Proactive Initiation Research Articles

Secure and Efficient Wireless Sensor Network and Machine Learning -based Monitoring System for Student Physical and Mental Health

In this research we have reviewed the performance of machine learning algorithms and WSNs for the monitoring student physical and mental health. We have found that logistic regression is a stronger alternative after an exhaustive evaluation of machine learning algorithms that consistently produce superior performance metrics than Gaussian mixture models (GMM). This has demonstrated average accuracy of 87.1% across 10 experiments, besting the average accuracy of 83.8% of GMM. It also illustrates greater efficacy for assessing system security, producing average accuracy of 86.6%, with 91.9% for GMM. The findings demonstrate the significance of select a machine learning algorithms that meets the specific needs of monitoring student health systems. They are also an illustration of logistic regressions dependability, and adeptness at identifying subtle changes in student health indicators that allow for proactive initiation of interventions and support mechanisms tailored to individual students’ needs. Going forward, monitoring systems should next be further refined and optimised so that they can more effectively support both student well-being and academic success in the complex and diverse educational settings of Indian universities.

"ReachOut": Pilot Evaluation of a Help-Seeking Intervention for Common Mental Health Concerns Among Distressed Non-Treatment-Seeking Young Adults.

Purpose There is a pressing need for interventions with the potential for scalability to enhance help-seeking inclination and behavior among individuals experiencing common mental health concerns. These interventions are important for addressing the widespread treatment gap. This study aimed to test the effectiveness, feasibility, and acceptability of a newly developed simple technology-based multi-component help-seeking intervention ("ReachOut") for common mental health concerns among distressed, non-treatment-seeking young adults. Methods "ReachOut" was delivered to 172 young adults aged 20-35 years, scoring above the cut-off on the Kessler Psychological Distress scale. Effectiveness was studied using a single-group short-term prospective study design to examine changes in help-seeking barriers, inclination, and behavior. We assessed intervention feasibility in terms of demand, implementation, practicality, and limited efficacyand acceptability was determinedbased on the rate of participation consent, the extent of pro-active initiation of contact with the facilitatorduring the intervention, feedback obtained on various "ReachOut" componentsand ratings on the likelihood of recommendingthe interventiontoa person in distress. Results Significant reductions in the mean barriers and improvement in mean help-seeking inclination from mental health professionals (MHPs) were observed on the Friedman test from baseline to the two-month follow-up period after the intervention. Thirty-eight percent of participants (N=41) reported seeking help from MHPs by two-month follow-up. Feedback from participants, assessments, and observations indicated that "ReachOut" was feasible and acceptable among the target sample. Conclusions The study provides preliminary evidence of the effectiveness, feasibility, and acceptability of the help-seeking intervention "ReachOut" in reducing barriers and improving help-seeking inclination and behavior for common mental health concerns among distressed non-treatment-seeking young adults.

Assessing the long-term implications of age 9 initiation of HPV vaccination on series completion by age 13-15 in the US: projections from an age-structured vaccination model.

Routine human papillomavirus (HPV) vaccination in the US is recommended at ages 11 or 12 years and can be given at age 9. Vaccination completion rates among adolescents 13-15 years in the US remain below the 80% goal. This study evaluated the long-term effects of increasing proactive HPV vaccination initiation rates at age 9 years in completion rates of adolescents. An age-structured vaccination model was developed and parametrized based on the National Immunization Survey-Teen (NIS-Teen) survey data. The model projected vaccination coverage (by vaccination status and age group), for 20 years, for a routine initiation scenario (no increase in initiation rates of 9-year-olds) and different proactive initiation (increased age 9 initiation) scenarios. The time to reach a completion rate of 80% for 13-15-year-olds was estimated. The model also generated projections stratified for subgroups of interest. Results indicated that vaccine completion rates of 80% in 13-15-year-olds may not be achieved by 2040 under current trends of routine initiation at ages 11 or 12 years. However, increasing initiation rates in 9-year-olds by 1% and 3% annually could shorten the time to achieve 80% completion by 4 and 8 years, respectively. Stratification analyses showed that increasing initiation rates in 9-year-olds can also reduce disparities across subgroups in the time to achieve vaccination completion targets. Increasing HPV vaccination initiation rates in 9-year-olds by as little as 1%-3% annually may be an effective strategy to improve HPV vaccination completion rates in adolescents by age 15 and reach the Healthy People goal of 80% completion much earlier.

Using electronic consultation (eConsult) to identify frailty in provider-to-provider communication: a feasibility and validation study

BackgroundFrailty is a complex age-related clinical condition that increases vulnerability to stressors. Early recognition of frailty is challenging. While primary care providers (PCPs) serve as the first point of contact for most older adults, convenient tools for identifying frailty in primary care are lacking. Electronic consultation (eConsult), a platform connecting PCPs to specialists, is a rich source of provider-to-provider communication data. Text-based patient descriptions on eConsult may provide opportunities for earlier identification of frailty. We sought to explore the feasibility and validity of identifying frailty status using eConsult data.MethodseConsult cases closed in 2019 and submitted on behalf of long-term care (LTC) residents or community-dwelling older adults were sampled. A list of frailty-related terms was compiled through a review of the literature and consultation with experts. To identify frailty, eConsult text was parsed to measure the frequency of frailty-related terms. Feasibility of this approach was assessed by examining the availability of frailty-related terms in eConsult communication logs, and by asking clinicians to indicate whether they can assess likelihood of frailty by reviewing the cases. Construct validity was assessed by comparing the number of frailty-related terms in cases about LTC residents with those about community-dwelling older adults. Criterion validity was assessed by comparing clinicians' ratings of frailty to the frequency of frailty-related terms.ResultsOne hundred thirteen LTC and 112 community cases were included. Frailty-related terms identified per case averaged 4.55 ± 3.95 in LTC and 1.96 ± 2.68 in the community (p < .001). Clinicians consistently rated cases with ≥ 5 frailty-related terms as highly likely of living with frailty.ConclusionsThe availability of frailty-related terms establishes the feasibility of using provider-to-provider communication on eConsult to identify patients with high likelihood of living with this condition. The higher average of frailty-related terms in LTC (versus community) cases, and agreement between clinician-provided frailty ratings and the frequency of frailty-related terms, support the validity of an eConsult-based approach to identifying frailty. There is potential for eConsult to be used as a case-finding tool in primary care for early recognition and proactive initiation of care processes for older patients living with frailty.

Early versus late administration of long-acting injectable antipsychotic agents among patients with newly diagnosed schizophrenia: an analysis of a commercial claims database.

This study was designed to assess healthcare resource utilization (HCRU) and costs in patients with newly diagnosed schizophrenia based on timing and context of long-acting injectable antipsychotic agent (LAI) initiation. Using claims data, patients (aged 18-40 years) with first schizophrenia diagnosis January 2013-September 2019 (index date), no LAI or oral antipsychotic agent claims during 12-month preindex period, and continuous benefit enrollment from 12 months before index date to 12 months after first LAI administration were identified. Patients were grouped based on timing [early (≤1 year after index date) vs. late] and circumstances [reactive (after schizophrenia-related event) vs. proactive] of LAI initiation. Of 1290 patients with at least one LAI claim, 306 met criteria for early ( n = 204; reactive, n = 107; proactive, n = 97) and late ( n = 102; n = 75; n = 27) initiation. HCRU and costs were numerically lower in early versus late groups, and significantly lower for proactive initiation in both groups. Comparing worst-case (late-reactive) and best-case (early-proactive) scenarios, the average annual cost difference was $7195.13 ( P = 0.0233), with major drivers being emergency department ($171.28; P < 0.05) and other outpatient ($2845.73; P < 0.00001) visits. In addition to the clinical advantages previously described in the literature, the proactive use of LAIs in early-phase schizophrenia is associated with lower healthcare costs.

HPV vaccine initiation at 9 or 10 years of age and better series completion by age 13 among privately and publicly insured children in the US

ABSTRACT The US Advisory Committee on Immunization Practice recommends routine human papillomavirus (HPV) vaccination at 11–12 years of age, but states that vaccination may be initiated as early as 9 years. Our primary goal was to assess whether initiating HPV vaccination at 9–10 years of age, compared to 11–12, was associated with a higher rate of series completion by 13 years of age, and to identify factors associated with series completion by age 13. The study used vaccine claims and other data from the IBM MarketScan Commercial Claims and Encounters (privately insured) and IBM MarketScan Multi-State Medicaid (publicly insured) databases. Participants were 9–12 years of age and initiated HPV vaccination between January 2006 and December 2018 (publicly insured) or February 2019 (privately insured). Among 100,117 privately insured individuals, those initiating the HPV vaccination series at 9–10 years of age had a significantly higher series completion rate by 13 years of age than did those initiating at 11–12 years of age (76.2% versus 48.1%; p < .001). The same pattern was observed for 115,863 publicly insured individuals (70.4% versus 40.0%; p < .001). Provider and health care plan type, female sex, race/ethnicity, and wellness checks or non-HPV vaccinations during the baseline period were significantly associated with series completion by 13 years of age. Proactive initiation of HPV vaccination at 9–10 years of age was associated with higher rates of series completion by 13 years of age. These findings can inform provider education and other interventions to encourage timely HPV vaccination series completion.

The Benefits of Being Proactive While Working Remotely: Leveraging Self-Leadership and Job Crafting to Achieve Higher Work Engagement and Task Significance.

Given the growing number of remote and hybrid working arrangements, this research investigates the process and outcomes of proactivity during remote work. We approach proactivity during remote working as a resource-building process and integrate self-leadership and job crafting literature. We propose that employees’ self-leadership allows them to regulate their resources optimally, enabling resource availability that can be used to arrange remote working demands and resources proactively. We collected three-wave data from remote workers (n = 329 observations) and tested our hypotheses using multilevel analyses. Results differed by level of analysis. Specifically, at the between level, comparing behaviors between participants, social expansion mediated the relationship between self-goal setting and task significance. In contrast, at the within level (analyzing differences in behavior within the same person), social expansion mediated the relationship between self-goal setting and work engagement. Overall, these findings suggest that self-leadership allows higher availability of resources enabling the proactive initiation of social interactions, which, at the within level enhance work engagement, and at the between level improve task significance during remote work. We discuss these findings considering the implications for interventions to foster more positive remote-work experiences.

Prediction of emergency department patient disposition decision for proactive resource allocation for admission.

We investigate the capability of information from electronic health records of an emergency department (ED) to predict patient disposition decisions for reducing "boarding" delays through the proactive initiation of admission processes (e.g., inpatient bed requests, transport, etc.). We model the process of ED disposition decision prediction as a hierarchical multiclass classification while dealing with the progressive accrual of clinical information throughout the ED caregiving process. Multinomial logistic regression as well as machine learning models are built for carrying out the predictions. Utilizing results from just the first set of ED laboratory tests along with other prior information gathered for each patient (2.5h ahead of the actual disposition decision on average), our model predicts disposition decisions with positive predictive values of 55.4%, 45.1%, 56.9%, and 47.5%, while controlling false positive rates (1.4%, 1.0%, 4.3%, and 1.4%), with AUC values of 0.97, 0.95, 0.89, and 0.84 for the four admission (minor) classes, i.e., intensive care unit (3.6% of the testing samples), telemetry unit (2.2%), general practice unit (11.9%), and observation unit (6.6%) classes, respectively. Moreover, patients destined to intensive care unit present a more drastic increment in prediction quality at triage than others. Disposition decision classification models can provide more actionable information than a binary admission vs. discharge prediction model for the proactive initiation of admission processes for ED patients. Observing the distinct trajectories of information accrual and prediction quality evolvement for ED patients destined to different types of units, proactive coordination strategies should be tailored accordingly for each destination unit.

Overcoming vulnerability: Channel design strategies to alleviate vulnerability perceptions in customer journeys

Research has shown that any individual consumer, regardless of membership in any particular class, may experience vulnerability in the marketplace. While studies have identified core determinants of customer vulnerability states and perceptions and outlined their impact on consumers and firms, there is little research on how channel design, as part of service design strategies, can be employed to alleviate or prevent states and perceptions of vulnerability. This study extends the current literature on customer vulnerability by developing a framework that delineates determinants and consequences of vulnerability that manifest in problems of accessing or processing resources. We outline three relevant channel design strategies that service providers might employ to alleviate vulnerability: (1) flexibility through multiple multichannel paths, (2) guidance through constrained channel paths and (3) proactive initiation of interactions. Additionally, we propose a future research agenda and offer recommendations for managerial practice regarding how to identify customer vulnerability and employ countermeasures.

REGISTRIES AND CARE OF NEUROMUSCULAR DISORDERS: P.287Mechanically assisted cough: how to keep it simple

Mechanical insufflation - exsufflation (MI:E) is a life extending method in neuromuscular patients with cough insufficiency. It supports airway clearance to prevent mucous retention, atelectasis and pneumonia. Some neuromuscular centers (NMC) are still unexperienced and hesitant in its use. In our pediatric NMC we have thus developed a standardized approach to facilitate practical use. Initial routine was based on literature and experience of two large centers. We use only one type of device. MI:E is introduced when cough peak flow is <50% of age-related reference, in ventilated patients and in case of clinical obvious cough insufficiency. We preset 3 different modes for home use. Mode 1 provides only insufflation for daily lung volume recruitment in health. In mode 2 in- and exsufflation are preset for airway secretions or SpO2<95%. In mode 3 expiratory oscillation during exsufflation is added for sticky secretions. Durations of in- and exsufflation are increased with age while pressures for in- and exsufflation are fixed at 30-35 cmH2O and -40 cmH2O. Staff, patients and caregivers are trained in MI:E to use modes depending on health condition of the patient and for emergencies. Retraining is performed regularly. This standardization facilitated teaching of staff, patients and caregivers in MI:E in our and other Austrian NMCs. Acceptance was rapid. Only 10% required adaptations to optimize efficacy. Proactive initiation and empowerment of patients and caregivers through training in applying those 3 different modes prevent emergencies. In 60 patients initiated using MI:E during 4 years no pneumothorax occurred. Only 2 SMA 1 patients died due to severe course of disease. This model could be used as a guide for NMCs with limited specialized staff for and expertise in respiratory management. Further investigations regarding the effects on clinical end points like hospitalisation rate and survival are needed.

Momentary Effects of Customer Incivility and Effectiveness of Emotion-Focused Coping Strategies

Customer incivility is a common occurrence for frontline service employees that is associated with employees’ impaired short term as well as long term well-being and performance. Given its severe impact, research has been trying to explore effective ways to mitigate the detrimental effect of customer mistreatment. However, the search has been predominately directed at external environmental factors and role of employees’ proactive initiation of coping behaviors only got minimal attention. This ignores employees’ own agency and proactivity in dealing with stressors. In this research, we examined effectiveness of two emotion- focused coping strategies. In more detail, we collected momentary data from parking officers and examined their engagement of job avoidance and venting after encountering customer incivility. While job avoidance buffers the negative impact of customer incivility, venting ironically aggravate the negative effect. Furthermore, our study also showed the boundary effect of employees’ prosocial motivation.

The Proactive Initiation of SMEs’ Foreign Business Relationships

Taking control over one's destiny by proactive internationalization has been considered an important performance indicator in small business research. We develop a model that examines how internal and external contextual factors influence SMEs’ foreign market entry through proactive initiation of business relationships in foreign markets. The ability to proactively leverage such relationships is essential for opening up avenues into foreign markets and serves as a first step in negating the liability of outsidership that could prohibit firms from acquiring relevant market‐specific resources. By examining the dynamics that either can enable or constrain firms in their efforts to become insiders in foreign markets in the entry phase, we contribute to international small business theory. We also add conceptual and practical insights to international small business research by providing valuable empirical verification of how and to what extent the proactive initiation of foreign business relationships of SMEs is internally or externally conditioned.

Creating Shared Value Through Implementing Vocational Rehabilitation In The Corporate Social Responsibility Strategy: A Literature Review

After an accident or illness, it may be difficult or even impossible to return to work. Although occupational safety and health (OHS) are essential elements of corporate social responsibility (CSR), support for employees returning to work or vocational rehabilitation are rarely part of the CSR strategy. The aim of this paper is to assess and synthesize the current state of research of vocational rehabilitation in the context of CSR. A literature analysis was conducted to examine the need to address vocational rehabilitation as part of the CSR strategy as well as the existing approaches for implementation. Vocational rehabilitation is an important part of a company's social responsibility towards its employees as well as towards society. The promotion of vocational rehabilitation should be an essential element of the CSR strategy and can create shared value. However, a commitment to vocational rehabilitation alone is not enough; the commitment must be explicitly described and go beyond the legal minimum. That can be done, for example, through return-to-work (RTW) policies, proactive initiation and coordination of the rehabilitation process, the adaptation of the workplace and work activities, the institutionalization of sheltered workplaces, and a specialist unit for vocational rehabilitation within the company. Particularly access for external persons to the company's sheltered workplaces, internships or entry-level positions is a critical aspect for substantially promoting vocational rehabilitation and achieving additional shared value. Vocational rehabilitation as part of the CSR strategy must continue to be examined empirically, in particular "best practice" approaches from business practice.

A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South.

Despite growing efforts to facilitate advance care planning (ACP) to decrease health disparities in palliative care, low completion rates of advance directives (AD) have been consistently found among African Americans. The objective was to examine the feasibility of a multicomponent ACP intervention program that integrates motivational interviewing, evidence-based ACP facilitation program (Respecting Choices(®)), and health-literacy adjusted AD. This pilot study aims to address the unique barriers to ACP engagement among African Americans in the Deep South. The design was a mixed-method randomized controlled trial design. Analysis of covariance (ANCOVA) and thematic content analysis (TCA) were conducted to identify barriers and facilitators for ACP engagement and to assess feasibility, knowledge, and intention to complete an AD. Thirty community-dwelling African Americans (mean age M = 55.43, SD = 6.71, range = 47-73) were recruited from the Deep South and randomly assigned to receive intervention (n = 15) or educational material (n = 15) at a local university medical center. All participants (n = 30) reported high satisfaction (M = 4.81, SD = 0.44, max score = 5) and increased intent to complete an AD at postintervention. A significant increase in knowledge on AD from baseline to postintervention was observed in the intervention group-t(14) = -3.06, p = 0.01, d = 1.67); no significant change was found for control. Lack of information, mistrust of doctors, and avoidance of discussing death were primary barriers to ACP discussions. Facilitators include ACP education, decreased mistrust, and proactive initiation of ongoing ACP discussions. Feasibility data revealed successful implementation of a brief intervention to increase ACP engagement and willingness to complete an AD among southern African Americans.

The Role of Negative Life Events in Comorbid Reactive Aggression and Marijuana Use Initiation among Latino Adolescents

Compelling epidemiological evidence shows that marijuana use is highly comorbid with aggressive behavior, particularly among adolescents and young adults; yet the causal nexus between these 2 phenomena remains elusive. To better understand the comorbidity of specific subtypes of aggression and marijuana use, this study evaluated associations between proactive and reactive aggression and marijuana use initiation and examined whether negative life events (NLEs) partially accounted for the link between reactive aggression and marijuana use initiation in a sample of Latino adolescents (N = 144, 54% male, mean age = 16.25 years). Results indicated that approximately 43% of participants had tried marijuana. NLEs were associated with both marijuana use initiation and reactive aggression, but were unrelated to proactive aggression, thereby providing support for similar environmental correlates for reactive aggression and marijuana use. Further, a test of indirect effects suggested that NLEs partially accounted for the link between reactive aggression and marijuana use initiation, with NLEs accounting for 14% of the variance in this association. Implications for intervention and future directions for research are discussed.

Assessment of Driver Stress from Physiological Signals collected under Real-Time Semi-Urban Driving Scenarios

AbstractDesigning a wearable driver assist system requires extraction of relevant features from physiological signals like galvanic skin response and photoplethysmogram collected from automotive drivers during real-time driving. In the discussed case, four stress-classes were identified using cascade forward neural network (CASFNN) which performed consistently with minimal intra- and inter-subject variability. Task-induced stress-trends were tracked using Triggs’ Tracking Variable-based regression model with CASFNN configuration. The proposed framework will enable proactive initiation of rescue and relaxation procedures during accidents and emergencies.

All about RIKEN Integrated Cluster of Clusters (RICC)

This is an introduction to the RIKEN’s supercomputer RIKEN Integrated Cluster of Clusters (RICC), that has been in operation since August 2009. The basic concept of the RICC is to “provide an environment with high power computational resources to facilitate research and development for RIKEN’s researchers”. Based on this concept, we have been operating the RICC system as a (i) data analysis environment for experimental researchers, (ii) development environment targeting the next-generation supercomputer; i.e., the “K” computer, and (iii) GPU (graphics processing unit) computers for exploring challenges in developing a future computer environment. The total performance of RICC is 97.94 TFlops, ranking it as the 125th on the Top500 list in Nov. 2011. We prepared four job class accounts, based on the researchers’ proposals prior to evaluation by our Review Committee. We also provided backup services to RIKEN’s researchers, such as conducting RICC training classes, software installation services, and speed up and visualization support. To encourage affirmative participation and proactive initiation, all the services were free of charge; however, access to RICC was limited to researchers and collaborators of RIKEN. As a result, RICC has been able to maintain a high activity ratio (> 90%) since the beginning of its operation.

Opportunism as the Inhibiting Trigger for Developing Long-Term-Oriented Western Exporter–Hong Kong Importer Relationships

Notwithstanding the extensive literature on opportunism in buyer–seller relationships, scant empirical attention has been given to this issue in both international and Chinese contexts. Using a sample of 202 Hong Kong Chinese importers, this article highlights the harmful effect of Western exporters’ opportunism on importers’ long-term orientation through the intervening role of key behavioral constructs. The study confirms almost all hypothesized associations between the constructs examined, indicating that an exporter's opportunistic behavior reduces trust and generates conflict. In turn, low trust reduces commitment, and conflict impedes communication. Low levels of both commitment and communication reduce importers’ satisfaction, which inhibits their long-term orientation. The importer's proactive initiation of the relationship moderates the link between opportunism and trust but not that of opportunism with conflict. The study also confirms the moderating role of importer dependence and exporters’ marketing adaptation on the association of satisfaction with long-term orientation. The authors find moderating effects on this association through the Chinese constructs of renqing and mianzi, albeit in the opposite direction to that hypothesized.