Effectiveness Of Different Approaches Research Articles

Spatial interpolation of hourly rainfall – effect of additional information, variogram inference and storm properties

Abstract. Hydrological modelling of floods relies on precipitation data with a high resolution in space and time. A reliable spatial representation of short time step rainfall is often difficult to achieve due to a low network density. In this study hourly precipitation was spatially interpolated with the multivariate geostatistical method kriging with external drift (KED) using additional information from topography, rainfall data from the denser daily networks and weather radar data. Investigations were carried out for several flood events in the time period between 2000 and 2005 caused by different meteorological conditions. The 125 km radius around the radar station Ummendorf in northern Germany covered the overall study region. One objective was to assess the effect of different approaches for estimation of semivariograms on the interpolation performance of short time step rainfall. Another objective was the refined application of the method kriging with external drift. Special attention was not only given to find the most relevant additional information, but also to combine the additional information in the best possible way. A multi-step interpolation procedure was applied to better consider sub-regions without rainfall. The impact of different semivariogram types on the interpolation performance was low. While it varied over the events, an averaged semivariogram was sufficient overall. Weather radar data were the most valuable additional information for KED for convective summer events. For interpolation of stratiform winter events using daily rainfall as additional information was sufficient. The application of the multi-step procedure significantly helped to improve the representation of fractional precipitation coverage.

Role of patient and public participation in health technology assessment and coverage decisions

Health technology assessment (HTA) has become an integral part of decision-making on the coverage of new health technologies in most health systems in the developed world. In recent years, pressure to involve patients and members of the public in HTA has grown. In this article, we summarize findings from peer-reviewed and ‘gray’ literature, and discussions with key informants to determine potential roles for patients and the public in HTA and coverage decision-making. We also summarize existing roles for both groups in jurisdictions. Although there appears to be a general view that involvement of patients and the public is highly desirable, research offering insights into the effectiveness of different approaches to accomplish this is scarce. Nonetheless, many of the HTA agencies in developed countries have established some mechanism for seeking input from patients or the public in their processes.

Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients.

Background:Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. Little is known regarding the effect of different approaches on the incidence of PDPH.Objectives:In this study we aimed to compare the incidence of PDPH in the case of median and paramedian approaches in patients undergoing spinal anesthesia for orthopedic operations.Patients and Methods:Patients scheduled for orthopedic surgery under spinal anesthesia between 2007 and 2008 were studied in a double-blinded randomized controlled trial. The patients were randomized to receive spinal anesthesia by either a median (n = 75) or paramedian (n = 75) approach through a 25-gauge Crawford needle. No premedication was given, and all patients received 500 mL of normal saline intravenously and 4 mL of 0.5% isobaric Marcaine 30 minutes prior to surgery in both approaches.Results:Fifteen patients (10%) developed PDPH. There was no significant difference in the incidence of PDPH in both groups, with 7 (9.3%) patients in the median approach group versus 8 (10.7%) in the paramedian approach group developing typical PDPH (P = 0.875). However, a significant difference in PDPH incidence (P = 0.041) was observed between females (9; 16.7%) and males (6; 6.3%).Conclusions:There is no difference between median and paramedian approaches with respect to PDPH incidence; the paramedian approach is therefore recommended, especially for older patients with degenerative changes in the spine and intervertebral spaces and those who cannot take the proper position. Moreover, the rate of PDPH was found to be significantly higher in females than in males.

Multimedia education programme for patients with a stoma: effectiveness evaluation

This paper is a report of an evaluation of the effectiveness of a multimedia education program in relation to stoma knowledge, self-care attitudes and behaviour with patients with a stoma in the postoperative period. Multimedia education programmes not only give patients with useful information in the absence of health professionals, but can also augment information given in traditional clinical practice. However, the literature on the effectiveness of different approaches to stoma education is limited. A randomized experimental study design was used. Participants were recruited from a surgical unit in a large hospital in Taiwan. A total of 102 patients with a stoma were randomly assigned to either the multimedia education programme (n=46) or a conventional stoma education programme (n=56) with a follow-up of 1 week. Outcome variables measured were levels of self-care knowledge, attitudes towards self-care and self-care behaviour. Patients who received the multimedia education programme improved their overall self-care knowledge, attitudes and behaviour statistically significantly when compared with those who received the conventional stoma education programme. Although further, longer-term follow-up will be useful, this study demonstrates that multimedia packages can enhance patient involvement in their stoma care and can augment stoma education - particularly in resource challenged healthcare environments.

C-A4-01: Providing Care for Cancer Survivors in Integrated Delivery Systems: An Assessment of Current Practices and Future Opportunities

Jessica Chubak, PhD1, Clarissa Hsu, PhD2, Leah Tuzzio, MPH1, Beth Kirlin, BA1 and Larissa Nekhlyudov, MD, MPH3,4 1Group Health; 2Group Health Research Institute; 3Harvard Medical School; 4Harvard Vanguard Medical Associates

Measuring the Impact of Outreach and Enrollment Strategies for Public Health Insurance in California

OBJECTIVE AND STUDY SETTING: To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative. Administrative enrollment databases. The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children. Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter. Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies. National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments.

Comparing the Efficiency of Different Approaches to Teach Informatics at Secondary Schools

Each of the 16 federal states of Germany has its own school system and also its own pol- icy to integrate informatics, computer science or ICT into this system. Till present there aren't any tests of students' knowledge on a nation-wide level. Therefore nation-wide or international con- tests currently offer the only opportunities to compare the knowledge of the participating students on a large scale level. By evaluating the overall performance of the students of different federal states, we were able to compare the effectiveness of different approaches of teaching Informatics at secondary schools.

Reduction in elective delivery at

No studies exist that have examined the effectiveness of different approaches to a reduction in elective early term deliveries or the effect of such policies on newborn intensive care admissions and stillbirth rates. We conducted a retrospective cohort study of prospectively collected data and examined outcomes in 27 hospitals before and after implementation of 1 of 3 strategies for the reduction of elective early term deliveries. Elective early term delivery was reduced from 9.6-4.3% of deliveries, and the rate of term neonatal intensive care admissions fell by 16%. We observed no increase in still births. The greatest improvement was seen when elective deliveries at <39 weeks were not allowed by hospital personnel. Physician education and the adoption of policies backed only by peer review are less effective than "hard stop" hospital policies to prevent this practice. A 5% rate of elective early term delivery would be reasonable as a national quality benchmark.

Cross-Sector Partnerships: City Regeneration and Social Justice

In this article, the ability of partnerships to generate goods that enhance the quality-of-life of socially and economically deprived urban communities is explored. Drawing on Rawl’s study on social justice [Rawls, J.: 1971, A Theory of Justice (Harvard University Press, Cambridge)] and Sen’s capabilities approach [Sen, A.: 1992, Inequality Re-Examined (Harvard University Press, Cambridge, MA); 1999, Development as Freedom (Oxford University Press, Oxford); 2009, The Idea of Justice (Ellen Lane, London)], we undertake an ethical evaluation of the effectiveness of different approaches to partnership activity in city neighbourhood regeneration. We focus, in particular, on their impact on the social regeneration of disadvantaged communities. Governance of cross-sector partnerships, built upon negotiated values and strong community voice, may result in a greater sense of procedural justice, as well as improvements to orderliness in local neighbourhoods. However, distributive justice, the accumulation of, and access to, goods that enable greater participation in society, remains largely elusive within neighbourhood partnership activity. We conclude that social provision that deals fairly with the causes of disadvantage by enhancing the capabilities of local communities and increasing social capital is likely to be a more effective and sustainable approach for partnerships, despite being a longer-term and more costly endeavour.

Toilet Training

Toilet Training

Protocol for a mixed methods study investigating the impact of investment in housing, regeneration and neighbourhood renewal on the health and wellbeing of residents: the GoWell programme.

BackgroundThere is little robust evidence to test the policy assumption that housing-led area regeneration strategies will contribute to health improvement and reduce social inequalities in health. The GoWell Programme has been designed to measure effects on health and wellbeing of multi-faceted regeneration interventions on residents of disadvantaged neighbourhoods in the city of Glasgow, Scotland.Methods/DesignThis mixed methods study focused (initially) on 14 disadvantaged neighbourhoods experiencing regeneration. These were grouped by intervention into 5 categories for comparison. GoWell includes a pre-intervention householder survey (n = 6008) and three follow-up repeat-cross sectional surveys held at two or three year intervals (the main focus of this protocol) conducted alongside a nested longitudinal study of residents from 6 of those areas. Self-reported responses from face-to-face questionnaires are analysed along with various routinely produced ecological data and documentary sources to build a picture of the changes taking place, their cost and impacts on residents and communities. Qualitative methods include interviews and focus groups of residents, housing managers and other stakeholders exploring issues such as the neighbourhood context, potential pathways from regeneration to health, community engagement and empowerment.DiscussionUrban regeneration programmes are 'natural experiments.' They are complex interventions that may impact upon social determinants of population health and wellbeing. Measuring the effects of such interventions is notoriously challenging. GoWell compares the health and wellbeing effects of different approaches to regeneration, generates theory on pathways from regeneration to health and explores the attitudes and responses of residents and other stakeholders to neighbourhood change.

HIV Risk Behavior Before and After HIV Counseling and Testing in Jail: A Pilot Study

Jail incarceration represents an opportunity to deliver HIV counseling and testing (C&T) services to persons at increased risk of infection. However, jails can be chaotic with rapid turnover of detainees. We conducted a pilot study to investigate the feasibility of comparing the effect of different approaches to HIV C&T in jail on subsequent HIV risk behaviors among persons testing HIV negative. Consecutive cohorts of newly incarcerated jail detainees were recruited with 132 subjects completing standard HIV C&T as per jail protocol and 132 subjects completing rapid testing with an individualized counseling session. Risk behavior was assessed and compared at baseline and 6 weeks after jail release. Among the 264 male participants, preincarceration substance use and sexual risk were common. The follow-up visit was completed by 59% of eligible participants. There were no differences in postrelease HIV risk behavior between the 2 arms but there was an overall decrease in risk behavior after jail release for the cohort. In addition, all participants in the rapid arm received rapid HIV test results compared with participants receiving 28% of conventional test results. Jail incarceration represents an important public health opportunity to deliver HIV C&T. This study demonstrated (1) feasibility in delivering rapid HIV testing combined with individualized counseling to jail detainees, (2) improved test result delivery rates, and (3) success with evaluating risk behaviors during the transition from jail to the community. Further research is needed to determine the optimal approach to HIV C&T in jail with the goal of increasing awareness of HIV serostatus and decreasing HIV risk behavior.

Impact of 6‐month Caloric Restriction on Autonomic Nervous System Activity in Healthy, Overweight, Individuals

Caloric restriction (CR) increases maximum lifespan but the mechanisms are unclear. Dominance of the sympathetic nervous system (SNS) over the parasympathetic nervous system (PNS) has been shown to be a strong risk factor for cardiovascular disease. Obesity and aging are associated with increased SNS activity, and weight loss and/or exercise seem to have positive effects on this balance. We therefore evaluated the effect of different approaches of CR on autonomic function in 28 overweight individuals participating in the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) trial. Participants were randomized to either control, CR: 25% decrease in energy intake, CREX: 12.5% CR + 12.5% increase in energy expenditure, or LCD: low-calorie diet until 15% weight reduction followed by weight maintenance. Autonomic function was assessed by spectral analysis of heart-rate variability (HRV) while fasting and after a meal. Measurements were performed at baseline and 6 months. HR and SNS index decreased and PNS index increased in all intervention groups but reached significance only in CREX. HR and SNS index increased and PNS index decreased in response to the meal in all intervention groups. The results therefore suggest that weight loss improved SNS/PNS balance especially when CR is combined with exercise.

The effects of different approaches to reading instruction on letter detection tasks in normally achieving and low achieving readers

The present study used two letter detection tasks, the classic missing letter effect paradigm and a single word versus familiar word compound version of this paradigm, to study bottom-up and top–down processes involved in reading in normally achieving as compared to low achieving elementary school readers. The research participants were children in grades first to sixth who had been taught to read by three approaches to reading instruction (ARI): the whole language/global approach, the phonic/synthetic approach or the eclectic approach. Thus, the study attempted to clarify how different ARIs activate these processes in these two types of readers. The main hypothesis was that since low achieving readers rely on top–down processes for word recognition (see, e.g., Stanovich, 1980), the whole language ARI will reduce the difference in bottom-up tasks between them and the normally achieving readers. In the two experiments included in the study, participants were required to perform a letter detection task while reading short texts in Hebrew for comprehension. Contrary to this study hypotheses, the main finding was that the whole language ARI does not compensate for difficulties in bottom-up processes of low achieving readers. Moreover, the results of this study imply that any improvement in basic processes involved in reading proficiency produced by the whole language ARI for both the normal and the low achieving readers dissipates by grade three.

What constitutes effective manual handling training? A systematic review

Injuries caused by manual handling are a major burden to society. Manual handling training programmes have been designed to reduce the likelihood of injury among the workforce; however, concerns have been raised over the efficacy of current manual handling training methods. To undertake a systematic review of the literature examining the effectiveness of different approaches to training in manual handling. Peer-reviewed publications along with published conference proceedings published in English, between 1980 and 2009, on the topic of manual handling training comprised the search criteria. A published checklist for reviewing papers was selected, which formed the basis for assessing the quality of the papers reviewed. A total of 1827 papers were located. Following elimination of duplicates, 221 papers were collected and reviewed. Of these, 53 papers were intervention studies with the primary aim of investigating the effectiveness of manual handling training. The review identified little evidence supporting the effectiveness of both technique- and educational-based manual handling training. In addition, there was considerable evidence supporting the idea that the principles learnt during training are not applied in the working environment. Strength and flexibility training shows promise; however, further research is needed to ascertain whether such an intervention is sustainable over the long term. The evidence collected indicates that manual handling training is largely ineffective in reducing back pain and back injury. High priority should be given to developing and evaluating multidimensional interventions, incorporating exercise training to promote strength and flexibility, which are tailored to the industrial sector.

Poster - Wed Eve-52: Radiobiological Modeling of a Proposed Dose Escalation in TMI

Purpose: To compare the effectiveness of different approaches to total marrow irradiation (TMI) using Helical TomoTherapy. Methods: TMI treatment was planned on a 55 year‐old male patient (87% of the GTV to receive a prescribed dose ( D p ) of 20Gy). Field sizes (fs) of 25 and 50mm were examined. The normal tissue complication probability (NTCP) was calculated using Lyman‐Kutcher‐Burman model. Tumour control probability (TCP) was evaluated using the Poisson model. Dose escalation analysis was performed by linearly escalating the DVHs from the 20Gy‐TMI plan, to any D p . Results: There was no substantial difference between TCP using 25mm (40±9%) or 50mm fs (42±9%). For organs of the torso, the difference in the prescribed dose to the GTV that would lead to a normal organ complication of 50% from the TMI ( D p /50 ) between 25 and 50mm was less than 3%. For organs in the head, the D p /50 for 50mm fs was consistently lower by up to 15% compared to 25 mm fs. The optimal dose given by maximizing TCP(1‐NTCP), was ∼39Gy for lungs, resulting in 95% (±3%) of tumor control and 3% (0, 16%) rate of pneumonistis. Conclusion: TCP and NTCP were estimated for a TMI patient, originally receiving 20Gy and linearly escalating the DVHs to higher doses.Tissue sparing was seen by using 25mm fs only in the organs of the head. This suggests it would be beneficial to use the small fields in the head only; since using small fields for the whole treatment would lead to long treatment times.

The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of randomised controlled trials

. Dretzke J., Davenport C., Frew E., Barlow J., Stewart‐Brown S., Bayliss S., Taylor R. S., Sandercock J. &amp; Hyde C. ( 2009 ) , 3 , 7 . DOI: 10.1186/1753‐2000‐3‐7 . Background Conduct problems are common, disabling and costly. The prognosis for children with conduct problems is poor, with outcomes in adulthood including criminal behaviour, alcoholism, drug abuse, domestic violence, child abuse and a range of psychiatric disorders. There has been a rapid expansion of group‐based parent‐training programmes for the treatment of children with conduct problems in a number of countries over the past 10 years. Existing reviews of parent training have methodological limitations such as inclusion of non‐randomized studies, the absence of investigation for heterogeneity prior to meta‐analysis or failure to report confidence intervals. The objective of the current study was to systematically review randomized controlled trials (RCTs) of parenting programmes for the treatment of children with conduct problems. Methods Standard systematic review methods were followed including duplicate inclusion decisions, data extraction and quality assessment. Twenty electronic databases from the fields of medicine, psychology, social science and education were comprehensively searched for RCTs and systematic reviews to February 2006. Inclusion criteria were: RCT; of structured, repeatable parenting programmes; for parents/carers of children up to the age of 18 with a conduct problem; and at least one measure of child behaviour. Meta‐analysis and qualitative synthesis were used to summarize included studies. Results A total of 57 RCTs were included. Studies were small with an average group size of 21. Metaanalyses using both parent (SMD1−0.67; 95% CI: −0.91, −0.42) and independent (SMD −0.44; 95% CI: −0.66, −0.23) reports of outcome showed significant differences favouring the intervention group. There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes. Conclusion Parenting programmes are an effective treatment for children with conduct problems. The relative effectiveness of different parenting programmes requires further research.

Eradication of Methicillin‐ResistantStaphylococcus aureusCarriage: A Systematic Review

A systematic review was performed to determine the effectiveness of different approaches for eradicating methicillin-resistant Staphylococcus aureus carriage. Twenty-three clinical trials were selected that evaluated oral antibiotics (7 trials), topically applied antibiotics (12 trials), or both (4 trials). Because of clinical heterogeneity, quantitative analysis of all studies was deemed to be inappropriate, and exploratory subgroup analyses were performed for studies with similar study populations, methods, and targeted bacteria. The estimated pooled relative risk of treatment failure 1 week after short-term nasal mupirocin treatment, compared with placebo, was 0.10 (range, 0.07-0.14). There was low heterogeneity between study outcomes, and effects were similar for patients and healthy subjects, as well as in studies that included only methicillin-susceptible S. aureus carriers or both methicillin-susceptible S. aureus and methicillin-resistant S. aureus carriers. The development of drug resistance during treatment was reported in 1% and 9% of patients receiving mupirocin and oral antibiotics, respectively. Short-term nasal application of mupirocin is the most effective treatment for eradicating methicillin-resistant S. aureus carriage, with an estimated success of rate of 90% 1 week after treatment and approximately 60% after a longer follow-up period.

The clinical effectiveness of different parenting programmes for children with conduct problems: a systematic review of randomised controlled trials.

BackgroundConduct problems are common, disabling and costly. The prognosis for children with conduct problems is poor, with outcomes in adulthood including criminal behaviour, alcoholism, drug abuse, domestic violence, child abuse and a range of psychiatric disorders.There has been a rapid expansion of group based parent-training programmes for the treatment of children with conduct problems in a number of countries over the past 10 years. Existing reviews of parent training have methodological limitations such as inclusion of non-randomised studies, the absence of investigation for heterogeneity prior to meta-analysis or failure to report confidence intervals.The objective of the current study was to systematically review randomised controlled trials of parenting programmes for the treatment of children with conduct problems.MethodsStandard systematic review methods were followed including duplicate inclusion decisions, data extraction and quality assessment. Twenty electronic databases from the fields of medicine, psychology, social science and education were comprehensively searched for RCTs and systematic reviews to February 2006.Inclusion criteria were: randomised controlled trial; of structured, repeatable parenting programmes; for parents/carers of children up to the age of 18 with a conduct problem; and at least one measure of child behaviour. Meta-analysis and qualitative synthesis were used to summarise included studies.Results57 RCTs were included. Studies were small with an average group size of 21. Meta-analyses using both parent (SMD -0.67; 95% CI: -0.91, -0.42) and independent (SMD -0.44; 95% CI: -0.66, -0.23) reports of outcome showed significant differences favouring the intervention group. There was insufficient evidence to determine the relative effectiveness of different approaches to delivering parenting programmes.ConclusionParenting programmes are an effective treatment for children with conduct problems. The relative effectiveness of different parenting programmes requires further research.

Effect of different approaches to decouple the dependence of nuclei-liquid surface energy on size and temperature

Tests involving the Classical Nucleation Theory (CNT) often disregard the size dependence of surface energy. Thus, the surface energy of critical nuclei is assumed to be a macroscopic quantity that depends only on the temperature of a flat surface. However, because the size of critical nuclei changes with temperature, σcl(T) should be described as a function of both temperature and size of critical nuclei. The present work examines the temperature dependence of macroscopic surface energy, decoupling it from the size dependent part. Tolman, Rasmussen and Vogelsberger's equations are used to decouple the dependence of surface energy on size, using experimental data for the following silicate glasses Li2O.2SiO2 (LS2) and Na2O.2CaO.3SiO2 (N1C2S3). These equations are successful in obtaining a decrease in σcl(T), in agreement with theoretical predictions. For all the values of δ , Tolman's equation produces the lowest values of σcl(T). Nevertheless, they are very close to the liquid/vapor surface energy (σlv), which contradicts the Stefan's rule (i.e. σcl/σ lv << 1). Therefore, it is demonstrated that the assumption of the curvature dependence of surface energy does not suffice, per se, to explain the discrepancy between the experimental and theoretical values of nucleation rates.