Visit Planning Research Articles

The Waste Management System in the Parking and Traders Arrangement in the Borobudur Temple Area, Central Java, Indonesia

The Indonesian government continues to accelerate the resolution of all problems related to the planning, infrastructure development, and arrangement of tourist visits, including the arrangement of parking spaces and commercial areas in the Borobudur temple area. The purpose of this study is to develop a waste management system in the parking and commercial areas of Kujon as an alternative to structuring the Borobudur temple area. The research method is a descriptive-qualitative observational approach. Surface water and groundwater examinations are carried out in laboratories and compared with quality criteria determined by the Indonesian government. Toxic and hazardous waste is stored in temporary facilities until it is collected by a company licensed by the Indonesian environmental ministry. The Shannon-Wiener Plankton and Benthos Diversity Index measures the diversity of organisms in a community. The study’s findings highlight the need to establish a waste processing facility based on the reduction, reuse, and recycling principles. Waste will be collected at a certain site and stored temporarily in line with the technical instructions for the Minister of Environment and Forestry’s Regulation. The findings of surface water and groundwater studies demonstrate that all measured parameters continue to meet the Indonesian government’s quality thresholds. Plankton Bioindicator Measurements: Plankton diversity index values range from 1.040 to 1.943, indicating moderate pollution, while benthos values range from 0.811 to 0.918, indicating weakly to moderately contaminated conditions. Sustainable environmental management is critical and should serve as a baseline for environmental quality in the activity area.

Direct annual healthcare costs in survivors of acute pulmonary embolism: estimates based on a prospective multicentre cohort study

Abstract Background Patients surviving acute pulmonary embolism (PE) necessitate long-term care and follow-up. However, the economic impact of PE on healthcare systems after the acute event remains largely unknown. Purpose To estimate the direct cost of PE during the first year after discharge from hospital for the index event, focusing on rehospitalizations, anticoagulant medication, and outpatient follow-up. Methods We analyzed the data from a multicentre cohort study of 1017 unselected patients with confirmed acute symptomatic PE in Germany. After the index episode, the costs of which were not considered, patients prospectively followed an outpatient visit plan at 3, 12 and 24 months. All rehospitalisations were documented with the main and accompanying diagnoses; hospital costs were calculated based on current reimbursement in the German Diagnosis Research Groups (G-DRG) system. The duration and type (central unique drug identifier) of anticoagulant treatment was documented at each visit. Per-patient costs of ambulatory follow-up visits and tests were calculated by multiplying (i) the costs of each visit/test (German ambulatory healthcare services reimbursement catalogue) by (ii) the probability π (0.0≤π≤1.0) of needing that specific service, based on the PE follow-up algorithm of the ESC Guidelines which we populated with the actual results per step in the present study (Figure). The primary analysis was conducted in all patients with ≥3-month follow-up. An additional sensitivity analysis included only the patients completing ≥12-month follow-up. We additionally identified the baseline predictors for the number of rehospitalizations and costs using multivariable zero-inflated Poisson and hurdle regression and accounting for censored data. Results Of 1017 enrolled patients, 958 (94%) were included in the primary analysis. Of them, 24% were rehospitalized, for a marginal mean of 0.34 (bootstrapped 95% CI: 0.30-0.39) readmissions per PE survivor. Age, coronary artery, pulmonary and kidney disease, diabetes, and (in the sensitivity analysis) cancer, emerged as independent cost predictors by multivariable hurdle gamma regression (Table). Estimated overall rehospitalisation costs were €1138 (95% CI 896-1420) per patient (€1171 [908-1479] in the sensitivity analysis). Mean anticoagulation duration was 330 days, with estimated per-patient costs of €1050 (€1190 in the sensitivity analysis). Per-patient costs of ambulatory follow-up visits and tests were estimated at €182, yielding a total cost of illness per PE survivor of €2370-2543. For the entire country, the annual direct costs after acute PE would thus amount to €202-217 million. Conclusions By estimating per-patient costs and identifying major cost drivers of post-PE care, the present study may inform decisions concerning implementation and reimbursement of follow-up programmes aiming at improved overall cardiovascular prevention.TableFigure

Intelligent System for Tourist Guidance in Tumbes-Perú

An Intelligent System (IS) for Tourist Guidance was developed for the city of Tumbes, Peru. Considering the preferences of the tourist, the IS obtains the optimal route for the visit and provides a visit plan with schedules and times of stay in each place. It is an innovative hybrid system since it is complemented by two artificial intelligence techniques, a rule-based expert system and a genetic algorithm. The methodology for the implementation of the IS consisted of the collection of tourist, geographic, georeferenced information and photographs of 28 tourist places, grouped into Beaches, Nature, Adventure, Culture and Medicinal Sites, then the logical rules, the distance matrix and time of stay in each place were developed, and finally with the vehicle routing technique the genetic algorithm is implemented that allows obtaining the optimal route. The results indicate that the GA provides optimal solutions with an execution time of 5.6 seconds and zero errors. This contribution is very important for future work on tourist profiles and new tourist routes, since the intelligent system can be adapted for use in other cities.

Perceptions of Stakeholders and the Way Forward to Implementing the Family Adoption Programme in Medical Education: A Study From Assam, India.

Background The Family Adoption Programme (FAP) has been introduced under the competency-based medical education curriculum wherein each medical student adopts families. Theobjective of this study was to determine the stakeholders' perspective and to suggest measures to make it relevant for Indian medical graduates. Methodology A mixed-method study was conducted among the faculty, undergraduate students, and community using prestructured, validated instruments. The quantitative data were entered into Microsoft Excel (Microsoft Corp., Redmond, WA) and analysed, while the qualitative data were coded and analysed thematically. Results All faculty members (12, 100%), the majority of students (49, 44.30%), and the community members strongly agreed that the policy decision to introduce the FAP was 'right'.The benefits mentioned were that FAP helps improve knowledge, psychomotor skills, attitudes and communication, attitude and behaviour skills, understanding of the social structures, health status of the community, and health-seeking behaviour of the families and provides an appropriate early clinical exposure. The challenges mentioned were selecting a site, gaining cooperation from family, communication, arrangement of logistics and transportation, gettingsupport from teachers, difficulties in managing students in the community and coordinating among faculty, staff and students. Most faculty members recommended that the FAP should be started later in the curriculum and there should be restrictions on the number of families to be adopted. The students suggested that adequate logistics be provided as well as a reduction in the number of family visits. Conclusion The programme has been welcomed by most stakeholders. It requires the necessary support from the institution authorities, prior planning of visits, judicious utilization of social media, and coordination with government field-level health workers e.g. Accreditated Social Health Activists (ASHA).A comprehensive program evaluation and formulation of a standard operating module will further strengthen the programme.

Reinforcement learning for individualized lung cancer screening schedules: A nested case–control study

AbstractBackgroundThe current guidelines for managing screen‐detected pulmonary nodules offer rule‐based recommendations for immediate diagnostic work‐up or follow‐up at intervals of 3, 6, or 12 months. Customized visit plans are lacking.PurposeTo develop individualized screening schedules using reinforcement learning (RL) and evaluate the effectiveness of RL‐based policy models.MethodsUsing a nested case–control design, we retrospectively identified 308 patients with cancer who had positive screening results in at least two screening rounds in the National Lung Screening Trial. We established a control group that included cancer‐free patients with nodules, matched (1:1) according to the year of cancer diagnosis. By generating 10,164 sequence decision episodes, we trained RL‐based policy models, incorporating nodule diameter alone, combined with nodule appearance (attenuation and margin) and/or patient information (age, sex, smoking status, pack‐years, and family history). We calculated rates of misdiagnosis, missed diagnosis, and delayed diagnosis, and compared the performance of RL‐based policy models with rule‐based follow‐up protocols (National Comprehensive Cancer Network guideline; China Guideline for the Screening and Early Detection of Lung Cancer).ResultsWe identified significant interactions between certain variables (e.g., nodule shape and patient smoking pack‐years, beyond those considered in guideline protocols) and the selection of follow‐up testing intervals, thereby impacting the quality of the decision sequence. In validation, one RL‐based policy model achieved rates of 12.3% for misdiagnosis, 9.7% for missed diagnosis, and 11.7% for delayed diagnosis. Compared with the two rule‐based protocols, the three best‐performing RL‐based policy models consistently demonstrated optimal performance for specific patient subgroups based on disease characteristics (benign or malignant), nodule phenotypes (size, shape, and attenuation), and individual attributes.ConclusionsThis study highlights the potential of using an RL‐based approach that is both clinically interpretable and performance‐robust to develop personalized lung cancer screening schedules. Our findings present opportunities for enhancing the current cancer screening system.

Is patients’ activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

BackgroundProlonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients’ activities of daily living (ADL) score may be a proxy for home care workers’ standing time at work. The objective of the present study was to investigate the association between patients’ ADL self-care score, and workers standing time.MethodsThis cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients’ ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories.ResultsWe analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients.ConclusionOur findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers’ total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.

Conservation and In Situ Enhancement of Earthen Architecture in Archaeological Sites: Social and Anthropic Risks in the Case Studies of the Iberian Peninsula

Archaeological sites constitute one of the main tourist attractions in the heritage offerings of most populations. Their ability to convey the ways of life and construction techniques of past societies through physical remains positions them as a culturally significant alternative for visitors. However, their physical conservation, essential for efficiently ensuring information with precision, poses a serious challenge for the various professionals involved, as numerous social and anthropic risks threaten long-term preservation for the enjoyment of future generations. Of all traditional building materials, earth is undoubtedly one of the most fragile and sensitive to loss in the absence of the original protection systems, so that a precise assessment of its threats is essential to minimizing the destruction of these non-renewable assets. The objective of this study is to evaluate the most determining human risk factors within the territorial scope of the Iberian Peninsula, including aspects such as its musealization, suitable interpretation, visit planning, agricultural land use, vandalism and rural depopulation. This is achieved through a literature review and on-site data collection from 85 archaeological sites, as well as the development of an analysis tool to assess the degree of vulnerability, aiming to develop prevention measures.

Parents’ and neonatal healthcare professionals’ views on barriers and facilitators to parental presence in the neonatal unit: a qualitative study

BackgroundParent and infant separation in the neonatal unit is associated with adverse health outcomes. Family-integrated care has several advantages and the potential to reduce these adverse outcomes but requires parental presence. This study aimed to explore the views of parents and neonatal healthcare professionals (nHCPs) on barriers and facilitators to parental presence in a Swiss neonatal unit and to identify possible differences between nHCPs and parents, and between mothers and fathers.MethodsData were collected through semi-structured interviews with parents and focus group discussions with nHCPs. Inductive content analysis was used to identify barriers and facilitators to parental presence in the neonatal unit.ResultsTwenty parents (10 mothers and 10 fathers) and 21 nHCPs (10 nurses and 11 physicians) participated in the study. Parents and nHCPs experienced barriers and facilitators related to: (1) Structural factors of the institution, such as infrastructure or travel and distance to the neonatal unit. (2) Organization and time management of parental presence, daily activities, and work. (3) Resources, which include factors related to the legal situation, support services, family, and friends. (4) Physical and psychological aspects, such as pain, which mainly affected mothers, and aspects of emotional distress, which affected both parents. Self-care was an important physical and psychological facilitator. (5) Parent-professional interaction. Parental presence was influenced by communication, relationship, and interaction in infant care; and (6) Cultural aspects and language. Some perspectives differed between mothers and fathers, while the overall views of parents and nHCPs provided complementary rather than conflicting insights. Using visit plans to support the organization, educating nHCPs in knowledge skills and available resources to improve encouragement and information to parents, strengthening parent self-care, and improving nHCPs’ attitudes towards parental presence were seen as possible improvements.ConclusionsMultifactorial barriers and facilitators determine parental presence and experience in the neonatal unit. Parents and nHCPs made specific recommendations to improve parental presence.

Implementing a Palliative Care Junior Faculty Visiting Professor Program: Pearls and Pitfalls.

Palliative Care (PC) is a small, relatively young interprofessional sub-specialty; hence mentorship for early-career research faculty is widely dispersed across schools and universities. We developed the Junior Visiting Professor Program (JVPP) to provide junior faculty in palliative care (PC) with opportunities to meet multidisciplinary PC researchers from other institutions and to advance their research through networking and presenting their work. We describe how we designed and implemented the program, and we report on the first cohort of participants. We invited PC research groups from US schools of medicine and nursing to participate in this 5-year interprofessional exchange program by nominating junior faculty and serving as hosts. We matched nominees to host institutions based on nominee training experiences, nominee research interests, and host institution faculty expertise. In addition, we provided logistical guidance on visit planning. Post-visit, we surveyed both hosts and junior visiting professors (JVPs) regarding their satisfaction, perceived value, and suggestions regarding the program. We recruited 13 schools to participate and matched 10 nominees to host institutions in our first year. Nine JVPs completed their visit; 6 JVPs and 8 host faculty/staff responded to the post-visit survey. Overall, JVPs were highly satisfied with their matches and the visiting professor experience. Hosts were generally satisfied with their matches and believed the program to be mutually beneficial. The most frequent suggestion was for greater administrative support to plan visits. Structured, well-supported opportunities for networking across institutions is beneficial for emerging PC researchers and for building PC research capacity.

A Prospective Study with Patients and Families on the Usefulness of Accurate Prognosis for Palliative Care Patients

Prediction of life expectancy in terminally ill patients is an important end-of-life care issue for patients, families and mental health workers during the last days of life. This study was conducted to examine the importance/usefulness for patients/families to have an accurate prognosis and its impact on planning their activities prior to death. All patients admitted during a period of one year were included. Patients’ and families’ viewpoints on the usefulness of an accurate prognosis was documented at admission. There were 285 patients in the cohort. The median time to death was 8 days. Most families (83%) rated the importance of an accurate prognosis as moderately (13%) to very much useful (70%). A total of 42% of patients were able to complete e the questionnaire. Among these, 58% found it moderately to very much useful. For families, having an accurate prognosis influenced the planning of visits (69%), communication/closure (42%) and spiritual needs/funeral arrangements (31%). Patients identified planning of visits (10%), communication/closure (12%), and goals/accomplishments (9%) as very important. Discussing the prognosis and its impact is very helpful for the mental health professionals to have open and honest conversations with patients/families to identify, prioritize and adapt treatment to achieve goals prior to death.

Review of Contemporary Methods for Reliability Analysis in Aircraft Components

The performance degradation of an aircraft and its engine components takes place over time due to a combination of factors like foreign object damage (FoD), domestic object damage (DoD), impact of environmental conditions (corrosive, temperate, hot, and dry), atmospheric particulate matter, and gases like NO2 and SO2. While natural wear and tear happens gradually depending on a wide variety of operational characteristics, FoD and DoD are incidents that occur randomly. To model this degradation process so as to predict or estimate the remaining useful life is to enable optimal build goal and work-scope determination, reducing repair costs and increasing part and system reliability. Determining the impact of various parameters on reliability will help optimize maintenance costs and visit plans over the course of an aircraft’s or engine’s life. A substantial number of models have been proposed to address the reliability prediction problem, but practically only a few are employed. In this paper, we provide a precise yet comprehensive study of these models, classifying them broadly based on their methodology. We focus on the methods, their limitations, production readiness, and the associated datasets in an effort to facilitate faster industrial adoption of the techniques that have remained exclusively as a part of academic initiatives.

Integration of Genetic Testing and Counseling in Patients With Breast Cancer in a Large, Multisite Community-Based Practice.

Despite data-driven consensus recommendations, there remains significant nonadherence to genetic screening and testing. More than 300,000 patients are diagnosed with breast cancer annually, with one third of these estimated to be eligible for homologous recombination deficiency (HRD)/BRCA testing following National Comprehensive Cancer Network (NCCN) guidelines. Only 35% of eligible patients are referred for genetic counseling. The goal of this project was to apply NCCN guidelines for germline genetic testing to all new patients with breast cancer within a large community oncology practice to improve HRD/BRCA testing. Plan-Do-Study-Act methodology was used, and cycles were built on a proven teaching infrastructure. In cycle 1, providers were educated and directed to use electronic health record (EHR) templates in the setting of an initial diagnosis visit and treatment planning. Discreet data fields were created in the EHR during cycle 2 to streamline and automate the process. Appropriate patients were referred to the genetics team for further evaluation, counseling, and testing. Adherence to the plan was maintained and measured using data analytic reports and chart audits. Of the 1,203 patients with breast cancer eligible for inclusion, 1,200 (99%) were screened according to NCCN guidelines. Of the screened patients, 631 (52.5%) met the referral/testing criteria. In total, 585 (92.7%) of the 631 were referred to a genetic specialist. Seven percent had previous referrals. A total of 449 (71%) patients were acceptable to genetics referral while 136 (21.5%) patients refused. The implemented methods of education, NCCN guidelines imbedded within provider notes, and discreet data fields in the EHR have proven to be highly effective in screening appropriate patients and ordering subsequent genetic referrals.

Oral health outcomes in an HIV cohort with comorbidities- implementation roadmap for a longitudinal prospective observational study

BackgroundLong-term antiretroviral therapy (ART) perpetually suppresses HIV load and has dramatically altered the prognosis of HIV infection, such that HIV is now regarded as a chronic disease. Side effects of ART in Patients With HIV (PWH), has introduced new challenges including “metabolic” (systemic) and oral complications. Furthermore, inflammation persists despite great viral load suppression and normal levels of CD4+ cell count.The impact of ART on the spectrum of oral diseases among PWH is often overlooked relative to other systemic complications. There is paucity of data on oral complications associated with ART use in PWH. This is in part due to limited prospective longitudinal studies designed to better understand the range of oral abnormalities observed in PWH on ART.MethodsWe describe here the study design, including processes associated with subject recruitment and retention, study visit planning, oral health assessments, bio-specimen collection and preprocessing procedures, and data management and statistical plan.DiscussionWe present a procedural roadmap that could be modelled to assess the extent and progression of oral diseases associated with ART in PWH. We also highlight the rigors and challenges associated with our ongoing participant recruitment and retention.A rigorous prospective longitudinal study requires proper planning and execution. A great benefit is that large data sets are collected and biospecimen repository can be used to answer more questions in future studies including genetic, microbiome and metabolome-based studies.Trial registrationNational Institute of Health Clinical Trials Registration (NCT) #: NCT04645693.

Qualitative research on the work experience of caseworkers at child protection agencies during the COVID-19 pandemic

The purpose of this study is to explore the work experience of caseworkers at child protection agencies during the COVID-19 pandemic. Six caseworkers from child protection agencies in Daejeon City were selected as participants and in-depth interviews were conducted. The collected data were analyzed using thematic analysis. The analysis yielded three themes and 10 subthemes. The three themes derived were “urgent problems to resolve amid the spread of infectious diseases,” “exhaustion of caseworkers who struggled to change work environments,” and “measures to effectively respond to infectious diseases in the field of practice.” Based on the results, the study suggested preparing non-face-to-face visit plans for children who entered the facility separate from their parents, improving the rigid organizational culture, and expanding services to prevent the exhaustion of caseworkers.

Relationship between the Use of Video Terminals and Dry Eye Symptoms during the COVID-19 Pandemic: Assessments Based on a Meta-Analytical Approach

Purpose: The objective of this meta-analytical study is to consider the impact of the use of VDTs on the onset and/or worsening of the signs and symptoms of dry eye during the COVID-19 pandemic, but also to offer the best solutions to perform the various tasks in daily life in order to safeguard vision, with the aim of promoting a lifestyle that allows you to work and perform different activities more safely and efficiently. Patients should be encouraged to follow proper planning of visits. Methods: Scientific articles chosen by the following inclusion criteria were analyzed: 1) Type of study (Primary); 2) Population (patients suffering from dry eye); 3) Study period (all studies carried out in the period between January 2020 and January 2022); 4) Result variables (correlation between increased use of VDTs during the pandemic and worsening of the symptoms of dry eye syndrome; correlation between autoimmune mechanism from Covid- 19 and etiology of dry eye); 5) Language (English). Results: The results of the various cross-sectional studies, obtained thanks to the administration of an online and anonymous questionnaire, have found a correlation between excessive use of VDTs and the onset of complications related to dry eye syndrome. The results suggest that in university students there is a higher incidence of problems related to dry eyes following the many hours spent in front of a screen to follow the lessons that were proposed to them remotely during the lockdown following the COVID-19 pandemic. Dry eye is the most commonly diagnosed pathology among eye disorders during the lockdown, as people spent much more time locked in the house, even 20-24h in the first months of lockdown in 2020. Conclusions: In conclusion, the analysis of the data shows a correlation between prolonged use of VDTs (exacerbated during the COVID-19 era) and the onset or worsening of dry eye syndrome.

Digitally designed casting ring and sprue system - a contemporary approach to the casting process in dentistry

The current paper aims to present a new casting approach in dentistry by eliminating some conventional preliminary procedures and digitalising the process as much as possible.The experiment uses six digital crown patterns. They are aligned with each other and to the wall of a virtual casting ring. Then a digital sprue system is created. The object alignment and sizes are revised, and the optimal correlation is set. Finally, a single virtual object is created and is 3D printed of light curing acrylic resin suitable for casting, invested, and cast.The castings that are achieved have good quality and no defects. At the same time, the virtual designing and aligning of the patterns and all the components of the sprue system and casting ring save much time and allows better precision to be achieved. All these facts allow better control of the casting process results, making the process faster, more predictable, and more accurate.The limitations of this study concerns pattern selection. It is well-known that the acrylic resin sublimates and expands massively during a temperature rise, which may cause mould fracture. This obstacle is very representative as solid objects with higher volumes are examined. This may enforce alignment revision or even temperature rate modification.Suggested approach will be very useful for daily dental laboratory practice by optimizing the working time of the dental technician, making the denture production process faster, more predictable, and more accurate. As a result, the process optimizes the working process in dental offices, by allowing shortening the time of each visit and treatment plan terms.Presented approach reveals some new opportunities for dental technicians to substitute the conventional raw stages of sprue system fabrication with digital planning and designing. This allows dental technicians to take advantage of the full potential of digital technologies.

Establishing a Cystic Fibrosis Learning Network: Interventions to promote collaboration and data-driven improvement at scale.

A learning health network is a type of learning health system in which stakeholders use network organization to improve health and health care. Building on existing resources in the cystic fibrosis (CF) community, the Cystic Fibrosis Learning Network (CFLN) was designed to improve medical outcomes and quality of life through an intentional focus on achieving reliable evidence-based chronic care delivery and creating a system for data-driven collaborative learning. We describe the development and growth of the CFLN considering six domains of a Network Maturity Grid: system leadership; governance and policy management; quality improvement (QI); engagement and community building; data and analytics; and research. We illustrate the impact of the CFLN experience on chronic care processes and indicators of collaborative infrastructure. The CFLN represents 36 accredited care centers in the CF Foundation Care Center Network caring for over 6300 patients. Of 6779 patient clinical care visits/quarter, 77% are entered into the CF Foundation Patient Registry within 30 days, providing timely means to track outcomes. Collaborative visit planning is occurring in 93% of clinical care visits to share agenda setting with patients and families. Almost all CFLN teams (94%, n=34) have a patient/family partner (PFP), and 74% of PFPs indicate they are actively participating, taking ownership of, or leading QI initiatives with the interdisciplinary care team. In 2022, 97% of centers reported completing 1-13 improvement cycles per month, and 82% contributed to monthly QI progress reports to share learning. The CFLN is a maturing, collaborative infrastructure. CFLN centers practice at an advanced level of coproduction. The CFLN fosters interdisciplinary and PFP leadership and the performance of consistent data-driven improvement cycles. CFLN centers are positioned to respond to rapid changes in evidence-based care and advance the practice of QI and implementation science on a broader scale.

Interrater reliability of the BelRAI Social Supplement in Flanders, Belgium: Simultaneous rating of community-dwelling adults with care needs during COVID-19.

BackgroundThe BelRAI Screener is a short-form assessment consolidating internationally validated interRAI items focusing on physical and psychological aspects of functioning and problems with activities of daily living. It was fully implemented in the Flemish home care setting as of June 2021. In a biopsychosocial model for developing a personalized and effective care plan social and contextual aspects are considered equally important to biomedical ones. Thus, a social supplement to the BelRAI Screener was collaboratively developed with stakeholders and tested to gather additional information on the social context of community-dwelling adults with care needs.Objective and methodsTo examine the interrater reliability of the BelRAI Social Supplement in Flanders, Belgium, an observational study was conducted using a convenience sample. The method of simultaneous rating was used due to strict COVID-19 guidelines at the time and to minimize assessment burden. Fifty two community-dwelling adults requesting home care support were simultaneously assessed by two independent assessors during home visits. Interrater reliability was tested on all 80 items of the BelRAI Social Supplement using observed agreement, kappa coefficients, and intraclass correlation coefficients.ResultsThe kappa mean (0.74) and median (0.79) values for nominal items, show substantial agreement, while the kappa mean and median values for ordinal items were 0.81 and 0.90, which correspond to almost perfect agreement. Following the traditional cut-off points for the interpretation of the kappa statistic, reliability was almost perfect (κ > 0.81) for 49% of all items, substantial (0.60 < κ ≤ 0.80) for 33%, moderate (0.40 < κ ≤ 0.60) for 8%, and poor (κ < 0.40) for 10%. The majority of items with poor kappa value, showed a high observed agreement, reflecting homogeneity of the sample rather than poor agreement.ConclusionThe strength of kappa agreement for the items in this version of the BelRAI Social Supplement is generally substantial to almost perfect, with high proportions of observed agreement. COVID-19 restrictions had a large impact on the planning and execution of the home visits. A final optimization of the instrument and accompanying manual according to the findings will result in an improved version ready for nation-wide implementation.

School Visits to Science Museums: A Framework for Analyzing Teacher Practices

ABSTRACT School visits to science museums are recognized educational resources that provide students with unique learning experiences, if teachers intentionally plan these. Surprisingly one finds that investigations analyzing teachers adopted practices by systematic monitoring, without researcher intervention, are almost non-existent in the literature. We developed the School Visits Articulated Framework (SVAF) to identify and classify (through levels’ scale) the school visits planning practices. The mainly objective was to reach a characterization of teachers’ practices in a perspective of articulations formal education and non-formal education contexts may then be defined. In this article, we describe how we applied the SVAF on five case studies configured as school visits to a science museum, simultaneously we test the framework efficiency. The analysis of the visit plan from the perspective of the SVAF allowed us to identify moments in which the teachers’ practices did not meet expectations according to the literature in the area. Likewise, it revealed the predominance of activities carried out in the steps before the visit to the museum and emphasized the lack of activities carried out in the museum and on returning to school after the visit. These results allow us to better outline the objectives and needs to be met in the initial and continuous training courses for teachers and museum educators, aiming at the best use of this resource for student learning. The SVAF is a framework capable of to identify and classify the teachers’ practices, since the instruments it integrates provided important and detailed information.

A First Route Second Assign decomposition to enforce continuity of care in home health care

Home health care (HHC) is a very popular service that plays an important role in reducing hospitalization costs and improving the quality of life for patients. Human resource planning is one of the most important processes in HHC facilities, and service providers must deal with several operational problems, e.g., the assignment of nurses to patients and the nurse routing. These two problems in HHC are intrinsically related. In the literature, they are solved simultaneously or sequentially, by exploiting First Assign Second Route (FASR) decomposition approaches in which the assignment problem is solved first and the routing problem is solved second. However, on the one hand, the simultaneous approach focuses primarily on the routing component of the problem but fails to offer continuity of care to the patients. On the other hand, FASR is more adequate to enforce the continuity of care constraint but is less effective toward the routing part. In this paper, we propose a novel decomposition approach that combines the advantages of each these approaches, which is based on the First Route Second Assign (FRSA) paradigm. To validate our FRSA approach and compare with a benchmark FASR decomposition, we also develop an instance generator that is inspired by real HHC settings with different sizes and travel time ratios. Experiments show the effectiveness of the FRSA decomposition and improvements with respect to the classical FASR, especially when travel times constitute a relevant part of the workload and the routing component of the problem is predominant; moreover, continuity of care is fully respected. Thus, FRSA can be effectively implemented by HHC providers for an efficient planning of resources and visits, especially where patients are spread in a vast territory.