Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

Towards Motivation-based Plan Evaluation

AI planning systems tend to be disembodied and are not situated within the environment for which plans are generated, thus losing information concerning the interaction between the system and its environment. This paper argues that such information may potentially be valuable in constraining plan formulation, and presents both an agent- and domainindependent architecture that extends the classical AI planning framework to take into account context, or the interaction between an autonomous situated planning agent and its environment. The paper describes how context constrains the goals an agent might generate, enables those goals to be prioritised, and constrains plan selection.

EVALUATION OF THE CONSERVATION LANDS OF MAINE BASED ON PRESENCE OF HABITAT SUITABLE FOR LISTED SPECIES

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Evaluation of the Conservation Lands of Maine Based on Presence of Habitat Suitable for Listed Species

“Conservation Lands” include both public and private lands that are devoted to the protection of wildlife and natural resources. “Listed Species” include federally and state endangered and threatened animals that are in danger of extermination in the state of Maine. The purpose of this study is to determine how well conservation lands are protecting the habitats of listed species. GAP data was used for 13 terrestrial vertebrate species indicating the presence or absence of suitable habitats. This data was compiled in GIS, generating a layer showing the number of listed species an area is suitable for. The areas that were suitable for at least one habitat were compared to answer three questions: (1) Is there is a difference between the presence and absence of listed species on protected lands and lands that are not protected? (2) Is there is a difference between the presence and absence of listed species on public lands managed by the state and the federal government and private land? (3) Is there is a difference between the presence and absence of listed species on lands protected under easements and lands that are protected fee simple? We found significant differences between all three categories. Conservation lands, private lands, and lands held under easement protect the habitat of listed species most effectively. We believe that this is due to the large number of private land trusts in the state of Maine and the effective management strategies of state lands.

Evaluation Of Reservoir Model Integration With Deterministic And Probabilistic Streamflow Forecasts

Due to the increase in water demand and hydropower energy, it is getting more important to operate hydraulic structures in an efficient manner while sustaining multiple demands. Especially, companies, governmental agencies, consultant offices require effective, practical integrated tools and decision support frameworks to operate reservoirs, cascades of run-of-river plants and related elements such as canals by merging hydrological and reservoir simulation/optimization models with various numerical weather predictions, radar and satellite data. The model performance is highly related with the streamflow forecast, related uncertainty and its consideration in the decision making. While deterministic weather predictions and its corresponding streamflow forecasts directly restrict the manager to single deterministic trajectories, probabilistic forecasts can be a key solution by including uncertainty in flow forecast scenarios for dam operation. The objective of this study is to compare deterministic and probabilistic streamflow forecasts on an earlier developed basin/reservoir model for short term reservoir management. The study is applied to the Yuvacık Reservoir and its upstream basin which is the main water supply of Kocaeli City located in the northwestern part of Turkey. The reservoir represents a typical example by its limited capacity, downstream channel restrictions and high snowmelt potential. Mesoscale Model 5 and Ensemble Prediction System data are used as a main input and the flow forecasts are done for 2012 year using HEC-HMS. Hydrometeorological rule-based reservoir simulation model is accomplished with HEC-ResSim and integrated with forecasts. Since EPS based hydrological model produce a large number of equal probable scenarios, it will indicate how uncertainty spreads in the future. Thus, it will provide risk ranges in terms of spillway discharges and reservoir level for operator when it is compared with deterministic approach. The framework is fully data driven, applicable, useful to the profession and the knowledge can be transferred to other similar reservoir systems.

Performance Evaluation Of SMOS Soil Moisture Retrieval Parameters For Hydrological Application

Microwave remote sensing has high potential for soil moisture retrieval. However, the efficient retrieval of soil moisture depends on optimally choosing the soil moisture retrieval parameters. In this study first the initial evaluation of SMOS L2 product is performed and then four approaches regarding soil moisture retrieval from SMOS brightness temperature are reported. The radiative transfer equation based tau-omega rationale is used in this study for the soil moisture retrievals. The single channel algorithms (SCA) using H polarisation is implemented with modifications, which includes the effective temperatures simulated from ECMWF (downscaled using WRF-NOAH Land Surface Model (LSM)) and MODIS. The retrieved soil moisture is then utilized for soil moisture deficit (SMD) estimation using empirical relationships with Probability Distributed Model based SMD as a benchmark. The square of correlation during the calibration indicates a value of R2 =0.359 for approach 4 (WRF-NOAH LSM based LST with optimized roughness parameters) followed by the approach 2 (optimized roughness parameters and MODIS based LST) (R2 =0.293), approach 3 (WRF-NOAH LSM based LST with no optimization) (R2 =0.267) and approach 1(MODIS based LST with no optimization) (R2 =0.163). Similarly, during the validation a highest performance is reported by approach 4. The other approaches are also following a similar trend as calibration. All the performances are depicted through Taylor diagram which indicates that the H polarisation using ECMWF based LST is giving a better performance for SMD estimation than the original SMOS L2 products at a catchment scale.

Optimizing the Performance Evaluation Process for Non-Academic Staff

If conducted poorly and without support from all employee levels, performance management programs at institutions may devolve into annual evaluations that represent a staff burden rather than an ongoing career development opportunity. This brief analyzes the key components of successful performance evaluation systems for non-academic staff, incorporating insights from employers outside of the higher education sector as well. It examines the importance of midyear check-in meetings; employee goal-setting; simplified rating scales on evaluation forms; and core staff competencies that reflect institutional priorities. It also describes how institutions communicate modifications to the evaluation system and offers recommendations for the implementation of process change.

Brazilian Federal Universities : relative efficiency evaluation and data envelopment analysis

The papers aims at considering the issue of relative efficiency measurement in the context of the public sector. In particular, we consider the efficiency measurement approach provided by Data Envelopment Analysis (DEA). The application considered the main Brazilian federal universities for the year of 1994. Given the large number of inputs and outputs, this paper advances the idea of using factor analysis to explore common dimensions in the data set. Such procedure made possible a meaningful application of DEA, which finally provided a set of efficiency scores for the universities considered .

Breadcrumbs: location and context aware mobile platform for story sharing

With the current proliferation of sensor equipped mobile devices such as smartphones and tablets, location aware services are expanding beyond the mere efficiency and work related needs of users, evolving in order to incorporate fun, culture and the social life of users. Today people on the move have more and more connectivity and are expected to be able to communicate with their usual and familiar social networks. That means communications not only with their peers and colleagues, friends and family but also with unknown people that might share their interests, curiosities or happen to use the same social network. Through social networks, location aware blogging, cultural mobile applications relevant information is now available at specific geographical locations and open to feedback and conversations among friends as well as strangers. In fact, nowadays smartphone technologies aloud users to post and retrieve content while on the move, often relating to specific physical landmarks or locations, engaging and being engaged in conversations with strangers as much as their own social network. The use of such technologies and applications while on the move can often lead people to serendipitous discoveries and interactions. Throughout our thesis we are engaging on a two folded investigation: how can we foster and support serendipitous discoveries and what are the best interfaces for it? In fact, to read and write content while on the move is a cognitively intensive task. While the map serves the function of orienting the user, it also absorbs most of the user’s concentration. In order to address this kind of cognitive overload issue with Breadcrumbs we propose a 360 degrees interface that enables the user to find content around them by means of scanning the surrounding space with the mobile device. By using a loose metaphor of a periscope, harnessing the power of the smartphone sensors we designed an interactive interface capable of detecting content around the users and display it in the form of 2 dimensional bubbles which diameter depends on their distance from the users. Users will navigate the space in relation to the content that they are curious about, rather than in relation to the traditional geographical map. Through this model we envisage alleviating a certain cognitive overload generated by having to continuously confront a two dimensional map with the real three dimensional space surrounding the user, but also use the content as a navigational filter. Furthermore this alternative mean of navigating space might bring serendipitous discovery about places that user where not aware of or intending to reach. We hence conclude our thesis with the evaluation of the Breadcrumbs application and the comparison of the 360 degrees interface with a traditional 2 dimensional map displayed on the devise screen. Results from the evaluation are compiled in findings and insights for future use in designing and developing context aware mobile applications.

Evaluation of anti-inflammatory activity of derivatives from aerial parts of Baccharis uncinella

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Evaluation of an average numerator relationship matrix model and a Bayesian hierarchical model for growth traits in Nellore cattle with uncertain paternity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Nutritional evaluation of stage 5 chronic kidney disease patients on dialysis

CONTEXTO E OBJETIVO: Portadores de insuficiência renal crônica em diálise apresentam alta prevalência de desnutrição proteico-energética. Não existe ainda um método uniforme para avaliar o estado nutricional desses pacientes. Recomenda-se a aplicação de um conjunto de métodos subjetivos e objetivos para se chegar aos diagnósticos nutricionais adequados. O objetivo deste estudo é traçar o perfil nutricional de pacientes submetidos a hemodiálise. TIPO DE ESTUDO E LOCAL: Estudo transversal descritivo realizado na Unidade de Tratamento Dialítico de Araraquara, São Paulo, Brasil, em 2008. MÉTODOS: 48 pacientes tiveram seus indicadores antropométricos e bioquímicos caracterizados, sendo também submetidos ao questionário Avaliação Global Subjetiva modificada (SGAm), verificando-se possíveis correlações entre esses indicadores. RESULTADOS: A frequência de desnutrição moderada e grave variou de 22% a 54%, de acordo com o parâmetro utilizado. Com relação à adequação do peso ideal, 29% da amostra estavam com porcentagem de adequação abaixo do percentil 75, classificados como portadores de desnutrição moderada e grave. As correlações mais significativas foram observadas entre índice de massa corporal (IMC) e adequações de prega triciptal (PCT), circunferência do braço (CB) e circunferência muscular do braço (CMB); e entre o SGAm e adequações de CB e CMB. CONCLUSÃO: A desnutrição apresentou grande variabilidade de frequência entre os pacientes de acordo com o critério escolhido para avaliação. O acompanhamento nutricional de rotina e a validação de métodos que avaliem a composição corporal desses pacientes são de extrema importância para diagnosticar precocemente a desnutrição e assim prevenir complicações e reduzir as taxas de morbimortalidade nesta população.

Evaluation of a bounded high order upwind scheme for 3D incompressible free surface flow computations

fit the context of normalized variable formulation (NVF) of Leonard and total variation diminishing (TVD) constraints of Harten. this paper presents an extension of it previous work by the authors for solving unsteady incompressible flow problems. The main contributions of the paper are threefold. First, it presents the results of the development and implementation of a bounded high order upwind adaptative QUICKEST scheme in the 3D robust code (Freeflow), for the numerical solution of the full incompressible Navier-Stokes equations. Second, it reports numerical simulation results for 1D hock tube problem, 2D impinging jet and 2D/3D broken clam flows. Furthermore, these results are compared with existing analytical and experimental data. and third, it presents the application of the numerical method for solving 3D free surface flow problems. (C) 2007 IMACS. Published by Elsevier B.V. All rights reserved,