The social safety net responded in significant and favorable ways during the Great Recession. Aggregate per capita expenditures in safety net programs grew significantly, with particularly strong ...growth in the SNAP, EITC, UI, and Medicaid programs. The increase in transfers was widely shared across demographic groups, including families with and without children, and single-parent and two-parent families. Transfers grew as well among families with more employed members and with fewer employed members. In the low-income population, however, the increase in transfer amounts was not strongly progressive across income classes, with transfers to those just below or above the poverty line increasing slightly, compared to those at the bottom of the income distribution. This was mainly because of the EITC program, which provides greater benefits to those with higher family earnings. The expansions of SNAP and UI benefitted those at the bottom of the income distribution to a greater extent.
Static analysis tools report software defects that may or may not be detected by other verification methods. Two challenges complicating the adoption of these tools are spurious false positive ...warnings and legitimate warnings that are not acted on. This paper reports automated support to help address these challenges using logistic regression models that predict the foregoing types of warnings from signals in the warnings and implicated code. Because examining many potential signaling factors in large software development settings can be expensive, we use a screening methodology to quickly discard factors with low predictive power and cost-effectively build predictive models. Our empirical evaluation indicates that these models can achieve high accuracy in predicting accurate and actionable static analysis warnings, and suggests that the models are competitive with alternative models built without screening.
This paper discusses the fundamental importance of achieving quality implementation when assessing the impact of social and emotional learning interventions. Recent findings in implementation science ...are reviewed that include a definition of implementation, its relation to programme outcomes, current research on the factors that affect implementation, and a framework for understanding the steps, actions and challenges involved in achieving quality implementation. Examples from the social and emotional learning literature are used to illustrate different issues.
This study offers a commentary on the articles contained in the special issue of
Prevention Science
, “Readiness to implement Social- Emotional Learning interventions.” The commentary also puts these ...articles into current context by summarizing important findings in implementation research and listing some priorities for future work.
Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not ...on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation.
We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files.
Selected studies included all English-language articles concerning adult patients using the search terms 'intensive care' or 'critical care' with 'palliative care,' 'supportive care,' 'end-of-life care,' or 'ethics.'
: After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus.
Existing evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and families face challenges after discharge from intensive care.
Palliative care is increasingly accepted as an essential component of comprehensive care for critically ill patients, regardless of diagnosis or prognosis. A variety of strategies to improve ICU palliative care appear to be effective, and resources including technical assistance and tools are available to support improvement efforts. As the longer-term impact of intensive care on those surviving acute critical illness is increasingly documented, palliative care can help prepare and support patients and families for challenges after ICU discharge. Further research is needed to inform efforts to integrate palliative care with intensive care more effectively and efficiently in and after the ICU and to document improvement using valid and responsive outcome measures.
The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published ...by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact of possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for “intensity modulated radiation therapy (IMRT)” as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient.
Evaluation is an activity to find out the teaching and learning process has achieved the goals that have been set. Meanwhile, the Independent Learning Activity Unit program is a small unit of lessons ...arranged sequentially from easy to difficult with respect to knowledge and skills. This study aims to determine the existence of the Independent Learning Activity Unit program in terms of context, input, process and product at MAN 3 Medan. This research is a quantitative research with CIPP model evaluation. Data was collected by means of questionnaires or questionnaires, interviews and documentation. The population is 329 students with a sample of 82 students consisting of class XI at MAN 3 Medan. Data analysis techniques with editing, tabulating, analyzing and concluding. The results showed that the Independent Learning Activity Unit program at MAN 3 Medan was effective as seen from the results of the average value of the process in the category 51.02. When viewed from the results of the context, input and product, the Independent Learning Activity Unit has complied with the guidelines and is equipped with supporting facilities.
•The home visiting field lacks a standard definition for what “high-quality” program implementation means.•We engaged experts from the field in a co-design process to develop a framework to ...understand home visiting quality.•The framework captures the multiple levels of the home visiting system and theorized key aspects of quality.
Early childhood home visiting is a two-generation approach to promote positive health and well-being outcomes among people who are pregnant and families with infants and young children. A popular family support strategy for the past several decades, home visiting expanded exponentially in the United States when the federal Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) was authorized in 2010 through a provision within the Affordable Care Act. MIECHV currently funds evidence-based home visiting services in underserved and historically marginalized communities in all 50 states, 22 tribes, the District of Columbia, and five U.S. territories. It is widely accepted that achieving intended child and family outcomes through home visiting services requires “high-quality” program implementation, but the field lacks a standard definition or empirical evidence for what “quality” means in the context of home visiting. With the rapid expansion of home visiting that has accompanied MIECHV, there is increased interest from the field in having a shared understanding of home visiting implementation quality that is applicable across models and accounts for dimensions of quality across the entirety of the home visiting implementation system. This paper describes the process used to develop a conceptual framework to understand home visiting quality. We engaged MIECHV awardees and other experts from the fields of home visiting, early childhood, implementation science, and health equity in a co-design process that involved initial brainstorming, a series of iterative framework drafts, and finalization of the model. The resulting framework captures the multiple levels (i.e., the contexts, agencies, entities, and individuals) that are part of the home visiting system and the theorized key aspects of quality that are applicable across the levels of the systems. We discuss potential uses of the conceptual framework, as well as lessons learned from the co-design process.
Migrant students tend to underperform in Science, Technology, Engineering, and Mathematics (STEM) subjects and are less likely to pursue higher education in STEM when compared with their nonmigrant ...peers. Given the substantial increase in migration, this disparity has been a central concern in science education in many European countries. The purpose of this study was to investigate the effectiveness of an innovative science outreach program that brings together migrant students and STEM professionals with the same linguistic and cultural backgrounds. The program consists of one‐off workshops that follow an inquiry‐based approach and include hands‐on activities and science communication in the students' heritage language. Using surveys with adapted scales and open‐ended questions, we applied a randomized block design with waitlist control groups and repeated measures. Eighty‐three Portuguese‐speaking migrant students aged 6–17 years participated in the workshops in Germany and the United Kingdom. Results indicate that both the students and STEM professionals evaluated the program positively and that students who participated in the workshops tended to demonstrate an increase in their attainment value for science and an increase in their self‐concept of ability for the heritage language 4 weeks after the intervention when compared with students in the control condition. These effects were particularly pronounced for students with low prior motivation to study science or speak the heritage language. Our results thus show that it is possible to foster migrant students' attainment value for science and increase their self‐concept of ability regarding the heritage language through a brief science outreach intervention.
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