Implementation Considerations Research Articles

N-of-1 health optimization: Digital monitoring of biomarker dynamics to gamify adherence to metabolic switching.

The digital health field is experiencing substantial growth due to its potential for sustained and longitudinal deployment. In turn, this may drive improved monitoring and intervention as catalysts for behavioral change compared to traditional point-of-care practices. In particular, the increase in incidence of population health challenges such as diabetes, heart disease, fatty liver disease, and other disorders coupled with rising healthcare costs have emphasized the importance of exploring technical, economics, and implementation considerations, among others in the decentralization of health and healthcare innovations. Both healthy individuals and patients stand to benefit from continued technical advances and studies in these domains. To address these points, this study reports a N-of-1 study comprised of sustained regimens of intermittent fasting, fitness (strength and cardiovascular training), and high protein, low carbohydrate diet and parallel monitoring. These regimens were paired with serial blood ketone, blood glucose (wearable and finger stick) and blood pressure readings, as well as body weight measurements using a collection of devices. Collectively this suite of platforms and approaches were used to monitor metabolic switching from glucose to ketones as energy sources-a process associated with potential cardio- and neuroprotective functions. In addition to longitudinal biomarker dynamics, this work discusses user perspectives on the potential role of harnessing digital devices to these dynamics as potential gamification factors, as well as considerations for the role of biomarker monitoring in health regimen development, user stratification, and potentially informing downstream population-scale studies to address metabolic disease, healthy aging and longevity, among other indications.

ISTH clinical practice guideline for treatment of congenital hemophilia A and B based on the Grading of Recommendations Assessment, Development, and Evaluation methodology: considerations for practice management and implementation

ISTH clinical practice guideline for treatment of congenital hemophilia A and B based on the Grading of Recommendations Assessment, Development, and Evaluation methodology: considerations for practice management and implementation

Embedding student-centred active learning environment with upside-down pedagogies in teaching practice: What works for psychology?

Student-Centred Active Learning Environment with Upside-down Pedagogies (SCALE-UP) is a set of collaborative learning techniques that are shown to reduce the continuation and awarding gaps between students of Black, Asian and other Minority Ethnicities (BAME) and White students when SCALE-UP is implemented throughout every module in an undergraduate course. The aim of this project was to evaluate the impact of SCALE-UP on a level-four Psychology module consisting of 140 students to inform considerations of wider implementation. Although the grades and gaps on this single module did not differ significantly from other modules, written feedback from students indicated that students appreciated the authenticity of interactions afforded by SCALE-UP. Staff recognised the growing confidence of their students when expressing their views in class, peer interactions and group activities. These are indicators of the potential benefits that large-scale implementation of SCALE-UP could contribute to closing or removing continuation and awarding gaps.

Family-centered decision making: A culturally responsive collaborative approach among Asians living in the United States.

Compared to Western cultures, self-determination needs are expressed and pursued differently in Asian cultures, where interdependence and achieving greater good for the group are prioritized. To accommodate these needs, we propose the use of family-centered decision making (FCDM) to complement the shared decision-making (SDM) practice, fostering collaborative psychiatric care for Asian individuals residing in the United States. This article synthesizes various literature to outline the similarities and differences between SDM and FCDM, discuss implementation steps, challenges associated with implementation, potential solutions, and future research considerations. Our review suggests that FCDM is more responsive to and inclusive of Asian cultural experience, better reflecting these cultures' expression of self-determination. We propose a five-step framework for FCDM implementation in psychiatric rehabilitation for Asian and Asian American individuals, while identifying three further practical considerations: logistical difficulties, intrafamilial differences, and making the decision to use FCDM or not. Given the heterogeneity of Asian individuals in the United States, we urge providers to allow flexibility in practicing FCDM. We outline the important components for providers to help individuals with psychiatric disabilities distinguish between the characteristics of FCDM and SDM, evaluate the potential pros and cons of utilizing FCDM, and then initiate FCDM if appropriate or requested by the individuals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Revolutionizing Healthcare: Lessons Learned from an Integrative Approach to Transforming the Hospital Accreditation System in Lebanon

Background: Lebanon was the first country in the Eastern Mediterranean region to develop and implement a national hospital accreditation system, but the system has not been updated since 2011. This study aims to describe the process of developing and piloting context-specific hospital accreditation standards in Lebanon, and share lessons from extensive stakeholder consultations. Methods: Mixed-methods approach was used for development and piloting of standards. This included extensive documentation review, stakeholder and expert consultations, standard review, and capacity building for piloting. Experts were required to review standards using pre-identified criteria and expert sub-group meetings were conducted to discuss changes. Piloting of standards included assessment of feasibility and compliance with standards/guiding measures in addition to implementation considerations. Results: More than 60 experts were consulted. Pilot testing showed a positive outcome for clarity, feasibility, and compliance of hospitals to standards. Managing stakeholders’ expectation was challenging at the policy-political encounter. The rigorous expert review led to the development of context-specific and robust standards that provided guidance for hospitals to improve quality care. Results showed that health system changes at the governance, finance and delivery levels are needed to achieve and sustain the gains of accreditation. Conclusions: The study methodology showed the promising influence of using science in development of accreditation standards. Stakeholder involvement remains critical to push the agenda of accreditation. Continuous follow-up to the survey process is recommended to ensure optimal impact of the accreditation system. The process can be scaled up and replicated in the Eastern Mediterranean Region (EMR) and beyond. Patient or Public Contribution: Patients and public where not involved in this study. While patients and the public bring are key for sharing lived experiences, the development of the standards required deep understanding and expertise especially with regards to healthcare and health systems. Highlights Implications for policy makers • Study can be replicated in contexts without a national accreditation system • Ensuring political commitment is critical for implementation of accreditation • Rigorous approaches are key in managing resistance to change • Stakeholder engagement is pivotal for developing contextualized standards

TYPES AND DESCRIPTIVE ASPECTS OF EDUCATIONAL TASKS IN DEVELOPING LISTENING COMPREHENSION SKILLS

This article explores the diverse landscape of educational tasks aimed at fostering listening comprehension skills among learners. Through a comprehensive examination of task types and descriptive aspects, it unveils the intricacies that underpin effective pedagogical strategies in this domain. Drawing upon various methodologies and theoretical frameworks, the article offers insights into the design, implementation, and contextual considerations of these tasks. From structured exercises to authentic interactions, each task type serves a unique purpose in nurturing listening proficiency. By elucidating the taxonomy of educational tasks and examining their empirical evidence, this article equips educators with valuable resources to tailor instructional practices effectively, whether in traditional classroom settings or digital learning environments.

Legal accountability and ethical considerations of AI in financial services

Artificial Intelligence (AI) is revolutionizing the financial services industry, offering unparalleled opportunities for efficiency, innovation, and personalized services. However, along with its benefits, AI in financial services raises significant legal and ethical concerns. This paper explores the legal accountability and ethical considerations surrounding the use of AI in financial services, aiming to provide insights into how these challenges can be addressed. The legal accountability of AI in financial services revolves around the allocation of responsibility for AI-related decisions and actions. As AI systems become more autonomous, questions arise about who should be held liable for AI errors, misconduct, or regulatory violations. This paper examines the existing legal frameworks, such as data protection laws, consumer protection regulations, and liability laws, and assesses their adequacy in addressing AI-related issues. Ethical considerations in AI implementation in financial services are paramount, as AI systems can impact individuals' financial well-being and access to services. Issues such as algorithmic bias, transparency, and fairness are critical in ensuring ethical AI practices. This paper discusses the importance of ethical guidelines and frameworks for AI development and deployment in financial services, emphasizing the need for transparency, accountability, and fairness. The paper also examines the role of regulatory bodies and industry standards in addressing legal and ethical challenges associated with AI in financial services. It proposes recommendations for policymakers, regulators, and industry stakeholders to promote responsible AI practices, including the development of clear guidelines, enhanced transparency measures, and mechanisms for accountability. Overall, this paper highlights the complex interplay between AI, legal accountability, and ethical considerations in the financial services industry. By addressing these challenges, stakeholders can harness the full potential of AI while ensuring that it is deployed in a responsible and ethical manner, benefiting both businesses and consumers.

Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue.

People living with human immunodeficiency virus (HIV) are living longer with health-related disability associated with ageing, including complex conditions. However, health systems in Canada have not adapted to meet these comprehensive care needs. We convened three citizen panels and a national stakeholder dialogue. The panels were informed by a plain-language citizen brief that outlined data and evidence about the challenge/problem, elements of an approach for addressing it and implementation considerations. The national dialogue was informed by a more detailed version of the same brief that included a thematic analysis of the findings from the panels. The 31 citizen panel participants emphasized the need for more prevention, testing and social supports, increased public education to address stigma and access to more timely data to inform system changes. The 21 system leaders emphasized the need to enhance person-centred care and for implementing learning and improvement across provinces, territories and Indigenous communities. Citizens and system leaders highlighted that policy actions need to acknowledge that HIV remains unique among conditions faced by Canadians. Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Such a collaborative should be grounded in a rapid-learning and improvement approach that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely data and evidence; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement.

Peer-Mediated Programs Amidst a Pandemic: Perspectives on Implementation, Impact, and Future Considerations

Peer-Mediated Programs Amidst a Pandemic: Perspectives on Implementation, Impact, and Future Considerations

Analysis of the Implementation of E-Litigation with Artificial Intelligence Approach in Procedural Justice and Access to Justice in Pretrial Proceedings

The development of Artificial Intelligence in the current digital era across every sector of society has become a topic of discussion among legal experts for its potential application within the realm of justice systems. Consistency and time efficiency have become key considerations for implementation within the judicial system. Pre-trial proceedings in Indonesia are often seen as a secondary trial process, leading to inconsistencies in time, understanding of legislation, and document management, resulting in disadvantageous situations for the suspects. The integration of Artificial Intelligence in legal proceedings can enhance efficiency, accuracy, and ensure access to justice for suspects within the legal process. In the context of pre-trial proceedings, AI can be utilized to aid in data processing and analysis, decision-making, and monitoring compliance with principles of procedural justice. The research problem in this study revolves around two main questions: First, how does the legitimacy and legal certainty of utilizing electronic media within the Indonesian judicial system stand? Second, how can procedural justice and access to justice be implemented through the utilization of electronic media, particularly artificial intelligence, in pre-trial proceedings? This research is a doctrinal or normative study, relying on secondary data sources consisting of primary legal materials and qualitative data.

3D Visualization in Furniture Ecommerce

This paper explores the integration of 3D visualization in online furniture stores to improve user experience. Through literature review and case studies, it examines the benefits and challenges. Insights are provided for businesses aiming to optimize 3D visualization techniques. Findings suggest significant potential in enhancing engagement, reducing uncertainties, and boosting customer satisfaction. Practical considerations for successful implementation are discussed, offering valuable insights for e-commerce stakeholders. Keywords— threeJS, webGL, furniture e-commerce, web development, CRUD, MERN stack, React, NodeJS, 3D visualization, Interactive Product Visualisation

Optimizing test and treat options for vivax malaria: An options assessment toolkit (OAT) for Asia Pacific national malaria control programs.

Designing policy in public health is a complex process requiring decision making that incorporates available evidence and is suitable to a country's epidemiological and health system context. The main objective of this study was to develop an options assessment toolkit (OAT) to provide a pragmatic and evidence-based approach to the development of policies for the radical cure (prevention of relapse) of vivax malaria for national malaria control programs in the Asia-Pacific region. The OAT was developed using participatory research methods and a Delphi process using a sequential multi-phase design, adapted with a pre-development phase, a development phase, and a final development phase. In the pre-development phase, a literature review was conducted to inform the toolkit development. Data collection in the development phase consisted of core research team discussions, multiple rounds of consultation with participants from National Malaria Control Programs (NMP) (online and in person), and two separate modified e-Delphi processes with experts. The final development phase was the piloting of the toolkit during the annual meeting of the Asia Pacific Malaria Elimination Network (APMEN) Vivax Working Group. We developed a tool kit containing the following elements: i) Baseline Assessment Tool (BAT) to assess the readiness of NMPs for new or improved coverage of radical cure, ii) eight scenarios representative of Asia Pacific region, iii) matching test and treat options based on available options for G6PD testing and radical cure for the given scenarios, iv) an approaches tool to allow NMPs to visualize considerations for policy change process and different implementation strategies/approaches for each test and treat option. The OAT can support vivax radical cure policy formulation among NMPs and stakeholders tailoring for their unique country context. Future studies are needed to assess the utility and practicality of using the OAT for specific country context.

LEADERSHIP STYLES AND PERFORMANCE OF ROAD PROJECTS UNDER KENYA RURAL ROADS AUTHORITY IN KENYA

Road infrastructure drives global economic growth by facilitating the movement of goods, services, and people, enhancing trade and regional integration; recent improvements in developing countries have reduced cost overruns, highlighting the importance of effective strategy implementation, stakeholder engagement, and sustainability considerations for project success. The aim of the study was to establish whether leadership styles influence the performance of road projects by Kenya Rural Roads Authority. The study sought to establish whether leadership styles influence the performance of road projects by Kenya Rural Roads Authority. The study employs multiple theories, including Resource-Based Theory, Agency Theory, and others, within a mixed-methods approach guided by pragmatism. Focused on 140 Development Road Projects by KeRRA, it includes 104 Strategy Implementation Officers, Contractors’ CEOs, and KeRRA officials. Data, gathered through questionnaires and interviews, underwent statistical analysis revealing a significant positive correlation (r = 0.508, p < 0.05) between leadership styles and project performance, using SPSS Version 27. The study suggests that project managers at the Kenya Rural Roads Authority demonstrate positive leadership qualities, such as agreeableness and visionary leadership, which are linked to timely completion of road construction projects, although challenges like resistance to change and laissez-faire leadership tendencies may impede project success. Recommendations include reinforcing and promoting positive leadership qualities among project managers at the Kenya Rural Roads Authority, focusing on aspects such as agreeableness, visionary leadership, and developmental leadership, while addressing challenges related to laissez-faire and resistance to change through training and support initiatives, and emphasizing the importance of directive leadership to improve project outcomes and ensure successful completion of road construction projects. KEY WORDS: Leadership Styles, Performance of Road Construction Projects, Kenya Rural Roads Authority

Digital Learning Demand and Applicability of Quality 4.0 for Future Education: A Systematic Review

This study investigates the demand for digital learning and the application of Quality 4.0 for future education in higher education institutes (HEIs). Quality 4.0 leads to digital transformation for innovation, excellence, and performance. Over the past decade, the educational landscape has undergone a revolution due to digitalization and enhancing academic development. The present study, through a systematic review of the literature published from 2017 to 2023, aims to highlight how digital advancements have played a critical role in improving the people and operations of higher education institutes to meet the growing challenges in the education sector. The implementation of Quality 4.0 and the application of its practices in HEIs can drive innovation through technological advancements in the Internet of Things (IOT), blended learning, and artificial intelligence (AI) to meet the increasing demand for digital learning. The findings suggest that digital learning through various technologies brings about significant changes in employment, skill development, and the educational environment. However, these advancements do not come without challenges, including the imperative of faculty development, the establishment of robust technological infrastructure, ethical considerations in AI implementation, and quality management. More research is needed to address the gap in understanding the applicability of Quality 4.0 and the demand for digital learning in higher education institutes.

Understanding supported self-management for people living with a lower-grade glioma: Implementation considerations through the lens of normalisation process theory.

Supported self-management can improve clinical and psychosocial outcomes in people with cancer; the considerations required to implement self-management support (SMS) for people living with a lower-grade glioma (LGG)-who often have complex support needs-are not known. We aimed to identify and understand these implementation considerations through the lens of normalisation process theory (NPT), from the perspectives of healthcare professionals (HCP) and people with LGG. We conducted semistructured interviews with HCPs who support adults with brain tumours (n = 25; 12 different healthcare professions), and people with LGG who had completed primary treatment (n = 28; male n = 16, mean age 54.6 years, mean time since diagnosis 8.7 years), from across the United Kingdom. Interviews were transcribed and inductive open coding conducted, before deductively mapping to constructs of NPT. We first mapped HCP data, then integrated data from people with LGG to explore alignment in experiences and perspectives. We generated supporting evidence for all four NPT constructs and related subconstructs, namely: 'Coherence', 'Cognitive participation', 'Collective action'and 'Reflexive monitoring'. Data from HCPs and people with LGG clearly demonstrated that effective SMS constitutes a collective activity. Key implementation considerations included: ensuring awareness of, and access to, support; building strong HCP-support recipient relationships; and careful inclusion of close family and friends. We identified pertinent challenges, such as identifying support needs (influenced by the extent to which those with LGG engage in help-seeking), resistance to support (e.g., technology literacy), training for HCPsand HCP cooperation. This study demonstrates the collective nature of, and provides insight into the individual roles within, supported self-management. We outline considerations to operationalise, sustainand appraise the implementation of SMS for people with LGG. People with brain tumours, and informal caregivers, were involved in the development of information materials and topic guides to ensure accessibility and pertinence. They also had opportunities to comment on interview findings.

Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review.

We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.

Adherence to buprenorphine-XR through hybrid telehealth contingency management procedures: a case series

ABSTRACT Background and objectives Contingency management (CM) for substance use disorders (SUD) is effective in strengthening recovery behaviors, however can be quite burdensome. When health facilities experience staff shortages, adapting current CM protocols to be less staff and time intensive may be one way to address this challenge. Methods Case series (N = 3). Results Three veterans with opioid use disorder (OUD) received CM for treatment adherence through a Veteran Health Administration Outpatient Substance Disorder program. Due to the COVID-19 pandemic, traditional CM procedures resulted in limited accessibility and staff, delayed appointments, and decreased patient satisfaction. In response, the hybrid telehealth contingency management (HTCM) procedure was developed and implemented. Flexibility offered by HTCM allowed for consecutive completion of appointments and maintained adherence to BUP-XR treatment. Conclusions This is a novel method of CM implementation. HTCM streamlined the process and was successful in increasing accessibility, reducing time-burden on patients and staff, while preserving fidelity to key components of the model. Considerations for future implementation and implications of HTCM are discussed.

Implementation of an integrated primary care prevention and management program for chronic low back pain (LBP): patient-reported outcomes and predictors of pain interference after six months

BackgroundIntegrated primary care programs for patients living with chronic pain which are accessible, interdisciplinary, and patient-centered are needed for preventing chronicity and improving outcomes. Evaluation of the implementation and impact of such programs supports further development of primary care chronic pain management. This study examined patient-reported outcomes among individuals with low back pain (LBP) receiving care in a novel interdisciplinary primary care program.MethodsPatients were referred by primary care physicians in four regions of Quebec, Canada, and eligible patients received an evidence-based interdisciplinary pain management program over a six-month period. Patients were screened for risk of chronicity. Patient-reported outcome measures of pain interference and intensity, physical function, depression, and anxiety were evaluated at regular intervals over the six-month follow-up. A multilevel regression analysis was performed to evaluate the association between patient characteristics at baseline, including risk of chronicity, and change in pain outcomes.ResultsFour hundred and sixty-four individuals (mean age 55.4y, 63% female) completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement in pain intensity and interference at six months. Patients with moderate (71%) or high risk (81%) of chronicity showed greater improvement in pain interference than those with low risk (51%). Significant predictors of improvement in pain interference included a higher risk of chronicity, younger age, female sex, and lower baseline disability.ConclusionThe outcomes of this novel LBP program will inform wider implementation considerations by identifying key components for further effectiveness, sustainability, and scale-up of the program.

Automated Lead Qualification Using RPA and Sales Force

Lead qualification is a critical process in sales and marketing, determining which leads have the highest potential for conversion into customers. This paper explores the integration of Robotic Process Automation (RPA) with Salesforce Customer Relationship Management (CRM) to automate lead qualification processes. By leveraging the capabilities of RPA bots to extract, process, and analyze data from Salesforce, businesses can achieve faster and more accurate lead qualification, leading to increased sales efficiency and revenue generation. This paper discusses the benefits, challenges, and implementation considerations of this integration, supported by real-world examples from companies that have successfully implemented automated lead qualification using RPA and Salesforce.

Taxonomy of theories for blockchain applications in business and management

The rising prominence of blockchain technology has spurred researchers to delve deeper into its applications through the lens of organizational and management theories. Our thematic analysis of blockchain literature reveals examination across five key areas: economic, strategic, operational, behavioral, and implementation considerations, each viewed through various theoretical perspectives. The multifaceted nature of blockchain phenomena necessitates diverse types of theory and research questions. Thus, the unique characteristics within each area stimulate the formulation of inquiries that address a system of research questions about what, how, why, when, where, what will be, and how to do. Existing literature predominantly emphasizes explanatory and predictive type of theories, notably expanding research topics such as blockchain adoption behavior. However, this singular focus limits the exploration of diverse reasoning approaches suited to blockchain's complexity. Our study illustrates how different types of theory contribute to understanding each of the identified blockchain application areas. Based on our findings, we propose pertinent questions that highlight the need for varied theoretical frameworks and address specific issues within each application area. Furthermore, we recommend appropriate type of theories to address these questions, fostering a more multi-perspective investigation across the breadth of blockchain-related research topics and areas. By embracing diverse theoretical perspectives, we aim to create a more balanced research landscape, facilitating deeper insights into blockchain phenomena.