A realistic evaluation : the case of protocol-based care

Background 'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways. Methods Situated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances. Results In this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs). Conclusions As one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice

Endogenous fantasy and learning in digital games.

Many people believe that educational games are effective because they motivate children to actively engage in a learning activity as part of playing the game. However, seminal work by Malone (1981), exploring the motivational aspects of digital games, concluded that the educational effectiveness of a digital game depends on the way in which learning content is integrated into the fantasy context of the game. In particular, he claimed that content which is intrinsically related to the fantasy will produce better learning than that which is merely extrinsically related. However, this distinction between intrinsic and extrinsic (or endogenous and exogenous) fantasy is a concept that has developed a confused standing over the following years. This paper will address this confusion by providing a review and critique of the empirical and theoretical foundations of endogenous fantasy, and its relevance to creating educational digital games. Substantial concerns are raised about the empirical basis of this work and a theoretical critique of endogenous fantasy is offered, concluding that endogenous fantasy is a misnomer, in so far as the "integral and continuing relationship" of fantasy cannot be justified as a critical means of improving the effectiveness of educational digital games. An alternative perspective on the intrinsic integration of learning content is described, incorporating game mechanics, flow and representations

Entropy/IP: Uncovering Structure in IPv6 Addresses

In this paper, we introduce Entropy/IP: a system that discovers Internet address structure based on analyses of a subset of IPv6 addresses known to be active, i.e., training data, gleaned by readily available passive and active means. The system is completely automated and employs a combination of information-theoretic and machine learning techniques to probabilistically model IPv6 addresses. We present results showing that our system is effective in exposing structural characteristics of portions of the IPv6 Internet address space populated by active client, service, and router addresses. In addition to visualizing the address structure for exploration, the system uses its models to generate candidate target addresses for scanning. For each of 15 evaluated datasets, we train on 1K addresses and generate 1M candidates for scanning. We achieve some success in 14 datasets, finding up to 40% of the generated addresses to be active. In 11 of these datasets, we find active network identifiers (e.g., /64 prefixes or `subnets') not seen in training. Thus, we provide the first evidence that it is practical to discover subnets and hosts by scanning probabilistically selected areas of the IPv6 address space not known to contain active hosts a priori.Comment: Paper presented at the ACM IMC 2016 in Santa Monica, USA (https://dl.acm.org/citation.cfm?id=2987445). Live Demo site available at http://www.entropy-ip.com

Best practice in undertaking and reporting health technology assessments : Working Group 4 report

[Executive Summary] The aim of Working Group 4 has been to develop and disseminate best practice in undertaking and reporting assessments, and to identify needs for methodologic development. Health technology assessment (HTA) is a multidisciplinary activity that systematically examines the technical performance, safety, clinical efficacy, and effectiveness, cost, costeffectiveness, organizational implications, social consequences, legal, and ethical considerations of the application of a health technology (18). HTA activity has been continuously increasing over the last few years. Numerous HTA agencies and other institutions (termed in this report “HTA doers”) across Europe are producing an important and growing amount of HTA information. The objectives of HTA vary considerably between HTA agencies and other actors, from a strictly political decision making–oriented approach regarding advice on market licensure, coverage in benefits catalogue, or investment planning to information directed to providers or to the public. Although there seems to be broad agreement on the general elements that belong to the HTA process, and although HTA doers in Europe use similar principles (41), this is often difficult to see because of differences in language and terminology. In addition, the reporting of the findings from the assessments differs considerably. This reduces comparability and makes it difficult for those undertaking HTA assessments to integrate previous findings from other HTA doers in a subsequent evaluation of the same technology. Transparent and clear reporting is an important step toward disseminating the findings of a HTA; thus, standards that ensure high quality reporting may contribute to a wider dissemination of results. The EUR-ASSESS methodologic subgroup already proposed a framework for conducting and reporting HTA (18), which served as the basis for the current working group. New developments in the last 5 years necessitate revisiting that framework and providing a solid structure for future updates. Giving due attention to these methodologic developments, this report describes the current “best practice” in both undertaking and reporting HTA and identifies the needs for methodologic development. It concludes with specific recommendations and tools for implementing them, e.g., by providing the structure for English-language scientific summary reports and a checklist to assess the methodologic and reporting quality of HTA reports

The Repair and Return to Flight of Solid Rocket Booster Forward Skirt Serial Number 20022

On April 5, 1991, a solid rocket booster (SRB) forward skirt serial number (S/N) 20022 sustained buckling damage during water impact after the launch of Space Transportation System Flight 37 (STS-37). As of that date, five forward skirts had been lost during water impact. Repair attempts began with the least damaged skirt available (S/N 20022). Sp ecial hydraulic tooling was used to remove buckled areas of the skirt. Afterwards, its aft clevis pinholes were found to be out of alignment with the redesigned solid rocket motor (RSRM) check gauge, but weld passes were used to correct this condition. Meanwhile, USA Analytics generated mechanical property data for buckled and subsequently debuckled material. Their analysis suggested that structural integrity might be improved by adding stringer reinforcements, stiffeners, to the aft bay section of the skirt. This improvement was recommended as a fleet modification to be implemented on a case-by-case basis

Multiply Folded Graphene

The folding of paper, hide, and woven fabric has been used for millennia to achieve enhanced articulation, curvature, and visual appeal for intrinsically flat, two-dimensional materials. For graphene, an ideal two-dimensional material, folding may transform it to complex shapes with new and distinct properties. Here, we present experimental results that folded structures in graphene, termed grafold, exist, and their formations can be controlled by introducing anisotropic surface curvature during graphene synthesis or transfer processes. Using pseudopotential-density functional theory calculations, we also show that double folding modifies the electronic band structure of graphene. Furthermore, we demonstrate the intercalation of C60 into the grafolds. Intercalation or functionalization of the chemically reactive folds further expands grafold's mechanical, chemical, optical, and electronic diversity.Comment: 29 pages, 10 figures (accepted in Phys. Rev. B

COLLABORATING IN THE CAPTURE LAB: Computer Support for Group Writing

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67328/2/10.1177_108056999005300208.pd

E. coli Fate and Transport in Macroporous Soils: Short-Circuiting to the Subsurface

Pathogen concentrations in streamflow are commonly reported as a significant cause of water quality degradation throughout the world. Research has begun to attempt to model pathogen fate and transport, primarily through surface runoff mechanisms. A significant component of pathogen movement to streams commonly identified but not explicitly simulated in many models is pathogen movement to the subsurface, which can be important in several scenarios such as tile drainage systems. As colloidal contaminants, pathogens such as E. coli tend to become physically trapped in the soil matrix but can move quickly through soil macropores. In fact, concerns exist about the rapid transport of contaminants, such as pesticides, pathogens, and nutrients, from the soil surface to ground water through macropores. Recent research suggests short-circuiting or direct hydrologic connectivity between macropores and subsurface drains. The objective of this paper is to provide an overview of the current research regarding the fate and transport of E. coli through soil macropores and into subsurface drain systems. This paper reports early results from the first year of a multi-year study funded by the USDA Cooperative State Research, Education, and Extension Service as part of the their National Research Initiative program. Field experiments to document short-circuiting by macropores are described and also laboratory data is presented from soil column experiments, capable of simulating surface-connected macropores, with artificial subsurface drainage boundary conditions. These column studies generated information regarding the importance of directly connected macropores on pathogen transport to subsurface drains