884 resultados para 300705 Evaluation of Management Strategies


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This report was commissioned by the Department of Health, Ireland. Obesity is a public health problem in Ireland which is largely responsible for the increasing prevalence of diet-related diseases and growing financial burden on our healthcare system. Although overweight and obesity rates may have reached a plateau in Irish adults and children, they remain at an extremely high level as 1 in 4 children areoverweight or obese and an estimated 61% of adults are overweight or obese. Urgent public health action is required to reduce the levels of obesity among our children and adults. A sustainable national intervention strategy that combines government and community-led interventions is required. These interventions need to incorporate both nutrition education and environmental modification strategies to reduce levels of obesity. International literature suggests that calorie posting has the potential to have a positive effect on the obesity crisis by encouraging people to make healthier food choices through informed consumer decisions. This evaluation focuses on the uptake of voluntary calorie posting from a national representative sample of food service businesses in Ireland and explores the attitudes of food service businesses that do and do not display calories. This evaluation will explore the most effective and efficient way of implementing mandatory calorie posting on menus in Ireland.

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Transportation and land-use are independent, inter-active systems. Land-use patterns shape local transportation demand, but transportation systems in turn influence land-use patterns. In attempting to satisfy transportation demand created by existing land-use patterns, transportation planners directly, if not always consciously or intentionally, influence future land-use patterns. This study examines that complex relationship. The purpose of the study was threefold: to compile the body of knowledge already existing; to apply this body of knowledge to the context of midsize cities in the Midwest; and, to make the knowledge accessible both to transportation planners and to public officials who make key decisions about land use.

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Aims: To improve engagement of Health Visitors and Community Practitioners delivering the Healthy Child Programme with fathers. To evaluate a one-day, father-focused workshop with a supporting handbook for Practitioners. To identify institutional and organisational barriers to engagement with fathers. Background: The UK government policy encourages health professionals to engage with fathers. This derives from robust evidence that fathers’ early involvement with their children impacts positively on emotional, behavioural and educational development. Yet, there is little evidence that the importance of engaging fathers is reflected in Health Visitor training or that primary-care services are wholly embracing father-inclusive practice. The Fatherhood Institute (FI), a UK charity, has developed a workshop for Practitioners delivering the Healthy Child Programme. Method: A ‘before and after’ evaluation study, comprising a survey followed by telephone interviews, evaluated the impact of the FI workshop on Health Visitors’ and Community Practitioners’ knowledge, attitudes and behaviour in practice. A total of 134 Health Visitors and Community Practitioners from eight NHS Trusts in England attended the workshop from November 2011 to January 2014 at 12 sites. A specially constructed survey, incorporating a validated questionnaire, was administered before the workshop, immediately afterwards and three months later. Telephone interviews further explored participants’ responses. Findings: Analysis of the questionnaire data showed that the workshop and handbook improved participants’ knowledge, attitudes and behaviour in practice. This was sustained over a three-month period. In telephone interviews, most participants said that the workshop had raised their awareness of engaging fathers and offered them helpful strategies. However, they also spoke of barriers to engagement with fathers. NHS Trusts need to review the training and education of Health Visitors and Community Practitioners and take a more strategic approach towards father-inclusive practice and extend services to meet the needs of fathers.

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Thesis (Ph.D.)--University of Washington, 2016-08

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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.

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On-site detection of inoculum of polycyclic plant pathogens could potentially contribute to management of disease outbreaks. A 6-min, in-field competitive immunochromatographic lateral flow device (CLFD) assay was developed for detection of Alternaria brassicae (the cause of dark leaf spot in brassica crops) in air sampled above the crop canopy. Visual recording of the test result by eye provides a detection threshold of approximately 50 dark leaf spot conidia. Assessment using a portable reader improved test sensitivity. In combination with a weather-driven infection model, CLFD assays were evaluated as part of an in-field risk assessment to identify periods when brassica crops were at risk from A. brassicae infection. The weather-driven model overpredicted A. brassicae infection. An automated 7-day multivial cyclone air sampler combined with a daily in-field CLFD assay detected A. brassicae conidia air samples from above the crops. Integration of information from an in-field detection system (CLFD) with weather-driven mathematical models predicting pathogen infection have the potential for use within disease management systems.

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Interactive applications do not require more bandwidth to go faster. Instead, they require less latency. Unfortunately, the current design of transport protocols such as TCP limits possible latency reductions. In this paper we evaluate and compare different loss recovery enhancements to fight tail loss latency. The two recently proposed mechanisms "RTO Restart" (RTOR) and "Tail Loss Probe" (TLP) as well as a new mechanism that applies the logic of RTOR to the TLP timer management (TLPR) are considered. The results show that the relative performance of RTOR and TLP when tail loss occurs is scenario dependent, but with TLP having potentially larger gains. The TLPR mechanism reaps the benefits of both approaches and in most scenarios it shows the best performance.

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Background: Athletic groin pain (AGP) is prevalent in sports involving repeated accelerations, decelerations, kicking and change-of-direction movements. Clinical and radiological examinations lack the ability to assess pathomechanics of AGP, but three-dimensional biomechanical movement analysis may be an important innovation. Aim: The primary aim was to describe and analyse movements used by patients with AGP during a maximum effort change-of-direction task. The secondary aim was to determine if specific anatomical diagnoses were related to a distinct movement strategy. Methods: 322 athletes with a current symptom of chronic AGP participated. Structured and standardised clinical assessments and radiological examinations were performed on all participants. Additionally, each participant performed multiple repetitions of a planned maximum effort change-of-direction task during which whole body kinematics were recorded. Kinematic and kinetic data were examined using continuous waveform analysis techniques in combination with a subgroup design that used gap statistic and hierarchical clustering. Results: Three subgroups (clusters) were identified. Kinematic and kinetic measures of the clusters differed strongly in patterns observed in thorax, pelvis, hip, knee and ankle. Cluster 1 (40%) was characterised by increased ankle eversion, external rotation and knee internal rotation and greater knee work. Cluster 2 (15%) was characterised by increased hip flexion, pelvis contralateral drop, thorax tilt and increased hip work. Cluster 3 (45%) was characterised by high ankle dorsiflexion, thorax contralateral drop, ankle work and prolonged ground contact time. No correlation was observed between movement clusters and clinically palpated location of the participant's pain. Conclusions: We identified three distinct movement strategies among athletes with long-standing groin pain during a maximum effort change-of-direction task. These movement strategies were not related to clinical assessment findings but highlighted targets for rehabilitation in response to possible propagative mechanisms. Trial registration number NCT02437942, pre results.

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The recently developed network-wide real-time signal control strategy TUC has been implemented in three traffic networks with quite different traffic and control infrastructure characteristics: Chania, Greece (23 junctions); Southampton, UK (53 junctions); and Munich, Germany (25 junctions), where it has been compared to the respective resident real-time signal control strategies TASS, SCOOT and BALANCE. After a short outline of TUC, the paper describes the three application networks; the application, demonstration and evaluation conditions; as well as the comparative evaluation results. The main conclusions drawn from this high-effort inter-European undertaking is that TUC is an easy-to-implement, inter-operable, low-cost real-time signal control strategy whose performance, after very limited fine-tuning, proved to be better or, at least, similar to the ones achieved by long-standing strategies that were in most cases very well fine-tuned over the years in the specific networks.

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This paper describes how the recently developed network-wide real-time signal control strategy TUC has been implemented in three traffic networks with quite different traffic and control infrastructure characteristics: Chania, Greece (23 junctions); Southampton, U.K. (53 junctions); and Munich, Germany (25 junctions), where it has been compared to the respective resident real-time signal control strategies TASS, SCOOT and BALANCE. After a short outline of TUC, the paper describes the three application networks; the application, demonstration and evaluation conditions; as well as the comparative evaluation results. The main conclusions drawn from this high-effort inter-European undertaking is that TUC is an easy-to-implement, inter-operable, low-cost real-time signal control strategy whose performance, after limited fine-tuning, proved to be better or, at least, similar to the ones achieved by long-standing strategies that were in most cases very well fine-tuned over the years in the specific networks.

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The paper describes the strategies for Congestion and Incident Management (CIM) on the basis of Automatic Congestion and Incident Detection (ACID) that COSMOS will develop, implement in SCOOT, UTOPIA and MOTION, and validate and demonstrate in London, Piraeus and Torino. Four levels of operation were defined for CIM: strategies, tactics, tools and realisation. The strategies for CIM form the top level of this hierarchy. They have to reflect the strategic requirements of the system operators. The tactics are the means that can be employed by the strategies to achieve particular goals in particular situations. The tools that are used by the tactics relate to the elements of the signal plan and the ways in which they can be modified. Strategies, tactics and tools are generally common to all three systems, while the realisation of individual strategies and tactical decisions, through the use of particular common sets of tools, will generally be system specific. For the covering abstract, see IRRD 490001.

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Well-designed marine protected area (MPA) networks can deliver a range of ecological, economic and social benefits, and so a great deal of research has focused on developing spatial conservation prioritization tools to help identify important areas. However, whilst these software tools are designed to identify MPA networks that both represent biodiversity and minimize impacts on stakeholders, they do not consider complex ecological processes. Thus, it is difficult to determine the impacts that proposed MPAs could have on marine ecosystem health, fisheries and fisheries sustainability. Using the eastern English Channel as a case study, this paper explores an approach to address these issues by identifying a series of MPA networks using the Marxan and Marxan with Zones conservation planning software and linking them with a spatially explicit ecosystem model developed in Ecopath with Ecosim. We then use these to investigate potential trade-offs associated with adopting different MPA management strategies. Limited-take MPAs, which restrict the use of some fishing gears, could have positive benefits for conservation and fisheries in the eastern English Channel, even though they generally receive far less attention in research on MPA network design. Our findings, however, also clearly indicate that no-take MPAs should form an integral component of proposed MPA networks in the eastern English Channel, as they not only result in substantial increases in ecosystem biomass, fisheries catches and the biomass of commercially valuable target species, but are fundamental to maintaining the sustainability of the fisheries. Synthesis and applications. Using the existing software tools Marxan with Zones and Ecopath with Ecosim in combination provides a powerful policy-screening approach. This could help inform marine spatial planning by identifying potential conflicts and by designing new regulations that better balance conservation objectives and stakeholder interests. In addition, it highlights that appropriate combinations of no-take and limited-take marine protected areas might be the most effective when making trade-offs between long-term ecological benefits and short-term political acceptability.