The effect of a urinary incontinence self-management program for older women in South Korea: A pilot study

© 2015 Chinese Nursing Association.Background Although self-management approaches have shown strong evidence of positive outcomes for urinary incontinence prevention and management, few programs have been developed for Korean rural communities. Objectives This pilot study aimed to develop, implement, and evaluate a urinary incontinence self-management program for community-dwelling women aged 55 and older with urinary incontinence in rural South Korea. Methods This study used a one-group pre- post-test design to measure the effects of the intervention using standardized urinary incontinence symptom, knowledge, and attitude measures. Seventeen community-dwelling older women completed weekly 90-min group sessions for 5 weeks. Descriptive statistics and paired t-tests and were used to analyze data. Results The mean of the overall interference on daily life from urine leakage (pre-test: M = 5.76 ± 2.68, post-test: M = 2.29 ± 1.93, t = -4.609, p < 0.001) and the sum of International Consultation on Incontinence Questionnaire scores (pre-test: M = 11.59 ± 3.00, post-test: M = 5.29 ± 3.02, t = -5.881, p < 0.001) indicated significant improvement after the intervention. Improvement was also noted on the mean knowledge (pre-test: M = 19.07 ± 3.34, post-test: M = 23.15 ± 2.60, t = 7.550, p < 0.001) and attitude scores (pre-test: M = 2.64 ± 0.19, post-test: M = 3.08 ± 0.41, t = 5.150, p < 0.001). Weekly assignments were completed 82.4% of the time. Participants showed a high satisfaction level (M = 26.82 ± 1.74, range 22-28) with the group program. Conclusions Implementation of a urinary incontinence self-management program was accompanied by improved outcomes for Korean older women living in rural communities who have scarce resources for urinary incontinence management and treatment. Urinary incontinence self-management education approaches have potential for widespread implementation in nursing practice.

Multi-program benchmark definition

© 2015 IEEE.Although definition of single-program benchmarks is relatively straight-forward-a benchmark is a program plus a specific input-definition of multi-program benchmarks is more complex. Each program may have a different runtime and they may have different interactions depending on how they align with each other. While prior work has focused on sampling multiprogram benchmarks, little attention has been paid to defining the benchmarks in their entirety. In this work, we propose a four-tuple that formally defines multi-program benchmarks in a well-defined way. We then examine how four different classes of benchmarks created by varying the elements of this tuple align with real-world use-cases. We evaluate the impact of these variations on real hardware, and see drastic variations in results between different benchmarks constructed from the same programs. Notable differences include significant speedups versus slowdowns (e.g., +57% vs -5% or +26% vs -18%), and large differences in magnitude even when the results are in the same direction (e.g., 67% versus 11%).

Clinical utility of a Web-enabled risk-assessment and clinical decision support program.

PURPOSE: Risk-stratified guidelines can improve quality of care and cost-effectiveness, but their uptake in primary care has been limited. MeTree, a Web-based, patient-facing risk-assessment and clinical decision support tool, is designed to facilitate uptake of risk-stratified guidelines. METHODS: A hybrid implementation-effectiveness trial of three clinics (two intervention, one control). PARTICIPANTS: consentable nonadopted adults with upcoming appointments. PRIMARY OUTCOME: agreement between patient risk level and risk management for those meeting evidence-based criteria for increased-risk risk-management strategies (increased risk) and those who do not (average risk) before MeTree and after. MEASURES: chart abstraction was used to identify risk management related to colon, breast, and ovarian cancer, hereditary cancer, and thrombosis. RESULTS: Participants = 488, female = 284 (58.2%), white = 411 (85.7%), mean age = 58.7 (SD = 12.3). Agreement between risk management and risk level for all conditions for each participant, except for colon cancer, which was limited to those <50 years of age, was (i) 1.1% (N = 2/174) for the increased-risk group before MeTree and 16.1% (N = 28/174) after and (ii) 99.2% (N = 2,125/2,142) for the average-risk group before MeTree and 99.5% (N = 2,131/2,142) after. Of those receiving increased-risk risk-management strategies at baseline, 10.5% (N = 2/19) met criteria for increased risk. After MeTree, 80.7% (N = 46/57) met criteria. CONCLUSION: MeTree integration into primary care can improve uptake of risk-stratified guidelines and potentially reduce "overuse" and "underuse" of increased-risk services.Genet Med 18 10, 1020-1028.

Utility of a molecular prescreening program in advanced colorectal cancer for enrollment on biomarker-selected clinical trials.

BACKGROUND: Incorporation of multiple enrichment biomarkers into prospective clinical trials is an active area of investigation, but the factors that determine clinical trial enrollment following a molecular prescreening program have not been assessed. PATIENTS AND METHODS: Patients with 5-fluorouracil-refractory metastatic colorectal cancer at the MD Anderson Cancer Center were offered screening in the Assessment of Targeted Therapies Against Colorectal Cancer (ATTACC) program to identify eligibility for companion phase I or II clinical trials with a therapy targeted to an aberration detected in the patient, based on testing by immunohistochemistry, targeted gene sequencing panels, and CpG island methylation phenotype assays. RESULTS: Between August 2010 and December 2013, 484 patients were enrolled, 458 (95%) had a biomarker result, and 157 (32%) were enrolled on a clinical trial (92 on biomarker-selected and 65 on nonbiomarker selected). Of the 458 patients with a biomarker result, enrollment on biomarker-selected clinical trials was ninefold higher for predefined ATTACC-companion clinical trials as opposed to nonpredefined biomarker-selected clinical trials, 17.9% versus 2%, P < 0.001. Factors that correlated positively with trial enrollment in multivariate analysis were higher performance status, older age, lack of standard of care therapy, established patient at MD Anderson, and the presence of an eligible biomarker for an ATTACC-companion study. Early molecular screening did result in a higher rate of patients with remaining standard of care therapy enrolling on ATTACC-companion clinical trials, 45.1%, in contrast to nonpredefined clinical trials, 22.7%; odds ratio 3.1, P = 0.002. CONCLUSIONS: Though early molecular prescreening for predefined clinical trials resulted in an increase rate of trial enrollment of nonrefractory patients, the majority of patients enrolled on clinical trials were refractory to standard of care therapy. Within molecular prescreening programs, tailoring screening for preidentified and open clinical trials, temporally linking screening to treatment and optimizing both patient and physician engagement are efforts likely to improve enrollment on biomarker-selected clinical trials. CLINICAL TRIALS NUMBER: The study NCT number is NCT01196130.

Elementary Principals' Perceptions of a Leadership Development Training Program

Research indicates that school leaders are crucial to improving instruction and raising student achievement (Council of Chief State School Officers, 2008). As such, educational reforms such as the No Child Left Behind Act (2001) and Race to the Top (2009) have sparked an accountability movement where principals are being held accountable for students' academic achievement and educational outcomes. The shift towards greater accountability has placed new attention on the ways principals are trained. Researchers have noted that organized professional development programs have not adequately prepared school principals to meet the priority demands of the 21st century (Hale & Moorman, 2003; Murphy, 1994). Murphy (1994) stated, "Traditional preparation programs - usually pre-service programs based in colleges or universities, that awarded certification and advanced degrees - rarely concentrated on the leadership challenges that principals actually face in real schools" (p. 4). As a result, many school districts are seeking ways to develop leadership development training programs that will prepare principals for their job responsibilities as a school leader. In spite of the additional training principals receive, researchers suggests that there is an obvious gap between the readiness of administrators to be instructional leaders and the demands for accountability that school administrators face (Hale & Moorman, 2003). This quantitative study examined elementary school principals' perceptions of their leadership development training program. Guided by four research questions, the study examined principals' perceptions of their overall training and how well their training prepared them to deal with school and classroom practices that contribute to student achievement; to work with teachers and others to design and implement a system for continuous student achievement; and to provide necessary support to carry out sound school, curriculum, and instructional practices. Data for this study was collected by way of survey responses from a total of 46 elementary school principals. The results from the study revealed that more than half (58.7%) of participants perceived their training as excellent. While principals' perceived that their training adequately prepared them to work collaboratively in teams, set clear visions and goals, and to use data to improve students achievement, many respondents reported a lack of training in being informed and focused on student achievement. Principals also suggested that they were not effectively trained in finding effective ways to obtain support from central office or community members.

Supporting students with learning disabilities to explore linear relationships using online learning objects

The study of linear relationships is foundational for mathematics teaching and learning. However, students’ abilities connect different representations of linear relationships have proven to be challenging. In response, a computer-based instructional sequence was designed to support students’ understanding of the connections among representations. In this paper we report on the affordances of this dynamic mode of representation specifically for students with learning disabilities. We outline four results identified by teachers as they implemented the online lessons.

A versatile policy toolkit supporting run-time policy reconfiguration

This paper describes an autonomics development tool which serves as both a powerful and flexible policy-expression language and a policy-based framework that supports the integration and dynamic composition of several autonomic computing techniques including signal processing, automated trend analysis and utility functions. Each of these technologies has specific advantages and applicability to different types of dynamic adaptation. The AGILE platform enables seamless interoperability of the different technologies to each perform various aspects of self-management within a single application. Self-management behaviour is specified using the policy language semantics to bind the various technologies together as required. Since the policy semantics support run-time re-configuration, the self-management architecture is dynamically composable. The policy language and implementation library have integrated support for self-stabilising behaviour, enabling oscillation and other forms of instability to be handled at the policy level with very little effort on the part of the application developer. Example applications are presented to illustrate the integration of different autonomics techniques, and the achievement of dynamic composition.

Web-based course support systems: an essential tool for supporting flexible learning environment

In Higher Education web-based course support systems are essential for supporting flexible learning environments. They provide tools to enable the interaction between student and tutor to reinforce transfer of theory to understanding particularly in an academic environment, therefore this paper will examine issues associated with the use of curriculum and learning resources within Web-based course support systems and the effectiveness of the resulting flexible learning environments This paper is a general discussion about flexible learning and in this case how it was applied to one of the courses at undergraduate level one. The first section will introduce what is flexible learning and the importance of flexible learning in Higher Education followed by the description of the course and why the flexible learning concepts is important in such a course and finally, how the flexibility was useful for this particular instance.

Supporting breastfeeding mothers on children’s wards: an overview

Just under half of all six-week-old babies in the UK are breastfed, and just under a quarter are still being breastfed at six months old so it is likely that children’s nurses will frequently encounter breastfed babies on children’s wards. Support for breastfeeding has traditionally been left to midwives but Department of Health guidance requires that all relevant staff have training in this practice. Children’s nurses need to understand the principles and practice of breastfeeding support including correct positioning and attachment, prevention and management of breastfeeding problems, mothers’ needs and safe use of breast pumps. Breastfeeding should be part of the curriculum for children’s nursing courses, including practical sessions to observe breastfeeding support in the clinical setting. Children’s nurses should be aware that literature and learning resources written for midwives might be appropriate for them to access to increase their understanding in this important area of practice.

Realizing an Applied Gaming Ecosystem: Towards Supporting Service-based Innovation Knowledge Management and Transfer

The EU-based industry for non-leisure games is an emerging business. As such it is still fragmented and needs to achieve critical mass to compete globally. Nevertheless its growth potential is widely recognized. To become competitive the relevant applied gaming communities and SMEs require support by fostering the generation of innovation potential. The European project Realizing an Applied Gaming Ecosystem (RAGE) is aiming at supporting this challenge. RAGE will help by making available an interoperable set of advanced technology assets, tuned to applied gaming, as well as proven practices of using asset-based applied games in various real-world contexts, and finally a centralized access to a wide range of applied gaming software modules, services and related document, media, and educational resources within an online community portal called the RAGE Ecosystem. It is based on an integrational, user-centered approach of Knowledge Management and Innovation Processes in the shape of a service-based implementation.

Ecosystem services, targets, and indicators for the conservation and sustainable use of biodiversity

After the collective failure to achieve the Convention on Biological Diversity's (CBD's) 2010 target to substantially reduce biodiversity losses, the CBD adopted a plan composed of five strategic goals and 20 “SMART” (Specific, Measurable, Ambitious, Realistic, and Time-bound) targets, to be achieved by 2020. Here, an interdisciplinary group of scientists from DIVERSITAS – an international program that focuses on biodiversity science – evaluates these targets and considers the implications of an ecosystem-services-based approach for their implementation. We describe the functional differences between the targets corresponding to distinct strategic goals and identify the interdependency between targets. We then discuss the implications for supporting research and target indicators, and make several specific suggestions for target implementation.

Why is it so hard to set MSFD indicators and targets? Messages from the plankton

Unprecedented basin-scale ecological changes are occurring in our seas. As temperature and carbon dioxide concentrations increase, the extent of sea ice is decreasing, stratification and nutrient regimes are changing, and pH is decreasing. These unparalleled changes present new challenges for managing our seas as we are only just beginning to understand the ecological manifestations of these climate alterations. The Marine Strategy Framework Directive requires all European Member States to achieve Good Environmental Status (GES) in their seas by 2020; this means management toward GES will take place against a background of climate-driven macroecological change. Each Member State must set environmental targets to achieve GES; however, in order to do so an understanding of large-scale ecological change in the marine ecosystem is necessary. Much of our knowledge of macroecological change in the North Atlantic is a result of research using data gathered by the Continuous Plankton Recorder (CPR) survey, a near-surface plankton monitoring program which has been sampling in the North Atlantic since 1931. CPR data indicate that North Atlantic and North Sea plankton dynamics are responding to both climate and human-induced changes, presenting challenges to the development of pelagic targets for achievement of GES in European seas. Thus the continuation of long-term ecological time-series such as the CPR is crucial for informing and supporting the sustainable management of European seas through policy mechanisms.