Implementation Of Year Research Articles

Abstract C111: Do electronic health records assist providers to provide equitable referral for breast and cervical cancer screening between black and white women?

Abstract Background: Breast and Cervical Cancer screening (BCS and CCS) are essential tools to prevent cancer. Yet, non-Hispanic Black (NHB) women die at a much higher rate from Breast and Cervical cancer than non-Hispanic White (NHW) women. Thus, it is important that providers recommend BCS (Mammogram) and CCS (Pap test), equitably, for maximum cancer prevention. Meaningful Use (MU), as part of the HITECH Act, incentivized providers to utilize electronic health records (EHR) not only for billing, but to increase the quality of patient care. MU also included an aim to reduce health disparities using EHR. The intent of this study was to evaluate BCS and CCS rates before and after the advent of MU to examine potential cancer screening disparities between NHW and NHB. It is imperative that cancer screenings are recommended, equally, to address grave disparities for NHB cancer mortality. Methods: Using a pre-post design, we examined BCS and CCS rates before the enactment of MU (2013) in a Medicaid population and after MU implementation for years 2014-2016. Medicaid data were extracted from the Michigan Department of Health & Human Services data warehouse for Medicaid enrollees. Inclusion criteria were physicians who were continually enrolled in MU from 2014-2016 who saw women of BCS and CCS screening age. Odds Ratios were used to examine differences in screening rates over time between Black and White women. Results: For BCS, no differences were detected between NHW and NHB women, although a trend was observed for post-MU for 2015 (OR = 1.167, 95% CI [0.876, 1.580]). Analyses of CCS rates post-MU showed differences (p<0.01) between NHW and NHB for 2014 (OR = 1.211, 95% CI [1.079, 1.377] and 2015 (OR = 1.141, 95% CI [1.029, 1.266], respectively. Regression analyses from 2013 to 2016 showed differences between NHW and NHB women for both BCS and CCS over time with NHW and NHB screening rates converging in 2016 (p<0.05). Conclusion: We did not find any discernable differences in BCS between NHW and NHB women after providers subscribed to MU. CCS screening rates for NHB were higher than NHW in 2014-2015, but not in 2016. However, changes in BCS and CCS rates were significant by year and over time. For both BCS and CCS, rates converged over time for both NHW and NHB reducing screening disparities, but screening rates decreased over time. This decrease over time was attributable to changes in screening recommendations for both BCS and CCS (ACOG, ACS, CDC). Notably, the guidelines changed from yearly CCS to every three years for women at low-risk for cervical cancer. Further analyses are warranted to adjust for the change in screening guidelines. These findings are complex and will be fully discussed to discern screening differences between NHW and NHB women, and use of EHR as a tool to reduce health disparities. Citation Format: Sabrina Ford, Laura Houdeshell-Putt, Molly Polverento, Kevin Brooks. Do electronic health records assist providers to provide equitable referral for breast and cervical cancer screening between black and white women? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C111.

Impact of Antimicrobial Stewardship Programme on Antimicrobial Utilisation, Cost and Bacterial Resistance in a Malaysian Public Tertiary Hospital

Antimicrobial stewardship programme (ASP) was introduced as one of the strategies to curb the rise of multi-drug resistant (MDR) organism. The findings on the programme establishment are important in strengthening ASP measures. This study aimed to assess the impact of ASP implementation on the antimicrobial utilisation, antimicrobial cost and the MDR bacterial resistant rate before and after the programme initiation. A retrospective cohort study involving adult inpatient in a public tertiary hospital was conducted between pre-ASP implementation in year 2015 and post-ASP implementation from year 2016 to 2019. The statistical analysis of Student t-test or Mann-Whitney U test was used depending on the data distribution. The mean defined daily dose (DDD) per 1,000 patient days for ASP targeted antibiotics was significantly decreased by 17% from 161.52 DDD per 1,000 patient days in pre-ASP period to 134.49 DDD per 1,000 patient days in post-ASP period mainly from the usage of third generation cephalosporin, carbapenem and colistin. The annual expenditure for ASP targeted antibiotics had significant monetary reduction from RM30,580.50 in pre-ASP period to RM20,590.60 during post-ASP period. Significant reduction in the mean MDR bacterial resistant rate were notable for extended spectrum beta-lactamase E. coli (27.48%–17.85%), methicillin-resistant Staphylococcus aureus (22.25%–15.73%) and MDR Acinetobacter spp. (71.46%–49.34%). The implementation of ASP leads to significant reduction on the ASP targeted antibiotics utilisation, antimicrobial cost and MDR bacterial resistance rate. These outcomes are beneficial in justification and expansion of ASP activities in Malaysia.

STATE-LEVEL DESEGREGATION EFFORTS IN THE U.S. SOUTH POST-BROWN AND DEMENTIA RISK AMONG BLACK AND WHITE OLDER ADULTS

Abstract Although education is a key protective factor against dementia, older U.S. adults experienced vastly different educational contexts. One of the most consequential legal decisions impacting educational contexts was Brown v. Board of Education, which declared ‘separate but equal’ schools unconstitutional. School desegregation in the U.S. South was inconsistent, however, and many states delayed implementation for years. State resistance to school desegregation created school environments for Black children that were stressful and discriminatory. Thus, state variation in exposure to school desegregation may serve to differentiate individuals in their risk for dementia. Our project links historical data on state-level school desegregation efforts to the Health and Retirement Study, a nationally representative sample of U.S. adults over 50. We determine if state-level variation in the timing and completeness of school desegregation explains Black-White disparities in transition to cognitive impairment and dementia among older adults who attended school in the US South post-Brown.

Actual challenges for the implementation of judgments of the European Court of Human Rights

The author analyzes the problem of the implementation of judgments of the European Court of Human Rights (ECtHR). In light of the European Convention on Human Rights (ECHR), a special role in its control mechanism is played by the Committee of Ministers of the Council of Europe. Despite the measures taken, there have been delays in the execution of judgments or the lack of their implementation for years. The author analyzed this problem in light of the latest reports of the Committee of Ministers and the recommendations of the Parliamentary Assembly. He pointed to the need for greater activity in this process of other bodies of the Council of Europe, including: the Commissioner for Human Rights, the Venice Commission, the CPT, the ECRI as well as institutions of the civil society. In the last decade, the interest of the Parliamentary Assembly of the Council of Europe in this matter has clearly increased. The author postulates that parliamentarians sitting in this body should be more active in this regard in their countries. They have instruments of control on the executive power, which could be used to increase the effectiveness of the execution of the ECtHR’s judgements.

Solar power plant utilization on mass rapid transit based public transportation company

Nowadays, the growth of population and business activities in a city is creating a new problem, which is the movement of the people itself. Mass Rapid Transit (MRT), which included in public transportation with a dedicated lane continues to prove that this kind of public transportation is effective and efficient to solve that problem by reducing congestion and creating a greener environment. However, MRT requires electrical power in a relatively big number. To meet this requirement and support a greener environment, a study is conducted. The method of this study is to simulate on how much potentially a solar power plant can be built on Jakarta MRT facility and conduct an analysis on engineering, economic, regulation, and strategic of the Company itself. The result is a 451.2 kWp Solar Power Plant could be built on the Workshop Building on Jakarta MRT, has NPV of US$ 44,706.70, and payback period in 12.82 years if the implementation in year 2022. The Cost of Capacity Charge could be avoided by giving the Power Utility Company of Indonesia a Business to Business (B2B) scheme.

Open Education for a Better World: A Mentoring Programme Fostering Design and Reuse of Open Educational Resources for Sustainable Development Goals

An international online mentoring programme Open Education for a Better World (OE4BW) has been developed to unlock the potential of open education in achieving the UN Sustainable Development Goals. The programme provides an innovative approach to building Open Educational Resources, connecting developers of educational materials with experts volunteering as mentors. The model of the programme has been carefully designed and tested in two subsequent implementations in years 2018 and 2019. Results have proved the model to be useful for building capacities in open education, while producing concrete educational materials with great potential for social impact. Analysis of results has been used to suggest further improvements needed for enabling the program to be used on an even larger scale. The paper presents the development of the OE4BW model, its main characteristics, implementation results and guidelines for the future.

Examination of Various Economic Factors of Indian States & Union Territories through Mathematical Modeling using Factor Theory

The total value of goods produced and services rendered within a country during a year is its Gross Domestic Products.” GDP is the growth measurement technique. In this research paper, we analyze India’s gross state domestic products (GSDP) data, using the factor analysis model to find out the impact of GSDP contributing factors. There are several methods to test the adequacy of the factor model. Here researcher has used Principal Component factor analysis approaches by varimax rotation method. Data has been collected by the Ministry of statistics & program implementation of year 2017-2018. Basically Indian economy is segmented into three major sectors as primary sector, secondary sector & tertiary sector. Primary sector means “Agriculture, forestry & fishing”, Secondary sector means “Manufacturing, construction & electricity, gas water & other utilities services” and tertiary sectors includes “Trade, Transport, Hotels & financial services” so on. India has 28 states and 9 union territories. But in this paper, we have examined 28 states & 5 union territories on the basis of 15 variables. Factor analysis is the factor redemption technique so here, we have reduced these 15 variables into three common factors.

P447 Dissemination and implementation of the mental health guidelines in the United States: results of implementation in year 2 at 120 cystic fibrosis centres

P447 Dissemination and implementation of the mental health guidelines in the United States: results of implementation in year 2 at 120 cystic fibrosis centres

Factors Predicting Sustained Implementation of a Universal Behavior Support Framework

In this 3-year prospective study, we tested the extent to which school-, practice-, and district-level variables predicted sustained implementation for schools in various stages of implementation of school-wide positive behavioral interventions and supports (SWPBIS) Tier 1 (universal) systems. Staff from 860 schools in 14 U.S. states completed a research-validated measure of factors associated with sustained implementation of school interventions during Year 1 of this study. Analyses included multigroup structural equation modeling of school and district implementation fidelity data. Results indicated that adequate implementation fidelity and better Team Use of Data for decision making in Study Year 1 were the strongest predictors of sustained implementation in Year 3. In addition, the number of other schools in the district adopting SWPBIS was a similarly strong predictor. A critical mass of schools implementing was also predictive, especially for schools earlier in implementation. School characteristics were not predictive, except for grade levels served, which was an inconsistent predictor by stage.

The YEARS algorithm for suspected pulmonary embolism: shorter visit time and reduced costs at the emergency department

Essentials The YEARS algorithm was designed to simplify the diagnostic workup of suspected pulmonary embolism. We compared emergency ward turnaround time of YEARS and the conventional algorithm. YEARS was associated with a significantly shorter emergency department visit time of ˜60 minutes. Treatment of pulmonary embolism was initiated 53 minutes earlier with the YEARS algorithm SUMMARY: Background Recently, the safety of the YEARS algorithm, designed to simplify the diagnostic work-up of pulmonary embolism (PE), was demonstrated. We hypothesize that by design, YEARS would be associated with a shorter diagnostic emergency department (ED) visit time due to simultaneous assessment of pre-test probability and D-dimer level and reduction in number of CT scans. Aim To investigate whether implementation of the YEARS diagnostic algorithm is associated with a shorter ED visit time compared with the conventional algorithm and to evaluate the associated cost savings. Methods We selected consecutive outpatients with suspected PE from our hospital included in the YEARS study and ADJUST-PE study. Different time-points of the diagnostic process were extracted from the to-the-minute accurate electronic patients' chart system of the ED. Further, the costs of the ED visits were estimated for both algorithms. Results All predefined diagnostic turnaround times were significantly shorter after implementation of YEARS: patients were discharged earlier from the ED; 54 min (95% CI, 37-70) for patients managed without computed tomography pulmonary angiography (CTPA) and 60 min (95% CI, 44-76) for the complete study population. Importantly, patients diagnosed with PE by CTPA received the first dose of anticoagulants 53 min (95% CI, 22-82) faster than those managed according to the conventional algorithm. Total costs were reduced by on average €123 per visit. Conclusion YEARS was shown to be associated with a shorter ED visit time compared with the conventional diagnostic algorithm, leading to faster start of treatment in the case of confirmed PE and savings on ED resources.

‘The island is full. Please don't come’: Narratives of austerity and migration in a UK citizenship class

In the lead up to, and aftermath of, the UK referendum on its membership of the European Union, issues relating to migration and entitlement dominated public debates. In a ruthless campaign, the ‘Leave’ camp exploited the implementation of years of austerity policies by explicitly correlating their negative effects with supposedly high migrant numbers. Examining the discourses of scarcity, austerity and deservingness which prevailed during the referendum campaign, this article discusses the way in which UK citizenship classes act as spaces for both the reproduction and subversion of these narratives. On the one hand, migrants in the classes reproduce discourses which scapegoat other migrants for the effects of austerity. On the other, however, powerful messages about the fundamental human right to migrate are also championed.

Analysis of the integration of a steel plant in Australia with a carbon capture system powered by renewable energy and NG-CHP

This study demonstrates an economic feasibility analysis of renewable energy (solar and wind)-powered carbon capture plant integrated with a steel making facility located in Sydney, Melbourne and Townsville. This evaluation is performed assuming implementation in year 2020. Two financial metrics are used to determine the economic viability of the proposed project, namely, cost of avoidance (COA) and net annual benefit (NB). The natural gas combined heat and power (NG-CHP) plant is used as an alternative to renewable energy to power the carbon capture system. Results show that the integration of renewable energy-powered carbon capture system with a steel plant was more feasible compare to NG-CHP powered carbon capture system when deployed in Sydney and Townsville. The renewable energy technology was also able to capture a high proportion of the CO2 capture target by capturing up to 93%, 74% and 94% of the total emissions capture target in Sydney, Melbourne and Townsville respectively. Out of the five solar thermal technologies analysed, evacuated tube collectors (ETCs) and parabolic trough collectors (PTCs) were found to be most economically feasible in Townsville and Sydney respectively for capturing high fractions of the carbon dioxide capture target. While this study explores a fully renewable energy-powered and fully NG-CHP powered carbon capture facility, it is likely that a mix of these two technologies may produce an optimal economic and operational output in which nearly all the carbon dioxide capture target can be met at a reasonable cost while ensuring stable operation of the carbon capture plant.

Factors influencing implementation of a preschool-based physical activity intervention.

Examining factors that influence implementation of key program components that underlie an intervention’s success provides important information to inform the development of effective dissemination strategies. We examined direct and indirect effects of preschool capacity, quality of prevention support system and teacher characteristics on implementation levels of a component, called Move Outside (i.e., preschool classroom teachers to provide at least 40 min of outdoor recess per day), that was fundamental to the success of a preschool-based physical activity intervention. Level of implementation, defined as the percent of daily goal met for the Move Outside component, was assessed via direct observation. Items assessing preschool capacity, quality of prevention support system and teacher characteristics were selected from surveys and an environmental checklist completed by preschool directors and teachers. Preschool classroom was used as the unit of analysis (Year 1: n = 19; Year 2: n = 17). Results from Bayesian path analyses showed that the three factors were not significantly associated with level of implementation in Year 1, but preschool capacity was directly associated with level of implementation in Year 2 (β= 0.528, 95% CI: 0.134, 0.827). The current findings suggest that factors that influence level of implementation appear to differ as an intervention evolved over time.

Effectiveness of Community-Based Minigrants to Increase Physical Activity and Decrease Sedentary Time in Youth.

To determine the effectiveness of targeted grant funding for the implementation of multilevel community interventions to increase moderate to vigorous physical activity (MVPA) and decrease time spent sedentary among a large sample of youth in North Carolina. A repeated, cross-sectional, group-randomized controlled trial design with a delayed treatment group. Twenty counties in North Carolina. Analyses were conducted on 2138 youth, grades 4 to 8, who provided complete data across the 3 waves. The North Carolina Eat Smart, Move More Community Grants program consisted of 20 separate community interventions implemented by grantees that targeted increasing physical activity and/or decreasing sedentary time in youth. County grantees were pair-matched and randomized to receive funding for implementation in year 1 (2010-2011) or year 2 (2011-2012). MVPA/sedentary time was assessed via accelerometer with demographics assessed via self-report in 3 waves of data collection (fall 2010, 2011, and 2012). MVPA and sedentary time measured via accelerometry. After adjusting for covariates, there was no difference in MVPA between counties implementing in year 1 (2010-2011) and those implementing in year 2 (2011-2012; ie, waitlist controls) comparing data collection wave 1 to wave 2 (fall 2010-2011). A significant increase of 2.32 minutes per day of MVPA was observed following the implementation year across all counties as compared with the baseline year. Differences were largely driven by increased MVPA in elementary school youth (fourth and fifth grades). No significant changes in sedentary time were observed. Low-cost, high-reach mini-grants can have a small, but meaningful effect on children's MVPA, with greater effects seen in younger children. Future studies should examine characteristics of mini-grants projects that are associated with the greatest increases in MVPA among youth.

Investigating the Effect of Customization on Rework in a Higher Education Enterprise Resource Planning (ERP) Post-Implementation Environment: A System Dynamics Approach

Management of enterprise resource planning (ERP) projects is exceedingly challenging due to their large scope and complexity. Schedule and cost overruns have been widely reported in ERP implementation for years. Not only are resources critical to successful ERP implementation, but the post-implementation requires substantial resources as well. However, the resources required to maintain and extend ERP systems after implementation are not well understood, especially in the presence of software customizations which increase the total cost of ownership. This research applies system dynamics simulation modeling, focusing on the rework cycle, to data of a case study toward three primary goals. First, it contributes to both the system dynamics literature and the pre-packaged software literature by exploring the post-adoption ERP environment and extending the task rework cycle. Secondly, it develops a simulation model, grounded in ERP literature and in well-established system dynamics project models, helping practitioners and organizations in making more informed customization decisions by giving them a tool to better assess the long-term resource implications of ERP customization. Lastly, it addresses research gaps recently identified regarding issues such as customization, project evaluation, effort estimation, impact of adoption, system maintenance, performing updates with enterprise apps, and potential reasons for system abandonment.

Have the Year 2000 Neonatal Resuscitation Program Guidelines Changed the Delivery Room Management or Outcome of Meconium-Stained Infants?

To study the impact of neonatal resuscitation program (NRP) guidelines on delivery room (DR) management of infants born through meconium-stained amniotic fluid (MSAF). A retrospective study of all term (>or=37 weeks) infants born through MSAF was performed. Patients were divided into two periods: pre year 2000 NRP and post year 2000 NRP. Meconium consistency, APGAR scores and intubation (INT) for suctioning and respiratory outcome were recorded. Groups were analyzed using chi (2) tests and stepwise logistic regression. The incidence of MSAF remained constant in period 1 (13.6%) and period 2 (13.1%) while the proportion of infants intubated fell from 67 to 41% (p<0.001). The incidence of meconium aspiration and nonspecific respiratory distress did not differ between groups. Since the implementation of year 2000 NRP guidelines, the rate of DR INT for tracheal suctioning has fallen significantly without a change in overall respiratory complications. Results of this study support the efficacy of year 2000 NRP recommendations.