Implementation Of Similar Interventions Research Articles

A future classroom lab with active and gamified STEAM proposal for mathematics and science disciplines: Analyzing the effects on pre-service teacher’s affective domain

The recent emergence of innovative learning spaces, Future Classroom Lab (FCL), provides educators the use of physical learning spaces (to research, interact, exchange, develop, create, and present) and diverse technological tools to work according to active methodologies. Learners become more active in the learning process with the introduction of innovative learning environments that enable the application of interdisciplinary STEAM methodology and foster the development of 21st century competences. This study aims to uncover the probable link between application active and gamified STEAM educational interventions in the FCL and Pre-Service Teachers’ (PSTs) affective domain. The findings obtained showed statistically significant variations and, therefore, positive effects on the PSTs’ affective domain (self-efficacy, attitude, and emotion) after performing the intervention. The sample consisted of a total of 54 PSTs enrolled in the second year of Primary Education. Limited studies regarding the affective domain in the FCL were found, which restricted the comparison with prior research. This study has several implications, such as the introduction of innovative educational proposals to PSTs at the university level and, consequently, the implementation of similar interventions in elementary schools. This research intended to reveal how the different variables work as a support system for students’ learning process in mathematics and science disciplines.

The effect of phonics skills intervention on early reading comprehension in an adolescent with autism: A longitudinal study

AbstractReading comprehension requires phonics skills, described as “blending phonemes in a word”. Adolescents diagnosed with Autism Spectrum Disorder (ASD) often experience poor reading comprehension. The aim of the present study was to explore if it is possible for an adolescent with ASD and intellectual disability to learn reading comprehension skills even without direct teaching, when the focus of the intervention is on teaching phonics skills. An adolescent with ASD, profound intellectual disability and limited behavioral repertoire participated in the study. The participant received intensive ABA‐based interventions according to University of California at Los Angeles‐Young Autism Project (UCLA‐YAP) model and intensive phonics training. Intervention data show emergence of early reading comprehension skills in terms of words/pictures matching and responding to written instructions. It is suggested that implementation of similar interventions could change the opportunities for people with autism who have limited behavioral repertoire and who did not begin an ABA‐based interventions until their adolescence.

Effects of Te Ara Mua – Future Streets suburban street retrofit on traffic speed and volume: Controlled before-after study

BackgroundTraffic speed and volume are important determinants of road traffic injury rates for all travel modes, and high traffic speed and volume can deter walking and cycling. Te Ara Mua – Future Streets is a project in Māngere, Aotearoa New Zealand, that aims to make it safer and easier for people to get around their local neighbourhood, especially by walking and cycling. Key components include implementation of a street hierarchy and street design changes to reduce speeds on neighbourhood streets, as well as other components including improved active transport infrastructure. MethodsWe used tube counters to measure motor vehicle speed and volume before and after the intervention, at different levels of the street hierarchy: arterial, collector and local streets. A difference-in-differences approach was used to assess changes in the intervention area compared with a matched control area. ResultsWe found post-intervention mean speed reductions of 8 km/h on local streets, and 5–6 km/h on collector streets, relative to the control area. Mean traffic volumes reduced by 17–24% on local streets, with no change on collectors or arterials. Both post-intervention time points showed similar results, indicating a sustained effect. ConclusionsOverall, this intervention successfully reinforced a street hierarchy, creating local residential streets that are more conducive to road safety and active travel. Implementation of similar interventions in disadvantaged neighbourhoods could help reduce road traffic injury inequities within cities. The findings suggest a promising contribution to safer streets that are more attractive for walking and cycling. Our future research will evaluate broader impacts of this intervention on travel mode shift, injury rates and other health and social outcomes.

Participating in a parenting intervention in prison, perceptions from incarcerated fathers and mothers-A convergent mixed-methods study.

Children of incarcerated parents run a high risk of ill-health and future delinquency, whereas positive parenting can support children's healthy development. The For Our Children's Sake (FOCS) parenting intervention for parents in prison was evaluated as a controlled trial during 2019-2021 within The Swedish Prison and Probation Service (SPPS). This study reports on the process evaluation and aimed to describe how parents perceived their participation and aspects that influenced implementation of the FOCS intervention. This convergent mixed-methods study (QUAL + quan) included qualitative interview data after participation in the FOCS intervention group (12 parents), and quantitative questionnaire data from intervention and control groups (46 parents). Qualitative data were analysed using inductive qualitative content analysis and quantitative data using descriptive and non-parametric statistics. An integrated synthesis of the qualitative and quantitative results showed three joint concepts that provided an extended understanding of the importance of a child and parent focused intervention available to parents in prison, where FOCS was perceived as the only place where inmates could openly reflect, and express sensitive feelings and thoughts related to the children and being a parent. Also, that the SPPS as an organisation entails partly unsupportive organisational norms with irregular individual staff engagement, which made FOCS invisible in prisons, and the importance of engagement and motivation from all participants and group leaders in the group was essential for a successful FOCS group. This study showed that availability of a child and parent focused intervention in prison is perceived as very important, and at the same time dependent on a trustful relationship in the group to be rewarding to the participants, where organisational norms within the SPSS need amendments for successful implementation of FOCS. These findings can guide further implementation of similar interventions in prison.

178. Impact of a microbiology comment nudge on the diagnostic evaluation of Staphylococcus aureus bacteriuria

Abstract Background Staphylococcus aureus is a relatively uncommon cause of urinary tract infections. S. aureus bacteriuria is thought to result most commonly from urinary tract instrumentation (ascending infection) or via hematogenous seeding of the genitourinary tract (descending infection). Given the devastating impact of invasive S. aureus infection and awareness that S. aureus bacteriuria is often a marker for S. aureus bacteremia, growth of S. aureus from urine cultures should prompt urgent clinical assessment, including blood culture collection. In April 2021, a comment nudge was added to the microbiology culture and susceptibility report for all S. aureus isolated from urine cultures performed at the Atlantic Consolidated Laboratory (ACL) at Atlantic Health System. The purpose of this study is to assess the impact of a comment nudge on the diagnostic evaluation of S. aureus bacteriuria. S. aureus bacteriuria comment nudge Methods All patients with S. aureus bacteriuria were retrospectively identified from the ACL microbiology database. The primary endpoint was collection of blood cultures within 96 hours of positive urine culture during the 6-month period pre-comment (October 2020 – April 2021) compared to 6-month period post comment (May 2021 – November 2021). In addition, incidence of S. aureus bacteremia among the patients with collected blood cultures was also evaluated. Results S. aureus bacteriuria was identified in 122 patients during the Pre-Comment period and 188 patients in the Post-Comment period. Blood cultures were collected more frequently in the Post-Comment period compared to the Pre-Comment period (64% vs. 51%, p=0.018). Among patients for whom blood cultures were collected, 29% had concomitant S. aureus bacteremia in the Pre-Comment period compared to 16% in the Post-Comment period (p=0.03). Conclusion The addition of a comment nudge to the microbiology report of urine cultures growing S. aureus significantly improved follow-up blood culture collection. Health systems may consider implementation of similar interventions, particularly in resource-limited settings, to avoid delayed recognition of S. aureus bacteremia. Disclosures All Authors: No reported disclosures.

A standardized implementation of multicenter quality improvement program of very low birth weight newborns could significantly reduce admission hypothermia and improve outcomes

BackgroundAdmission hypothermia (AH, < 36.5℃) remains a major challenge for global neonatal survival, especially in developing countries. Baseline research shows nearly 89.3% of very low birth weight (VLBW, < 1500 g) infants suffer from AH in China. Therefore, a prospective multicentric quality improvement (QI) initiative to reduce regional AH and improve outcomes among VLBW neonates was implemented.MethodsThe study used a sequential Plan—Do—Study—Act (PDSA) approach. Clinical data were collected prospectively from 5 NICUs within the Sino-Northern Neonatal Network (SNN) in China. The hypothermia prevention bundle came into practice on January 1, 2019. The clinical characteristics and outcomes data in the pre-QI phase (January 1, 2018– December 31, 2018) were compared with that from the post-QI phase (January 1, 2019–December 31, 2020). Clinical characteristics and outcomes data were analyzed.ResultsA total of 750 in-born VLBW infants were enrolled in the study, 270 in the pre-QI period and 480 in the post- QI period, respectively. There were no significant differences in clinical characteristics of infants between these two phases. Compared with pre-QI period, the incidence of AH was decreased significantly after the QI initiative implementation in the post-QI period (95.9% vs. 71.3%, P < 0.01). Incidence of admission moderate-to-severe hypothermia (AMSH, < 36℃) also decreased significantly, manifesting a reduction to 38.5% in the post-QI (68.5% vs 30%, P < 0.01). Average admission temperature improved from after QI (35.5 pm 0.7℃ vs. 36.0 pm 0.6℃, P < 0.01). There was no increase in proportion the number of infants with a temperature of > 37.5 °C or thermal burns between the two groups. The risk ratio of mortality in infants during the post-QI period was significantly lower in the post-QI period as compared to the pre-QI period [adjusted risk ratio (aRR): 0.26, 95% confidence interval (CI): 0.13–0.50]. The risk ratio of late-onset neonatal sepsis (LOS) also significantly lowered in the post-QI period (aRR: 0.66, 95% CI: 0.50–0.87).ConclusionImplementation of multicentric thermoregulatory QI resulted in a significant reduction in AH and AMSH in VLBW neonates with associated reduction in mortality. We gained a lot from the QI, and successfully aroused the attention of perinatal medical staff to neonatal AH. This provided a premise for continuous quality improvement of AH in the future, and might provide a reference for implementation of similar interventions in developing countries.Trial registrationTrial registration number: ChiCTR1900020861. Date of registration: 21 January 2019(21/01/2019). Prospectively registered.

A study to investigate the implementation process and fidelity of a hospital to community pharmacy transfer of care intervention.

BackgroundHospital to community pharmacy transfer of care medicines-related interventions for inpatients discharged home aim to improve continuity of care and patient outcomes. One such intervention has been provided for seven years within a region in England. This study reports upon the implementation process and fidelity of this intervention.MethodsThe process evaluation guidance issued by the Medical Research Council has informed this study. A logic model to describe the intervention and causal assumptions was developed from preliminary semi-structured interviews with project team members. Further semi-structured interviews were undertaken with intervention providers from hospital and community pharmacy, and with patient and public representatives. These aimed to investigate intervention implementation process and fidelity. The Consolidated Framework for Implementation Research and the Consolidated Framework for Intervention Fidelity informed interview topic guides and underpinned the thematic framework analysis using a combined inductive and deductive approach.ResultsThemes provided information about intervention fidelity and implementation that were mapped across the sub processes of implementation: planning, execution, reflection and evaluation, and engagement. Interviewees described factors such as lack of training, awareness, clarity on the service specification, governance and monitoring and information and feedback which caused significant issues with the process of intervention implementation and suboptimal intervention fidelity.ConclusionsThis provides in-depth insight into the implementation process and fidelity of a ToC intervention, and the extant barriers and facilitators. The findings offer learning to inform the design and implementation of similar interventions, contribute to the evidence base about barriers and facilitators to such interventions and provides in-depth description of the implementation and mechanisms of impact which have the potential to influence clinical and economic outcome evaluation.

Efficacy and cost-feasibility of the Timely Chest Compression Training (T-CCT): a contextualized cardiopulmonary resuscitation training for personal support workers participating during in-hospital cardiac arrests.

The Timely Chest Compression Training (T-CCT) was created to promote more frequent training in chest compressions for personal support workers. This study aims to assess the efficacy of the T-CCT on the chest compression performance and to examine costs related to this intervention. A prospective single group, before-after study was conducted at a university-affiliated hospital. The T-CCT is adapted for support workers and lasts 20min during working hours. Guided by peer trainers, live feedback devices and mannikins, the T-CCT targets chest compression training. Using an algorithm, chest compression performance scores were gathered before and after the intervention. Of 875 employed support workers, 573 were trained in 5days. Prior to the intervention, the median performance score was 72%. Participants significantly improved after the intervention (p < 0.001) and the median of the differences was 32% (95% CI 28.5-36.0). Support workers in critical care units and those with an active basic life support (BLS) certification performed better at baseline and were less inclined to have large changes in performance scores after the intervention. When compared to basic life support training, the T-CCT is over three times less expensive. The T-CCT was an effective and low-cost initiative that allowed to train a large group of support workers in a short amount of time. Since they are actively involved in resuscitation efforts in Quebec (Canada), it may promote the delivery of high-quality compressions during in-hospital cardiac arrests. Our inquiry can incite and guide other organizations in the implementation of similar interventions.

An information marketing campaign promotes physician donation to a radiology political action committee: Campaign Promotes Donation to Radiology PAC

ObjectiveTo evaluate the impact of an informational marketing campaign on radiology political action committee (PAC) donations. MethodsThe Society of Interventional Radiology (SIR) Resident and Fellow Section (RFS) Advocacy Committee implemented an informational marketing campaign beginning with an email survey in January 2017. Society of Interventional Radiology Political Action Committee (SIRPAC) donors (n = 564) and donations were compared prior to and after the marketing campaign. ResultsComparisons from 2015-2016 (n = 353, 62.6%) to 2017-2018 (n = 432, 76.6%) showed a statistically significant increase (p < 0.001) in donors. Comparisons from 2015-2016 (M=$124.73, SD = 202.18) to 2017-2018 (M=$229.96, SD = 404.72) showed a statistically significant mean increase (p < 0.001) in donations. DiscussionRaising awareness of SIRPAC through a targeted informational marketing initiative had a positive impact on PAC donations. Although a causal relationship cannot be definitively determined, we believe that implementation of similar interventions can be useful in order to help raise funds for other medical specialty PACs.

Integrating health and social care in Brazil

Abstract Integrating health and social care is now a high priority for public health policy in high-income countries. It has received much less attention in low and middle-income country (LMIC) settings. There is particular value in assessing the potential to integrate care services for older adults, given the speed of population ageing in LMICs. The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil (drawing on a study co-funded by the UK MRC and CONFAP Brazil). Programa Maior Cuidado (PMC) was established in the Brazilian city of Belo Horizonte in 2011. It is jointly managed by the departments of health and of social assistance and involves close community-level collaboration between health posts and neighbourhood social service centres. A key element of PMC is the provision of paid trained lay carers to support family care for dependent older people in socially vulnerable families. We will present findings on the implementation process and operation of PMC, as well as its effects on the following outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers. Quasi-experimental analysis using spatial-based Propensity Score Matching shows promising results in terms of increasing planned attentions as well as access to rehabilitation services, which confirms the ability of the Program to improve interface with health services avoiding unplanned unnecessary attentions We will examine the implementation of similar interventions in other Brazilian cities, including Fortaleza and Contagem, and will study the role of national and international processes in dissemination, knowledge sharing and agenda-setting. Key messages The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil. Programme under evaluation lead to interesting outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers.

Briefing: The Ugandan CrossRoads Construction Guarantee Fund: key achievements and impacts

Limited access to finance can often be a significant barrier to the growth of small- and medium-sized enterprises (SMEs) in the road sector in developing countries. Financial institutions are often reluctant to lend to domestic road contractors or do so at high interest rates accompanied by onerous collateral obligations. This retards the development and growth of a competitive roads industry, which in turn reduces the overall economic growth. The Ugandan CrossRoads Construction Guarantee Fund (CGF) was established to improve access to finance (bid bonds, performance bonds and advance payment guarantees) by small- and medium-sized local road contractors. The CGF was able to build confidence and trust among the key players in the road sector in Uganda. After running for a mere 4 years, the financial market was completely transformed to a point where commercial banks now provide bonds and guarantees to contactors within 24 h of application, provided that all the required information is availed in the application. A number of key lessons have come out of the Ugandan CrossRoads CGF experience, which should help inform the design and implementation of similar interventions, particularly in developing countries. One of the most important lessons is that a relatively low-cost development intervention can lead to long-term, sustainable, positive behavioural change in the market.

Implementation of a Physician Incentive Program for 18-Month Developmental Screening in Ontario, Canada

To evaluate factors associated with uptake of a financial incentive for developmental screening at an enhanced 18-month well-child visit (EWCV) in Ontario, Canada. Population-based cohort study using linked administrative data of children (17-24months of age) eligible for EWCV between 2009 and 2017. Logistic regression modeled associations of EWCV receipt by provider and patient characteristics. Of 910 976 eligible children, 54.2% received EWCV (annually, 39.2%-61.2%). The odds of assessment were lower for socially vulnerable children, namely, those from the lowest vs highest neighborhood income quintile (aOR, 0.84; 95% CI, 0.83-0.85), those born to refugee vs nonimmigrant mothers (aOR, 0.90; 95% CI, 0.88-0.93), and to teenaged mothers (aOR, 0.70; 95% CI, 0.69-0.71)). Children were more likely to have had developmental screening if cared for by a pediatrician vs family physician (aOR, 1.28; 95% CI, 1.13-1.44), recently trained physician (aOR, 1.38; 95% CI, 1.29-1.48 for ≤5years in practice vs ≥21years) and less likely if the physician was male (aOR, 0.64; 95% CI, 0.61-0.66). For physicians eligible for a pay-for-performance immunization bonus, there was a positive association with screening. In the context of a universal healthcare system and a specific financial incentive, uptake of the developmental assessment increased over time but remains moderate. The implementation of similar interventions or incentives needs to account for physician factors and focus on socially vulnerable children to be effective.

Implementing a novel strategy for interprofessional medication review using collegial mentoring and systematic clinical evaluation in nursing homes (COSMOS)

BackgroundMultimorbid patients in nursing homes are prescribed long lists of medication, often without sufficient clinical evaluations beforehand. This results in poor clinical effects of the prescribed medication and significant side-effects, especially in patients with impaired cognition. The aim of this paper is to describe the process, content and implementation of a clinical medication review encompassing clinical testing and collegial support to prescribers.MethodsThe implementation process of a novel approach to medication review in nursing homes was logged thoroughly by structured staff feedback. Staff experienced promotors and barriers to implementation also were collected. The study was part of a cluster randomized controlled trial, in which 36 long-term care units received the COSMOS intervention. Nurses and physicians randomized to the intervention group participated in educational programs, training in clinical evaluation of the patients, and interprofessional medication review with collegial mentoring.ResultsThe intervention group contained 297 patients from 36 nursing home units. There were 105 staff attendees for the education program. The units were served by 21 different physicians. Clinical medication reviews were performed in all units and all patients were assessed prior to the medication reviews. Of the 240 patients with a logged intervention process, 220 (92%) underwent a medication review. The intervention generated enthusiasm and improved communication among nursing staff and between nursing staff and physicians. The interprofessional discussions helped to facilitate difficult decisions pertaining to treatment levels. Reported barriers were lack of time, low engagement of all nursing staff and physicians, and ethical dilemmas.ConclusionsClinical medication reviews were implemented for almost all patients, and every patient was systematically assessed prior to the medication review. The physicians perceived collegial mentoring as an asset, learning from each other facilitated decision making in terms of difficult aspects of prescribing. Knowledge about barriers and promotors can improve implementation of similar interventions in other nursing homes.Trial registrationClinicaltrials.gov (NCT02238652). Registered July 7th 2014.

A School-Based Educational Intervention for School-Aged Children and Caregivers about Rational Use of Antibiotics in Urban Areas of Shaanxi Province: A Study Protocol for a Randomized Controlled Research.

(1) Background: Antibiotic resistance is an imperative public health issue globally. Major factors that are resulting in this trend are the irrational and excessive use of antibiotics. Children account for a greater population of antibiotics use, therefore, an educational intervention on the rational use of antibiotics for children and caregivers will be beneficial. (2) Methods: A randomized controlled and parallel group study of fifth grade children and their caregivers will be evaluated in four primary schools in Baoji and Weinan of the Shaanxi Province. Two primary schools will be randomly selected for the educational intervention and two schools will serve as a control group. In the intervention arm, educational interventions will be conducted among caregivers and their children. The intervention measures include interactive training sessions, booklets, and printed or electronic educational materials that will be given to the caregivers or the school-aged children. In the control arm, no interventions will be implemented. Baseline data collected from June, 2018 and the intervention will last for three months. Knowledge-Attitude-Practice (KAP) questionnaires will be used to evaluate the caregivers’ knowledge, their attitude, and their practice. Knowledge-Retention questionnaires will be used to assess the children’s knowledge about microbes, antibiotics, and hygiene. (3) Discussion: This study is a unique comprehensive intervention targeting both children and their caregivers. We hypothesize a decrease in the irrational use of antibiotics among the studied population. Hence, this result would provide evidence for policy makers and educational departments for the implementation of similar interventions on the rational use of antibiotics.

A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa

BackgroundUnderstanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa.MethodsA systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation.ResultsThe main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution.ConclusionMass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.

Introducing rapid diagnostic tests for malaria into registered drug shops in Uganda: lessons learned and policy implications.

BackgroundMalaria is a major public health problem in Uganda and the current policy recommends introduction of rapid diagnostic tests for malaria (RDTs) to facilitate effective case management. However, provision of RDTs in drug shops potentially raises a new set of issues, such as adherence to RDTs results, management of severe illnesses, referral of patients, and relationship with caretakers. The main objective of the study was to examine the impact of introducing RDTs in registered drug shops in Uganda and document lessons and policy implications for future scale-up of malaria control in the private health sector.MethodsA cluster-randomized trial introducing RDTs into registered drug shops was implemented in central Uganda from October 2010 to July 2012. An evaluation was undertaken to assess the impact and the processes involved with the introduction of RDTs into drug shops, the lessons learned and policy implications.ResultsIntroducing RDTs into drug shops was feasible. To scale-up this intervention however, drug shop practices need to be regulated since the registration process was not clear, supervision was inadequate and record keeping was poor. Although initially it was anticipated that introducing a new practice of record keeping would be cumbersome, but at evaluation this was not found to be a constraint. This presents an important lesson for introducing health management information system into drug shops. Involving stakeholders, especially the district health team, in the design was important for ownership and sustainability. The involvement of village health teams in community sensitization to the new malaria treatment and diagnosis policy was a success and this strategy is recommended for future interventions.ConclusionIntroducing RDTs into drug shops was feasible and it increased appropriate treatment of malaria with artemisinin-based combination therapy. It is anticipated that the lessons presented will help better implementation of similar interventions in the private sector.

Barriers and facilitators to the implementation of SPNS interventions designed to engage and retain HIV positive women of color in medical care.

The use of evidence-based strategies to increase access to medical care and improve health outcomes for people living with HIV is a major public health priority in the United States. As part of a multi-site evaluation funded under the Health Resources and Services Administration(HRSA), a process evaluation was conducted with the goal of understanding barriers and facilitators to the implementation of eleven heterogeneous interventions designed to engage and retain HIV positive women of color (WoC) in medical care. Findings identified barriers and facilitators to program implementation at five levels: (1) program; (2) team; (3) agency; (4) partner network; and (5) the larger socio-ecological context. We conclude with a series of recommendations that may be useful for the implementation of similar interventions focused on recruitment and retention of WoC in HIV medical care.

Outcomes of the SCS project and their applicability to multilateral cooperative initiatives for the management of coastal seas and marine basins

This paper summarizes the benefits of experience gained through the execution of the South China Sea project that offer useful insights into the successful development and implementation of similar multilateral interventions for environmental protection and remediation in other coastal and regional sea waters. These benefits fall into several categories: political commitment, management framework, cooperative arrangements; transparency; and scientific veracity. Experience gained in each of these categories during the South China Sea project is outlined to provide an exemplar for the successful formulation and implementation of similar interventions in other regional marine areas.

Understanding dissemination and implementation of a new intervention in assisted living settings: the case of function-focused care.

Function-focused care (FFC) was developed to change the philosophy of care in assisted living (AL) to one in which nurses, direct care workers (DCWs) and other members of the health care team work with residents to optimize function and time spent in physical activities. The purpose of this article is to describe dissemination and implementation of FFC within the two assisted living communities in Maryland that were randomized to our FFC for assisted living intervention (FFC-AL). The reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) model was used to evaluate dissemination and implementation of FFC in these communities. A total of 171 residents and 96 DCWs consented to participate in the study and outcomes based on data collected from the participants as well as evidence for dissemination and implementation at the site level are provided. Findings can be used to guide others in dissemination and implementation of similar interventions in AL communities.