Comprehensive Implementation Strategy Research Articles

Optimizing tool life in SiCp/Al composites milling with acoustic emission analysis: A comprehensive monitoring and implementation strategy

The machining of SiCp/Al composites is hampered by tool wear monitoring challenges. SiCp/Al composites are used in industries like aerospace where tool wear can lead to workpiece loss, necessitating real-time monitoring. Acoustic emission (AE) sources during machining are complex due to SiC particles. This paper attempts to isolate AE frequencies for plastic deformation and silicon carbide particle behavior through scratch experiments at different depths. The relationship between signal energy distribution and tool wear during milling is analyzed using the wavelet packet method. The frequency band correlating best to tool wear is identified outside the scratch experiment's frequency range. A monitoring strategy is proposed based on this, and the effect of machining parameters on AE monitoring is analyzed, with refinements to the monitoring model. The proposed strategy's effectiveness has been validated through experimental trials, resulting in an average tool utilization rate of 85 % during milling.

Review of the Capacity to Accurately Detect the Temperature of Human Skin Tissue Using the Microwave Radiation Method.

Microwave radiometry (MWR) is instrumental in detecting thermal variations in skin tissue before anatomical changes occur, proving particularly beneficial in the early diagnosis of cancer and inflammation. This study concisely traces the evolution of microwave radiometers within the medical sector. By analyzing a plethora of pertinent studies and contrasting their strengths, weaknesses, and performance metrics, this research identifies the primary factors limiting temperature measurement accuracy. The review establishes the critical technologies necessary to overcome these limitations, examines the current state and prospective advancements of each technology, and proposes comprehensive implementation strategies. The discussion elucidates that the precise measurement of human surface and subcutaneous tissue temperatures using an MWR system is a complex challenge, necessitating an integration of antenna directionality for temperature measurement, radiometer error correction, hardware configuration, and the calibration and precision of a multilayer tissue forward and inversion method. This study delves into the pivotal technologies for non-invasive human tissue temperature monitoring in the microwave frequency range, offering an effective approach for the precise assessment of human epidermal and subcutaneous temperatures, and develops a non-contact microwave protocol for gauging subcutaneous tissue temperature distribution. It is anticipated that mass-produced measurement systems will deliver substantial economic and societal benefits.

Domain Specific Adaptation of an Open-Source LLM (Large Language Model)

Abstract: This research project delves into the investigation of the integration of Large Language Models (LLMs), exemplified by models such as ChatGPT, within the realm of domain-specific conversation applications, with a focus on discerning their substantive impact on user interactions within specialized contexts. The abstract conscientiously recognizes the rapid strides in LLM development and their intrinsic potential to augment domain-specific applications. A meticulous literature review is conducted to discern and expound upon prevailing trends and findings in LLM application, establishing a robust foundation for the ensuing methodology of the study. The research employs a thorough and comprehensive implementation strategy, strategically addressing the multifaceted challenges encountered during the intricate process of LLM integration, while simultaneously harnessing performance metrics and soliciting user feedback to ensure a nuanced and holistic assessment. The ensuing discussion section meticulously scrutinizes the obtained results, thereby providing profound insights into the farreaching implications of LLM integration in domain-specific settings, thereby making a notable contribution to the burgeoning field of conversational AI. In summary, this research not only elucidates the practical nuances of LLM utilization but also delineates potential avenues for further exploration and development within this dynamic field.

Bridging Policy and Practice: Insights into Civic Education Implementation in Kabwe District Secondary Schools

This study investigated the implementation strategies of Civic Education as a compulsory subject in the senior secondary schools within Kabwe District. Utilising both quantitative and qualitative methods anchored on the convergent parallel design, the research provides a comprehensive analysis of the alignment between national policy directives and actual practices in schools through the strategies adopted by educators in the delivery of Civic Education. The findings reveal commendable adherence to national education policies, and disparities in local policy presence signal the need for comprehensive implementation strategies. Furthermore, the findings shed light on strategies schools adopted, including policy alignment, local policy development, and advocacy initiatives, emphasising the importance of fostering civic literacy and engagement beyond the classroom. Recommendations include enhancing policy alignment, strengthening local policy development, promoting advocacy and awareness, providing support and resources, fostering collaboration, and implementing monitoring and evaluation mechanisms. Remarkably, the findings offer novel and valuable insights for policymakers, educators, and stakeholders involved in Civic Education implementation, emphasising the importance of bridging policy and practice to cultivate informed and engaged citizens, ultimately contributing to broader societal goals of democratic participation and development.

SAN ANTONIO TRANSPORTATION PLANNING SYSTEM: MAPPING INFRASTRUCTURE CAPACITY AND COORDINATION

Abstract Ride Connect Texas and its partnering agencies seek to develop an expanded senior mobility management system supported by a One Call One Click transportation planning system. Its purpose is to enhance on-demand transportation system coordination and the application of technology, providing consumers, service providers, and mobility managers with direct access to comprehensive transportation information. GIS mapping is used to help develop a spatial awareness of the transportation challenges among older people and individuals with a disability and the current system capacity. Interviews with transit, non-transit, and health and human service agencies will reveal factors that influence coordination among providers and opportunities for capacity expansion. Surveys and focus groups of older adults and individuals with disability will show differentiating characteristics of riders and transportation needs and challenges. GIS mapping will allow us to geocode these findings relative to the user’s street address and zip code, illustrating variations in specialized client needs, service availability, travel behavior, and available amenities for basic daily living. Mapping will identify gaps in transportation services, hot zones revealing high user demand and low system capacity, and the ability to reduce fragmentation of service through seamless technology-based coordination. The mapping element informs the measurement of a community’s transportation system capacity for this user group. The value proposition of this tool is its ability to help any community measure its readiness toward developing a comprehensive implementation strategy for coordinated demand response transportation, including resource mobilization strategies, capacity augmentation, phasing of the system, and implementation timeline.

Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre–post trial

ObjectivesTo evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM).DesignPre–post study.SettingUniversity Hospital Schleswig-Holstein (UKSH), Kiel Campus.ParticipantsHealthcare...

Barriers to and Facilitators of Implementing Guidelines for Detecting Familial Hypercholesterolaemia in Australia

Familial hypercholesterolaemia (FH) is a genetic condition that is a preventable cause of premature cardiovascular morbidity and mortality. High-level evidence and clinical practice guidelines support preventative care for people with FH. However, it is estimated that less than 10% of people at risk of FH have been detected using any approach across Australian health settings. The aim of this study was to identify the implementation barriers to and facilitators of the detection of FH in Australia. Four, 2-hour virtual focus groups were facilitated by implementation scientists and a clinicians as part of the 2021 Australasian FH Summit. Template analysis was used to identify themes. There were 28 workshop attendees across four groups (n=6-8 each), yielding 13 barriers and 10 facilitators across three themes: (1) patient related, (2) provider related, and (3) system related. A "lack of care pathways" and "upskilling clinicians in identifying and diagnosing FH" were the most interconnected barriers and facilitators for the detection of FH. The relationships between barriers and facilitators across the patient, provider, and system themes indicates that a comprehensive implementation strategy is needed to address these different levels. Future research is underway to develop a model for implementing the Australian FH guidelines into practice.

Developing Collaborative Skills for High School Students in Lao People's Democratic Republic in Solving Mathematical Problems

The research article aims to develop collaborative problem-solving skills in high school mathematics education within the Lao People's Democratic Republic. It introduces five methods that enhance collaboration in solving mathematical problems, offering comprehensive descriptions and implementation strategies. The research equips teachers with effective strategies and creates opportunities for students to engage in collaborative problem-solving. However, the study is limited by its narrow focus on the specific context of the Lao People's Democratic Republic. Future research should explore the adaptability of these methods in diverse cultural and educational settings. To further advance collaborative problem-solving in mathematics education, future research should investigate the effectiveness of these methods across various grade levels and cultural contexts.

The delivery of Ask-Advise-Connect for smoking cessation in Dutch general practice during the COVID-19 pandemic: results of a pre-post implementation study

BackgroundThe Ask-Advise-Connect approach can help primary care providers to increase the number of smokers that attempt to quit smoking and enrol into cessation counselling. The approach has not yet been implemented in general practice in the Netherlands. The aim of this study was to investigate the influence of a comprehensive implementation strategy on the delivery of Ask-Advise-Connect for smoking cessation within Dutch general practice during the COVID-19 pandemic.MethodsA pre-post study was conducted between late 2020 and early 2022, and included 106 Dutch primary care providers (GPs, practice nurses and doctor’s assistants). Participation lasted nine months: during the first three months participants delivered smoking cessation care as usual (pre-intervention); the implementation strategy came into effect after three months and participants were followed up for another six months (post-intervention). The implementation strategy consisted of two meetings in which participants were educated about Ask-Advise-Connect, made agreements on the implementation of Ask-Advise-Connect and reflected on these agreements. Participants also received online educational materials and a desk card as reminder. The changes in the proportions of ‘Ask’ and ‘Advise’ over time were modelled using linear mixed effects models. A descriptive analysis was conducted with regard to referrals to cessation counselling.ResultsParticipants provided consultations to 29,112 patients (both smokers and non-smokers). Results of the linear mixed effects model show that the proportion of patients that were asked about smoking (‘Ask’) significantly decreased in the first three months (pre-intervention), but slightly increased again after the implementation strategy came into effect (post-intervention). No significant change over time was found with regard to the proportion of patients advised to quit smoking (‘Advise’). Descriptive statistics suggested that more participants proactively (vs. passively) referred patients to cessation counselling post-intervention (‘Connect’).ConclusionsThe findings indicate that a comprehensive implementation strategy can support primary care providers in offering smoking cessation care to patients, even under stressful COVID-19 conditions. Additional implementation efforts are needed to increase the proportion of patients that receive a quit advice and proactive referral.

Problems, Obstacles, and Suggestions for Improving the Quality of Higher Education Institutions in NEP

The National Educational Policy 2020 focuses on Affordability, Accessibility, Quality, Equity, and Accountability to ensure lifelong learning. India is a fast-growing country with over 1113 universities and over 42000 HEIs. To boost the Indian education system the current Government introduced NEP 2020 which has a vision for transforming our country into a society of equal and living knowledge, by providing quality education for all. NEP emphasizes Multidisciplinary education, digital literacy, improving communication skills, problem-solving, logical reasoning, and Vocational education and skilling through a comprehensive framework. However, they are many challenges our country needs to face to implement it. This paper discusses the challenges HEIs would be facing to promote continual learning and create opportunities for all stakeholders to meet Sustainable Development Goals 2030. The second-largest education system in the world is found in India. The policy empowers the faculty of HEIS to conduct innovative teaching, research, community services, incubation centers establishment, technology development, industrial and academic linkages, patents, etc. They are challenges like lack of access to higher education for the most economically disadvantaged castes, Technology set back and digital divide, Gender discrimination, improper evaluation and assessment system, Few faculty, few teacher training institutes, low levels of governance and leadership, Less funding, etc. There is no uniform comprehensive road map and implementation strategy for NEP. The role of the State Government is not stressed; NEP is silent on the RTE act, Language to be adopted in higher education to reach global standards, and Universalisation of education. The objective of the study is to identify the challenges before NEP to maintain quality and equity and recommendations for further development to reach its goal. The NEP 2020 may look good on paper but is complicated in a Real-world Environment.

What are the barriers and facilitators to community handwashing with water and soap? A systematic review.

Handwashing with water and soap (HWWS) is an effective method of cleaning and disinfecting the surface of the hands. HWWS is effective in infection control and prevention transmission, such as in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). However, rates of handwashing compliance vary globally. This systematic review aimed to identify the barriers and facilitators to community HWWS globally. We conducted a comprehensive search strategy in OVID Medline, OVID Embase, Web of Science Core Collection, and Scopus using keywords and subject headings related to handwashing. Studies were excluded if they reported hand hygiene among healthcare or food service workers, considered the use of alcohol rubs, or involved an intervention in a healthcare or food preparation setting. The quality of eligible studies was assessed using the Mixed Methods Appraisal Tool, and data were extracted from the articles and analyzed using the Theoretical Domains Framework and inductive thematic analysis. The search strategy yielded a total of 11,696 studies, and 46 studies met the eligibility criteria. Study dates ranged from 2003 to 2020 and included 26 countries; the most frequently represented were Bangladesh, India, and Kenya. A total of 21 barriers and 23 facilitators to HWWS were identified and organized into the Theoretical Domains Framework. The most frequently cited domains were environmental context and resources, goals, and knowledge. Nine themes emerged from these barriers and facilitators: resource availability, cost and affordability, handwash station design and infrastructure, accessibility, gender roles, champions, health promotion, time management, and knowledge, beliefs, and behaviors. This review uncovered multiple barriers and facilitators around a determinant framework to observe and create an in-depth, multidimensional image of a community-based hand hygiene situation. New comprehensive interventions and implementation strategies can be developed using the findings to target the contextual barriers and facilitators to improve and increase HWWS rates. Stakeholders (i.e., practitioners, researchers, policymakers) can use the findings to revise, design, or evaluate new or existing projects, interventions, and policies to improve HWWS. Registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO-International prospective register of systematic reviews database (Registration number: CRD42020221210).

Management of cultural events and festivals in cities

This article examines the role of festivals and cultural events in cities from a discursive perspective that merits research. Special attention is focused on values, which allows to supplement the very nature of practical activity, identifying and forming competent actions in the management of cultural events and festivals. The specifics of the management of cultural events and festivals, which can ensure the effective implementation of socio-cultural projects, thanks to the diversity of the program, the use of various forms of advertising, are analyzed , activities of the mass media, receiving resonance and becoming the property of the general public. In a professionally organized, positively emotional colored information field, different groups of the target audience are involved. They have the opportunity to freely choose the forms of participation in the festival program: from simple observation to direct participation. The purpose and importance of cultural events and festivals management is to participate in product development, strategic planning, collaboration, interrelationships between cultural events through a comprehensive implementation strategy, which in turn will increase competitive advantage and create economic stability in the city. Further research may be particularly relevant for examining issues from the perspective of business-public relations, as well as the development of festival cities. The conclusions are also relevant for arts managers, cultural organizations that encourage the use of cultural events and festivals through interaction with business structures.

How Hospital Patients Experience Pain the Previous 24 Hours–A Prevalence Assessment of Pain in Five Hospitals in Sweden

BackgroundPrevious studies show that pain is common among hospital inpatients. AimThis study measures the prevalence of pain and the impact of pain on sleep in patients admitted to five hospitals in Sweden. MethodsThe patients were admitted to a surgical or a medical ward. They answered on a self-reported questionnaire about their average pain intensity and how much their pain interfered with their sleep the previous 24 hours, on a 010 numerical rating scale (NRS). ResultsOf the 500 patients, 308 experienced pain (62%), (NRS ≥ 3) and 111 (22%) rated their pain as NRS ≥ 7. We found no difference between surgical and medical specialty regarding pain prevalence. The results suggest that roughly the same proportion of patients with pain also experienced poor sleep due to pain265 patients (53%) reported pain interference on sleep, NRS ≥ 3. Conclusions and Clinical ImplicationsThis study shows that there is still an unacceptable high pain prevalence in inpatients and that patients experience pain as negatively impacting their sleep. Future pain care is likely to include a more comprehensive implementation strategy for the dissemination of knowledge, especially related to the complex context of today’s healthcare system. That is, the possibility that anchoring new knowledge also benefits the patient is probably associated with optimization of the structural context. Future research should take this question further by examining how the organizational structure should be optimized for the dissemination of knowledge in healthcare professionals about pain and pain interference with sleep.

Integrated guidance to enhance the care of children and adolescents with familial hypercholesterolaemia: Practical advice for the community clinician.

Familial hypercholesterolaemia (FH) is a highly penetrant monogenic disorder present from birth that markedly elevates plasma low‐density lipoprotein (LDL)‐cholesterol (LDL‐C) concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). At a prevalence of 1:250 individuals, with over 90% undiagnosed, recent estimates suggest that there are approximately 22 000 children and adolescents with FH in Australia and New Zealand. However, the overwhelming majority remain undetected and inadequately treated until adulthood or after their first cardiac event. The guidance in this paper aims to increase awareness about paediatric FH and provide practical advice for the diagnosis and management of FH in children and adolescents. Recommendations are given on the detection, diagnosis, assessment and management of FH in children and adolescents. Recommendations are also made on genetic testing, including counselling and the potential for universal screening programmes. Practical guidance on management includes treatment of non‐cholesterol risk factors, and safe and appropriate use of LDL‐C lowering therapies, including statins, ezetimibe, PCSK9 inhibitors and lipoprotein apheresis. Models of care for FH need to be adapted to local and regional health care needs and available resources. Targeting the detection of FH as a priority in children and young adults has the potential to alter the natural history of atherosclerotic cardiovascular disease and recognise the promise of early detection for improving long‐term health outcomes. A comprehensive implementation strategy, informed by further research, including assessments of cost–benefit, will be required to ensure that this new guidance benefits all families with or at risk of FH.

Revisions in the 10 Essential Services Deserve a Comprehensive Implementation Strategy.

Revisions in the 10 Essential Services Deserve a Comprehensive Implementation Strategy.

Integrated Guidance for Enhancing the Care of Familial Hypercholesterolaemia in Australia

Familial hypercholesterolaemia (FH) is a dominant and highly penetrant monogenic disorder present from birth that markedly elevates plasma low-density lipoprotein (LDL)-cholesterol concentration and, if untreated, leads to premature atherosclerosis and coronary artery disease (CAD). There are approximately 100,000 people with FH in Australia. However, an overwhelming majority of those affected remain undetected and inadequately treated, consistent with FH being a leading challenge for public health genomics. To further address the unmet need, we provide an updated guidance, presented as a series of systematically collated recommendations, on the care of patients and families with FH. These recommendations have been informed by an exponential growth in published works and new evidence over the last 5 years and are compatible with a contemporary global call to action on FH. Recommendations are given on the detection, diagnosis, assessment and management of FH in adults and children. Recommendations are also made on genetic testing and risk notification of biological relatives who should undergo cascade testing for FH. Guidance on management is based on the concepts of risk re-stratification, adherence to heart healthy lifestyles, treatment of non-cholesterol risk factors, and safe and appropriate use of LDL-cholesterol lowering therapies, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors and lipoprotein apheresis. Broad recommendations are also provided for the organisation and development of health care services. Recommendations on best practice need to be underpinned by good clinical judgment and shared decision making with patients and families. Models of care for FH need to be adapted to local and regional health care needs and available resources. A comprehensive and realistic implementation strategy, informed by further research, including assessments of cost-benefit, will be required to ensure that this new guidance benefits all Australian families with or at risk of FH.

An automatic perfectly matched layer for acoustic finite element simulations in convex domains of general shape

This article addresses the efficient finite element solution of exterior acoustic problems with truncated computational domains surrounded by perfectly matched layers (PMLs). The PML is a popular nonreflecting technique that combines accuracy, computational efficiency, and geometric flexibility. Unfortunately, the effective implementation of the PML for convex domains of general shape is tricky because of the geometric parameters that are required to define the PML medium. In this work, a comprehensive implementation strategy is proposed. This approach, which we call the automatically matched layer (AML) implementation, is versatile and fully automatic for the end‐user. With the AML approach, the mesh of the layer is extruded, the required geometric parameters are automatically obtained during the extrusion step, and the practical implementation relies on a simple modification of the Jacobian matrix in the elementwise integrals. The AML implementation is validated and compared with other implementation strategies using numerical benchmarks in two and three dimensions, considering computational domains with regular and nonregular boundaries. A three‐dimensional application with a generally shaped domain generated using a convex hull is proposed to illustrate the interest of the AML approach for realistic industrial cases.

Process evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T3 trial): a qualitative study

BackgroundThe implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90-day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake.MethodsQualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups.ResultsTwenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols.ConclusionsDespite initial high ‘buy-in’ from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12614000939695).

PARTNER: a service delivery model to implement optimal primary care management of people with knee osteoarthritis: description of development

ObjectiveImplementation strategies, such as new models of service delivery, are needed to address evidence practice gaps. This paper describes the process of developing and operationalising a new model of service...

Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies.

Clinically significant distress is common in patients with cancer and if untreated can be associated with adverse outcomes. This article offers a review of current approaches to implementing and reporting the minimum components of distress screening and management interventions in cancer services. Twenty-two relevant published articles were identified from January 2018 to February 2020. The reporting of recommended minimum components of distress screening and management interventions in these articles was not consistent. The majority of studies used validated tools to conduct initial screening. However, recommendations were either not reported or not followed regarding subsequent pathway components, secondary assessment, referral pathways linked to screening results and rescreening. The majority of studies did not include a description of the implementation of the distress screening program. A small number of studies described a comprehensive set of implementation strategies. Distress screening and management interventions in cancer are an important component of comprehensive cancer care. To improve patient outcomes and guide researchers and services to identify effective models, studies must include and evaluate minimum recommended components and implementation strategies. Addressing these limitations with high-quality, robust interventions is vital for advancing the implementation of effective distress management.