76 research outputs found
Directorsâ Use of Data in Decision Making in 21st Century Community Learning Center Grants
Evidence of positive impact of youth participation in 21st Century Community Learning Center (CCLC) grants remains mixed (Leos-Urbel, 2015). Reports of conflicting results of 21st CCLC program success may plague the 21st CCLC reputation, potentially reducing support and capacity to which they can serve youth at risk. Stakeholders, such as school districts and policy makers lack understanding of the data of the effectiveness of these 21CCLC after school programs is putting current funding at risk (Farrell, CollierâMeek, & Furman, 2019). Throughout the field of education, expectation from policy makers is increasing that evidence-based practices that are based on research and data are used to guide practical decision making (Mahoney, p.35 2016).
Success in todayâs data-oriented environment requires program leaders and stakeholders to be able to think about data analytically (Provost & Fawcett, 2013). The potential concern is a science to practice gap, further undermining the credibility of the 21st CCLC initiative (Mahoney, p.34 2016). The problem and the importance of this research is to identify how directors collect, analyze and report data may be contributing to the lack of stakeholder understanding and mixed review of program success. The basis of this formative research is to examine the practice of 21st CCLC directors on how they use data to base decisions regarding their programs. âThe question is not if or why programs are successful but how is data used at program level to drive decisions and program improvementâ (Granger, 2010). Through semi- structured interviews of Washington State 21st CCLC grant directors, this inquiry seeks to answer what professional development directorsâ need to collect program data accurately, to analyze and develop a deeper understanding of the data, implement program improvement and decisions based on the data
Bureaucracy as a Lens for Analyzing and Designing Algorithmic Systems
Scholarship on algorithms has drawn on the analogy between algorithmic systems and bureaucracies to diagnose shortcomings in algorithmic decision-making. We extend the analogy further by drawing on Michel Crozierâs theory of bureaucratic organizations to analyze the relationship between algorithmic and human decision-making power. We present algorithms as analogous to impartial bureaucratic rules for controlling action, and argue that discretionary decision-making power in algorithmic systems accumulates at locations where uncertainty about the operation of algorithms persists. This key point of our essay connects with Alkhatib and Bernsteinâs theory of âstreet-level algorithmsâ, and highlights that the role of human discretion in algorithmic systems is to accommodate uncertain situations which inflexible algorithms cannot handle. We conclude by discussing how the analysis and design of algorithmic systems could seek to identify and cultivate important sources of uncertainty, to enable the human discretionary work that enhances systemic resilience in the face of algorithmic errors.Peer reviewe
Automated telephone communication systems for preventive healthcare and management of long-term conditions
Background
Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients
using either their telephoneâs touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact
between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice
communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice
(ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention.
Objectives
To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process,
cognitive, patient-centred and adverse outcomes.
Search methods
We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL;
Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses,
Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between
1980 and June 2015.
Selection criteria
Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS
interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any
preventive healthcare or long term condition management role were eligible.
Data collection and analysis
We used standard Cochrane methods to select and extract data and to appraise eligible studies.
Main results
We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation
of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for
managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily
because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half
the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to
blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome
reporting to be unclear.
For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR)
1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR
1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI
0.53 to 9.02; 2 studies, N = 1743; very low certainty).
For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462;
high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care.
It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate
certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36,
95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR
(RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.
Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low
certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions
(25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication
adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves
medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication
adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases
medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS,
compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or
no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage)
related to adherence, but only a small number of studies contributed clinical outcome data.
The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS
varied, including by the type of ATCS intervention in use.
Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS
types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity,
weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure,
hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/
substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia,
obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.
Only four trials (3%) reported adverse events, and it was unclear whether these were related to the intervention
A dyadic analysis of stress processes in Latinas with breast cancer and their family caregivers
Breast cancer diagnosis and treatment negatively affect quality of life for survivors and their family caregivers. The stress process model has been useful for describing the cascade of social and psychological experiences that culminate in degraded quality of life for both survivors and their family caregivers. This study is designed to test theoretically specified predictors of negative psychosocial outcomes in a dyadic context.
Participants were 230 dyads composed of Latinas recently diagnosed with breast cancer and their primary family caregiver, who completed measures of socioeconomic status, stress, family conflict, depression, and anxiety. Data were analyzed following the Actor-Partner Interdependence Mediation Model in structural equation modeling.
For both survivors and caregivers, there were significant direct and indirect actor effects (through family conflict) of perceived stress on depression and anxiety. Several indirect partner effects were also evident in this sample. Specifically, caregivers' stress was predictive of survivors' depression and anxiety through survivors' increased perceptions of family conflict.
As predicted by the stress process model, stress and family conflict were predictive of psychological distress in breast cancer survivors and their family caregivers. Significant partner effects in the Actor-Partner Interdependence Mediation Model suggest that there are some dyadic influences, particularly from caregivers' stress to survivors' perceptions of exacerbated family conflict. These findings show how strained family relationships can aggravate the well-being of cancer survivors and their family caregivers through this challenging experience
Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access
The Effects of Physical Distance from a Brand Extension on the Impact of Brand-Extension Fit
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