Intervention planning and modification of the BUMP intervention: a digital intervention for the early detection of raised blood pressure in pregnancy

Background: Hypertensive disorders in pregnancy, particularly pre-eclampsia, pose a substantial health risk for both maternal and foetal outcomes. The BUMP (Blood Pressure Self-Monitoring in Pregnancy) interventions are being tested in a trial. They aim to facilitate the early detection of raised blood pressure through self-monitoring. This article outlines how the self-monitoring interventions in the BUMP trial were developed and modified using the person-based approach to promote engagement and adherence. Methods: Key behavioural challenges associated with blood pressure self-monitoring in pregnancy were identified through synthesising qualitative pilot data and existing evidence, which informed guiding principles for the development process. Social cognitive theory was identified as an appropriate theoretical framework. A testable logic model was developed to illustrate the hypothesised processes of change associated with the intervention. Iterative qualitative feedback from women and staff informed modifications to the participant materials. Results: The evidence synthesis suggested women face challenges integrating self-monitoring into their lives and that adherence is challenging at certain time points in pregnancy (for example, starting maternity leave). Intervention modification included strategies to address adherence but also focussed on modifying outcome expectancies, by providing messages explaining pre-eclampsia and outlining the potential benefits of self-monitoring. Conclusions: With an in-depth understanding of the target population, several methods and approaches to plan and develop interventions specifically relevant to pregnant women were successfully integrated, to address barriers to behaviour change while ensuring they are easy to engage with, persuasive and acceptable

A Use of Theory of Constraints Thinking Processes for Improvements in the Merged Beams Experiment at Oak Ridge National Laboratory.

Thinking exercises used in the Theory of Constraints (TOC) were used to find and remove constraints at the Merged Beams Experiment at Oak Ridge National Laboratory. The goal of this project was to significantly reduce the amount of time used to take a certain type of measurement during an experimental cycle. After the TOC exercises were used, a basic plan for change was discovered. Preliminary data were taken to establish a baseline of performance from which changes were made. Post-Modification was analyzed showing the project was a success. The overlying reasoning for this exercise was to prove successfully that continuous improvement techniques used in the manufacturing industry can also be successful in a research environment. After overcoming the differences in the goals between each environment, it can be concluded that this reasoning is justified

Note – Fighting Foreclosure: Using Contract Law to Enforce the Home Affordable Modification Program (HAMP)

In 2009, the Secretary of the Treasury and the Obama Administration unveiled the Making Home Affordable Program (“MHA”) to slow the foreclosure crisis and stabilize the economy. A key component of the MHA is the Home Affordable Modification Program (“HAMP”), a seventy-five billion dollar program designed to incentivize loan servicers to modify loans for certain qualified borrowers. The Treasury estimated that HAMP would permanently modify three to four million mortgages by the end of 2012; however, HAMP has failed to meet its objective. Under HAMP, if a borrower meets certain criteria, she will be placed on a three-month trial period plan (“TPP”) where she will pay a lowered mortgage payment equal to 31% of her gross monthly income. If the borrower makes this lowered payment for three months and meets other requirements, the servicer should extend a permanent modification with a reduced monthly payment. As written, however, the provision allows servicers to deny permanent modifications even if borrowers successfully meet their reduced mortgage payments. Recently, borrowers began to bring common law breach of contract claims to enforce the TPP, arguing that the TPP is a binding contract that requires servicers to grant permanent loan modifications. Currently, there is controversy over the validity of the TPP-based breach of contract theory and a split amongst the federal courts. This Note provides an overview of the HAMP application process, examines the controversy and split amongst the federal courts, argues in favor of upholding the theory, and provides recommendations for national legislation

Designing a Culturally Relevant Lifestyle Modification Guide for Primary Care Providers to Improve Diabetes Management in the Hispanic Population.

ABSTRACT Diabetes mellitus type II (DMT2) affects the Hispanic population in the United States at an alarming rate, contributing to elevated morbidity and mortality. This growing ethnic group is also disproportionately at risk for obesity and being at a lower socioeconomic status, both of which contribute to DMT2 severity and prevalence. The provision of culturally competent care in the primary care setting using evidence-based lifestyle modifications has the potential to improve DMT2 outcomes among this socioeconomically disadvantaged population. Thus, the expert opinions of eight primary care providers in the Pueblo, Colorado community were sought where half of the patient population identified as being of Hispanic descent and almost a quarter were impoverished. As underpinned by Leininger’s (Leininger & McFarland, 2006) culture care theory (CCT), the purpose of this DNP scholarly project was to utilize the current literature and a panel of clinical experts to develop a culturally relevant lifestyle modification guide for management of DMT2 among Hispanic patients. The guide was developed using the Delphi method and was designed for use in the primary care setting to develop a plan of care that was culturally and socioeconomically sensitive with the goal of testing its effectiveness in future research. Keywords: diabetes mellitus type 2, Hispanic, cultural competence, low socioeconomic status, lifestyle modification

A Plan-Based Model for Response Generation in Collaborative Task-Oriented Dialogues

This paper presents a plan-based architecture for response generation in collaborative consultation dialogues, with emphasis on cases in which the system (consultant) and user (executing agent) disagree. Our work contributes to an overall system for collaborative problem-solving by providing a plan-based framework that captures the {\em Propose-Evaluate-Modify} cycle of collaboration, and by allowing the system to initiate subdialogues to negotiate proposed additions to the shared plan and to provide support for its claims. In addition, our system handles in a unified manner the negotiation of proposed domain actions, proposed problem-solving actions, and beliefs proposed by discourse actions. Furthermore, it captures cooperative responses within the collaborative framework and accounts for why questions are sometimes never answered.Comment: 8 pages, to appear in the Proceedings of AAAI-94. LaTeX source file, requires aaai.sty and epsf.tex. Figures included in separate file

Planning for the future : a grounded theory study of well older adults\u27 decision-making regarding home modifications

The purpose of this dissertation research was to understand the decision-making process that well older adults use when deciding whether to make a home modification. The researcher also sought to understand the views of well older adults concerning the use of home modification to prevent injury and declines in occupational performance. The researcher used the Person-Environment-Occupation (PEO) model (Law et al., 1996) from occupational therapy and occupational science as the orienting framework. A qualitative grounded theory approach based on that proposed by Strauss and Corbin (1998) was used to structure data collection and analysis. Participants were obtained using purposive and theoretical sampling and were interviewed by the researcher. The 19 participants in this study ranged in age from 65 to 89. Findings from this study include a model of the decision-making process that well older adults used to plan for their futures related to home setting and modification and also a substantive grounded theory. The Theory of Home Modification Decision-Making: Well Older Adults is proposed and explained. Central to the theory are two decision-making processes, including the conditions that influence the decisions. These findings and the theory are discussed relative to the PEO model and existing occupational therapy and gerontology literature. The information gained from this study is beneficial to occupational therapists and Certified Aging-in-Place Specialists to improve and expand their services to the well older adult population

Climate modification and climate change debates amongst Soviet physical geographers, 1940s-1960s

This review provides an insight into some of the main themes characterizing the work of Soviet physical geographers concerning climate during the decade following the Second World War. Post-1945, pressure was placed upon geography via the state and the Academy of Sciences to ensure that its activities were of practical use to the development of the socialist economy and this was particularly evident in the case of work related to climate and climate modification. The review is divided into four main sections. First, it provides an understanding of the range of work carried out by physical geographers with respect to climate and related phenomena in the late 1940s and 1950s. Second, it focuses on the work of geographers and climatologists in relation to the heat and water balance at the earth's surface, which attracted considerable attention within geographical circles as well as more broadly within Soviet science during the 1950s. Third, it reflects upon the way in which Soviet geography utilized its understanding of climate systems in order to participate in national schemes concerned with the modification of the climate and the transformation of nature. Finally, the review highlights the maturing of climate modification debates among geographers and cognate scientists during the late 1950s and early 1960s with the emergence of competing discussions over the potential for human activity to result in both positive and negative consequences for the global climate system

Hybrid Evolutionary Shape Manipulation for Efficient Hull Form Design Optimisation

‘Eco-friendly shipping’ and fuel efficiency are gaining much attention in the maritime industry due to increasingly stringent environmental regulations and volatile fuel prices. The shape of hull affects the overall performance in efficiency and stability of ships. Despite the advantages of simulation-based design, the application of a formal optimisation process in actual ship design work is limited. A hybrid approach which integrates a morphing technique into a multi-objective genetic algorithm to automate and optimise the hull form design is developed. It is envisioned that the proposed hybrid approach will improve the hydrodynamic performance as well as overall efficiency of the design process