21 research outputs found

    Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study

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    Abstract Background Numerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors 2.5 years after removal of study supports. INFORM was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015–2016, we successfully implemented two theory-based feedback strategies (compared to a simple feedback approach) to increase nursing home (NH) care aides’ involvement in formal communications about resident care. Methods Sustainability analyses included 51 Western Canadian NHs that had been randomly allocated to a simple and two assisted feedback interventions in INFORM. We measured care aide involvement in formal interactions (e.g., resident rounds, family conferences) and other study outcomes at baseline (T1, 09/2014-05/2015), post-intervention (T2, 01/2017-12/2017), and long-term follow-up (T3, 06/2019–03/2020). Using repeated measures, hierarchical mixed models, adjusted for care aide, care unit, and facility variables, we assess sustainability and associated factors: organizational context (leadership, culture, evaluation) and fidelity of the original INFORM intervention. Results We analyzed data from 18 NHs (46 units, 529 care aides) in simple feedback, 19 NHs (60 units, 731 care aides) in basic assisted feedback, and 14 homes (41 units, 537 care aides) in enhanced assisted feedback. T2 (post-intervention) scores remained stable at T3 in the two enhanced feedback arms, indicating sustainability. In the simple feedback group, where scores were had remained lower than in the enhanced groups during the intervention, T3 scores rose to the level of the two enhanced feedback groups. Better culture (β = 0.099, 95% confidence interval [CI] 0.005; 0.192), evaluation (β = 0.273, 95% CI 0.196; 0.351), and fidelity enactment (β = 0.290, 95% CI 0.196; 0.384) increased care aide involvement in formal interactions at T3. Conclusions Theory-informed feedback provides long-lasting improvement in care aides’ involvement in formal communications about resident care. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment during the intervention period may facilitate sustained improvement, warranting further study—as does possible post-intervention spread of our intervention to simple feedback homes

    Blackouts and Progress: Privatization, Infrastructure, and a Developmentalist State in Jimma, Ethiopia

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    Uncorrected proof. Supplemental material: http://culanth.org/?q=node/475The recent completion of a hydropower dam near Jimma, Ethiopia coincided with rolling blackouts throughout the country and accusations of corruption and mismanagement being directed toward the Ethiopian government and the Italian company that constructed the dam. The case appears to be one more example of an African state failing to provide its citizens with basic public services in a context of neoliberal economic restructuring. Recent road construction and urban renewal projects in Jimma have also been contracted out to private companies and have led to displaced families and disruptions of day-to-day life. Jimma residents, however, have generally met these projects with statements of approval and appreciation for the power of the Ethiopian state to bring progress. In this article, I examine contrasting narratives concerning privatized infrastructural development projects. I argue that although the provision of basic services is increasingly contracted out to private companies, the perceived presence of the Ethiopian state has expanded in new and surprising ways. Contrasting perceptions of dams and road construction are based in values concerning relations of power and exchange. In this case, the particular relationship between the privatization of infrastructure and perceptions of the state demonstrates the limits of neoliberalism as an analytical category. I argue that in recent anthropological scholarship a reliance on neoliberalism as a category of analysis obscures more than it reveals, and I call for more attention to correlations between specific techniques of governance and relations of power.National Science Foundation Grant #0717608; Fulbright-Hays Fellowshi

    A review of nitrous oxide mitigation by farm nitrogen management in temperate grassland-based agriculture

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    peer-reviewedNitrous oxide (N2O) emission from grassland-based agriculture is an important source of atmospheric N2O. It is hence crucial to explore various solutions including farm nitrogen (N) management to mitigate N2O emissions without sacrificing farm profitability and food supply. This paper reviews major N management practices to lower N2O emission from grassland-based agriculture. Restricted grazing by reducing grazing time is an effective way to decrease N2O emissions from excreta patches. Balancing the protein-to-energy ratios in the diets of ruminants can also decrease N2O emissions from excreta patches. Among the managements of synthetic fertilizer N application, only adjusting fertilizer N rate and slow-released fertilizers are proven to be effective in lowering N2O emissions. Use of bedding materials may increase N2O emissions from animal houses. Manure storage as slurry, manipulating slurry pH to values lower than 6 and storage as solid manure under anaerobic conditions help to reduce N2O emissions during manure storage stage. For manure land application, N2O emissions can be mitigated by reducing manure N inputs to levels that satisfy grass needs. Use of nitrification inhibitors can substantially lower N2O emissions associated with applications of fertilizers and manures and from urine patches. N2O emissions from legume based grasslands are generally lower than fertilizer-based systems. In conclusion, effective measures should be taken at each step during N flow or combined options should be used in order to mitigate N2O emission at the farm level.Department of Agriculture, Fisheries and Food, Ireland, Research Stimulus Fund (RSF 07 516, RSF 07 511

    Affordable housing : what states can do /

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    "HUD-713-PDR(4)"--P. [4] of cover."September 1987"--P. [4] of cover."The Joint Venture for Affordable Housing"--Cover.Mode of access: Internet
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