake and total fat intake. Results An average of 54.4 ± 13.2% of energy intake was derived from UPFs. A 1%-point increase in PEI-UPF was associated with a 1.33 kg increase in gestational weight gain (p = 0.016. Similarly, a 1%-point increase in PEI-UPF was associated with a 0.22 mm increase in thigh skinfold (p = 0.045, 0.14 mm in subscapular skinfold (p = 0.026, and 0.62 percentage points of total body adiposity (p = 0.037 in the neonate. Discussion PEI-UPF (percent of energy intake from ultra-processed foods was associated with and may be a useful predictor of increased gestational weight gain and neonatal

  3. Process evaluation of a promotora de salud intervention for improving hypertension outcomes for Latinos living in a rural U.S.-Mexico border region.

    Science.gov (United States)

    Sánchez, Victoria; Cacari Stone, Lisa; Moffett, Maurice L; Nguyen, PhoungGiang; Muhammad, Michael; Bruna-Lewis, Sean; Urias-Chauvin, Rita

    2014-05-01

    Hypertension is a growing public health problem for U.S.-Mexico border Latinos, who commonly experience low levels of awareness, treatment, and control. We report on a process evaluation that assessed the delivery of Corazón por la Vida, a 9-week promotora de salud-led curriculum to help Latinos manage and reduce hypertension risks in two rural/frontier counties in the New Mexico border region. Ninety-six adults participated in the program, delivered in three waves and in three communities. We assessed program delivery and quality, adherence, exposure, and participant responsiveness. Participant outcome measures included self-reported eating and physical activities and assessment of community resources. Findings suggest that the program was fully delivered (99%) and that most participants (81.7%) were very satisfied with the educational sessions. The average participant attendance for educational sessions was 77.47%. We found significant differences in self-reported behavioral changes depending on the number of sessions completed: The higher the dose of sessions, the better the self-reported outcomes. These findings suggest that a promotora-led curriculum may be useful for promoting self-management of chronic disease in rural/frontier border Latino populations. Future evaluation should focus on training and implementation adaptations within evidence-based chronic disease programs for diverse Latino communities.

  4. Proposed energy conservation contingency plan: emergency restrictions on advertising lighting. Authorities, need, rationale, and operation

    Energy Technology Data Exchange (ETDEWEB)

    1977-04-01

    The emergency restrictions on advertising lighting proposed in Energy Conservation Contingency Plan No. 5 of 1977 are presented. A statement is given on the need for rationale and operation of the Contingency Plan.

  5. The Danish Alzheimer Intervention Study: Rationale, Study Design and Baseline Characteristics of the Cohort

    DEFF Research Database (Denmark)

    Waldemar, G.; Waldorff, F.B.; Buss, D.V.

    2011-01-01

    There is a lack of appropriately designed trials investigating the efficacy of psychosocial interventions for patients with mild dementia and their family caregivers. This paper reports the rationale and design of the Danish Alzheimer Disease Intervention Study and baseline characteristics...

  6. The rationales of resilience in English and Dutch flood risk policies

    NARCIS (Netherlands)

    Wiering, M.A.; Green, C.; Rijswick, M. van; Priest, S.J.; Keessen, A.M.

    2015-01-01

    We compared the governance of flood risk in England and the Netherlands, focusing on the general policies, instruments used and underlying principles. Both physical and political environments are important in explaining how countries evolved towards very different rationales of

  7. Data book: Space station/base food system study. Book 3: Study selection rationale sheets

    Science.gov (United States)

    1970-01-01

    The supporting rationale sheets are presented which were utilized in the selection and support of the concepts considered in the final phase of the study. Each concept, conceived to fulfill a specific function of the food system, was assessed in terms of the eight critical factors depicted on the rationale sheet. When weighted and totaled, the resulting selection factor was used as a guide in making the final decision.

  8. China’s electric vehicle subsidy scheme: Rationale and impacts

    International Nuclear Information System (INIS)

    Hao, Han; Ou, Xunmin; Du, Jiuyu; Wang, Hewu; Ouyang, Minggao

    2014-01-01

    To promote the market penetration of electric vehicles (EV), China launched the Electric Vehicle Subsidy Scheme (EVSS) in Jan 2009, followed by an update in Sep 2013, which we named phase I and phase II EVSS, respectively. In this paper, we presented the rationale of China’s two-phase EVSS and estimated their impacts on EV market penetration, with a focus on the ownership cost analysis of battery electric passenger vehicles (BEPV). Based on the ownership cost comparison of five defining BEPV models and their counterpart conventional passenger vehicle (CPV) models, we concluded that in the short term, especially before 2015, China’s EVSS is very necessary for BEPVs to be cost competitive compared with CPVs. The transition from phase I to phase II EVSS will generally reduce subsidy intensity, thus resulting in temporary rise of BEPV ownership cost. However, with the decrease of BEPV manufacturing cost, the ownership cost of BEPV is projected to decrease despite of the phase-out mechanism under phase II EVSS. In the mid term of around 2015–2020, BEPV could become less or not reliant on subsidy to maintain cost competitiveness. However, given the performance disadvantages of BEPV, especially the limited electric range, China’s current EVSS is not sufficient for the BEPV market to take off. Technology improvement associated with battery cost reduction has to play an essential role in starting up China’s BEPV market. - Highlights: • China’s phase I and phase II electric vehicle subsidy schemes were reviewed. • Major electric vehicle models in China’s vehicle market were reviewed. • The ownership costs of five defining electric passenger vehicle models were compared. • Policies to promote electric vehicle deployment in China were discussed

  9. Checkpoint inhibitors in endometrial cancer: preclinical rationale and clinical activity.

    Science.gov (United States)

    Mittica, Gloria; Ghisoni, Eleonora; Giannone, Gaia; Aglietta, Massimo; Genta, Sofia; Valabrega, Giorgio

    2017-10-27

    Treatment of advanced and recurrent endometrial cancer (EC) is still an unmet need for oncologists and gynecologic oncologists. The Cancer Genome Atlas Research Network (TCGA) recently provided a new genomic classification, dividing EC in four subgroups. Two types of EC, the polymerase epsilon (POLE)-ultra-mutated and the microsatellite instability-hyper-mutated (MSI-H), are characterized by a high mutation rate providing the rationale for a potential activity of checkpoint inhibitors. We analyzed all available evidence supporting the role of tumor microenvironment (TME) in EC development and the therapeutic implications offered by immune checkpoint inhibitors in this setting. We performed a review on Pubmed with Mesh keywords 'endometrial cancer' and the name of each checkpoint inhibitor discussed in the article. The same search was operated on clinicaltrial.gov to identify ongoing clinical trials exploring PD-1/PD-L1 and CTLA-4 axis in EC, particularly focusing on POLE-ultra-muted and MSI-H cancer types. POLE-ultra-mutated and MSI-H ECs showed an active TME expressing high number of neo-antigens and an elevated amount of tumor infiltrating lymphocytes (TILs). Preliminary results from a phase-1 clinical trial (KEYNOTE-028) demonstrated antitumor activity of Pembrolizumab in EC. Moreover, both Pembrolizumab and Nivolumab reported durable clinical responses in POLE-ultra-mutated patients. Immune checkpoint inhibitors are an attractive option in POLE-ultra-mutated and MSI-H ECs. Future investigations in these subgroups include combinations of checkpoints inhibitors with chemotherapy and small tyrosine kinase inhibitors (TKIs) to enhance a more robust intra-tumoral immune response.

  10. Nondamaging Retinal Laser Therapy: Rationale and Applications to the Macula.

    Science.gov (United States)

    Lavinsky, Daniel; Wang, Jenny; Huie, Philip; Dalal, Roopa; Lee, Seung Jun; Lee, Dae Yeong; Palanker, Daniel

    2016-05-01

    Retinal photocoagulation and nondamaging laser therapy are used for treatment of macular disorders, without understanding of the response mechanism and with no rationale for dosimetry. To establish a proper titration algorithm, we measured the range of tissue response and damage threshold. We then evaluated safety and efficacy of nondamaging retinal therapy (NRT) based on this algorithm for chronic central serous chorioretinopathy (CSCR) and macular telangiectasia (MacTel). Retinal response to laser treatment below damage threshold was assessed in pigmented rabbits by expression of the heat shock protein HSP70 and glial fibrillary acidic protein (GFAP). Energy was adjusted relative to visible titration using the Endpoint Management (EpM) algorithm. In clinical studies, 21 eyes with CSCR and 10 eyes with MacTel were treated at 30% EpM energy with high spot density (0.25-diameter spacing). Visual acuity, retinal and choroidal thickness, and subretinal fluid were monitored for 1 year. At 25% EpM energy and higher, HSP70 was expressed acutely in RPE, and GFAP upregulation in Müller cells was observed at 1 month. Damage appeared starting at 40% setting. Subretinal fluid resolved completely in 81% and partially in 19% of the CSCR patients, and visual acuity improved by 12 ± 3 letters. Lacunae in the majority of MacTel patients decreased while preserving the retinal thickness, and vision improved by 10 letters. Heat shock protein expression in response to hyperthermia helps define the therapeutic window for NRT. Lack of tissue damage enables high-density treatment to boost clinical efficacy, therapy in the fovea, and retreatments to manage chronic diseases.

  11. Effects of Mindfulness on Diabetes Mellitus: Rationale and Overview.

    Science.gov (United States)

    Medina, Wilson L; Wilson, David; de Salvo, Vera; Vannucchi, Bruna; de Souza, Érika Leonardo; Lucena, Leandro; Sarto, Héctor Morillo; Modrego-Alarcón, Marta; Garcia-Campayo, Javier; Demarzo, Marcelo

    2017-01-01

    Diabetes mellitus (DM) is an emerging global healthcare problem and its prevalence is increasing at an alarming rate. Despite improvements in both medical and pharmacological therapies, a complex medical condition may demand a diversified approach, such as: drug therapy, healthy diet and exercises, diabetes education programs, adherence to medical treatment and active participation of the patients in their lifestyle changes, such as stress management. The concept of mindfulness is here defined as the awareness that unfolds from the intention to attentively observe the current experience in a non-judgmental and non-evaluative way. This state of awareness can be enhanced through the use of mindfulness-based interventions (MBIs), which have been associated to many physical and psychological health indicators. The aim of this overview is to offer the rationale and potential benefits of mindfulness in the control of DM and its complications. a narrative review of the current and updated literature available on online database and which came up using the terms "mindfulness" and "diabetes mellitus". Mindfulness-based Interventions (MBIs) can be seen as preventive and complementary interventions in DM, particularly for the relief of symptoms related to depression and anxiety in diabetic patients and also in the management of other factors, including mindful eating, physical exercises and treatment adherence. Although many studies only present research protocols, mindfulness seems to have beneficial effects on all aspects of diabetes, including incidence, control and complications. Furthermore, longer term and more carefully controlled trials are necessary in order to draw consistent conclusions on the beneficial role of MBIs on DM. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  12. A rationale for continuing mass antibiotic distributions for trachoma

    Directory of Open Access Journals (Sweden)

    House Jenafir

    2007-08-01

    Full Text Available Abstract Background The World Health Organization recommends periodic mass antibiotic distributions to reduce the ocular strains of chlamydia that cause trachoma, the world's leading cause of infectious blindness. Their stated goal is to control infection, not to completely eliminate it. A single mass distribution can dramatically reduce the prevalence of infection. However, if infection is not eliminated in every individual in the community, it may gradually return back into the community, so often repeated treatments are necessary. Since public health groups are reluctant to distribute antibiotics indefinitely, we are still in need of a proven long-term rationale. Here we use mathematical models to demonstrate that repeated antibiotic distributions can eliminate infection in a reasonable time period. Methods We fit parameters of a stochastic epidemiological transmission model to data collected before and 6 months after a mass antibiotic distribution in a region of Ethiopia that is one of the most severely affected areas in the world. We validate the model by comparing our predicted results to Ethiopian data which was collected biannually for two years past the initial mass antibiotic distribution. We use the model to simulate the effect of different treatment programs in terms of local elimination of infection. Results Simulations show that the average prevalence of infection across all villages progressively decreases after each treatment, as long as the frequency and coverage of antibiotics are high enough. Infection can be eliminated in more villages with each round of treatment. However, in the communities where infection is not eliminated, it returns to the same average level, forming the same stationary distribution. This phenomenon is also seen in subsequent epidemiological data from Ethiopia. Simulations suggest that a biannual treatment plan implemented for 5 years will lead to elimination in 95% of all villages. Conclusion Local

  13. A rationale for continuing mass antibiotic distributions for trachoma.

    Science.gov (United States)

    Ray, Kathryn J; Porco, Travis C; Hong, Kevin C; Lee, David C; Alemayehu, Wondu; Melese, Muluken; Lakew, Takele; Yi, Elizabeth; House, Jenafir; Chidambaram, Jaya D; Whitcher, John P; Gaynor, Bruce D; Lietman, Thomas M

    2007-08-07

    The World Health Organization recommends periodic mass antibiotic distributions to reduce the ocular strains of chlamydia that cause trachoma, the world's leading cause of infectious blindness. Their stated goal is to control infection, not to completely eliminate it. A single mass distribution can dramatically reduce the prevalence of infection. However, if infection is not eliminated in every individual in the community, it may gradually return back into the community, so often repeated treatments are necessary. Since public health groups are reluctant to distribute antibiotics indefinitely, we are still in need of a proven long-term rationale. Here we use mathematical models to demonstrate that repeated antibiotic distributions can eliminate infection in a reasonable time period. We fit parameters of a stochastic epidemiological transmission model to data collected before and 6 months after a mass antibiotic distribution in a region of Ethiopia that is one of the most severely affected areas in the world. We validate the model by comparing our predicted results to Ethiopian data which was collected biannually for two years past the initial mass antibiotic distribution. We use the model to simulate the effect of different treatment programs in terms of local elimination of infection. Simulations show that the average prevalence of infection across all villages progressively decreases after each treatment, as long as the frequency and coverage of antibiotics are high enough. Infection can be eliminated in more villages with each round of treatment. However, in the communities where infection is not eliminated, it returns to the same average level, forming the same stationary distribution. This phenomenon is also seen in subsequent epidemiological data from Ethiopia. Simulations suggest that a biannual treatment plan implemented for 5 years will lead to elimination in 95% of all villages. Local elimination from a community is theoretically possible, even in the

  14. Assessing the implementation process and outcomes of newly introduced assistant roles: a qualitative study to examine the utility of the Calderdale Framework as an appraisal tool

    Directory of Open Access Journals (Sweden)

    Nancarrow S

    2012-12-01

    Full Text Available Susan Nancarrow,1 Anna Moran,1 Leah Wiseman,2 Alison C Pighills,3 Karen Murphy41School of Health and Human Sciences, Southern Cross University, East Lismore, NSW; 2School of Community Health, Charles Sturt University, Albury, NSW; 3Faculty of Medicine Health and Molecular Sciences, James Cook University, Education and Research Centre, Mackay Base Hospital, Mackay, QLD; 4ACT Government Health Directorate, Canberra, ACT, AustraliaAbstract: Internationally, the health workforce has undergone rapid transformation to help meet growing staffing demands and population requirements. Several tools have been developed to support workforce change processes. The Calderdale Framework (CF is one such tool designed to facilitate competency-based training by engaging team members in a seven step process involving awareness raising, service and task analysis, competency identification, establishing support systems, training, and sustaining. This paper explores the utility of the CF as an appraisal tool to assess whether adherence to the tool influences outcomes. The CF was applied retrospectively to three complete evaluations of allied health assistant role introduction: a new podiatry assistant role (Australia, speech pathology assistant (Australia, and occupational therapy assistant practitioner role (UK. Adherence to the CF was associated with more effective and efficient use of the role, role flexibility and career development opportunities for assistants, and role sustainability. Services are less likely to succeed in their workforce change process if they fail to plan for and use a structured approach to change, assign targeted leadership, undertake staff engagement and consultation, and perform an initial service analysis. The CF provides a clear template for appraising the implementation of new roles and highlights the potential consequences of not adhering to particular steps in the implementation process.Keywords: workforce change, allied health

  15. Military Construction: Process and Outcomes

    Science.gov (United States)

    2016-12-14

    barracks, schools, hospitals, child development centers, and other facilities needed to support U.S. military forces at home and overseas. This military...and programming into the President’s budget could take three or more years. Furthermore, it is important to note that only those projects that have...travel, fuel, minor construction projects of $1M or less, training and education , and depot maintenance, and base operations support. O&M

  16. A comprehensive systematic review of the development process of 104 patient-reported outcomes (PROs for physical activity in chronically ill and elderly people

    Directory of Open Access Journals (Sweden)

    Frei Anja

    2011-12-01

    Full Text Available Abstract Background Capturing dimensions of physical activity relevant to patients may provide a unique perspective for clinical studies of chronically ill patients. However, the quality of the development of existing instruments is uncertain. The aim of this systematic review was to assess the development process of patient-reported outcome (PRO instruments including their initial validation to measure physical activity in chronically ill or elderly patient populations. Methods We conducted a systematic literature search of electronic databases (Medline, Embase, Psychinfo, Cinahl and hand searches. We included studies describing the original development of fully structured instruments measuring dimensions of physical activity or related constructs in chronically ills or elderly. We broadened the population to elderly because they are likely to share physical activity limitations. At least two reviewers independently conducted title and abstract screening and full text assessment. We evaluated instruments in terms of their aim, items identification and selection, domain development, test-retest reliability, internal consistency, validity and responsiveness. Results Of the 2542 references from the database search and 89 from the hand search, 103 full texts which covered 104 instruments met our inclusion criteria. For almost half of the instruments the authors clearly described the aim of the instruments before the scales were developed. For item identification, patient input was used in 38% of the instruments and in 32% adaptation of existing scales and/or unsystematic literature searches were the only sources for the generation of items. For item reduction, in 56% of the instruments patient input was used and in 33% the item reduction process was not clearly described. Test-retest reliability was assessed for 61%, validity for 85% and responsiveness to change for 19% of the instruments. Conclusions Many PRO instruments exist to measure

  17. Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician.

    Directory of Open Access Journals (Sweden)

    Amitesh Agarwal

    Full Text Available To examine the process and outcomes of care of COPD patients by Advanced Practice Providers (APPs and primary care physicians.We conducted a cross sectional retrospective cohort study of Medicare beneficiaries with COPD who had at least one hospitalization in 2010. We examined the process measures of receipt of spirometry evaluation, influenza and pneumococcal vaccine, use of COPD medications, and referral to a pulmonary specialist visit. Outcome measures were emergency department (ER visit, number of hospitalizations and 30-day readmission in 2010.A total of 7,257 Medicare beneficiaries with COPD were included. Of these, 1,999 and 5,258 received primary care from APPs and primary care physicians, respectively. Patients in the APP group were more likely to be white, younger, male, residing in non-metropolitan areas and have fewer comorbidities. In terms of process of care measures, APPs were more likely to prescribe short acting bronchodilators (adjusted odds ratio [aOR] = 1.18, 95%Confidence Interval [CI] 1.05-1.32, oxygen therapy (aOR = 1.25, 95% CI 1.12-1.40 and consult a pulmonary specialist (aOR = 1.39, 95% CI 1.23-1.56, but less likely to give influenza and pneumococcal vaccinations. Patients receiving care from APPs had lower rates of ER visits for COPD (aOR = 0.84, 95%CI 0.71-0.98 and had a higher follow-up rate with pulmonary specialist within 30 days of hospitalization for COPD (aOR = 1.25, 95%CI 1.07-1.48 than those cared for by physicians.Compared to patients cared for by physicians, patients cared for by APPs were more likely to receive short acting bronchodilator, oxygen therapy and been referred to pulmonologist, however they had lower rates of vaccination probably due to lower age group. Patients cared for by APPs were less like to visit an ER for COPD compared to patients care for by physicians, conversely there was no differences in hospitalization or readmission for COPD between MDs and APPs.

  18. Physical education resources, class management, and student physical activity levels: a structure-process-outcome approach to evaluating physical education effectiveness.

    Science.gov (United States)

    Bevans, Katherine B; Fitzpatrick, Leslie-Anne; Sanchez, Betty M; Riley, Anne W; Forrest, Christopher

    2010-12-01

    This study was conducted to empirically evaluate specific human, curricular, and material resources that maximize student opportunities for physical activity during physical education (PE) class time. A structure-process-outcome model was proposed to identify the resources that influence the frequency of PE and intensity of physical activity during PE. The proportion of class time devoted to management was evaluated as a potential mediator of the relations between resource availability and student activity levels. Data for this cross-sectional study were collected from interviews conducted with 46 physical educators and the systematic observation of 184 PE sessions in 34 schools. Regression analyses were conducted to test for the main effects of resource availability and the mediating role of class management. Students who attended schools with a low student-to-physical educator ratio had more PE time and engaged in higher levels of physical activity during class time. Access to adequate PE equipment and facilities was positively associated with student activity levels. The availability of a greater number of physical educators per student was found to impact student activity levels by reducing the amount of session time devoted to class management. The identification of structure and process predictors of student activity levels in PE will support the allocation of resources and encourage instructional practices that best support increased student activity levels in the most cost-effective way possible. Implications for PE policies and programs are discussed. © 2010, American School Health Association.

  19. Mapping of arithmetic processing by navigated repetitive transcranial magnetic stimulation in patients with parietal brain tumors and correlation with postoperative outcome.

    Science.gov (United States)

    Ille, Sebastian; Drummer, Katharina; Giglhuber, Katrin; Conway, Neal; Maurer, Stefanie; Meyer, Bernhard; Krieg, Sandro M

    2018-03-26

    Preserving functionality is of significant importance during neurosurgical resection of brain tumors. Specialized centers also map further brain functions apart from motor and language functions, such as arithmetic processing (AP). The mapping of AP by navigated repetitive transcranial magnetic stimulation (nrTMS) in healthy volunteers has been demonstrated. The present study aimed to correlate the results of mapping AP with functional patient outcomes. We included 26 patients with parietal brain tumors. Due to preoperative impairment of AP, mapping was not possible in 8 patients (31%). We stimulated 52 cortical sites by nrTMS while patients performed a calculation task. Pre- and postoperatively, patients underwent a standardized number-processing and calculation test (NPCT). Tumor resection was blinded to nrTMS results, and the change in NPCT performance was correlated to resected AP-positive spots as identified by nrTMS. The resection of AP-positive sites correlated with a worsening of the postoperative NPCT result in 12 cases. In 3 cases, no AP-positive sites were resected and the postoperative NPCT result was similar to or better than preoperatively. Also, in 3 cases, the postoperative NPCT result was better than preoperatively, although AP-positive sites were resected. Despite only presenting a low number of cases, nrTMS might be a useful tool for preoperative mapping of AP. However, the reliability of the present results has to be evaluated in a larger series and by intraoperative mapping data. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Pursuing Authenticity From Process to Outcome in a Community-Based Participatory Research Study of Intimate Partner Violence and HIV Vulnerability in North Karnataka, India.

    Science.gov (United States)

    Blanchard, Andrea Katryn; Sangha, Chaitanya Aids Tadegattuva Mahila; Nair, Sapna G; Thalinja, Raghavendra; Srikantamurthy, H S; Ramanaik, Satyanaryana; Javalkar, Prakash; Pillai, Priya; Isac, Shajy; Collumbien, Martine; Heise, Lori; Bhattacharjee, Parinita; Bruce, Sharon Gail

    2017-01-01

    Community-based participatory research has been seen to hold great promise by researchers aiming to bridge research and action in global health programs and practice. However, there is still much debate around whether achieving authenticity in terms of in-depth collaboration between community and academic partners is possible while pursuing academic expectations for quality. This article describes the community-based methodology for a qualitative study to explore intimate partner violence and HIV/AIDS among women in sex work, or female sex workers, and their male partners in Karnataka, South India. Developed through collaborative processes, the study methodology followed an interpretive approach to qualitative inquiry, with three key components including long-term partnerships, knowledge exchange, and orientation toward action. We then discuss lessons learned on how to pursue authenticity in terms of truly collaborative processes with inherent value that also contribute to, rather than hinder, the instrumental goal of enhancing the quality and relevance of the research outcomes. © The Author(s) 2016.

  1. Nursing students evaluation of problem based learning and the impact of culture on the learning process and outcomes: a pilot project.

    Science.gov (United States)

    Al-Kloub, Manal Ibrahim; Salameh, Taghreed Nayel; Froelicher, Erika Sivarajan

    2014-03-01

    This study evaluates students' learning experiences in a clinical pediatric nursing course adopting Problem Based Learning (PBL) and investigates how students' cultural background impacts on self directed learning. A mixed-methods approach combining quantitative and qualitative methods was utilized to answer the research objectives. An observational technique for the PBL teaching sessions was employed; and 226 third-year students were asked to complete PBL evaluation questionnaire. Fifty seven percent (n = 130) responses to the questionnaire were analyzed. Overall, students considered PBL to be moderately effective in their learning experience, with a mean of 3.64 (S.D = 1.18). Students qualitative responses fell within four thematic categories including: developing cognitive abilities, independent learning, motivation to learn, and group learning. Difficulties encountered by students were: it is time-consuming, it has unclear objectives, it is a stressful process, and it results in an increased workload. A small number of students indicated that PBL tutorials were boring and complained about lack of contribution from instructors and limited recourses. Learning is intertwined with culture; students' previous educational experiences, uncertainty, English language proficiency, computer resources, gender, and achievement were identified as the most important cultural issues that impact the learning process and outcomes. Successful implementation of PBL does not come easily; teachers should be alert to the issues of culture in designing curriculum. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Proposed food and drug administration protection action guides for human food and animal feed: Rationale and limits

    International Nuclear Information System (INIS)

    Shleien, B.; Schmidt, G.D.; Chiacchierini, R.P.

    1978-01-01

    The Food and Drug Administration is proposing Protective Action Guides (PAG's) to be used in the event that a radiological incident results in the radioactive contamination of human food and animal feed. PAG's are proposed for two levels of response: (1) PREVENTIVE PAG - establishes a level at which responsible officials should take protective action to prevent or reduce the concentration of radioactivity in food or animal feed. (2) EMERGENCY PAG - establishes a level at which responsible officials should isolate food containing radioactivity to prevent its introduction into commerce and determine whether condemnation or another disposition is appropriate. Derived response levels, which are defined as the concentration of radioactivity in food or animal feed corresponding to the above PAG's, are proposed for radionuclides of most significance. The presentation will discuss the supporting rationale as well as the numerical limits for the PAG's. This rationale is based on the process of risk assessment and cost-benefit and cost-effectiveness analysis. The risk assessment compares the risk of radiation exposure to the risk from prevalent hazards accepted by society and from variability of the natural radiation environment. The cost-benefit analysis is limited to protective actions efficacious in the reduction of iodine-131 dose to the thyroid via the milk pathway (condemnation and use of stored feed). In addition, the metabolic and agricultural transfer models that were used to calculate derived response levels will be described briefly. (author)

  3. Proposed food and drug administration protection action guides for human food and animal feed: Rationale and limits

    Energy Technology Data Exchange (ETDEWEB)

    Shleien, B; Schmidt, G D; Chiacchierini, R P [Food and Drug Administration, Bureau of Radiological Health, Rockville, MD (United States)

    1978-12-01

    The Food and Drug Administration is proposing Protective Action Guides (PAG's) to be used in the event that a radiological incident results in the radioactive contamination of human food and animal feed. PAG's are proposed for two levels of response: (1) PREVENTIVE PAG - establishes a level at which responsible officials should take protective action to prevent or reduce the concentration of radioactivity in food or animal feed. (2) EMERGENCY PAG - establishes a level at which responsible officials should isolate food containing radioactivity to prevent its introduction into commerce and determine whether condemnation or another disposition is appropriate. Derived response levels, which are defined as the concentration of radioactivity in food or animal feed corresponding to the above PAG's, are proposed for radionuclides of most significance. The presentation will discuss the supporting rationale as well as the numerical limits for the PAG's. This rationale is based on the process of risk assessment and cost-benefit and cost-effectiveness analysis. The risk assessment compares the risk of radiation exposure to the risk from prevalent hazards accepted by society and from variability of the natural radiation environment. The cost-benefit analysis is limited to protective actions efficacious in the reduction of iodine-131 dose to the thyroid via the milk pathway (condemnation and use of stored feed). In addition, the metabolic and agricultural transfer models that were used to calculate derived response levels will be described briefly. (author)

  4. The place of the clock in pediatric advice: rationales, cultural themes, and impediments to breastfeeding.

    Science.gov (United States)

    Millard, A V

    1990-01-01

    This analysis treats the U.S. medical literature as evidence concerning the formal system of knowledge in allopathic medicine. An examination of pediatric advice on breastfeeding reveals the logic of medical reasoning, the use of scientific rationales, and the intrusion of specific cultural themes. The corpus of data includes works of 18 authors published in 36 volumes from 1897 to 1987, 27 volumes being editions of two major pediatric textbooks. All sources advocate breastfeeding but the detailed advice on how to carry out the process actually tends to undermine it. Moreover, the clock has provided the main frame of reference, creating regimentation reminiscent of factory work, segmenting breastfeeding into a series of steps, and emphasizing efficiency in time and motion. Feeding schedules were advocated in former decades as a matter of discipline for the infant, but nowadays they are viewed as biologically innate to normal infants and to breast milk production. The literature manifests responses over the century to behavioral, biochemical and physiological studies; however, except possibly for one textbook, no thorough rethinking has occurred. Sources of the 1980s continue to focus on the tempo of feeding as a major concern. Cultural themes besides the factory model of breastfeeding include the extension of professional advice to family matters, the subordination of lay women to professional expertise, mistrust of women's bodily signals including the let-down reflex in determining the timing of feedings, mistrust of signals from infants as well, and a professional ideal of flexible advice coupled with rigid limits concerning schedules. The literature interweaves the cultural themes with rationales based on physiological studies in support of specific regimens in breastfeeding, and the relegation of control in breastfeeding to medical experts denies the validity of mutual bodily and emotional responses within the mother-infant dyad. Pediatric authorities thus

  5. Rationale and Design of the Echocardiographic Study of Hispanics/Latinos (ECHO-SOL).

    Science.gov (United States)

    Rodriguez, Carlos J; Dharod, Ajay; Allison, Matthew A; Shah, Sanjiv J; Hurwitz, Barry; Bangdiwala, Shrikant I; Gonzalez, Franklyn; Kitzman, Dalane; Gillam, Linda; Spevack, Daniel; Dadhania, Rupal; Langdon, Sarah; Kaplan, Robert

    2015-01-01

    Information regarding the prevalence and determinants of cardiac structure and function (systolic and diastolic) among the various Hispanic background groups in the United States is limited. The Echocardiographic Study of Latinos (ECHO-SOL) ancillary study recruited 1,824 participants through a stratified-sampling process representative of the population-based Hispanic Communities Health Study - Study of Latinos (HCHS-SOL) across four sites (Bronx, NY; Chicago, Ill; San Diego, Calif; Miami, Fla). The HCHS-SOL baseline cohort did not include an echo exam. ECHO-SOL added the echocardiographic assessment of cardiac structure and function to an array of existing HCHS-SOL baseline clinical, psychosocial, and socioeconomic data and provides sufficient statistical power for comparisons among the Hispanic subgroups. Standard two-dimensional (2D) echocardiography protocol, including M-mode, spectral, color and tissue Doppler study was performed. The main objectives were to: 1) characterize cardiac structure and function and its determinants among Hispanics and Hispanic subgroups; and 2) determine the contributions of specific psychosocial factors (acculturation and familismo) to cardiac structure and function among Hispanics. We describe the design, methods and rationale of currently the largest and most comprehensive study of cardiac structure and function exclusively among US Hispanics. ECHO-SOL aims to enhance our understanding of Hispanic cardiovascular health as well as help untangle the relative importance of Hispanic subgroup heterogeneity and sociocultural factors on cardiac structure and function.

  6. The Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures Project: Rationale and Approach.

    Science.gov (United States)

    MacLean, Paul S; Rothman, Alexander J; Nicastro, Holly L; Czajkowski, Susan M; Agurs-Collins, Tanya; Rice, Elise L; Courcoulas, Anita P; Ryan, Donna H; Bessesen, Daniel H; Loria, Catherine M

    2018-04-01

    Individual variability in response to multiple modalities of obesity treatment is well documented, yet our understanding of why some individuals respond while others do not is limited. The etiology of this variability is multifactorial; however, at present, we lack a comprehensive evidence base to identify which factors or combination of factors influence treatment response. This paper provides an overview and rationale of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, which aims to advance the understanding of individual variability in response to adult obesity treatment. This project provides an integrated model for how factors in the behavioral, biological, environmental, and psychosocial domains may influence obesity treatment responses and identify a core set of measures to be used consistently across adult weight-loss trials. This paper provides the foundation for four companion papers that describe the core measures in detail. The accumulation of data on factors across the four ADOPT domains can inform the design and delivery of effective, tailored obesity treatments. ADOPT provides a framework for how obesity researchers can collectively generate this evidence base and is a first step in an ongoing process that can be refined as the science advances. © 2018 The Obesity Society.

  7. Residents' Yard Choices and Rationales in a Desert City: Social Priorities, Ecological Impacts, and Decision Tradeoffs

    Science.gov (United States)

    Larson, Kelli L.; Casagrande, David; Harlan, Sharon L.; Yabiku, Scott T.

    2009-11-01

    As a dominant land use in urban ecosystems, residential yards impact water and other environmental resources. Converting thirsty lawns into alternative landscapes is one approach to water conservation, yet barriers such as cultural norms reinforce the traditional lawn. Meanwhile, the complex social and ecological implications of yard choices complicate programs aimed at changing grass and other yard features for particular purposes. In order to better understand individual landscape decisions, we qualitatively examined residents’ rationales for their preferred yard types in the desert metropolis of Phoenix, Arizona. After briefly presenting landscape choices across two survey samples, the dominant reasons for preferences are discussed: appearance, maintenance, environment, recreation, microclimate, familiarity, and health/safety. Three broader analytical themes emerged from these descriptive codes: (1) residents’ desires for attractive, comfortable landscapes of leisure encompassing pluralistic tastes, lifestyles, and perceptions; (2) the association of environmental benefits and impacts with different landscape types involving complex social and ecological tradeoffs; and (3) the cultural legacies evident in modern landscape choices, especially in terms of a dichotomous human-nature worldview among long-time residents of the Phoenix oasis. Given these findings, programs aimed at landscape change must recognize diverse preferences and rationalization processes, along with the perceived versus actual impacts and tradeoffs of varying yard alternatives.

  8. [Sex and gender equity in research: rationale for the SAGER guidelines and recommended use].

    Science.gov (United States)

    Heidari, Shirin; Babor, Thomas F; De Castro, Paola; Tort, Sera; Curno, Mirjam

    2018-05-03

    Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literatura search on sex and gender policies in scientific publishing. The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Explaining the impact of a women's group led community mobilisation intervention on maternal and newborn health outcomes: the Ekjut trial process evaluation

    Directory of Open Access Journals (Sweden)

    Sinha Rajesh

    2010-10-01

    Full Text Available Abstract Background Few large and rigorous evaluations of participatory interventions systematically describe their context and implementation, or attempt to explain the mechanisms behind their impact. This study reports process evaluation data from the Ekjut cluster-randomised controlled trial of a participatory learning and action cycle with women's groups to improve maternal and newborn health outcomes in Jharkhand and Orissa, eastern India (2005-2008. The study demonstrated a 45% reduction in neonatal mortality in the last two years of the intervention, largely driven by improvements in safe practices for home deliveries. Methods A participatory learning and action cycle with 244 women's groups was implemented in 18 intervention clusters covering an estimated population of 114 141. We describe the context, content, and implementation of this intervention, identify potential mechanisms behind its impact, and report challenges experienced in the field. Methods included a review of intervention documents, qualitative structured discussions with group members and non-group members, meeting observations, as well as descriptive statistical analysis of data on meeting attendance, activities, and characteristics of group attendees. Results Six broad, interrelated factors influenced the intervention's impact: (1 acceptability; (2 a participatory approach to the development of knowledge, skills and 'critical consciousness'; (3 community involvement beyond the groups; (4 a focus on marginalized communities; (5 the active recruitment of newly pregnant women into groups; (6 high population coverage. We hypothesize that these factors were responsible for the increase in safe delivery and care practices that led to the reduction in neonatal mortality demonstrated in the Ekjut trial. Conclusions Participatory interventions with community groups can influence maternal and child health outcomes if key intervention characteristics are preserved and tailored to

  10. The Reversal Intervention for Metabolic Syndrome (TRIMS study: rationale, design, and baseline data

    Directory of Open Access Journals (Sweden)

    Troughton Jacqui

    2011-05-01

    Full Text Available Abstract Background Recent attention has focused on strategies to combat the forecast epidemic of type-2 diabetes (T2DM and its major vascular sequelae. Metabolic syndrome (MetS comprises a constellation of factors that increase the risk of cardiovascular disease (CVD and T2DM. Our study aims to develop a structured self-management education programme for people with MetS, which includes management of cardiovascular and diabetes risk factors, and to determine its impact. This paper describes the rationale and design of the TRIMS study, including intervention development, and presents baseline data. Methods Subjects recruited from a mixed-ethnic population with MetS were randomised to intervention or control arms. The intervention arm received structured group education based on robust psychological theories and current evidence. The control group received routine care. Follow-up data will be collected at 6 and 12 months. The primary outcome measure will be reversal of metabolic syndrome in the intervention group subjects compared to controls at 12 months follow-up. Results 82 participants (44% male, 22% South Asian were recruited between November 2009 and July 2010. Baseline characteristics were similar for both the intervention (n = 42 and control groups (n = 40. Median age was 63 years (IQR 57 - 67, mean waist size 106 cm (SD ± 11, and prescribing of statins and anti-hypertensives was 51% in each case. Conclusion Results will provide information on changes in diabetes and CVD risk factors and help to inform primary prevention strategies in people with MetS from varied ethnic backgrounds who are at high risk of developing T2DM and CVD. Information gathered in relation to the programme's acceptability and effectiveness in a multi-ethnic population would ensure that our results are widely applicable. Trial registration The study is registered at ClinicalTrials.gov, study identifier: NCT01043770.

  11. Influence of inpatient service specialty on care processes and outcomes for patients with non ST-segment elevation acute coronary syndromes.

    Science.gov (United States)

    Roe, Matthew T; Chen, Anita Y; Mehta, Rajendra H; Li, Yun; Brindis, Ralph G; Smith, Sidney C; Rumsfeld, John S; Gibler, W Brian; Ohman, E Magnus; Peterson, Eric D

    2007-09-04

    Since the broad dissemination of practice guidelines, the association of specialty care with the treatment of patients with acute coronary syndromes has not been studied. We evaluated 55 994 patients with non-ST-segment elevation acute coronary syndromes (ischemic ST-segment changes and/or positive cardiac markers) included in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Quality Improvement Initiative from January 2001 through September 2003 at 301 tertiary US hospitals with full revascularization capabilities. We compared baseline characteristics, the use of American College of Cardiology/American Heart Association guidelines class I recommendations, and in-hospital outcomes by the specialty of the primary in-patient service (cardiology versus noncardiology). A total of 35 374 patients (63.2%) were primarily cared for by a cardiology service, and these patients had lower-risk clinical characteristics, but they more commonly received acute (processes were improved when care was provided by a cardiology service regardless of the propensity to receive cardiology care. The adjusted risk of in-hospital mortality was lower with care provided by a cardiology service (adjusted odds ratio 0.80, 95% confidence interval 0.73 to 0.88), and adjustment for differences in the use of acute medications and invasive procedures partially attenuated this mortality difference (adjusted odds ratio 0.92, 95% confidence interval 0.83 to 1.02). Non-ST-segment elevation acute coronary syndrome patients primarily cared for by a cardiology inpatient service more commonly received evidence-based treatments and had a lower risk of mortality, but these patients had lower-risk clinical characteristics. Results from the present analysis highlight the difficulties with accurately determining how specialty care is associated with treatment patterns and clinical outcomes for patients with acute

  12. Self-reported interpersonal problems and impact messages as perceived by significant others are differentially associated with the process and outcome of depression therapy.

    Science.gov (United States)

    Altenstein-Yamanaka, David; Zimmermann, Johannes; Krieger, Tobias; Dörig, Nadja; Grosse Holtforth, Martin

    2017-07-01

    Interpersonal factors play a major role in causing and maintaining depression. This study sought to investigate how patients' self-perceived interpersonal problems and impact messages as perceived by significant others are interrelated, change over therapy, and differentially predict process and outcome in psychotherapy of depression. For the present study, we used data from 144 outpatients suffering from major depression that were treated within a psychotherapy study. Interpersonal variables were assessed pre- and posttherapy with the self-report Inventory of Interpersonal Problems-Circumplex Scale (IIP-32; Thomas, Brähler, & Strauss, 2011) and with the informant-based Impact Message Inventory (Caspar, Berger, Fingerle, & Werner, 2016). Patients' levels on the dimensions of Agency and Communion were calculated from both measures; their levels on Interpersonal Distress were measured with the IIP. Depressive and general symptomatology was assessed at pre-, post-, and at 3-month follow-up; patient-reported process measures were assessed during therapy. The Agency scores of IIP and IMI correlated moderately, but the Communion scores did not. IIP Communion was positively associated with the quality of the early therapeutic alliance and with the average level of cognitive-emotional processing during therapy. Whereas IIP Communion and IMI Agency increased over therapy, IIP Distress decreased. A pre-post-decrease in IIP Distress was positively associated with pre-postsymptomatic change over and above the other interpersonal variables, but pre-post-increase in IMI Agency was positively associated with symptomatic improvement from post- to 3-month follow-up. These findings suggest that significant others seem to provide important additional information about the patients' interpersonal style. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Troublesome Construction: The Rationale and Risks of IIRSA

    Directory of Open Access Journals (Sweden)

    Pitou van Dijck

    2008-10-01

    Full Text Available Latin American countries are involved in implementing a continental-wide infrastructure programme to deepen regional integration and facilitate their insertion in international markets. The IIRSA [Iniciativa para la Integración de la Infraestructura Regional Suramericana] program- me includes ten so called development hubs that may contribute to significant change in the location of economic activities in the continent as well. They may as well have a substantial impact on the environment in regions adjacent to the corridors. This study deals with the rationale and organization of the IIRSA infrastructure programme. Subsequently the study focuses on the spatial impact such corridors may have and the environmental, social and economic implication of these roads. Finally the paper deals with some critical methodological problems involved in the making of of strategic environmental assessment studies of IIRSA-related road infrastructure projects.  Resumen: Una construcción problemática: Razones y riesgos de IIRSALos países latinoamericanos están implementando un programa continental de infraestructura para profundizar la integración regional y facilitar su inserción en los mercados internacionales. El programa de IIRSA [Iniciativa para la Integración de la Infraestructura Regional Surameri cana] incluye diez centros de desarrollo que pueden contribuir a cambios importantes en la ubicación de las actividades económicas en el continente. Estos centros podrían tener un impacto substancial en el medioambiente de las regiones adyacentes a los corredores. Este estudio se ocupa de las razones y organización del programa de infraestructura de IIRSA. Luego nos concentramos en el impacto espacial que pueden tener esos corredores y las implicaciones sociales, económicas y para el medioambiente de esos caminos. Finalmente tratamos en el artículo algunos críticos problemas metodológicos en la elaboración de evaluaciones medioambientales

  14. Rationale for using Peltophorum africanum (Fabaceae extracts in veterinary medicine

    Directory of Open Access Journals (Sweden)

    S.E. Bizimenyera

    2005-06-01

    . aureus and 0.16 mg/mℓ for P. aeruginosa. There is therefore a rationale for the traditional use of root and bark of P. africanum in treating bacterial infection related diseases.

  15. Alignment of Outcome Instruments Used in Hand Therapy With the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health: A Scoping Review.

    Science.gov (United States)

    Lesher, Danielle Ann-Marie; Mulcahey, M J; Hershey, Peter; Stanton, Donna Breger; Tiedgen, Andrea C

    We sought to identify outcome instruments used in rehabilitation of the hand and upper extremity; to determine their alignment with the constructs of the International Classification of Functioning, Disability and Health (ICF) and the Occupational Therapy Practice Framework: Domain and Process; and to report gaps in the constructs measured by outcome instruments as a basis for future research. We searched CINAHL, MEDLINE, OTseeker, and the Cochrane Central Register of Controlled Trials using scoping review methodology and evaluated outcome instruments for concordance with the ICF and the Framework. We identified 18 outcome instruments for analysis. The findings pertain to occupational therapists' focus on body functions, body structures, client factors, and activities of daily living; a gap in practice patterns in use of instruments; and overestimation of the degree to which instruments used are occupationally based. Occupational therapy practitioners should use outcome instruments that embody conceptual frameworks for classifying function and activity. Copyright © 2017 by the American Occupational Therapy Association, Inc.

  16. Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial

    Science.gov (United States)

    Sung, Vivian W.; Borello-France, Diane; Dunivan, Gena; Gantz, Marie; Lukacz, Emily S.; Moalli, Pamela; Newman, Diane K.; Richter, Holly E.; Ridgeway, Beri; Smith, Ariana L.; Weidner, Alison C.; Meikle, Susan

    2016-01-01

    Introduction Mixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12 months. Methods ESTEEM is a multi-site, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient-centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12 months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure and need for additional treatment. Results The final study design was implemented in November 2013 across 8 clinical sites in the Pelvic Floor Disorders Network. As of February 27, 2016, 433 total /472 targeted participants have been randomized. Conclusions We describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision-making. PMID:27287818

  17. Process of care and preliminary outcome in limited-stage small-cell lung cancer: results of the 1995-1997 patterns of care study in Japan

    International Nuclear Information System (INIS)

    Uno, Takashi; Sumi, Minako; Sawa, Yoshihide M.S.; Teshima, Teruki; Hara, Ryusuke; Ikeda, Hiroshi; Inoue, Toshihiko

    2003-01-01

    Purpose: To evaluate the practice process using the national average (Na); to compare differences in the process of care by age group; and to provide a preliminary outcome data for limited-stage small-cell lung cancer in Japan. Methods and Materials: The Patterns of Care Study conducted a nationwide survey of the care process for Stage I-III small-cell lung cancer in Japan. Patients were divided into three age groups: <65 years (younger group, n = 73); between 65 and 74 years (intermediate group, n = 81); and ≥75 years (elderly group, n = 20). Results: The NA for the total dose was 49.0 Gy, and for use of photon energy ≥6 MV, chemotherapy, and prophylactic cranial irradiation was 77.3%, 93.2%, and 1.69%, respectively. Age stratification had no impact on the variables of radiotherapy (RT) such as total dose and field size. Only 37% of patients received chemotherapy and thoracic RT concurrently. The proportion of patients who received chemotherapy and RT concurrently was 44%, 27%, and 25% of the younger, intermediate, and elderly groups, respectively (p = 0.029). Etoposide and cisplatin were less frequently used in the elderly group (≥75 years old). Overall survival at 3 years for the entire group was 26%. The 3-year survival rate was 30% in the younger group, 28% in the intermediate group, and 9% in the elderly group. Variables found to have a significant impact on survival by multivariate analysis were the use of chemotherapy (p = 0.030), age (p 0.032), and T stage (p = 0.042). Conclusion: Calculated NAs showed that the results of clinical study had favorably penetrated into the practice process in Japan. The results demonstrated that patient age significantly influenced the process of chemotherapy such as the use of etoposide and cisplatin for limited-stage small-cell lung cancer in Japan. More concurrent chemotherapy and thoracic RT and the application of prophylactic cranial irradiation for complete responders need to be investigated in the future

  18. Zero Tolerance Policy in Schools: Rationale, Consequences, and Alternatives.

    Science.gov (United States)

    Casella, Ronnie

    2003-01-01

    Discusses theory/policies supporting zero tolerance policy in schools, including rational choice theory in criminology and national crime policies based on deterrence. Potential consequences of zero tolerance policy implementation are described and shown to involve outcomes similar to those identified by researchers studying national crime policy.…

  19. "Waiting on the words": procedures and outcomes of a drama class for individuals with aphasia.

    Science.gov (United States)

    Cherney, Leora R; Oehring, Ann K; Whipple, Keith; Rubenstein, Ted

    2011-08-01

    Drama therapy offers an authentic medium through which people with aphasia can interact and share their experiences. We describe the rationale and procedures of a drama class, informed by the principles and practices of drama therapy, in which individuals with chronic aphasia conceptualized, wrote, and produced a play addressing their experiences of having, living with, and coping with the effects of aphasia. Sessions were cofacilitated by a speech-language pathologist and a drama therapist. We describe the drama activities and techniques in each of four distinct stages of a drama therapy process through which the group transitioned. We also summarize patient-reported outcomes of a representational group of seven participants. Subscales of the Burden of Stroke Scale and the Communication Confidence Rating Scale for Aphasia were administered before and after participation in the 18-week class. Means, standard deviations, and effect sizes were computed. Results indicated perceived improvements in both communication and mood. © Thieme Medical Publishers.

  20. Successful recruitment to a study of first-episode psychosis by clinicians: a qualitative account of outcomes and influences on process.

    Science.gov (United States)

    Patterson, Sue; Duhig, Michael; Connell, Melissa; Scott, James

    2014-10-01

    Abstract Background: Strategies proposed to promote recruitment of representative samples to trials and mental health research have focused on researchers external to clinical services. How clinicians approach recruitment as researchers and particularities of recruiting people with first episode of psychosis warrant investigation. To describe recruitment, by clinicians, of people with first-episode psychosis (FEP) and factors influencing process and enrolment. Observational study nested within longitudinal examination of trauma and outcomes for patients experiencing first psychotic episode. Data collected during 20 scheduled meetings of clinicians recruiting from services in Australia. Timely recruitment of 60 young people demonstrates that clinicians can successfully engage patients in research. Success depends on satisfaction of organisational preconditions and clinician motivation grounded in considering the study worthwhile. Pre-selection of participants was informed by judgments about health, insight and quality of the therapeutic alliance. Patients' decisions were influenced by family support, acceptance of diagnosis and altruism. Honoraria had variable effect. Clinicians are well placed to recruit when appropriately supported, and people with FEP are willing to engage in research that fits their personal circumstances. Research should examine the meaning of participation in such studies and ways participation could support recovery.

  1. Qualitative insights into implementation, processes, and outcomes of a randomized trial on peer support and HIV care engagement in Rakai, Uganda.

    Science.gov (United States)

    Monroe, April; Nakigozi, Gertrude; Ddaaki, William; Bazaale, Jeremiah Mulamba; Gray, Ronald H; Wawer, Maria J; Reynolds, Steven J; Kennedy, Caitlin E; Chang, Larry W

    2017-01-10

    People living with human immunodeficiency virus (HIV) who have not yet initiated antiretroviral therapy (ART) can benefit from being engaged in care and utilizing preventive interventions. Community-based peer support may be an effective approach to promote these important HIV services. After conducting a randomized trial of the impact of peer support on pre-ART outcomes, we conducted a qualitative evaluation to better understand trial implementation, processes, and results. Overall, 75 participants, including trial participants (clients), peer supporters, and clinic staff, participated in 41 in-depth interviews and 6 focus group discussions. A situated Information Motivation, and Behavioral skills model of behavior change was used to develop semi-structured interview and focus group guides. Transcripts were coded and thematically synthesized. We found that participant narratives were generally consistent with the theoretical model, indicating that peer support improved information, motivation, and behavioral skills, leading to increased engagement in pre-ART care. Clients described how peer supporters reinforced health messages and helped them better understand complicated health information. Peer supporters also helped clients navigate the health system, develop support networks, and identify strategies for remembering medication and clinic appointments. Some peer supporters adopted roles beyond visiting patients, serving as a bridge between the client and his or her family, community, and health system. Qualitative results demonstrated plausible processes by which peer support improved client engagement in care, cotrimoxazole use, and safe water vessel use. Challenges identified included insufficient messaging surrounding ART initiation, lack of care continuity after ART initiation, rare breaches in confidentiality, and structural challenges. The evaluation found largely positive perceptions of the peer intervention across stakeholders and provided valuable

  2. Child/Adolescent Anxiety Multimodal Study (CAMS: rationale, design, and methods

    Directory of Open Access Journals (Sweden)

    Waslick Bruce D

    2010-01-01

    Full Text Available Abstract Objective To present the design, methods, and rationale of the Child/Adolescent Anxiety Multimodal Study (CAMS, a recently completed federally-funded, multi-site, randomized placebo-controlled trial that examined the relative efficacy of cognitive-behavior therapy (CBT, sertraline (SRT, and their combination (COMB against pill placebo (PBO for the treatment of separation anxiety disorder (SAD, generalized anxiety disorder (GAD and social phobia (SoP in children and adolescents. Methods Following a brief review of the acute outcomes of the CAMS trial, as well as the psychosocial and pharmacologic treatment literature for pediatric anxiety disorders, the design and methods of the CAMS trial are described. Results CAMS was a six-year, six-site, randomized controlled trial. Four hundred eighty-eight (N = 488 children and adolescents (ages 7-17 years with DSM-IV-TR diagnoses of SAD, GAD, or SoP were randomly assigned to one of four treatment conditions: CBT, SRT, COMB, or PBO. Assessments of anxiety symptoms, safety, and functional outcomes, as well as putative mediators and moderators of treatment response were completed in a multi-measure, multi-informant fashion. Manual-based therapies, trained clinicians and independent evaluators were used to ensure treatment and assessment fidelity. A multi-layered administrative structure with representation from all sites facilitated cross-site coordination of the entire trial, study protocols and quality assurance. Conclusions CAMS offers a model for clinical trials methods applicable to psychosocial and psychopharmacological comparative treatment trials by using state-of-the-art methods and rigorous cross-site quality controls. CAMS also provided a large-scale examination of the relative and combined efficacy and safety of the best evidenced-based psychosocial (CBT and pharmacologic (SSRI treatments to date for the most commonly occurring pediatric anxiety disorders. Primary and secondary results

  3. Hepatology may have problems with putative surrogate outcome measures

    DEFF Research Database (Denmark)

    Gluud, Christian; Brok, Jesper; Gong, Yan

    2007-01-01

    A surrogate outcome measure is a laboratory measurement, a physical sign, or another intermediate substitute that is able to predict an intervention's effect on a clinically meaningful outcome. A clinical outcome detects how a patient feels, functions, or survives. Surrogate outcome measures occur...... faster or more often, are cheaper, and/or are less invasively achieved than the clinical outcome. In practice, validation is surprisingly often overlooked, especially if a biologic plausible rationale is proposed. Surrogate outcomes must be validated before use. The first step in validation...... predicts the intervention's effect on the clinical outcome. In hepatology a number of putative surrogate outcomes are used both in clinical research and in clinical practice without having been properly validated. Sustained virological response to interferons and ribavirin in patients with chronic...

  4. Rationale and Methodology of Reprogramming for Generation of Induced Pluripotent Stem Cells and Induced Neural Progenitor Cells

    Directory of Open Access Journals (Sweden)

    Zuojun Tian

    2016-04-01

    Full Text Available Great progress has been made regarding the capabilities to modify somatic cell fate ever since the technology for generation of induced pluripotent stem cells (iPSCs was discovered in 2006. Later, induced neural progenitor cells (iNPCs were generated from mouse and human cells, bypassing some of the concerns and risks of using iPSCs in neuroscience applications. To overcome the limitation of viral vector induced reprogramming, bioactive small molecules (SM have been explored to enhance the efficiency of reprogramming or even replace transcription factors (TFs, making the reprogrammed cells more amenable to clinical application. The chemical induced reprogramming process is a simple process from a technical perspective, but the choice of SM at each step is vital during the procedure. The mechanisms underlying cell transdifferentiation are still poorly understood, although, several experimental data and insights have indicated the rationale of cell reprogramming. The process begins with the forced expression of specific TFs or activation/inhibition of cell signaling pathways by bioactive chemicals in defined culture condition, which initiates the further reactivation of endogenous gene program and an optimal stoichiometric expression of the endogenous pluri- or multi-potency genes, and finally leads to the birth of reprogrammed cells such as iPSCs and iNPCs. In this review, we first outline the rationale and discuss the methodology of iPSCs and iNPCs in a stepwise manner; and then we also discuss the chemical-based reprogramming of iPSCs and iNPCs.

  5. The rationale for energy efficiency policy: Assessing the recognition of the multiple benefits of energy efficiency retrofit policy

    International Nuclear Information System (INIS)

    Kerr, Niall; Gouldson, Andy; Barrett, John

    2017-01-01

    The rationale for energy efficiency policy can be framed in terms of a variety of different benefits. This paper considers how different benefits have been used within the overall rationale for energy efficient retrofit policy in different contexts. We posit that different rationales may be used for the same policy response, and that the form of rationale used may affect the design, delivery or the level of policy support, with different rationales making it easier to account for different results. Considering retrofit policy in the contexts of the UK, Germany, New Zealand and Ireland, we characterise policy rationale in each case, assessing what the key perceived benefits have been, and whether they have changed over time. The analysis identifies some marked differences between cases with the recognition of benefits and the ensuing policy rationale resulting from a complex mix of political, social and economic influences. We find that recognition of multiple benefits may not equate with multiplied policy support, and instead it is more likely that different rationales will have relevance at different times, for different audiences. The findings highlight that, alongside evidence for policy, it is important to also consider how the overall rationale for policy is eventually framed. - Highlights: • Energy efficiency as a policy issue with perceived multiple benefits. • Assessment of the influence of different benefits on rationale for energy efficient retrofit policy. • How does the rationale for retrofit policy differ in different national policy contexts. • To what extent are the perceived multiple benefits of policy recognised. • What influence does eventual rationale for policy have on the policy implemented.

  6. West End Walkers 65+: A randomised controlled trial of a primary care-based walking intervention for older adults: Study rationale and design

    Directory of Open Access Journals (Sweden)

    Rowe David A

    2011-02-01

    Full Text Available Abstract Background In Scotland, older adults are a key target group for physical activity intervention due to the large proportion who are inactive. The health benefits of an active lifestyle are well established but more research is required on the most effective interventions to increase activity in older adults. The 'West End Walkers 65+' randomised controlled trial aims to examine the feasibility of delivering a pedometer-based walking intervention to adults aged ≥65 years through a primary care setting and to determine the efficacy of this pilot. The study rationale, protocol and recruitment process are discussed in this paper. Methods/Design The intervention consisted of a 12-week pedometer-based graduated walking programme and physical activity consultations. Participants were randomised into an immediate intervention group (immediate group or a 12-week waiting list control group (delayed group who then received the intervention. For the pilot element of this study, the primary outcome measure was pedometer step counts. Secondary outcome measures of sedentary time and physical activity (time spent lying/sitting, standing or walking; activPAL™ monitor, mood (Positive and Negative Affect Schedule, functional ability (Perceived Motor-Efficacy Scale for Older Adults, quality of life (Short-Form (36 Health Survey version 2 and loneliness (UCLA Loneliness Scale were assessed. Focus groups with participants and semi-structured interviews with the research team captured their experiences of the intervention. The feasibility component of this trial examined recruitment via primary care and retention of participants, appropriateness of the intervention for older adults and the delivery of the intervention by a practice nurse. Discussion West End Walkers 65+ will determine the feasibility and pilot the efficacy of delivering a pedometer-based walking intervention through primary care to Scottish adults aged ≥65 years. The study will also

  7. Jump starting shared medical appointments for diabetes with weight management: Rationale and design of a randomized controlled trial.

    Science.gov (United States)

    Crowley, Matthew J; Edelman, David; Voils, Corrine I; Maciejewski, Matthew L; Coffman, Cynthia J; Jeffreys, Amy S; Turner, Marsha J; Gaillard, Leslie A; Hinton, Teresa A; Strawbridge, Elizabeth; Zervakis, Jennifer; Barton, Anna Beth; Yancy, William S

    2017-07-01

    Rates of glycemic control remain suboptimal nationwide. Medication intensification for diabetes can have undesirable side effects (weight gain, hypoglycemia), which offset the benefits of glycemic control. A Shared Medical Appointment (SMA) intervention for diabetes that emphasizes weight management could improve glycemic outcomes and reduce weight while simultaneously lowering diabetes medication needs, resulting in less hypoglycemia and better quality of life. We describe the rationale and design for a study evaluating a novel SMA intervention for diabetes that primarily emphasizes low-carbohydrate diet-focused weight management. Jump Starting Shared Medical Appointments for Diabetes with Weight Management (Jump Start) is a randomized, controlled trial that is allocating overweight Veterans (body mass index≥27kg/m 2 ) with type 2 diabetes into two arms: 1) a traditional SMA group focusing on medication management and self-management counseling; or 2) an SMA group that combines low-carbohydrate diet-focused weight management (WM/SMA) with medication management. Hemoglobin A1c reduction at 48weeks is the primary outcome. Secondary outcomes include hypoglycemic events, diabetes medication use, weight, medication adherence, diabetes-related quality of life, and cost-effectiveness. We hypothesize that WM/SMA will be non-inferior to standard SMA for glycemic control, and will reduce hypoglycemia, diabetes medication use, and weight relative to standard SMA, while also improving quality of life and costs. Jump Start targets two common problems that are closely related but infrequently managed together: diabetes and obesity. By focusing on diet and weight loss as the primary means to control diabetes, this intervention may improve several meaningful patient-centered outcomes related to diabetes. Copyright © 2017. Published by Elsevier Inc.

  8. A randomised controlled trial of the efficacy of the ABCD Parenting Young Adolescents Program: rationale and methodology

    Directory of Open Access Journals (Sweden)

    Burke Kylie

    2010-08-01

    Full Text Available Abstract Background The transition to adolescence is a time of increased vulnerability for risk taking and poor health, social and academic outcomes. Parents have an important role in protecting their children from these potential harms. While the effectiveness of parenting programs in reducing problem behavior has been demonstrated, it is not known if parenting programs that target families prior to the onset of significant behavioral difficulties in early adolescence (9-14 years improve the wellbeing of adolescents and their parents. This paper describes the rationale and methodology of a randomised controlled trial testing the efficacy of a parenting program for the promotion of factors known to be associated with positive adolescent outcomes, such as positive parenting practices, parent-adolescent relationships and adolescent behavior. Methods/Design One hundred and eighty parents were randomly allocated to an intervention or wait list control group. Parents in the intervention group participated in the ABCD Parenting Young Adolescents Program, a 6-session behavioral family intervention program which also incorporates acceptance-based strategies. Participants in the Wait List control group did not receive the intervention during a six month waiting period. The study was designed to comply with recommendations of the CONSORT statement. The primary outcome measures were reduction in parent-adolescent conflict and improvements in parent-adolescent relationships. Secondary outcomes included improvements in parent psychosocial wellbeing, parenting self-efficacy and perceived effectiveness, parent-adolescent communication and adolescent behavior. Conclusions Despite the effectiveness of parenting programs in reducing child behavioral difficulties, very few parenting programs for preventing problems in adolescents have been described in the peer reviewed literature. This study will provide data which can be used to examine the efficacy of a

  9. Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components.

    Science.gov (United States)

    Mariko, Mamadou

    2003-03-01

    The public finance and foreign exchange crisis of the 1980s aggravated the unfavourable economic trends in many developing countries and resulted in budget cuts in the health sector. Policymakers, following the suggestions of World Bank experts, introduced user fees. Economic analysis of the demand for health care in these countries focused on the impact of price and income on health service utilisation. But the lesson to date from experiences in cost recovery is that without visible and fairly immediate improvements in the quality of care, the implementation of user fees will cause service utilisation to drop. For this reason, the role of quality of health care has been recently a subject of investigation in a number of health care demand studies. In spite of using the data from both households and facilities, recent studies are quite limited because they measure quality only by structural attributes (availability of drugs, equipment, number and qualifications of staff, and so on). Structural attributes of quality are necessary but not sufficient conditions for demand. A unique feature of this study is that it also considers the processes followed by practitioners and the outcome of care, to determine simultaneously the respective influence of price and quality on decision making. A nested multinomial logit was used to examine the choice between six alternatives (self-treatment, modern treatment at home, public hospital, public dispensary, for-profit facility and non-profit facility). The estimations are based on data from a statistically representative sample of 1104 patients from 1191 households and the data from a stratified random sample of 42 out of 84 facilities identified. The results indicate that omitting the process quality variables from the demand model produces a bias not only in the estimated coefficient of the "price" variable but also in coefficients of some structural attributes of the quality. The simulations suggest that price has a minor effect

  10. Placebo versus "standard" hypnosis rationale: attitudes, expectancies, hypnotic responses, and experiences.

    Science.gov (United States)

    Accardi, Michelle; Cleere, Colleen; Lynn, Steven Jay; Kirsch, Irving

    2013-10-01

    In this study participants were provided with either the standard rationale that accompanies the Harvard Group Scale of Hypnotic Susceptibility: A (Shor & Orne, 1962) or a rationale that presented hypnosis as a nondeceptive placebo, consistent with Kirsch's (1994) sociocognitive perspective of hypnosis. The effects of the placebo and standard rationales were highly comparable with respect to hypnotic attitudes; prehypnotic expectancies; objective, subjective, and involuntariness measures of hypnotic responding; as well as a variety of subjective experiences during hypnosis, as measured by the Phenomenology of Consciousness Inventory (Pekala, 1982). Differences among correlations were not evident when measures were compared across groups. However, indices of hypnotic responding were correlated with attitudes in the hypnosis but not the placebo condition, and, generally speaking, the link between subjective experiences during hypnosis and measures of hypnotic responding were more reliable in the placebo than the hypnosis group. Researcher findings are neutral with respect to providing support for altered state versus sociocognitive models of hypnosis.

  11. Practices and rationales of community engagement with wind farms: awareness raising, consultation, empowerment

    DEFF Research Database (Denmark)

    Aitken, Mhairi; Haggett, Claire; Rudolph, David Philipp

    2016-01-01

    In light of the growing emphasis on community engagement in the literature on renewable energy planning, and given the acknowledgement of the complexity of community engagement as a concept, we conducted an empirical review of practice relating to community engagement with onshore wind farms...... in the UK, exploring what is actually happening in terms of community engagement relating to onshore wind farms, and examining the rationales underpinning approaches to community engagement. We found that a wide range of engagement methods are being used in relation to onshore wind farms across the UK......-hierarchical classification of community engagement approaches: awareness raising; consultation and empowerment. This provides a useful tool for reflecting on practices and rationales of community engagement. By considering the three approaches non-hierarchically, this model allows for an examination of how such rationales...

  12. Problem based learning in medical education: theory, rationale, process and implications for pakistan.

    Science.gov (United States)

    Baig, Lubna A

    2006-09-01

    Historically, lectures were the medium to transfer cognitive information to the learners in medical education. Apprenticeship training, labs, bedside teaching, tutorials etc. were used to impart psychomotor and affective skills. It was assumed that the learner will assimilate all this knowledge and will be competent to apply this learning in practical life. Problem-based learning (PBL) emerged due to problems in building the appropriate competencies in the medical graduates and is a relatively newer mode of transfer of knowledge. This paper will deal with problem-based learning which took the world with storm in the 80's and most institutions in the world started using different variants of PBL. This paper attempts to define and explore the theoretical basis and historical background of PBL. The paper will systematically review literature and argue about the advantages and disadvantages of PBL and the implications of its implementation in Pakistan.

  13. Developing an Undergraduate International Business Program: Context, Rationale, Process and Focus

    Science.gov (United States)

    Bell, Jim; Gray, Brendan; McNaughton, Rod

    2003-01-01

    This paper discusses the recent development of a new undergraduate international business program at the University of Otago in New Zealand. Firstly, it describes the context of the initiative in terms of the New Zealand business environment, the university sector in New Zealand and recent global trends in international business education.…

  14. NASA Standard for Models and Simulations (M and S): Development Process and Rationale

    Science.gov (United States)

    Zang, Thomas A.; Blattnig, Steve R.; Green, Lawrence L.; Hemsch, Michael J.; Luckring, James M.; Morison, Joseph H.; Tripathi, Ram K.

    2009-01-01

    After the Columbia Accident Investigation Board (CAIB) report. the NASA Administrator at that time chartered an executive team (known as the Diaz Team) to identify the CAIB report elements with Agency-wide applicability, and to develop corrective measures to address each element. This report documents the chronological development and release of an Agency-wide Standard for Models and Simulations (M&S) (NASA Standard 7009) in response to Action #4 from the report, "A Renewed Commitment to Excellence: An Assessment of the NASA Agency-wide Applicability of the Columbia Accident Investigation Board Report, January 30, 2004".

  15. The patents-based pharmaceutical development process: rationale, problems, and potential reforms.

    Science.gov (United States)

    Barton, John H; Emanuel, Ezekiel J

    2005-10-26

    The pharmaceutical industry is facing substantial criticism from many directions, including financial barriers to access to drugs in both developed and developing countries, high profits, spending on advertising and marketing, and other issues. Underlying these criticisms are fundamental questions about the value of the current patent-based drug development system. Six major problems with the patent system are (1) recovery of research costs by patent monopoly reduces access to drugs; (2) market demand rather than health needs determines research priorities; (3) resources between research and marketing are misallocated; (4) the market for drugs has inherent market failures; (5) overall investment in drug research and development is too low, compared with profits; and (6) the existing system discriminates against US patients. Potential solutions fall into 3 categories: change in drug pricing through either price controls or tiered pricing; change in drug industry structure through a "buy-out" pricing system or with the public sector acting as exclusive research funder; and change in development incentives through a disease burden incentive system, orphan drug approaches, or requiring new drugs to demonstrate improvement over existing products prior to US Food and Drug Administration approval. We recommend 4 complementary reforms: (1) having no requirement to test new drug products against existing products prior to approval but requiring rigorous comparative postapproval testing; (2) international tiered pricing and systematic safeguards to prevent flow-back; (3) increased government-funded research and buy-out for select conditions; and (4) targeted experiments using other approaches for health conditions in which there has been little progress and innovation over the last few decades.

  16. Canadian nuclear power principles for beyond design basis events - supporting rationale

    International Nuclear Information System (INIS)

    Elliott, M.; Newman, G.; Bhaloo, A.

    2014-01-01

    The development of the following principles and their rationale began during a special Chief Nuclear Engineers forum held on March 25th, 2013 in Toronto. These principles are intended to provide guidance to the Canadian Nuclear Power Industry in developing responses to the lessons learned from the Fukushima event of March 2011. These principles were accepted and signed off by the Chief Nuclear Officers of each of the three utilities in August 2013 and were presented to the CNSC at a public hearing on August 21, 2013. This document provides the underlying rationale for the principles. (author)

  17. A beginner's guide to writing the nursing conceptual model-based theoretical rationale.

    Science.gov (United States)

    Gigliotti, Eileen; Manister, Nancy N

    2012-10-01

    Writing the theoretical rationale for a study can be a daunting prospect for novice researchers. Nursing's conceptual models provide excellent frameworks for placement of study variables, but moving from the very abstract concepts of the nursing model to the less abstract concepts of the study variables is difficult. Similar to the five-paragraph essay used by writing teachers to assist beginning writers to construct a logical thesis, the authors of this column present guidelines that beginners can follow to construct their theoretical rationale. This guide can be used with any nursing conceptual model but Neuman's model was chosen here as the exemplar.

  18. Canadian nuclear power principles for beyond design basis events - supporting rationale

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, M. [OPG Nuclear, Ontario (Canada); Newman, G. [Bruce Power, Ontario (Canada); Bhaloo, A. [New Brunswick Power, New Brunswick (Canada)

    2014-09-15

    The development of the following principles and their rationale began during a special Chief Nuclear Engineers forum held on March 25th, 2013 in Toronto. These principles are intended to provide guidance to the Canadian Nuclear Power Industry in developing responses to the lessons learned from the Fukushima event of March 2011. These principles were accepted and signed off by the Chief Nuclear Officers of each of the three utilities in August 2013 and were presented to the CNSC at a public hearing on August 21, 2013. This document provides the underlying rationale for the principles. (author)

  19. Canadian nuclear power principles for beyond design basis events - supporting rationale

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, M. [Ontario Power Generation Nuclear, Pickering, ON (Canada); Newman, G. [Bruce Power, Tiverton, ON (Canada); Bhaloo, A. [New Brunswick Power, Fredericton, NB (Canada)

    2014-07-01

    The development of the following principles and their rationale began during a special Chief Nuclear Engineers forum held on March 25th, 2013 in Toronto. These principles are intended to provide guidance to the Canadian Nuclear Power Industry in developing responses to the lessons learned from the Fukushima event of March 2011. These principles were accepted and signed off by the Chief Nuclear Officers of each of the three utilities in August 2013 and were presented to the CNSC at a public hearing on August 21, 2013. This document provides the underlying rationale for the principles. (author)

  20. Shamba Maisha: Pilot agricultural intervention for food security and HIV health outcomes in Kenya: design, methods, baseline results and process evaluation of a cluster-randomized controlled trial.

    Science.gov (United States)

    Cohen, Craig R; Steinfeld, Rachel L; Weke, Elly; Bukusi, Elizabeth A; Hatcher, Abigail M; Shiboski, Stephen; Rheingans, Richard; Scow, Kate M; Butler, Lisa M; Otieno, Phelgona; Dworkin, Shari L; Weiser, Sheri D

    2015-01-01

    Despite advances in treatment of people living with HIV, morbidity and mortality remains unacceptably high in sub-Saharan Africa, largely due to parallel epidemics of poverty and food insecurity. We conducted a pilot cluster randomized controlled trial (RCT) of a multisectoral agricultural and microfinance intervention (entitled Shamba Maisha) designed to improve food security, household wealth, HIV clinical outcomes and women's empowerment. The intervention was carried out at two HIV clinics in Kenya, one randomized to the intervention arm and one to the control arm. HIV-infected patients >18 years, on antiretroviral therapy, with moderate/severe food insecurity and/or body mass index (BMI) loan (~$150) to purchase the farming commodities, 2) a micro-irrigation pump, seeds, and fertilizer, and 3) trainings in sustainable agricultural practices and financial literacy. Enrollment of 140 participants took four months, and the screening-to-enrollment ratio was similar between arms. We followed participants for 12 months and conducted structured questionnaires. We also conducted a process evaluation with participants and stakeholders 3-5 months after study start and at study end. Baseline results revealed that participants at the two sites were similar in age, gender and marital status. A greater proportion of participants at the intervention site had a low BMI in comparison to participants at the control site (18% vs. 7%, p = 0.054). While median CD4 count was similar between arms, a greater proportion of participants enrolled at the intervention arm had a detectable HIV viral load compared with control participants (49% vs. 28%, respectively, p loans, agricultural challenges due to weather patterns, and a challenging partnership with the microfinance institution. We expect the results from this pilot study to provide useful data on the impacts of livelihood interventions and will help in the design of a definitive cluster RCT. This trial is registered at Clinical

  1. The effect of out of hours presentation with acute stroke on processes of care and outcomes: analysis of data from the Stroke Improvement National Audit Programme (SINAP.

    Directory of Open Access Journals (Sweden)

    James T P Campbell

    Full Text Available BACKGROUND: There is inconsistent evidence that patients with stroke admitted to hospital out of regular working hours (such as weekends experience worse outcomes. We aimed to identify if inequalities in the quality of care and mortality exist in contemporary stroke care in England. METHODS: SINAP is a prospective database of acute stroke patients, documenting details of processes of care over the first 72 hours. We compared quality of care indicators and mortality at 72 hours, 7 days and 30 days, for patients who arrived within normal hours (Monday-Friday 8am to 6pm and for those who arrived out of hours, using multivariable logistic and Cox proportional hazard models. Quality of care was defined according to time from arrival at hospital to interventions (e.g., brain scan, and whether the patient received therapeutic interventions (such as thrombolysis. RESULTS: 45,726 stroke patients were admitted to 130 hospitals in England between 1 April 2010 and 31 January 2012. Patients admitted out of hours (n = 23779 had more features indicative of worse prognosis (haemorrhagic stroke, reduced consciousness, pre stroke dependency. Out of hours admission was significantly associated with longer delays in receiving a CT scan or being admitted to a stroke unit, and reduced odds of receiving thrombolysis. After adjusting for casemix, there was no consistent evidence of higher mortality for patients admitted out of hours, but patients admitted at the weekends had a higher risk of 30 day mortality (OR 1.14, 95% CI 1.06-1.21. CONCLUSION: Inequalities in the provision of stroke care for people admitted out of regular hours persist in contemporary stroke in England. The association with mortality is small and largely attributable to higher illness severity in patients admitted out of hours.

  2. Ethical issues in research involving minority populations: the process and outcomes of protocol review by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University, Thailand

    Science.gov (United States)

    2013-01-01

    Background Recruiting minorities into research studies requires special attention, particularly when studies involve “extra-vulnerable” participants with multiple vulnerabilities, e.g., pregnant women, the fetuses/neonates of ethnic minorities, children in refugee camps, or cross-border migrants. This study retrospectively analyzed submissions to the Ethics Committee of the Faculty of Tropical Medicine (FTM-EC) in Thailand. Issues related to the process and outcomes of proposal review, and the main issues for which clarification/revision were requested on studies, are discussed extensively. Methods The study data were extracted from proposals and amendments submitted to the FTM-EC during the period October 2009 – September 2012, and then analyzed qualitatively and quantitatively. The main issues for clarification/revision were analyzed by thematic content analysis. Results 373 proposals were submitted; 44 studies involved minority groups with 21 extra-vulnerable minorities. All clinical and 2/3 of non-clinical studies submitted for initial review underwent full-board review. For combined clinical and non-clinical study submissions, 92.1% were referred back to the investigators and approved after clarification/revision, while 2.7% were deferred due to major/critical changes, and 2.1% not approved due to substantial violations of ethical principles. The main issues needing clarification/revision differed between all studies and those involving minorities: participant information sheet (62.2% vs. 86.4%), informed consent/assent form (51.2% vs. 86.4%), and research methodology (80.7% vs. 84.1%), respectively. The main ethical issues arising during the meetings, regarding studies involving minorities, included ensuring no exploitation, coercion, or pressure on the minority to participate; methodology not affecting their legal status; considering ethnicity and cultural structure; and providing appropriate compensation. Conclusion Delays in the approval or non

  3. If you build it, they still may not come: outcomes and process of implementing a community-based integrated knowledge translation mapping innovation

    Directory of Open Access Journals (Sweden)

    Zahab Melanie

    2010-06-01

    Full Text Available Abstract Background Maps and mapping tools through geographic information systems (GIS are highly valuable for turning data into useful information that can help inform decision-making and knowledge translation (KT activities. However, there are several challenges involved in incorporating GIS applications into the decision-making process. We highlight the challenges and opportunities encountered in implementing a mapping innovation as a KT strategy within the non-profit (public health sector, reflecting on the processes and outcomes related to our KT innovations. Methods A case study design, whereby the case is defined as the data analyst and manager dyad (a two-person team in selected Ontario Early Year Centres (OEYCs, was used. Working with these paired individuals, we provided a series of interventions followed by one-on-one visits to ensure that our interventions were individually tailored to personal and local decision-making needs. Data analysis was conducted through a variety of qualitative assessments, including field notes, interview data, and maps created by participants. Data collection and data analysis have been guided by the Ottawa Model of Research Use (OMRU conceptual framework. Results Despite our efforts to remove all barriers associated with our KT innovation (maps, our results demonstrate that both individual level and systemic barriers pose significant challenges for participants. While we cannot claim a causal association between our project and increased mapping by participants, participants did report a moderate increase in the use of maps in their organization. Specifically, maps were being used in decision-making forums as a way to allocate resources, confirm tacit knowledge about community needs, make financially-sensitive decisions more transparent, evaluate programs, and work with community partners. Conclusions This project highlights the role that maps can play and the importance of communicating the importance of

  4. Exercise for methamphetamine dependence: rationale, design, and methodology.

    Science.gov (United States)

    Mooney, Larissa J; Cooper, Christopher; London, Edythe D; Chudzynski, Joy; Dolezal, Brett; Dickerson, Daniel; Brecht, Mary-Lynn; Peñate, Jose; Rawson, Richard A

    2014-01-01

    Effective pharmacotherapies to treat methamphetamine (MA) dependence have not been identified, and behavioral therapies are marginally effective. Based on behavioral studies demonstrating the potential efficacy of aerobic exercise for improving depressive symptoms, anxiety, cognitive deficits, and substance use outcomes, the study described here is examining exercise as a potential treatment for MA-dependent individuals. This study is randomizing 150 participants with MA dependence at a residential treatment facility for addictive disorders to receive either a thrice-weekly structured aerobic and resistance exercise intervention or a health education condition. Recruitment commenced in March, 2010. Enrollment and follow-up phases are ongoing, and recruitment is exceeding targeted enrollment rates. Seeking evidence for a possibly effective adjunct to traditional behavioral approaches for treatment of MA dependence, this study is assessing the ability of an 8-week aerobic and resistance exercise protocol to reduce relapse to MA use during a 12-week follow-up period after discharge from residential-based treatment. The study also is evaluating improvements in health and functional outcomes during and after the protocol. This paper describes the design and methods of the study. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Rationale, Feasibility and Acceptability of Ketogenic Diet for Cancer Treatment.

    Science.gov (United States)

    Chung, Hae-Yun; Park, Yoo Kyoung

    2017-09-01

    Ketogenic diet has been used for more than 80 years as a successful dietary regimen for epilepsy. Recently, dietary modulation by carbohydrate depletion via ketogenic diet has been suggested as an important therapeutic strategy to selectively kill cancer cells and as adjuvant therapy for cancer treatment. However, some researchers insist ketogenic diet to be highly undesirable as ketogenic diet may trigger and/or exacerbate cachexia development and usually result in significant weight loss. This review revisits the meaning of physiological ketosis in the light of this evidence and considers possibility of the use of ketogenic diet for oncology patients. Article search was performed from 1985 through 2017 and finally 10 articles were analyzed. The review focused on the results of human trials for cancer patients and checked the feasibility of using ketogenic diet for cancer patients as adjuvant therapy. The main outcomes showed improvement of body weight changes, anthropometric changes, serum blood profiles, and reduction in novel marker for tumor progression, TKTL1, and increase of ketone body. Lactate concentration was reduced, and no significant changes were reported in the measurements of quality of life. Ketogenic diet may be efficacious in certain cancer subtypes whose outcomes appear to correlate with metabolic status, but the results are not yet supportive and inconsistent. Therefore, it warrants further studies.

  6. Documenting the Engineering Design Process

    Science.gov (United States)

    Hollers, Brent

    2017-01-01

    Documentation of ideas and the engineering design process is a critical, daily component of a professional engineer's job. While patent protection is often cited as the primary rationale for documentation, it can also benefit the engineer, the team, company, and stakeholders through creating a more rigorously designed and purposeful solution.…

  7. Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care.

    Science.gov (United States)

    Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S

    2015-07-01

    In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided.

  8. Drug choice in medical practice : rationales, routines and remedies

    NARCIS (Netherlands)

    Denig, Petra

    1994-01-01

    The aim of the studies presented in this dissertation is to describe and analyse drug choice in medical practice, and provide a better understanding of the possible shortcomings and the role of biomedical knowledge in the drug choice process.

  9. A Theoretical Rationale for Cross-Cultural Family Counseling.

    Science.gov (United States)

    Arciniega, Miguel; Newlon, Betty J.

    1981-01-01

    Proposes seven Adlerian axioms of behavior for the cross-cultural pluralistic counselor working with minority families. Defines cross-cultural family counseling and urges counselors to understand minority cultures and the acculturation process. Discusses counseling techniques. (JAC)

  10. Digital technologies to support planning, treatment, and fabrication processes and outcome assessments in implant dentistry. Summary and consensus statements. The 4th EAO consensus conference 2015

    DEFF Research Database (Denmark)

    Hämmerle, Christoph H F; Cordaro, Luca; van Assche, Nele

    2015-01-01

    OBJECTIVE: The task of this working group was to assess the existing knowledge in computer-assisted implant planning and placement, fabrication of reconstructions applying computers compared to traditional fabrication, and assessments of treatment outcomes using novel imaging techniques. MATERIAL...

  11. On the rationale for hysteresis in economic decisions

    Science.gov (United States)

    Rios, Luis A.; Rachinskii, Dmitrii; Cross, Rod

    2017-02-01

    In the social sciences there are plausible reasons to postulate that hysteresis effects are important. The available evidence, however, is predominantly at the macro level. In this paper we review the evidence regarding hysteresis in the neural processes underlying human behavior. We argue that there is a need for experimental and neuroimaging studies to fill the gap in knowledge about hysteresis processes at the micro level in the social sciences.

  12. Neurophysiological evidence for abnormal cognitive processing of drug cues in heroin dependence

    NARCIS (Netherlands)

    Franken, Ingmar H. A.; Stam, Cornelis J.; Hendriks, Vincent M.; van den Brink, Wim

    2003-01-01

    Rationale. Recent studies provide evidence for specific aspects of cue processing in addictive disorders. Objective. The present study employs event related potentials (ERPs) to investigate heroin related visual information processing Methods. Neutral and heroin related pictures were presented to 19

  13. The rationale for early intervention in schizophrenia and related disorders

    DEFF Research Database (Denmark)

    Nordentoft, Merete; Jeppesen, Pia; Petersen, Lone

    2009-01-01

    and this relationship holds even after controlling for the potential confounding variable of premorbid functioning. In Norway, the early Treatment and Intervention in PSychosis study demonstrated that duration of untreated psychosis is amenable to intervention with the combination of educational campaigns...... and the initiation of treatment. The average duration of untreated psychosis is around 1–2 years. During this period, brain function may continue to deteriorate and social networks can be irreversibly damaged. Studies have consistently linked longer duration of untreated psychosis with poorer outcomes......, adherence to treatment, comorbid drug abuse, relapse and readmission. Some benefits persist after cessation of the intervention. Conclusions: Early intervention in schizophrenia is justified to reduce the negative personal and social impact of prolonged periods of untreated symptoms. Furthermore, phase...

  14. Rationales Shaping International Linkages in Higher Education: A Qualitative Case Study of the ASU-ITESM Strategic Alliance

    Science.gov (United States)

    Camacho Lizarraga, Monica Irene

    2011-01-01

    This qualitative case study examines the <