Perfect Implementation Research Articles

Value of Implementation of Strategies to Increase the Adherence of Health Professionals and Cancer Survivors to Guideline-Based Physical Exercise

BackgroundTo increase the adherence of health professionals and cancer survivors to evidence-based physical exercise, effective implementation strategies (ISTs) are required. ObjectivesTo examine to what extent these ISTs provide value for money and which IST has the highest expected value. MethodsThe net benefit framework of health economic evaluations is used to conduct a value-of-implementation analysis of nine ISTs. Seven are directed to health professionals and two to cancer survivors. The analysis consists of four steps: 1) analyzing the expected value of perfect implementation (EVPIM); 2) assessing the estimated costs of the various ISTs; 3) comparing the ISTs’ costs with the EVPIM; and 4) assessing the total net benefit (TNB) of the ISTs. These steps are followed to identify which strategy has the greatest value. ResultsThe EVPIM for physical exercise in the Netherlands is €293 million. The total costs for the ISTs range from €34,000 for printed educational materials for professionals to €120 million for financial incentives for patients, and thus all are cost-effective. The TNB of the ISTs that are directed to professionals ranges from €5.7 million for printed educational materials to €30.9 million for reminder systems. Of the strategies that are directed to patients, only the motivational program had a positive net benefit of €100.4 million. ConclusionsAll the ISTs for cancer survivors, except for financial incentives, had a positive TNB. The largest improvements in adherence were created by a motivational program for patients, followed by a reminder system for professionals.

Impact of the Universal Adoption of Ring Block Anesthesia Pre-Circumcision in a Tertiary Care Center [26I

INTRODUCTION: Neonatal circumcision causes behavioral and physiologic changes consistent with the perception of pain. Ring block anesthesia pre-circumcision leads to a smaller increase in heart rate and respiratory rate. They demonstrated less arousal during each operative interval, less crying and a smaller decrease in oxygen saturation compared to infants not receiving anesthesia. A Joint commission site visit to our institution in March 2014 prompted the adoption of pre-circumcision anesthesia preferably ring block in April 2014 with the mindset of providing our pediatric patients with the same high quality care during a painful procedure. METHODS: A descriptive analysis of circumcision related data pertaining to the use of ring block anesthesia during circumcisions performed at Erlanger tertiary care facilities from March 2013 through March 2015. RESULTS: The use of ring block anesthesia application increased to 94.1% (n= 1394) out of 1482 post adoption compared to the prior 41.1% (n=727) out of 1770). Of note is the reduction in the total number of circumcision done in the hospital from n=1770 between March 2013 and 2014 to n=1394 between April 2014 and March 2015 of the study period. CONCLUSION: The near perfect implementation of ring block anesthesia pre-neonatal circumcision does illustrate the importance of hospital encouraged compliance in improving the quality of medical practice.

Projected impacts of increased uptake of source control mitigation measures on agricultural diffuse pollution emissions to water and air

A multi-pollutant modelling framework for England and Wales is described. This includes emissions of nitrate, phosphorus and sediment to water and ammonia, methane and nitrous oxide to air, and has been used to characterise baseline (no uptake of on-farm measures) and business-as-usual (BAU) annual pollutant losses, comparing these with the loss under a range of new policies aimed at increasing the uptake of relevant source control measures to 95% across England and Wales. Model outputs, including uncertainty ranges, evaluated using national water and air quality data layers have been summarised at both farm (Robust Farm Type) and water management catchment (WMC) scale. Nationally, across all farm types, the median annual reductions in pollutant losses under the new scenario, relative to BAU in 2010, were predicted to range between 9 and 16% for nitrate, 13–37% for phosphorus, 12–21% for sediment, 2–57% for methane and 10–17% for nitrous oxide. For ammonia, the range was −2–28%, indicating the potential for pollution swapping and an increase in ammonia emissions under scenarios designed to reduce nitrogen flux to waters. Increased uptake of pollution source control measures would result in a wide range of annual total (capital and operational) costs (per farm) for the major farm types, with median estimates ranging from £635 yr−1 (Less Favourable Areas (LFA) with grazing livestock) to £15,492 yr−1 (Cereals) in Nitrate Vulnerable Zone (NVZ) areas, compared with a range of £23 yr−1 to £13,484 yr−1 for the same respective farm types in non-NVZ areas. The estimated median annual load reductions for all WMCs relative to BAU, were predicted to be 16% for nitrate, 20% for phosphorus, 16% for sediment, 16% for ammonia, 15% for methane and 18% for nitrous oxide. These predictions suggest that almost perfect (95% uptake) implementation of source control measures will not deliver substantial improvements in pollutant emissions.

Stability conditions for a heat transfer object control system with Schipanov controller under imperfections in the controller

We study stability conditions for a control system over a linear one-side bounded heat transfer object with the so-called "Schipanov controller"; this controller under perfect implementation must ensure invariant behavior of the object's output related to the input influence. We study the behavior of the output of a closed system under such possible imperfections in controller implementation as pure delay and inertia; we find classes of influences with respect to which one can ensure stability of the closed system, and find estimates of its output's response levels to influences from these classes.

Subgame perfect implementation of the deserving winner of a competition with natural mechanisms

A jury has to decide the winner of a competition among a group of contestants. All members of the jury know who the deserving winner is, but this contestant is unknown to the planner. The social optimum is that the jury selects the deserving winner. Each individual juror may be biased in favor (friend) or against (enemy) some contestant, and therefore her goal does not necessarily coincide with the social objective. We analyze the problem of designing extensive form mechanisms that give the jurors the right incentives to always choose the deserving winner when the solution concept is subgame perfect equilibrium. We restrict the class of mechanisms considered to those which satisfy two conditions: (1) the jurors take turns to announce the contestant they think should win the competition, and (2) telling the truth is always part of a profile equilibrium strategies. A necessary but not sufficient condition for these mechanisms to exist is that, for each possible pair of contestants, there is at least one juror who is impartial with respect to them. If, in addition, the planner knows the friend or the enemy of at least one juror, the existence of these mechanisms is guaranteed in the three contestants case.

Robustness of Subgame Perfect Implementation

In this paper we consider the robustness of subgame perfect implementation in situations when the preferences of players are almost perfectly known. More precisely, we consider a class of information perturbations where in each state of the world players know their own preferences with certainty and receive almost perfectly informative signals about the preferences of other players. We show that implementations using two-stage sequential move mechanisms are always robust under this class of restricted perturbations, while those using more stages are often not.

The Impact of on-the-Job Training on Employee Performance: The Case of Riley’s Hotel

<p><em>The main objective of this study was to investigate the impact of on-the-job training on employee performance. It was a case study conducted at Riley’s Hotel at Maun; a tourist destination in the North Western part of Botswana. The researchers used a questionnaire to collect data. The results of the study indicated that to a large extent Riley’s Hotel implemented on the job training and that the majority of employees have attended the training. There is also an indication that most of the employees believe that on the job training makes them effective in their jobs. Too much work and time constraints were revealed as challenges to the successful implementation of on the job training. Employment of trained staff was suggested as a major possible solution to the challenges of on the job training. The study concludes that even though on the job training was implemented at Riley’s Hotel there were a number of challenges militating against its perfect implementation. This study would benefit any organization interested in on-the-job training and employee performance.</em></p>

Adjusting Estimates of the Expected Value of Information for Implementation: Theoretical Framework and Practical Application.

Value of information (VoI) calculations give the expected benefits of decision making under perfect information (EVPI) or sample information (EVSI), typically on the premise that any treatment recommendations made in light of this information will be implemented instantly and fully. This assumption is unlikely to hold in health care; evidence shows that obtaining further information typically leads to "improved" rather than "perfect" implementation. To present a method of calculating the expected value of further research that accounts for the reality of improved implementation. This work extends an existing conceptual framework by introducing additional states of the world regarding information (sample information, in addition to current and perfect information) and implementation (improved implementation, in addition to current and optimal implementation). The extension allows calculating the "implementation-adjusted" EVSI (IA-EVSI), a measure that accounts for different degrees of implementation. Calculations of implementation-adjusted estimates are illustrated under different scenarios through a stylized case study in non-small cell lung cancer. In the particular case study, the population values for EVSI and IA-EVSI were £ 25 million and £ 8 million, respectively; thus, a decision assuming perfect implementation would have overestimated the expected value of research by about £ 17 million. IA-EVSI was driven by the assumed time horizon and, importantly, the specified rate of change in implementation: the higher the rate, the greater the IA-EVSI and the lower the difference between IA-EVSI and EVSI. Traditionally calculated measures of population VoI rely on unrealistic assumptions about implementation. This article provides a simple framework that accounts for improved, rather than perfect, implementation and offers more realistic estimates of the expected value of research.

The implementation imperative:Why one should implement even imperfect strategies perfectly

Research summary: We propose a theory that explains why the relentless pursuit of perfect implementation of strategy may be useful even in a world in which the strategies being implemented are far from optimal. We formulate a computational model in which an organization's strategy adapts based on performance feedback. However, the distinctive feature of our approach is that we abandon the “organization as a unitary actor” assumption, and model a separation of beliefs and actions. The central insight is that, given this separation, precise implementation has benefits beyond the well‐known effect of enabling exploitation of good strategies. It enables the discovery of better strategies by allowing more effective learning from feedback on the value of current strategies.Managerial summary: Given the reality that the strategies coming from theC‐suite are seldom perfect, is it sensible for managers to place such a heavy emphasis on implementing them precisely? In this paper we develop a theory that explains why the answer may be “yes”. In most organizations, the formulators and implementors of strategy are distinct. Imprecise implementation makes it difficult for the formulators to learn the value of their strategies, as neither success nor failure necessarily indicates something about the value of the strategy itself, when implementation is imprecise. Copyright © 2015 John Wiley & Sons, Ltd.

Q인자 조절 가능 2차원 이산 웨이브렛 변환 필터의 설계와 성능분석

The general wavelet transform has profitable property in non-stationary signal analysis specially. The tunable Q-factor wavelet transform is a fully-discrete wavelet transform for which the Q-factor Q and the asymptotic redundancy r, of the transform are easily and independently specified. In particular, the specified parameters Q and r can be real-valued. Therefore, by tuning Q, the oscillatory behavior of the wavelet can be chosen to match the oscillatory behavior of the signal of interest, so as to enhance the sparsity of a sparse signal representation. The TQWT is well suited to fast algorithms for sparsity-based inverse problems because it is a Parseval frame, easily invertible, and can be efficiently implemented. The transform is based on a real valued scaling factor and is implemented using a perfect reconstruction over-sampled filter bank with real-valued sampling factors. The transform is parameterized by its Q-factor and its over-sampling rate, with modest over-sampling rates being sufficient for the analysis/synthesis functions to be well localized. This paper describes filter design of 2D discrete-time wavelet transform for which the Q-factor is easily specified. With the advantage of this transform, perfect reconstruction filter design and implementation for performance improvement are focused in this paper. Hence, the 2D transform can be tuned according to the oscillatory behavior of the image signal to which it is applied. Therefore, application for performance improvement in multimedia communication field was evaluated.

The Impact of Implementation Fidelity on Mortality Under a CD4-Stratified Timing Strategy for Antiretroviral Therapy in Patients With Tuberculosis.

Among patients with tuberculosis and human immunodeficiency virus type 1, CD4-stratified initiation of antiretroviral therapy (ART) is recommended, with earlier ART in those with low CD4 counts. However, the impact of implementation fidelity to this recommendation is unknown. We examined a prospective cohort study of 395 adult patients diagnosed with tuberculosis and human immunodeficiency virus between August 2007 and November 2009 in Kinshasa, Democratic Republic of the Congo. ART was to be initiated after 1 month of tuberculosis treatment at a CD4 count of <100 cells/mm(3) or World Health Organization stage 4 (other than extrapulmonary tuberculosis) and after 2 months of tuberculosis treatment at a CD4 count of 100-350 cells/mm(3). We used the parametric g-formula to estimate the impact of implementation fidelity on 6-month mortality. Observed implementation fidelity was low (46%); 54% of patients either experienced delays in ART initiation or did not initiate ART, which could be avoided under perfect implementation fidelity. The observed mortality risk was 12.0% (95% confidence interval (CI): 8.2, 15.7); under complete (counterfactual) implementation fidelity, the mortality risk was 7.8% (95% CI: 2.4, 12.3), corresponding to a risk reduction of 4.2% (95% CI: 0.3, 8.1) and a preventable fraction of 35.1% (95% CI: 2.9, 67.9). Strategies to achieve high implementation fidelity to CD4-stratified ART timing are needed to maximize survival benefit.

Experimental measurement-device-independent entanglement detection.

Entanglement is one of the most puzzling features of quantum theory and of great importance for the new field of quantum information. The determination whether a given state is entangled or not is one of the most challenging open problems of the field. Here we report on the experimental demonstration of measurement-device-independent (MDI) entanglement detection using witness method for general two qubits photon polarization systems. In the MDI settings, there is no requirement to assume perfect implementations or neither to trust the measurement devices. This experimental demonstration can be generalized for the investigation of properties of quantum systems and for the realization of cryptography and communication protocols.

The Role of Bounded Rationality and Imperfect Information in Subgame Perfect Implementation: An Empirical Investigation

In this paper we conduct a laboratory experiment to test the extent to which Moore and Repullo's subgame perfect implementation mechanism induces truth-telling in practice, both in a setting with perfect information and in a setting where buyers and sellers face a small amount of uncertainty regarding the good's value. We find that Moore-Repullo mechanisms fail to implement truth-telling in a substantial number of cases even under perfect information about the valuation of the good. This failure to implement truth-telling is due to beliefs about the irrationality of one's trading partner. Therefore, although the mechanism should - in theory - provide incentives for truth-telling, many buyers in fact believe that they can increase their expected monetary payoff by lying. The deviations from truth-telling become significantly more frequent and more persistent when agents face small amounts of uncertainty regarding the good's value. Our results thus suggest that both beliefs about irrational play and small amounts of uncertainty about valuations may constitute important reasons for the absence of Moore-Repullo mechanisms in practice.

The Role of Bounded Rationality and Imperfect Information in Subgame Perfect Implementation - An Empirical Investigation

The Role of Bounded Rationality and Imperfect Information in Subgame Perfect Implementation - An Empirical Investigation

Complementarity's Monopoly on Justice in Uganda: The International Criminal Court, Victims and Thomas Kwoyelo

The International Criminal Court was established to tackle impunity for international crimes. Its jurisdiction is premised on states being primarily responsible for investigating and prosecuting those who commit international crimes, with the Court only acting as a last resort. The principle of complementarity has arisen to explain such an arrangement. However, in practice in situational countries before the Court there has not been a perfect implementation of complementarity. Far from it, states have struggled to investigate and prosecute all those responsible, competing with other transitional justice needs and regional politics. This is apparent in Uganda, as the first situation referred to the International Criminal Court (ICC) in 2003. It has been embroiled in controversy of peace versus justice, yet only this year saw the transfer of the first indictee, Dominic Ongwen, before the Court. In the interim the Uganda government has become a critic of the ICC in regional discussions of the Court targeting Africans, despite inviting the Court to investigate crimes in its own country. This article charts the effects of complementarity in Uganda examining the development of domestic legislation, the creation of the International Crimes Division and the first international crimes trial of Thomas Kwoyelo. The emphasis of this article is on a more victim-orientated perspective, as the ICC is often extolled for its ‘innovative’ victim provisions of participation, protection and reparation. Moreover, in ending impunity, victim provisions are seen as a way to operationalize the independence and effectiveness of such domestic processes, in the face of political settlements and governmental discretion.

The Role of Bounded Rationality and Imperfect Information in Subgame Perfect Implementation: An Empirical Investigation

In this paper we conduct a laboratory experiment to test the extent to which Moore and Repullo's subgame perfect implementation mechanism induces truth-telling in practice, both in a setting with perfect information and in a setting where buyers and sellers face a small amount of uncertainty regarding the good's value. We find that Moore-Repullo mechanisms fail to implement truth-telling in a substantial number of cases even under perfect information about the valuation of the good. This failure to implement truth-telling is due to beliefs about the irrationality of one's trading partner. Therefore, although the mechanism should – in theory – provide incentives for truth-telling, many buyers in fact believe that they can increase their expected monetary payoff by lying. The deviations from truth-telling become significantly more frequent and more persistent when agents face small amounts of uncertainty regarding the good's value. Our results thus suggest that both beliefs about irrational play and small amounts of uncertainty about valuations may constitute important reasons for the absence of Moore-Repullo mechanisms in practice.

Cost-Effectiveness Analysis of Clinically Indicated Versus Routine Replacement of Peripheral Intravenous Catheters

Millions of peripheral intravenous catheters are used worldwide. The current guidelines recommend routine catheter replacement every 72-96 h. This practice requires increasing healthcare resource use. The clinically indicated catheter replacement strategy is proposed as an alternative. To assess the cost effectiveness of clinically indicated versus routine replacement of peripheral intravenous catheters. A cost-effectiveness analysis from the perspective of Queensland Health, Australia, was conducted alongside a randomized controlled trial. Adult patients with an intravenous catheter of expected use for longer than 4 days were randomly assigned to receive either clinically indicated replacement or third-day routine replacement. The primary outcome was phlebitis during catheterization or within 48 h after catheter removal. Resource use data were prospectively collected and valued (2010 prices). The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations. Additionally, value of information (VOI) and value of implementation analyses were performed. The clinically indicated replacement strategy was associated with a cost saving per patient of AU$7.60 (95% confidence interval [CI] 4.96-10.62) and a non-significant difference in the phlebitis rate of 0.41% (95% CI -1.33 to 2.15). The incremental net monetary benefit was AU$7.60 (95% CI 4.96-10.62). The expected VOI was zero, whereas the expected value of perfect implementation of the clinically indicated replacement strategy was approximately AU$5 million over 5 years. The clinically indicated catheter replacement strategy is cost saving compared with routine replacement. It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinically indicated.

Balancing Market and Government Failure in Service Delivery

Whether to provide services by the public or the private sector has been at the center of debates within governments and those in the international aid industry for decades. Unfortunately, this debate has often been cast in terms of absolutes with the private sector either as savior or demon. Casting the issue in this light simply can’t be correct. It cannot be the case that either is appropriate for every service and with every government regardless of its capability to the exclusion of the other. In every case, policy makers need to ask “how can the government improve the well-being of citizens with the constraints and tools at hand?” Those constraints include the ability to implement and monitor policy. This paper outlines how limitations of the market can be matched to appropriate interventions by government as it actually performs, not as it is hoped to perform. This matching will, by necessity, vary with country circumstance. While pure public goods must be provided by government regardless of its weaknesses and pure private goods should generally be left to the market, most serious policies operate in between. The balance of the limitations of the sectors needs careful analysis. The welfare costs of private market failure are rarely measured and the difficulties of implementing different policies are rarely discussed let alone quantified. Policies that are sensitive to deviations from perfect implementation should be avoided in preference to those that are more robust to circumstances. Further, every policy will generate interest groups that will constrain future decisions through political pressure.

Implementation of a Security Protocol for Bluetooth and WI-FI

This paper is mainly based on providing security to the wireless networks through which devices like Bluetooth gets connected. The Wi-Fi connections are also prone to various attacks these days. The protocols that are required to provide security to wireless networks can be implemented by creating a wireless scenario using the software Network Simulator. This paper illustrates a scenario to check the security protocol. As NS2 mainly has the implementation of routing protocols, a new protocol should be designed especially for security purpose. This is done by following many tutorials to get a minimum basic knowledge of NS2, C/C++ coding. The security feature followed in the paper is encryption/decryption of the data that is being exchanged. Data should be ensured as and then there will be a perfect implementation of the protocol. So, the paper throughout concentrates on adding a new security protocol to NS2 and implementation of that protocol by providing a wireless scenario.

A neural computational model for animal’s time-to-collision estimation

The time-to-collision (TTC) is the time elapsed before a looming object hits the subject. An accurate estimation of TTC plays a critical role in the survival of animals in nature and acts as an important factor in artificial intelligence systems that depend on judging and avoiding potential dangers. The theoretic formula for TTC is 1/τ≈θ'/sin θ, where θ and θ' are the visual angle and its variation, respectively, and the widely used approximation computational model is θ'/θ. However, both of these measures are too complex to be implemented by a biological neuronal model. We propose a new simple computational model: 1/τ≈Mθ-P/(θ+Q)+N, where M, P, Q, and N are constants that depend on a predefined visual angle. This model, weighted summation of visual angle model (WSVAM), can achieve perfect implementation through a widely accepted biological neuronal model. WSVAM has additional merits, including a natural minimum consumption and simplicity. Thus, it yields a precise and neuronal-implemented estimation for TTC, which provides a simple and convenient implementation for artificial vision, and represents a potential visual brain mechanism.