Developing leadership in managers to facilitate the implementation of national guideline recommendations : a process evaluation of feasibility and usefulness

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

Newham’s Every Child a Sports Person (NECaSP): A Summative Process Evaluation of a School-and-Community Based Intervention in East London, UK

Background: The NECaSP intervention aspires to increase sport and physical activity (PA) participation amongst young people in the UK. The aims of this paper are to report on a summative process evaluation of the NECaSP and make recommendations for future interventions. Methods: Seventeen schools provided data by students aged 11-13 (n=1,226), parents (n=192) and teachers (n= 14) via direct observation and questionnaires. Means, standard deviations and percentages were calculated for socio-demographic data. Qualitative data was analysed via directed content analysis and main themes identified. Results: Findings indicate further administrative, educational and financial support will help facilitate the success of the programme in improving PA outcomes for young people, and of other similar intervention programmes globally. Data highlighted the need to engage parents to increase likelihood of intervention success. Conclusions: One main strength of this study is the mixed-methods nature of the process evaluation. It is recommended that future school based interventions that bridge sports clubs and formal curriculum provision, should consider a more broad approach to the delivery of programmes throughout the academic year, school week and school day. Finally, changes in the school curriculum can be successful once all parties are involved (community, school, families).

The Development and Evaluation of a School-Based Programme to Promote and the Enhance Well-Being of Primary School Children

The current study was carried out to evaluate the impact of a well-being curriculum based on existing knowledge of themes within PP, which contribute to well-being. The Positive Well-Being Curriculum consists of twelve ninety minute sessions delivered weekly during a school term. The twelve well-being sessions fit into four domains: positive experience, positive emotions, positive relationships, achievement and meaning (Seligman, 2007). The objectives of the study were to test the practical implications of running a well-being curriculum, to develop a range of activities within each domain and to evaluate the impact on student well-being with regard to life satisfaction, positive affectivity and subjective happiness. A pilot was carried out as preparation for the main mixed method intervention study, which was conducted in two London primary schools. Pre and post data was collected using standardised measures, focus groups and one to one interviews. Findings from the pilot demonstrated a significant increase in well-being as demonstrated by increases in: life satisfaction, positive affect and subjective happiness. Additional information was gathered which informed the content and implementation of the curriculum in the main study. The experience of taking part in the study as evidenced through qualitative and quantitative results, indicate that the Positive Well-being Curriculum was perceived by participating teachers and children to contribute positively to the well-being of the children. These findings would be of interest to educational psychologists as there is an increasing interest by schools to include creative and validated resources to support and enhance the well-being of all children. A number of useful insights were developed about the usefulness of the curriculum for children in a variety of educational settings.

Evaluation of Tottenham Thinking Space Pilot: Final Report. Research Report 11.

This reports summarises research that began in March 2014 and was completed in October 2015 by an experienced inter-disciplinary research team from the Centre for Social Justice and Change and Psycho-Social Research Group, School of Social Sciences, the University of East London (UEL) and included Dr Yang Li from the Centre for Geo-Information Studies, UEL, for the first phase of the study. Tottenham ‘Thinking Space’ (TTS) was a pilot therapeutic initiative based in local communities and delivered by the Tavistock & Portman NHS Foundation Trust and funded by the London Borough of Haringey Directorate of Public Health. TTS aimed to improve mental health and enable and empower local communities. TTS was situated within a mental health agenda that was integral to Haringey’s Health and Wellbeing Strategy 2012-2015 and aimed to encourage people to help themselves and each other and develop confident communities. On the one hand TTS was well-suited to this agenda, but, on the other, participants were resistant to, and were trying to free themselves from labelling that implied ‘mental health difficulties’. A total of 243 meetings were held and 351 people attended 1,716 times. The majority of participants attended four times or less, and 33 people attended between 5 and 10 times and 39 people attended over 10 times. Attending a small number of times does not necessarily mean that the attendee was not helped. Attendees reflected the ethnic diversity of Tottenham; 29 different ethnic groups attended. The opportunity to meet with people from different cultural backgrounds in a safe space was highly valued by attendees. Similarly, participants valued the wide age range represented and felt that they benefited from listening to inter-generational experiences. The majority of participants were women (72%) and they were instrumental in initiating further Thinking Spaces, topic specific meetings, the summer programme of activities for mothers and young children and training to meet their needs. The community development worker had a key role in implementing the initiative and sustaining its growth throughout the pilot period. We observed that TTS attracted those whose life experiences were marked by personal struggle and trauma. Many participants felt safe enough to disclose mental health difficulties (85% of those who completed a questionnaire). Participants also came seeking a stronger sense of community in their local area. Key features of the meetings are that they are democratic, non-judgemental, respectful, and focussed on encouraging everyone to listen and to try to understand. We found that the therapeutic method was put in place by high quality facilitators and health and personal outcomes for participants were consistent with those predicted by the underpinning psychoanalytical and systemic theories. Outcomes included a reduction in anxieties and improved personal and social functioning; approximately two thirds of those who completed a questionnaire felt better understood, felt more motivated and more hopeful for the future. The overwhelming majority of survey respondents also felt good about contributing to their community, said that they were more able to cooperate with others and accepting of other cultures, and had made new friends. Participants typically had a better understanding of their current situation and how to take positive action; of those who completed a questionnaire, over half felt more confident to seek support for a personal issue and to contact services. Members of TTS supported each other and instilled hope and build community-mindedness that reduced social isolation.

Evaluation of online higher education: learning, interaction and technology

The work presents a theoretical framework for the evaluation of e-Teaching that aims at positioning the online activities designed and developed by the teacher as to the Learning, Interaction and Technology Dimensions. The theoretical research that underlies the study was developed reflecting current thinking on the promotion of quality of teaching and of the integration of information and communication tools into the curriculum in Higher Education (HE), i.e., bearing in mind some European guidelines and policies on this subject. This way, an answer was sought to be given to one of the aims put forward in this study, namely to contribute towards the development of a conceptual framework to support research on evaluation of e-teaching in the context of HE. Based on the theoretical research carried out, an evaluation tool (SCAI) was designed, which integrates the two questionnaires developed to collect the teachers' and the students' perceptions regarding the development of e-activities. Consequently, an empirical study was structured and carried out, allowing SCAI tool to be tested and validated in real cases. From the comparison of the theoretical framework established and the analysis of the data obtained, we found that the differences in teaching should be valued and seen as assets by HE institutions rather than annihilated in a globalizing perspective.

Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.

Effects of trawling on sessile megabenthos in the Great Barrier Reef and evaluation of the efficacy of management strategies

A series of related research studies over 15 years assessed the effects of prawn trawling on sessile megabenthos in the Great Barrier Reef, to support management for sustainable use in the World Heritage Area. These large-scale studies estimated impacts on benthos (particularly removal rates per trawl pass), monitored subsequent recovery rates, measured natural dynamics of tagged megabenthos, mapped the regional distribution of seabed habitats and benthic species, and integrated these results in a dynamic modelling framework together with spatio-temporal fishery effort data and simulated management. Typical impact rates were between 5 and 25% per trawl, recovery times ranged from several years to several decades, and most sessile megabenthos were naturally distributed in areas where little or no trawling occurred and so had low exposure to trawling. The model simulated trawl impact and recovery on the mapped species distributions, and estimated the regional scale cumulative changes due to trawling as a time series of status for megabenthos species. The regional status of these taxa at time of greatest depletion ranged from ∼77% relative to pre-trawl abundance for the worst case species, having slow recovery with moderate exposure to trawling, to ∼97% for the least affected taxon. The model also evaluated the expected outcomes for sessile megabenthos in response to major management interventions implemented between 1999 and 2006, including closures, effort reductions, and protected areas. As a result of these interventions, all taxa were predicted to recover (by 2-14% at 2025); the most affected species having relatively greater recovery. Effort reductions made the biggest positive contributions to benthos status for all taxa, with closures making smaller contributions for some taxa. The results demonstrated that management actions have arrested and reversed previous unsustainable trends for all taxa assessed, and have led to a prawn trawl fishery with improved environmental sustainability. © 2015 International Council for the Exploration of the Sea 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

PART STUDY OF PERCEPTION OF EDUCATIONAL PROGRAMS IN THE LIBRARY COMMUNITY: OPINION (AS) EMPLOYERS (AS) AND GRADUATES (AS) SCHOOL LIBRARY, DOCUMENTATION AND INFORMATION FOR THE NATIONAL UNIVERSITY

This article provides a brief description of some general aspects of self-evaluation process conducted in the School of Library, Documentation and Information from the National University of Costa Rica, to obtain accreditation from the career of Library and Documentation in 2005 and to achieve re-accreditation in 2009.The objective consists in a comparison between the two evaluation processes from the point of view of two specific sectors, employers and graduates, and presents the views provided by each of them as a partial analysis of the social impact assessment of educational programs in the community librarianship as a first input to raise awareness of the importance of these studies in the institutional and national level.

Evaluation of the cytotoxic and genotoxic effects of benchmark multi-walled carbon nanotubes in relation to their physicochemical properties

To contribute with scientific evidence to the grouping strategy for the safety assessment of multi-walled carbon nanotubes (MWCNTs), this work describes the investigation of the cytotoxic and genotoxic effects of four benchmark MWCNTs in relation to their physicochemical characteristics, using two types of human respiratory cells. The cytotoxic effects were analysed using the clonogenic assay and replication index determination. A 48h-exposure of cells revealed that NM-401 was the only cytotoxic MWCNT in both cell lines, but after 8-days exposure, the clonogenic assay in A549 cells showed cytotoxic effects for all the tested MWCNTs. Correlation analysis suggested an association between the MWCNTs size in cell culture medium and cytotoxicity. No induction of DNA damage was observed after any MWCNTs in any cell line by the comet assay, while the micronucleus assay revealed that both NM-401 and NM-402 were genotoxic in A549 cells. NM-401 and NM-402 are the two longest MWCNTs analyzed in this work, suggesting that length may be determinant for genotoxicity. No induction of micronuclei was observed in Beas-2B cell line and the different effect in both cell lines is explained in view of the size-distribution of MWCNTs in the cell culture medium, rather than cell's specificities.

Urban dynamics evaluation of Envigado city

This article presents the methodological conceptualization and the main results of a System Dynamics model, which main objective is to support the housing policies in the city of Envigado -- The used methodology developed a scenario-based model to emulate the approximate evolution of the housing demand and supply for the city, using a scenario of the Gross Domestic Product (GDP) and a housing authorization strategy as input -- Diverse results were obtained, for instance it was found that due to the soil availability, the housing supply reaches the saturation point between 2040 and 2046 -- Finally this article could be considered as an example of how academic tools such as System Dynamics can be used by decisions makers in the government

Evaluation of the reaction of watermelon parent and F1 plants to Meloidogyne enterolobii.

The aim of this study was to evaluate the performance of progenies from Citrullus lanatus var. lanatus (cultivated watermelons) when crossed with progenies from C. lanatus var. citroides (fodder watermelon with a historic of resistance to the nematode Meloidogyne enterolobii). The parents and their F1s were evaluated for resistance to this nematode. In the initial stages of eleven treatments, watermelon seedlings plantlets were transplanted to plastic bags of six kilograms once the first leaves developed. Ten inoculated plants with 5,200 eggs in the soil near the stem of the plant and four non-inoculated ones were used in each treatment, in a complete block design. Sixty-two days after sowing, the following characteristics were evaluated: the length of the aerial part of the plant (LAP, in m), fresh mass of the aerial part (FMAP, in g), root fresh mass (RFM, in g), egg number (EN) and reproduction factor (RF). A comparison between the averages of inoculated and non-inoculated plants was performed using Scott-Knott test at 5% and the diallelic analysis was performed using the GENES program. The morphological characteristics did not allow for the identification of the parent plants or the F1s with respect to nematode resistance, but the variables EN and RF were useful for such identification. The analyses of the general and specific combining abilities indicate highly significant effects with respect to this resistance, showing additive gene effects as well as dominance and epistatic gene effects, allowing for identification of parents and F1s that can be used in watermelon breeding programs to improve resistance to the M. enterolobii.

Evaluation of the Evidential Value of the Elemental Composition of Glass, Ink and Paper by Laser-Based Micro-Spectrochemical Methods

Elemental analysis can become an important piece of evidence to assist the solution of a case. The work presented in this dissertation aims to evaluate the evidential value of the elemental composition of three particular matrices: ink, paper and glass. In the first part of this study, the analytical performance of LIBS and LA-ICP-MS methods was evaluated for paper, writing inks and printing inks. A total of 350 ink specimens were examined including black and blue gel inks, ballpoint inks, inkjets and toners originating from several manufacturing sources and/or batches. The paper collection set consisted of over 200 paper specimens originating from 20 different paper sources produced by 10 different plants. Micro-homogeneity studies show smaller variation of elemental compositions within a single source (i.e., sheet, pen or cartridge) than the observed variation between different sources (i.e., brands, types, batches). Significant and detectable differences in the elemental profile of the inks and paper were observed between samples originating from different sources (discrimination of 87 – 100% of samples, depending on the sample set under investigation and the method applied). These results support the use of elemental analysis, using LA-ICP-MS and LIBS, for the examination of documents and provide additional discrimination to the currently used techniques in document examination. In the second part of this study, a direct comparison between four analytical methods (µ-XRF, solution-ICP-MS, LA-ICP-MS and LIBS) was conducted for glass analyses using interlaboratory studies. The data provided by 21 participants were used to assess the performance of the analytical methods in associating glass samples from the same source and differentiating different sources, as well as the use of different match criteria (confidence interval (±6s, ±5s, ±4s, ±3s, ±2s), modified confidence interval, t-test (sequential univariate, p=0.05 and p=0.01), t-test with Bonferroni correction (for multivariate comparisons), range overlap, and Hotelling’s T2 tests. Error rates (Type 1 and Type 2) are reported for the use of each of these match criteria and depend on the heterogeneity of the glass sources, the repeatability between analytical measurements, and the number of elements that were measured. The study provided recommendations for analytical performance-based parameters for µ-XRF and LA-ICP-MS as well as the best performing match criteria for both analytical techniques, which can be applied now by forensic glass examiners.

Introducing a pilot data collection model for real-time evaluation of data redundancy

In order to reduce serious health incidents, individuals with high risks need to be identified as early as possible so that effective intervention and preventive care can be provided. This requires regular and efficient assessments of risk within communities that are the first point of contacts for individuals. Clinical Decision Support Systems CDSSs have been developed to help with the task of risk assessment, however such systems and their underpinning classification models are tailored towards those with clinical expertise. Communities where regular risk assessments are required lack such expertise. This paper presents the continuation of GRiST research team efforts to disseminate clinical expertise to communities. Based on our earlier published findings, this paper introduces the framework and skeleton for a data collection and risk classification model that evaluates data redundancy in real-time, detects the risk-informative data and guides the risk assessors towards collecting those data. By doing so, it enables non-experts within the communities to conduct reliable Mental Health risk triage.

Evaluation of DUALEM, OptRx and Grassmaster II sensors for monitoring the spatial variability and the temporal stability of a Mediterranean pasture

Site-specific management (SSM) is a form of precision agriculture whereby decisions on resource application and agronomic practices are improved to better match soil and crop requirements as they vary in the field. SSM enables the identification of regions (homogeneous management zones) within the area delimited by field boundaries. These subfield regions constitute areas that have similar permanent characteristics. Traditional soil and pasture sampling and the necessary laboratory analysis are time-consuming, labour-intensive and cost prohibitive, not viable from a SSM perspective because it needs a large number of soil and pasture samples in order to achieve a good representation of soil properties, nutrient levels and pasture quality and productivity. The main objective of this work was to evaluate technologies which have potential for monitoring aspects related to spatial and temporal variability of soil nutrients and pasture green and dry matter yield (respectively, GM and DM, in kg/ha) and support to decision making for the farmer. Three types of sensors were evaluated in a 7ha pasture experimental field: an electromagnetic induction sensor (“DUALEM 1S”, which measures the soil apparent electrical conductivity, ECa), an active optical sensor ("OptRx®", which measures the NDVI, “Normalized Difference Vegetation Index”) and a capacitance probe ("GrassMaster II" which estimates plant mass). The results indicate the possibility of using a soil electrical conductivity probe as, probably, the best tool for monitoring not only some of the characteristics of the soil, but also those of the pasture, which could represent an important help in simplifying the process of sampling and support SSM decision making, in precision agriculture projects. On the other hand, the significant and very strong correlations obtained between capacitance and NDVI and between any of these parameters and the pasture productivity shows the potential of these tools for monitoring the evolution of spatial and temporal patterns of the vegetative growth of biodiverse pasture, for identifying different plant species and variability in pasture yield in Alentejo dry-land farming systems. These results are relevant for the selection of an adequate sensing system for a particular application and open new perspectives for other works that would allow the testing, calibration and validation of the sensors in a wider range of pasture production conditions, namely the extraordinary diversity of botanical species that are characteristic of the Mediterranean region at the different periods of the year.

Predictive And Prognostic Role Of Biological Markers In Neuroendocrine Neoplasia And Evaluation Of Activity And Safety Of Second Line Treatments In Neuroendocrine Carcinoma Patients

BACKGROUND Neuroendocrine neoplasia (NEN) are divided in well differentiated G1,G2 and G3 neuroendocrine tumors (NETs) and G3 neuroendocrine carcinomas (NECs). For the latter no standard therapy in second-line is available and prognosis is poor. METHODS Primary aim was to evaluate new prognostic and predictive biomarkers (WP1-3). In WP4 we explored the activity of FOLFIRI and CAPTEM as second-line in NEC patients in a multicenter non-comparative phase II trial RESULTS In WP1-2 we found that 4 of 6 GEP-NEC patients with a negative 68Ga-PET/CT had a loss of expression of RB1. In WP3 on 47 GEP-NENs patients the presence of DLL3 in 76.9% of G3 NEC correlate with RB1-loss (p<0.001), negative 68Ga-PET/CT(p=0.001) and a poor prognosis. In the WP4 we conducted a multicenter non-comparative phase II trial to explore the activity of FOLFIRI or CAPTEM in terms of DCR, PFS and OS given as second-line in NEC patients. From 06/03/2017 to 18/01/2021 53 out of 112 patients were enrolled in 17 of 23 participating centers. Median follow-up was 10.8 (range 1.4 – 38.6) months. The 3-month DCR was 39.3% in the FOLFIRI and 32.0 % in the CAPTEM arm. The 6-months PFS rate was 34.6% ( 95%CI 17.5-52.5) in FOLFIRI and 9.6% (95%CI 1.8-25.7) in CAPTEM group. In the FOLFIRI subgroup the 6-months and 12-months OS rate were 55.4% (95%CI 32.6-73.3) and 30.3% (CI 11.1-52.2) respectively. In CAPTEM arm the 6-months and 12-months OS rate were 57.2% (95%34.9-74.3) and 29.0% (95%10.0-43.3). The miRNA analysis of 20 patients compared with 20 healthy subjects shows an overexpression of miRNAs involved in staminality , neo-angiogenesis and mitochontrial anaerobic glycolysis activation. CONCLUSION WP1-3 support the hypothesis that G3NECs carrying RB1 loss is associated with a DLL3 expression highlighting a potential therapeutic opportunity. Our study unfortunately didn’t met the primary end–point but the results are promising