Quality Improvement for Well Child Care

Presented to the Faculty of University of Alaska Anchorage in Partial Fulfillment of Requirements for the Degree of MASTER OF SCIENCEThe American Academy of Pediatrics (AAP) Bright Futures (BF) guidelines for well child care were designed to provide quality pediatric care. Adherence to AAP-BF guidelines improves: screenings, identification of developmental delay, immunization rates, and early identification of children with special healthcare needs. The current guideline set is comprehensive and includes thirty one well child exams, thirty three universal screening exams and one hundred seventeen selective screening exams. Many providers have difficulty meeting all guideline requirements and are at risk of committing Medicaid fraud if a well exam is coded and requirements are not met. The goal of this quality improvement project was to design open source and adaptable templates for each pediatric age group to improve provider adherence to the BF guidelines. A Plan-Do-Study-Act (PDSA) quality improvement model was used to implement the project. Templates were created for ages twelve months to eighteen years and disseminated to a pilot clinic in Anchorage, Alaska. The providers were given pre-implementation and postimplementation surveys to determine the efficacy and usefulness of the templates. Templates were determined to be useful and efficient means in providing Bright Futures focused well child care. The templates are in the process of being disseminated on a large scale to assist other providers in meeting BF guideline requirements.Title Page / Table of Contents / List of Tables / List of Appendices / Abstract / Introduction / Background / Clinical Significance / Current Clinical Practice / Research Question / Literature Review / Framework: Evidence Based Practice Model/ Ethical Considerations and Institutional Review Board / Methods / Implementation Barriers / Findings / Discussion / Disseminatio

Implementing cardiovascular disease prevention guidelines to translate evidence-based medicine and shared decision making into general practice: theory-based intervention development, qualitative piloting and quantitative feasibility

Background: The use of cardiovascular disease (CVD) prevention guidelines based on absolute risk assessment is poor around the world, including Australia. Behavioural barriers amongst GPs and patients include capability (e.g. difficulty communicating/understanding risk) and motivation (e.g. attitudes towards guidelines/medication). This paper outlines the theory-based development of a website for GP guidelines, and piloting of a new risk calculator/decision aid. Methods: Stage 1 involved identifying evidence-based solutions using the Behaviour Change Wheel (BCW) framework, informed by previous research involving 400 GPs and 600 patients/consumers. Stage 2 co-developed website content with GPs. Stage 3 piloted a prototype website at a national GP conference. Stage 4 iteratively improved the website based on "think aloud" interviews with GPs and patients. Stage 5 was a feasibility study to evaluate potential efficacy (guidelines-based recommendations for each risk category), acceptability (intended use) and demand (actual use over 1 month) amongst GPs (n = 98). Results: Stage 1 identified GPs as the target for behaviour change; the need for a new risk calculator/decision aid linked to existing audit and feedback training; and online guidelines as a delivery format. Stage 2-4 iteratively improved content and format based on qualitative feedback from GP and patient user testing over three rounds of website development. Stage 5 suggested potential efficacy with improved identification of hypothetical high risk patients (from 26 to 76%) and recommended medication (from 57 to 86%) after viewing the website (n = 42), but prescribing to low risk patients remained similar (from 19 to 22%; n = 37). Most GPs (89%) indicated they would use the website in the next month, and 72% reported using it again after one month (n = 98). Open feedback identified implementation barriers including a need for integration with medical software, low health literacy resources and pre-consultation assessment. Conclusions: Following a theory-based development process and user co-design, the resulting intervention was acceptable to GPs with high intentions for use, improved identification of patient risk categories and more guidelines-based prescribing intentions for high risk but not low risk patients. The effectiveness of linking the intervention to clinical practice more closely to address implementation barriers will be evaluated in future research

Sharing a conceptual model of grid resources and services

Grid technologies aim at enabling a coordinated resource-sharing and problem-solving capabilities over local and wide area networks and span locations, organizations, machine architectures and software boundaries. The heterogeneity of involved resources and the need for interoperability among different grid middlewares require the sharing of a common information model. Abstractions of different flavors of resources and services and conceptual schemas of domain specific entities require a collaboration effort in order to enable a coherent information services cooperation. With this paper, we present the result of our experience in grid resources and services modelling carried out within the Grid Laboratory Uniform Environment (GLUE) effort, a joint US and EU High Energy Physics projects collaboration towards grid interoperability. The first implementation-neutral agreement on services such as batch computing and storage manager, resources such as the hierarchy cluster, sub-cluster, host and the storage library are presented. Design guidelines and operational results are depicted together with open issues and future evolutions.Comment: 4 pages, 0 figures, CHEP 200

Performance of an Echo Canceller and Channel Estimator for On-Channel Repeaters in DVB-T/H Networks

This paper investigates the design and performance of an FIR echo canceller for on-channel repeaters in DVB-T/H network within the framework of the PLUTO project. The possible approaches for echo cancellation are briefly reviewed and the main guidelines for the design of such systems are presented. The main system parameters are discussed. The performance of an FIR echo canceller based on an open loop feedforward approach for channel estimation is tested for different radio channel conditions and for different number of taps of the FIR filter. It is shown that a minimum number of taps is recommended to achieve a certain mean rejection ratio or isolation depending on the type of channel. The expected degradation in performance due to the use of fixed point rather than floating point arithmetic in hardware implementation is presented for different number of bits. Channel estimation based on training sequences is investigated. The performance of Maximum Length Sequences and Constant Amplitude Zero Autocorrelation (CAZAC) Sequences is compared for different channels. Recommendations are given for training sequence type, length and level for DVB-T/H on-channel repeater deployment

A proposal of accessibility guidelines for human-robot interaction

We will increasingly become dependent on automation to support our manufacturing and daily living, and robots are likely to take an important place in this. Unfortunately, currently not all the robots are accessible for all users. This is due to the different characteristics of users, as users with visual, hearing, motor or cognitive disabilities were not considered during the design, implementation or interaction phase, causing accessibility barriers to users who have limitations. This research presents a proposal for accessibility guidelines for human-robot interaction (HRI). The guidelines have been evaluated by seventeen HRI designers and/or developers. A questionnaire of nine five-point Likert Scale questions and 6 open-ended questions was developed to evaluate the proposed guidelines for developers and designers, in terms of four main factors: usability, social acceptance, user experience and social impact. The questions act as indicators for each factor. The majority (15 of 17 participants) agreed that the guidelines are helpful for them to design and implement accessible robot interfaces and applications. Some of them had considered some ad hoc guidelines in their design practice, but none of them showed awareness of or had applied all the proposed guidelines in their design practice, 72% of the proposed guidelines have been applied by less than or equal to 8 participants for each guideline. Moreover, 16 of 17 participants would use the proposed guidelines in their future robot designs or evaluation. The participants recommended the importance of aligning the proposed guidelines with safety requirements, environment of interaction (indoor or outdoor), cost and users’ expectations

Pengaruh Layanan Bimbingan Kelompok terhadap Peningkatan Etika Pergaulan Siswa Kelas XI Mipa di SMA Negeri 12 Pekanbaru Tahun Ajaran 2015/2016

This study aims at bertujan to find out the influence of group guidance services to increased ethical guidelines for students. This research was conducted from June to August 2016 2016. Research methods used are real methods of experimental with pretest-posttest pattern control group design. The subjects in this research is research grade XI with the ethical guidelines for a low total of 10 students. Data collection instrument used was the now are open. Data analysis technique used was statistics nonparametric techniques. Based on hhasil test of wilcoxon research hypothesis turns out to be accepted IE there is a difference of ethical guidelines for students before and after the implementation of the experimental group guidance and group control based on the test results of the mann-withneyy there is a significant difference of ethical guidelines for students on the Group\u27s experiments with a group control. Spearman Rank test based on the influence of group guidance services against the ethics guidelines for students that is 46.1%

The dilemma of open or double-blind food challenges in diagnosing food allergy in children:Design of the ALDORADO trial

BACKGROUND: It is of major importance to diagnose food allergy accurately. Current guidelines support the use of oral food challenges to do so. The double-blind placebo-controlled food challenge (DBPCFC) has been regarded as the 'gold standard' for decades. However, DBPCFCs are costly, and time- and resource-intensive procedures. Structural implementation of less demanding open food challenges will only find support if research demonstrates that their outcome is comparable to DBPCFC, yet this has been proven difficult to investigate. METHODS: We performed a literature review to investigate the diagnostic accuracy of oral food challenges and interviewed 19 parents of children with proven or suspected food allergy about the design of a trial to study this. RESULTS: An overview of the dilemma of diagnosing food allergy using oral food challenges, and the methodological issues and parents' opinions to study this. No comparative studies have been performed using the latest guidelines on oral food challenges. CONCLUSIONS: There is an urgent need to investigate the diagnostic accuracy of different oral food challenge protocols. We present the rationale and design of the ALDORADO trial (ALlergy Diagnosed by Open oR DOuble-blind food challenge) that has been set up to investigate whether the outcome of the open food challenge is comparable to DBPCFC

A MOOC on universal design for learning designed based on the UDL paradigm

This article presents the design and pilot of an open online course, based on the principle of universal design for learning (Center for Applied Special Technology, 2011), to promote inclusive virtual education as an improvement transferable to other contexts. The course constitutes the first massive open online course (MOOC) training proposal of the University of Atlántico in Colombia. In this case study, we employed the instructional design methodology of analysis, design, development, implementation, and evaluation (Branch, 2009) and the universal design for learning guidelines. The design of this online training activity enhances the quality of inclusive virtual education, improves accessibility with no need for platform adjustments, and involves participants in their learning. This educational initiative complements the academic offer for students, graduates, administrators, teachers, and external guests, and contributes to the democratisation of education. The result is the creation of a MOOC, “Inclusive Educational Contexts: Design for all”, which is accessible to a diverse range of learners.This work was supported by the Spanish Ministry of Economy and Competitiveness under project TIN2017-89517-P

St. Johns River: Environmental and Urban Design Study

The St. Johns River flows for approximately 39 miles through Duval County to the ocean. Shoreline uses range from residential, industrial, military, port, central business district, open spaces, to saltwater marshes. Environmental and design improvements are needed. Background studies were developed as part of the study. Topics covered included geophysical aspects, terrestrial vegetation, aquatic ecology and fishery resources, wildlife, historic resources, portand river-related industry, port maintenance, and commercial fishing. Development Intensity Analysis was conducted for the river corridor. Five environmental factors utilized were vegetation, wildlife, soils, slope, and flood probability. Four general levels of development were recommended, ranging from preservation to high intensity. Design guidelines for principal shoreline land uses were also formulated. The entire shoreline was divided into 21 study areas. Each of these areas was mapped with specific development proposals. Functional programs to improve the river and shoreline were formulated. The programs developed addressed housing, recreation, environmental improvement, industry, historical preservation, commercial areas, and transportation. Several strategies were developed to ensure proper shoreline development and implementation of the plans. Strategies include development of a Coordinating Committee, enactment of Codes and Ordinances, adoption of river-related policies, and implementation of design guidelines. Numerous studies were also recommended. PALM