Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery

This article presents the experience of a rehabilitation program that un- dertook the challenge to reorganize its services to address accessibility issues and im- prove service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to im- prove the quality of services provided to children with disabilities, their families, and their communities.

Program slice metrics and their potential role in DSL design, position paper

The advantages a DSL and the benefits its use potentially brings imply that informed decisions on the design of a domain specific language are of paramount importance for its use. We believe that the foundations of such decisions should be informed by analysis of data empirically collected from systems to highlight salient features that should then form the basis of a DSL. To support this theory, we describe an empirical study of a large OSS called Barcode, written in C, and from which we collected two well-known 'slice' based metrics. We analyzed multiple versions of the system and sliced its functions in three separate ways (i.e., input, output and global variables). The purpose of the study was to try and identify sensitivities and traits in those metrics that might inform features of a potential slice-based DSL. Results indicated that cohesion was adversely affected through the use of global variables and that appreciation of the role of function inputs and outputs can be revealed through slicing. The study presented is motivated primarily by the problems with current tools and interfaces experienced directly by the authors in extracting slicing data and the need to promote the benefits that analysis of slice data and slicing in general can offer.

Wellspring: an intrinsic case study of community-based education for adults living with cancer /

This paper presents education research as vital to addressing the issues faced by adults living with cancer. This qualitative study looked at philosophies of practice for cancer patient education. It was about understanding how values and beliefs shape the way program planners and managers operationalize their knowledge of adult education and how this has significant impact on meeting the needs of those touched by cancer. Improved technology has extended life expectancy, so that Canadians living with cancer, or even dying with cancer now spend less time in direct medical care. The notion of cancer as simply a medical concern is outdated. This study found that informational and support needs of adults living with cancer are often unmet, ignored or unknown. This research investigated a community-based education initiative that is inviting, accessible, and promotes a sense of hope. More specifically, this case study uncovered factors contributing to the success of Wellspring, a grass-roots cancer patient support centre which has been recognized nationally for its ability to effectively meet the diverse non-medical supportive care needs of as many cancer patients and caregivers as possible. Therefore, Wellspring was selected as a case study. Educating people to take charge of their own lives and supporting them in making informed decisions about their lifestyle choices made Wellspring part of a social action movement that focused on improving social attitudes toward people living with cancer. Results of this descriptive inquiry and philosophical inquiry evolved into data that was used to devise an organic model of community-based education that encompasses Adler's (1993) four dimensions of philosophy within a socio-cultural context.

Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.

Navigating Evidence-Based Practice: A Presentation for Parents and Caregivers

Prevalence rates for children with Autism Spectrum Disorder (ASD) have increased dramatically, to the current estimation of 1 in 68 (Centers for Disease Control and Prevention [CDC], 2014). The overall intention of this project is to develop a workshop for families, and caregivers, which will enhance awareness, the importance of evidence-based practice for individuals with ASD and provide local resources that are available. This project involves a literature review of ASDs, evidence-based practice (EBP) and how it affects both families and caregivers. The literature review attempted to answer the question, what are the most popular evidence-based practices and what are the benefits in parents understanding EBP for children with ASD that are currently being utilized today. The purpose of this project is to assist families and caregivers in making well-informed decisions involving the choice of treatments that will have the most positive impact on their children with ASD.

Neural correlates of affordance competition in dorsal premotor cortex

Le travail présenté dans cette thèse porte sur le rôle du cortex prémoteur dorsal (PMd) au sujet de la prise de décision (sélection d’une action parmis nombreux choix) et l'orientation visuelle des mouvements du bras. L’ouvrage décrit des expériences électrophysiologiques chez le singe éveillé (Macaca mulatta) permettant d’adresser une fraction importante des prédictions proposées par l'hypothèse des affordances concurrentes (Cisek, 2006; Cisek, 2007a). Cette hypothèse suggère que le choix de toute action est l’issue d'une concurrence entre les représentations internes des exigences et des atouts de chacune des options présentées (affordances; Gibson, 1979). Un intérêt particulier est donné au traitement de l'information spatiale et la valeur des options (expected value, EV) dans la prise de décisions. La première étude (article 1) explore la façon dont PMd reflète ces deux paramètres dans la période délai ainsi que de leur intéraction. La deuxième étude (article 2) explore le mécanisme de décision de façon plus détaillée et étend les résultats au cortex prémoteur ventral (PMv). Cette étude porte également sur la représentation spatiale et l’EV dans une perspective d'apprentissage. Dans un environnement nouveau les paramètres spatiaux des actions semblent être présents en tout temps dans PMd, malgré que la représentation de l’EV apparaît uniquement lorsque les animaux commencent à prendre des décisions éclairées au sujet de la valeur des options disponibles. La troisième étude (article 3) explore la façon dont PMd est impliqué aux “changements d'esprit“ dans un procès de décision. Cette étude décrit comment la sélection d’une action est mise à jour à la suite d'une instruction de mouvement (GO signal). I II Les résultats principaux des études sont reproduits par un modèle computationnel (Cisek, 2006) suggérant que la prise de décision entre plusieurs actions alternatives peux se faire par voie d’un mécanisme de concurrence (biased competition) qui aurait lieu dans la même région qui spécifie les actions.

Introduction du modèle axé sur le partenariat des soins : la pratique collaborative dans une équipe interdisciplinaire en santé mentale

Essai critique de stage

Provision of information about drug side-effects to patients

To make informed decisions about taking medicinal drugs, people need accurate information about side-effects. A European Union guideline now recommends use of qualitative descriptions for five bands of risk, ranging from very rare (affecting < 0·01% of the population), to very common (>10%). We did four studies of more than 750 people, whom we asked to estimate the probability of having a side-effect on the basis of qualitative and quantitative descriptions. Our results showed that qualitative descriptions led to gross overestimation of risk. Until further work is done on how patients taking the drugs interpret these terms, the terms should not be used in drug information leaflets.

An illustration of the modelling of cost and efficacy data from a clinical trial

Health care providers, purchasers and policy makers need to make informed decisions regarding the provision of cost-effective care. When a new health care intervention is to be compared with the current standard, an economic evaluation alongside an evaluation of health benefits provides useful information for the decision making process. We consider the information on cost-effectiveness which arises from an individual clinical trial comparing the two interventions. Recent methods for conducting a cost-effectiveness analysis for a clinical trial have focused on the net benefit parameter. The net benefit parameter, a function of costs and health benefits, is positive if the new intervention is cost-effective compared with the standard. In this paper we describe frequentist and Bayesian approaches to cost-effectiveness analysis which have been suggested in the literature and apply them to data from a clinical trial comparing laparoscopic surgery with open mesh surgery for the repair of inguinal hernias. We extend the Bayesian model to allow the total cost to be divided into a number of different components. The advantages and disadvantages of the different approaches are discussed. In January 2001, NICE issued guidance on the type of surgery to be used for inguinal hernia repair. We discuss our example in the light of this information. Copyright © 2003 John Wiley & Sons, Ltd.

Monitoring and evaluation in Malawi

When Ian Wilson and Carlos Barahona of the Statistical Services Centre at the University of Reading were asked to review an evaluation of the effectiveness of an aid package in Malawi, they expected a simple enough task. But few things in the developing world are simple. Where aid for the poorest is concerned, is evidence collected and analysed with enough rigour to enable well-informed decisions to be made?

Sequentially testing for a gene-drug interaction in a genomewide analysis

Assaying a large number of genetic markers from patients in clinical trials is now possible in order to tailor drugs with respect to efficacy. The statistical methodology for analysing such massive data sets is challenging. The most popular type of statistical analysis is to use a univariate test for each genetic marker, once all the data from a clinical study have been collected. This paper presents a sequential method for conducting an omnibus test for detecting gene-drug interactions across the genome, thus allowing informed decisions at the earliest opportunity and overcoming the multiple testing problems from conducting many univariate tests. We first propose an omnibus test for a fixed sample size. This test is based on combining F-statistics that test for an interaction between treatment and the individual single nucleotide polymorphism (SNP). As SNPs tend to be correlated, we use permutations to calculate a global p-value. We extend our omnibus test to the sequential case. In order to control the type I error rate, we propose a sequential method that uses permutations to obtain the stopping boundaries. The results of a simulation study show that the sequential permutation method is more powerful than alternative sequential methods that control the type I error rate, such as the inverse-normal method. The proposed method is flexible as we do not need to assume a mode of inheritance and can also adjust for confounding factors. An application to real clinical data illustrates that the method is computationally feasible for a large number of SNPs. Copyright (c) 2007 John Wiley & Sons, Ltd.

Deconstruction plan assessment using multi-criteria decision-making methods

The purpose of this paper is to present two multi-criteria decision-making models, including an Analytic Hierarchy Process (AHP) model and an Analytic Network Process (ANP) model for the assessment of deconstruction plans and to make a comparison between the two models with an experimental case study. Deconstruction planning is under pressure to reduce operation costs, adverse environmental impacts and duration, in the meanwhile to improve productivity and safety in accordance with structure characteristics, site conditions and past experiences. To achieve these targets in deconstruction projects, there is an impending need to develop a formal procedure for contractors to select a most appropriate deconstruction plan. Because numbers of factors influence the selection of deconstruction techniques, engineers definitely need effective tools to conduct the selection process. In this regard, multi-criteria decision-making methods such as AHP have been adopted to effectively support deconstruction technique selection in previous researches. in which it has been proved that AHP method can help decision-makers to make informed decisions on deconstruction technique selection based on a sound technical framework. In this paper, the authors present the application and comparison of two decision-making models including the AHP model and the ANP model for deconstruction plan assessment. The paper concludes that both AHP and ANP are viable and capable tools for deconstruction plan assessment under the same set of evaluation criteria. However, although the ANP can measure relationship among selection criteria and their sub-criteria, which is normally ignored in the AHP, the authors also indicate that whether the ANP model can provide a more accurate result should be examined in further research.

Performance-based contracting in the construction sector

Construction procurement is complex and there is a very wide range of options available to procurers. Inappropriate choices about how to procure may limit practical opportunities for innovation. In particular, traditional approaches to construction procurement set up many obstacles for technology suppliers to provide innovative solutions. This is because they are often employed as sub-contractors simply to provide and install equipment to specifications developed before the point at which they become involved in a project. A research team at the University of Reading has developed a procurement framework that comprehensively defines the various options open to procurers in a more fine-grained way than has been known in the past. This enables informed decisions that can establish tailor-made procurement approaches that take into account the needs of specific clients. It enables risk and reward structures to be aligned so that contracts and payment mechanisms are aligned precisely with what a client seeks to achieve. This is not a “one-size-fits-all” approach. Rather, it is an approach that enables informed decisions about how to organize individual procurements that are appropriate to particular circumstances, acknowledging that they differ for each client and for each procurement exercise. Within this context, performance-based contracting (PBC) is explored in terms of the different ways in which technology suppliers within constructed facilities might be encouraged and rewarded for the kinds of innovation sought by the ultimate clients. Examples from various industry sectors are presented, from public sector and from private sector, with a commentary about what they sought to achieve and the extent to which they were successful. The lessons from these examples are presented in terms of feasibility in relation to financial issues, governance, economics, strategic issues, contractual issues and cash flow issues for clients and for contractors. Further background documents and more detailed readings are provided in an appendix for those who wish to find out more.

Cereal aphids and their natural enemies: responses to landscape composition and agri-environment schemes

There are potential conflicts between food security, biodiversity conservation and ecosystem services. Currently, there are still gaps in our understanding on the links between land use, biodiversity and ecosystem services; all have implications for sustainable agriculture. To improve food productivity in an ecologically friendly manner we should consider adapting current pest control techniques from being reliant on chemical means towards a more integrated approach. However, to do this, farmers and land owners require more information in order to make informed decisions. This brief review explores field level and landscape scale impacts on aphid control by their natural enemies. This will be done by exploring the effects of local field margin flower strips and two key landscape scale factors, winter wheat and lowland calcareous grasslands on aphids and their natural enemies. Research questions which need answering are discussed.

The Impact of Land Use Patterns and Watershed Characteristics on China Lake, Kennebec County, Maine

China Lake is located in Kennebec County, Maine. Since 1983 the lake has suffered from yearly algal blooms as a result of the addition of excess nutrients. The nutrient load was amplified by erosion within the watershed. Erosion varies widely depending on a number of factors, including the slope of the land, the type of soil, and the way the land is being used. Certain land use types have a high potential to add nutrients to the environment, while others may help absorb excess nutrients and prevent erosion and runoff into the lake. A comprehensive examination of the China Lake watershed was completed using GIS to calculate the erosion potential for the entire area, taking into account past and present land use patterns. This information will help the towns around the lake to make informed decisions about future development and land management.