Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness

Intensive Case Management (ICM) is widely claimed to be an evidence-based and cost effective program for people with high levels of disability as a result of mental illness. However, the findings of recent randomized controlled trials comparing ICM with ‘usual services’ suggest that both clinical and cost effectiveness of ICM may be weakening. Possible reasons for this, including fidelity of implementation, researcher allegiance effects and changes in the wider service environment within which ICM is provided, are considered. The implications for service delivery and research are discussed.

Evaluation of implementation of a healthy food and drink supply strategy throughout the whole school environment in Queensland state schools, Australia

BACKGROUND/OBJECTIVES: This paper reports on the evaluation of the Smart Choices healthy food and drink supply strategy for Queensland schools (Smart Choices) implementation across the whole school environment in state government primary and secondary schools in Queensland, Australia. SUBJECTS/METHODS: Three concurrent surveys using different methods for each group of stakeholders that targeted all 1275 school Principals, all 1258 Parent and Citizens’ Associations (P&Cs) and a random sample of 526 tuckshop convenors throughout Queensland. Nine hundred and seventy-three Principals, 598 P&Cs and 513 tuckshop convenors participated with response rates of 78%, 48% and 98%, respectively. RESULTS: Nearly all Principals (97%), P&Cs (99%) and tuckshop convenors (97%) reported that their school tuckshop had implemented Smart Choices. The majority of Principals and P&Cs reported implementation, respectively, in: school breakfast programs (98 and 92%); vending machine stock (94 and 83%); vending machine advertising (85 and 84%); school events (87 and 88%); school sporting events (81 and 80%); sponsorship and advertising (93 and 84%); fundraising events (80 and 84%); and sporting clubs (73 and 75%). Implementation in curriculum activities, classroom rewards and class parties was reported, respectively, by 97%, 86% and 75% of Principals. Respondents also reported very high levels of understanding of Smart Choices and engagement of the school community. CONCLUSIONS: The results demonstrated that food supply interventions to promote nutrition across all domains of the school environment can be implemented successfully.

Complexity and the science of implementation in health IT — knowledge gaps and future visions

Objectives The intent of this paper is in the examination of health IT implementation processes – the barriers to and facilitators of successful implementation, identification of a beginning set of implementation best practices, the identification of gaps in the health IT implementation body of knowledge, and recommendations for future study and application. Methods A literature review resulted in the identification of six health IT related implementation best practices which were subsequently debated and clarified by participants attending the NI2012 Research Post Conference held in Montreal in the summer of 2012. Using the framework for implementation research (CFIR) to guide their application, the six best practices were applied to two distinct health IT implementation studies to assess their applicability. Results Assessing the implementation processes from two markedly diverse settings illustrated both the challenges and potentials of using standardized implementation processes. In support of what was discovered in the review of the literature, “one size fits all” in health IT implementation is a fallacy, particularly when global diversity is added into the mix. At the same time, several frameworks show promise for use as “scaffolding” to begin to assess best practices, their distinct dimensions, and their applicability for use. Conclusions Health IT innovations, regardless of the implementation setting, requires a close assessment of many dimensions. While there is no “one size fits all”, there are commonalities and best practices that can be blended, adapted, and utilized to improve the process of implementation. This paper examines health IT implementation processes and identifies a beginning set of implementation best practices, which could begin to address gaps in the health IT implementation body of knowledge.

Analytical study of implementation issues of NTRU

Nth-Dimensional Truncated Polynomial Ring (NTRU) is a lattice-based public-key cryptosystem that offers encryption and digital signature solutions. It was designed by Silverman, Hoffstein and Pipher. The NTRU cryptosystem was patented by NTRU Cryptosystems Inc. (which was later acquired by Security Innovations) and available as IEEE 1363.1 and X9.98 standards. NTRU is resistant to attacks based on Quantum computing, to which the standard RSA and ECC public-key cryptosystems are vulnerable to. In addition, NTRU has higher performance advantages over these cryptosystems. Considering this importance of NTRU, it is highly recommended to adopt NTRU as part of a cipher suite along with widely used cryptosystems for internet security protocols and applications. In this paper, we present our analytical study on the implementation of NTRU encryption scheme which serves as a guideline for security practitioners who are novice to lattice-based cryptography or even cryptography. In particular, we show some non-trivial issues that should be considered towards a secure and efficient NTRU implementation.

Family-based programmes for preventing smoking by children and adolescents

BACKGROUND: There is evidence that children's decisions to smoke are influenced by family and friends. OBJECTIVES: To assess the effectiveness of interventions to help family members to strengthen non-smoking attitudes and promote non-smoking by children and other family members. SEARCH STRATEGY: We searched 14 electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO and CINAHL. We also searched unpublished material, and the reference lists of key articles. We performed both free-text Internet searches and targeted searches of appropriate websites, and we hand-searched key journals not available electronically. We also consulted authors and experts in the field. The most recent search was performed in July 2006. SELECTION CRITERIA: Randomized controlled trials (RCTs) of interventions with children (aged 5-12) or adolescents (aged 13-18) and family members to deter the use of tobacco. The primary outcome was the effect of the intervention on the smoking status of children who reported no use of tobacco at baseline. Included trials had to report outcomes measured at least six months from the start of the intervention. DATA COLLECTION AND ANALYSIS: We reviewed all potentially relevant citations and retrieved the full text to determine whether the study was an RCT and matched our inclusion criteria. Two authors independently extracted study data and assessed them for methodological quality. The studies were too limited in number and quality to undertake a formal meta-analysis, and we present a narrative synthesis. MAIN RESULTS: We identified 19 RCTs of family interventions to prevent smoking. We identified five RCTs in Category 1 (minimal risk of bias on all counts); nine in Category 2 (a risk of bias in one or more areas); and five in Category 3 (risks of bias in design and execution such that reliable conclusions cannot be drawn from the study).Considering the fourteen Category 1 and 2 studies together: (1) four of the nine that tested a family intervention against a control group had significant positive effects, but one showed significant negative effects; (2) one of the five RCTs that tested a family intervention against a school intervention had significant positive effects; (3) none of the six that compared the incremental effects of a family plus a school programme to a school programme alone had significant positive effects; (4) the one RCT that tested a family tobacco intervention against a family non-tobacco safety intervention showed no effects; and (5) the one trial that used general risk reduction interventions found the group which received the parent and teen interventions had less smoking than the one that received only the teen intervention (there was no tobacco intervention but tobacco outcomes were measured). For the included trials the amount of implementer training and the fidelity of implementation are related to positive outcomes, but the number of sessions is not. AUTHORS' CONCLUSIONS: Some well-executed RCTs show family interventions may prevent adolescent smoking, but RCTs which were less well executed had mostly neutral or negative results. There is thus a need for well-designed and executed RCTs in this area.

An investigation into the barriers to the implementation of automation and robotics technologies in the construction industry

The rising problems associated with construction such as decreasing quality and productivity, labour shortages, occupational safety, and inferior working conditions have opened the possibility of more revolutionary solutions within the industry. One prospective option is in the implementation of innovative technologies such as automation and robotics, which has the potential to improve the industry in terms of productivity, safety and quality. The construction work site could, theoretically, be contained in a safer environment, with more efficient execution of the work, greater consistency of the outcome and higher level of control over the production process. By identifying the barriers to construction automation and robotics implementation in construction, and investigating ways in which to overcome them, contributions could be made in terms of better understanding and facilitating, where relevant, greater use of these technologies in the construction industry so as to promote its efficiency. This research aims to ascertain and explain the barriers to construction automation and robotics implementation by exploring and establishing the relationship between characteristics of the construction industry and attributes of existing construction automation and robotics technologies to level of usage and implementation in three selected countries; Japan, Australia and Malaysia. These three countries were chosen as their construction industry characteristics provide contrast in terms of culture, gross domestic product, technology application, organisational structure and labour policies. This research uses a mixed method approach of gathering data, both quantitative and qualitative, by employing a questionnaire survey and an interview schedule; using a wide range of sample from management through to on-site users, working in a range of small (less than AUD0.2million) to large companies (more than AUD500million), and involved in a broad range of business types and construction sectors. Detailed quantitative (statistical) and qualitative (content) data analysis is performed to provide a set of descriptions, relationships, and differences. The statistical tests selected for use include cross-tabulations, bivariate and multivariate analysis for investigating possible relationships between variables; and Kruskal-Wallis and Mann Whitney U test of independent samples for hypothesis testing and inferring the research sample to the construction industry population. Findings and conclusions arising from the research work which include the ranking schemes produced for four key areas of, the construction attributes on level of usage; barrier variables; differing levels of usage between countries; and future trends, have established a number of potential areas that could impact the level of implementation both globally and for individual countries.

Impeding good governance implementation in Indonesian regional government : the effect of a bureaucratic generation gap

The implementation of ‘good governance’ in Indonesia’s regional government sector became a central tenet in governance research following the introduction of the national code for governance in 2006. The code was originally drafted in 1999 as a response to the Asian financial crises and many cases of unearthed corruption, collusion, and nepotism. It was reviewed in 2001 and again in 2006 to incorporate relevant political, economical, and social developments. Even though the national code exists along with many regional government decrees on good governance, the extent of implementation of the tenets of good governance in Indonesia’s regional government is still questioned. Previous research on good governance implementation in Indonesian regional government (Mardiasmo, Barnes and Sakurai, 2008) identified differences in the nature and depth of implementation between various Indonesian regional governments. This paper analyses and extends this recent work and explores key factors that may impede the implementation and sustained application of governance practices across regional settings. The bureaucratic culture of Indonesian regional government is one that has been shaped for over approximately 30 years, in particular during that of the Soeharto regime. Previous research on this regime suggests a bureaucratic culture with a mix of positive and negative aspects. On one hand Soeharto’s regime resulted in strong development growth and strong economic fundamentals, resulting in Indonesia being recognised as one of the Asian economic tigers prior to the 1997 Asian financial crises. The financial crises however revealed a bureaucratic culture that was rife with corruption, collusion, and nepotism. Although subsequent Indonesian governments have been committed to eradicating entrenched practices it seems apparent that the culture is ingrained within the bureaucracy and eradication of it will take time. Informants from regional government agree with this observation, as they identify good governance as an innovative mechanism and to implement it will mean a deviation from the “old ways.” Thus there is a need for a “changed” mind set in order to implement sustained governance practices. Such an exercise has proven to be challenging so far, as there is “hidden” resistance from within the bureaucracy to change its ways. The inertia of such bureaucratic cultures forms a tension against the opportunity for the implementation of good governance. From this context an emergent finding is the existence of a ‘bureaucratic generation gap’ as an impeding variable to enhanced and more efficient implementation of governance systems. It was found that after the Asian financial crises the Indonesian government (both at national and regional level) drew upon a wider human resources pool to fill government positions – including entrants from academia, the private sector, international institutions, foreign nationals and new graduates. It suggested that this change in human capital within government is at the core of this ‘inter-generational divide.’ This divergence is exemplified, at one extreme, by [older] bureaucrats who have been in-position for long periods of time serving during the extended Soeharto regime. The “new” bureaucrats have only sat in their positions since the end of Asian financial crisis and did not serve during Soeharto’s regime. It is argued that the existence of this generation gap and associated aspects of organisational culture have significantly impeded modernising governance practices across regional Indonesia. This paper examines the experiences of government employees in five Indonesian regions: Solok, Padang, Gorontalo, Bali, and Jakarta. Each regional government is examined using a mixed methodology comprising of on-site observation, document analysis, and iterative semi-structured interviewing. Drawing from the experiences of five regional governments in implementing good governance this paper seeks to better understand the causal contexts of variable implementation governance practices and to suggest enhancements to the development of policies for sustainable inter-generational change in governance practice across regional government settings.

The impact of outcomes-driven curriculum reform on teacher perspectives of professional practice

This thesis is the result of an investigation of a Queensland example of curriculum reform based on outcomes, a type of reform common to many parts of the world during the last decade. The purpose of the investigation was to determine the impact of outcomes on teacher perspectives of professional practice. The focus was chosen to permit investigation not only of changes in behaviour resulting from the reform but also of teachers' attitudes and beliefs developed during implementation. The study is based on qualitative methodology, chosen because of its suitability for the investigation of attitudes and perspectives. The study exploits the researcher's opportunities for prolonged, direct contact with groups of teachers through the selection of an over-arching ethnography approach, an approach designed to capture the holistic nature of the reform and to contextualise the data within a broad perspective. The selection of grounded theory as a basis for data analysis reflects the open nature of this inquiry and demonstrates the study's constructivist assumptions about the production of knowledge. The study also constitutes a multi-site case study by virtue of the choice of three individual school sites as objects to be studied and to form the basis of the report. Three primary school sites administered by Brisbane Catholic Education were chosen as the focus of data collection. Data were collected from three school sites as teachers engaged in the first year of implementation of Student Performance Standards, the Queensland version of English outcomes based on the current English syllabus. Teachers' experience of outcomes-driven curriculum reform was studied by means of group interviews conducted at individual school sites over a period of fourteen months, researcher observations and the collection of artefacts such as report cards. Analysis of data followed grounded theory guidelines based on a system of coding. Though classification systems were not generated prior to data analysis, the labelling of categories called on standard, non-idiosyncratic terminology and analytic frames and concepts from existing literature wherever practicable in order to permit possible comparisons with other related research. Data from school sites were examined individually and then combined to determine teacher understandings of the reform, changes that have been made to practice and teacher responses to these changes in terms of their perspectives of professionalism. Teachers in the study understood the reform as primarily an accountability mechanism. Though teachers demonstrated some acceptance of the intentions of the reform, their responses to its conceptualisation, supporting documentation and implications for changing work practices were generally characterised by reduced confidence, anger and frustration. Though the impact of outcomes-based curriculum reform must be interpreted through the inter-relationships of a broad range of elements which comprise teachers' work and their attitudes towards their work, it is proposed that the substantive findings of the study can be understood in terms of four broad themes. First, when the conceptual design of outcomes did not serve teachers' accountability requirements and outcomes were perceived to be expressed in unfamiliar technical language, most teachers in the study lost faith in the value of the reform and lost confidence in their own abilities to understand or implement it. Second, this reduction of confidence was intensified when the scope of outcomes was outside the scope of the teachers' existing curriculum and assessment planning and teachers were confronted with the necessity to include aspects of syllabuses or school programs which they had previously omitted because of a lack of understanding or appreciation. The corollary was that outcomes promoted greater syllabus fidelity when frameworks were closely aligned. Third, other benefits the teachers associated with outcomes included the development of whole school curriculum resources and greater opportunity for teacher collaboration, particularly among schools. The teachers, however, considered a wide range of factors when determining the overall impact of the reform, and perceived a number of them in terms of the costs of implementation. These included the emergence of ethical dilemmas concerning relationships with students, colleagues and parents, reduced individual autonomy, particularly with regard to the selection of valued curriculum content and intensification of workload with the capacity to erode the relationships with students which teachers strongly associated with the rewards of their profession. Finally, in banding together at the school level to resist aspects of implementation, some teachers showed growing awareness of a collective authority capable of being exercised in response to top-down reform. These findings imply that Student Performance Standards require review and, additional implementation resourcing to support teachers through times of reduced confidence in their own abilities. Outcomes prove an effective means of high-fidelity syllabus implementation, and, provided they are expressed in an accessible way and aligned with syllabus frameworks and terminology, should be considered for inclusion in future syllabuses across a range of learning areas. The study also identifies a range of unintended consequences of outcomes-based curriculum and acknowledges the complexity of relationships among all the aspects of teachers' work. It also notes that the impact of reform on teacher perspectives of professional practice may alter teacher-teacher and school-system relationships in ways that have the potential to influence the effectiveness of future curriculum reform.

Implementation of lean manufacturing in Saudi manafacturing organisations : an empirical study

In this paper, the level of lean manufacturing implementation by Saudi manufacturing companies is investigated, the extent of application of lean manufacturing practice is identified and the benefits and barriers of Lean implementation are evaluated. The results reported in this paper are based on data collected from a survey using a standard questionnaire administered to 120 manufacturers in Saudi Arabia. Evidence indicates that large size companies are more likely to implement and gain the advantages of lean manufacturing than small and medium size companies. The most implemented lean manufacturing tools are Computerized Planning Systems, TQM, Maintenance Optimization and CIP. Main barriers against lean manufacturing implementation include the organization culture, lack of management commitment and lack of skilled workers. Results also show that benefits gained from lean manufacturing implementation are significant and are correlated with the level of implementation of lean strategies.

A model of organizational innovation implementation effectiveness in small to medium firms

The present study aims to validate the current best-practice model of implementation effectiveness in small and mid-size businesses. Data from 135 organizations largely confirm the original model across various types of innovation. In addition, we extended this work by highlighting the importance of human resources in implementation effectiveness and the consequences of innovation effectiveness on future adoption attitudes. We found that the availability of skilled employees was positively related to implementation effectiveness. Furthermore, organizations that perceived a high level of benefits from implemented innovations were likely to have a positive attitude towards future innovation adoption. The implications of our improvements to the original model of implementation effectiveness are discussed.

Using ‘think aloud’ as a strategy for learning clinical reasoning in high fidelity case-based simulation for undergraduate nursing students

AIMS This paper reports on the implementation of a research project that trials an educational strategy implemented over six months of an undergraduate third year nursing curriculum. This project aims to explore the effectiveness of ‘think aloud’ as a strategy for learning clinical reasoning for students in simulated clinical settings. BACKGROUND Nurses are required to apply and utilise critical thinking skills to enable clinical reasoning and problem solving in the clinical setting [1]. Nursing students are expected to develop and display clinical reasoning skills in practice, but may struggle articulating reasons behind decisions about patient care. For students learning to manage complex clinical situations, teaching approaches are required that make these instinctive cognitive processes explicit and clear [2-5]. In line with professional expectations, nursing students in third year at Queensland University of Technology (QUT) are expected to display clinical reasoning skills in practice. This can be a complex proposition for students in practice situations, particularly as the degree of uncertainty or decision complexity increases [6-7]. The ‘think aloud’ approach is an innovative learning/teaching method which can create an environment suitable for developing clinical reasoning skills in students [4, 8]. This project aims to use the ‘think aloud’ strategy within a simulation context to provide a safe learning environment in which third year students are assisted to uncover cognitive approaches that best assist them to make effective patient care decisions, and improve their confidence, clinical reasoning and active critical reflection on their practice. MEHODS In semester 2 2011 at QUT, third year nursing students will undertake high fidelity simulation, some for the first time commencing in September of 2011. There will be two cohorts for strategy implementation (group 1= use think aloud as a strategy within the simulation, group 2= not given a specific strategy outside of nursing assessment frameworks) in relation to problem solving patient needs. Students will be briefed about the scenario, given a nursing handover, placed into a simulation group and an observer group, and the facilitator/teacher will run the simulation from a control room, and not have contact (as a ‘teacher’) with students during the simulation. Then debriefing will occur as a whole group outside of the simulation room where the session can be reviewed on screen. The think aloud strategy will be described to students in their pre-simulation briefing and allow for clarification of this strategy at this time. All other aspects of the simulations remain the same, (resources, suggested nursing assessment frameworks, simulation session duration, size of simulation teams, preparatory materials). RESULTS Methodology of the project and the challenges of implementation will be the focus of this presentation. This will include ethical considerations in designing the project, recruitment of students and implementation of a voluntary research project within a busy educational curriculum which in third year targets 669 students over two campuses. CONCLUSIONS In an environment of increasingly constrained clinical placement opportunities, exploration of alternate strategies to improve critical thinking skills and develop clinical reasoning and problem solving for nursing students is imperative in preparing nurses to respond to changing patient needs. References 1. Lasater, K., High-fidelity simulation and the development of clinical judgement: students' experiences. Journal of Nursing Education, 2007. 46(6): p. 269-276. 2. Lapkin, S., et al., Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: a systematic review. Clinical Simulation in Nursing, 2010. 6(6): p. e207-22. 3. Kaddoura, M.P.C.M.S.N.R.N., New Graduate Nurses' Perceptions of the Effects of Clinical Simulation on Their Critical Thinking, Learning, and Confidence. The Journal of Continuing Education in Nursing, 2010. 41(11): p. 506. 4. Banning, M., The think aloud approach as an educational tool to develop and assess clinical reasoning in undergraduate students. Nurse Education Today, 2008. 28: p. 8-14. 5. Porter-O'Grady, T., Profound change:21st century nursing. Nursing Outlook, 2001. 49(4): p. 182-186. 6. Andersson, A.K., M. Omberg, and M. Svedlund, Triage in the emergency department-a qualitative study of the factors which nurses consider when making decisions. Nursing in Critical Care, 2006. 11(3): p. 136-145. 7. O'Neill, E.S., N.M. Dluhy, and C. Chin, Modelling novice clinical reasoning for a computerized decision support system. Journal of Advanced Nursing, 2005. 49(1): p. 68-77. 8. Lee, J.E. and N. Ryan-Wenger, The "Think Aloud" seminar for teaching clinical reasoning: a case study of a child with pharyngitis. J Pediatr Health Care, 1997. 11(3): p. 101-10.

Implementation of the MARPOL Convention in Bangladesh

Vessel-source marine pollution is one of the main sources of marine pollution in Bangladesh. Due to unfettered operation of vessels, the country has been exposed to massive pollution that is causing a serious imbalance in the marine environment. Against this backdrop, this article seeks to demonstrate that the regulatory system of Bangladesh should be strengthened and made more effective in the light of international instruments to ensure the conservation and sustainable management of its marine environment. With this aim the article examines the present status of implementation of the MARPOL Convention in Bangladesh

Free for all : a case study examining implementation factors of one-to-one device programs

Despite significant investment in school one-to-one device programs, little is known about which aspects of program implementation work and why. Through a comparison of two implementation models, adopter-diffusion and saturation, and using existing data from the One Laptop per Child Australia laptop program, we explored how factors of implementation may affect device diffusion, learning and educational outcomes, and program sustainability in schools. In this article we argue that more focused research into implementation of one-to-one device programs, moving beyond comparisons of “devices versus without devices,” is needed to provide reliable data to inform future program funding and advance this area of research.

The relationship between teachers' perceptions of school leadership and their perceptions of the implementation of the national curriculum

The National Curriculum is a current innovation in Australian schooling history which is likely to have a widespread and long-term impact on schools, teachers and students. This paper has investigated educational change during the early phase of curriculum implementation in a large secondary school, north of Brisbane, Australia. Specifically, this study explored teachers’ perceptions of the principal’s transformational leadership skills during an early stage of the curriculum’s implementation along with teachers’ perceptions of implementing a National Curriculum in their classroom. For this research, sixty-nine teachers were surveyed about their perceptions of their principal’s leadership and their perceptions of the difficulty of implementation of the new curriculum. Findings indicated that teachers with positive perceptions of their principal's leadership also had positive perceptions of their capacity to implement the new National Curriculum. Specifically, teachers who perceived the principal as holding high expectations and providing intellectual stimulation believed they had the capacity to successfully implement curriculum change.

Implementation mechanism: Protection against harassment of women at workplace

Pakistan is widely known and appreciated in the world for its history, Islamic culture and norms. Since the creation of Pakistan, it inherited poverty in its roots. There are many reasons for poverty but one lies on the shoulder of women who are 50% of the total population of Pakistan. On the apex of it, women do not take part in the development of Pakistan because when they step out of their homes, they suffer a lot of problems. These problems are a hurdle in their active participation in development .Government has tried to create an environment for those women, who suffer different problems. Harassment of women at work place is one of those problems which discourage women in taking active part in economic and social development of society. Women Activists, from the last decade, were working for the protection of woman’s right at workplace and they succeeded in formulation of Harassment Act 2010. Since law is ineffective without its proper mechanism of implementation, steps should be taken for its proper implementation mechanism. This article aims to provide information about the provisions of law, related to the harassment of women at workplace with an attempt to explore the effectiveness of its implementation. The study was conducted in twin cities of Pakistan, Islamabad and Rawalpindi. Interviews were conducted with the employees and employers of organizations, educational institutions, women activists, NGOs workers, lawyers, judges and some law enforcement officers. Group discussions were also held with teachers, students of Human rights and religious personalities. This report focuses on the implementation mechanism of new legislation in Pakistan. It also highlights some important facts related to its enforcement.