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OBJECTIVE:Describe the planning, development, and implementation of the Focus Forward Oklahoma Program, a statewide contraceptive access initiative focused on increasing access to the full range of contraceptive options through three strategies: 1) policy change, 2) communication, and 3) workforce development. STUDY DESIGN:An implementation science framework was used for planning, development, and implementation. Planning and development included four components: 1) establishing an advisory committee, 2) conducting a needs assessment, 3) developing primary strategies, and 4) identifying baseline metrics. Implementation used iterative action cycles to continually assess and adapt implementation to ensure success. RESULTS:Eighteen policy issues were identified with 14 resolved as of publication. The communication strategy resulted in collaboration among organizations, alignment of priorities, and the development of training materials, guidance documents, and a resource library. Workforce development resulted in 663 clinicians receiving contraceptive access training. CONCLUSIONS:The planning, development, and implementation of the program demonstrates that implementation science-based efforts can produce strategies that address systemic barriers to contraceptive access. Aligning payer policies, coalition-building, and responsive training are all key activities of the program and process adaptations and lessons learned have contributed to the continued viability of the program. IMPLICATIONS:Increasing contraceptive access requires a multifaceted approach in which key barriers are addressed. Clinicians can contribute to addressing access via their personal practice and through participation in broader programs such as this one.
Aggregate gradation is crucial in controlling the workability of slip-formed airfield paving concrete. This study explores the impact of varying amounts of coarse aggregate [retained on a 4.75 mm (#4 sieve)] on the workability of airfield paving concrete. The study focuses on the aggregate retention of sieve sizes 25 mm (1 in.), 12.5 mm (1/2 in.), 9.5 mm (3/8 in.), and 4.75 mm (#4 sieve). The workability investigation includes the consolidation response, edge slump, and the slump test. This work reveals that various aggregate gradations can achieve good workability, while some may perform poorly. Edge slump-related failure generally occurs more with higher retention on the 25 mm (1 in.) and 12.5 mm (1/2 in.) sieves, while surface voids are more significant at higher retention on the 9.5 mm (3/8 in.) and 4.75 mm (#4) sieves. Based on the findings, the combined aggregate limits of the tarantula curve have been modified for slip-forming concrete in airfield paving applications. The mixture design methods will guide practitioners in optimizing concrete mixture design for airfield paving applications.
For architectural educators in India, online education was still emerging before the pandemic, and limited research has been conducted in this area. This research investigates the pedagogical adaptations by architectural educators in response to the pandemic-driven external factors, focusing on their perceptions and the transformation of architectural education in India. This research addresses the critical knowledge gap concerning the proficiency of architectural educators in India for online content delivery by examining nine relationships across three core dimensions of the online learning environment: technology requirements, institutional support, and enhancements in educator proficiency. An online survey was administered to educators affiliated with more than 450 architectural colleges in India. The findings, based on responses from 165 architectural educators, demonstrate notable advancements in online teaching proficiency among educators and a moderate correlation between educators' online teaching proficiency and their overall teaching experience. However, the country's insufficient technological infrastructure and institutional support continue to pose challenges. This study also uncovers a significant relationship between technology requirements, interactions with students enrolled in courses, and students' engagement during online sessions. The practical applications of this research highlight the difficulties encountered by architectural educators and propose strategies for the continuous improvement of online architectural education in India.
Aims:Proximal humerus fractures (PHFs) often occur in a population at risk for complications following surgery. The purpose of this study is to assess the associations of frailty with complications of surgical intervention for PHFs. Methods:The American College of Surgeons National Surgical Quality Improvement Program database was queried from January 2015 to December 2020 for patients aged ≥ 60 years who were undergoing surgery for PHFs. Tiered frailty scores were calculated by the revised risk analysis index (RAI-Rev) and the modified five-term frailty index (mFI-5) factor. Outcomes included 30-day mortality, readmission, length of stay, and complications. Analysis of variance and binary logistic regression were used to assess associations with odds ratio (OR) and 95% CI. Discriminatory accuracy was quantified by receiver operating characteristic curve analysis and C-statistics. Results:A total of 6,020 patients with PHFs underwent surgical intervention (51% frail or severely frail). The use of reverse total shoulder arthroplasty (rTSA) for PHFs increased over time (OR 1.14 (95% CI 1.11 to 1.18)), whereas all other procedures decreased. Frail patients were more likely to experience a complication after surgery (OR 2.92 (95% CI 2.48 to 3.43)). Overall, rTSA had higher rates of complications (17% (OR 0.93 (95% CI 0.86 to 0.99)) and non-home discharge (32% (OR 0.84 (95% CI 0.79 to 0.90)). However, these decreased from 2015 to 2020. The RAI-Rev had superior predictability to mFI-5 for any complication (area under the curve (AUC) 0.674 vs 0.601), postoperative blood transfusion (AUC 0.704 vs 0.618), and non-home discharge (AUC 0.778 vs 0.637). Conclusion:Frail patients have a three-times higher 30-day complication risk following proximal humerus surgery. rTSA is associated with higher rates of complications compared with internal fixation, but has steadily narrowed the gap over time. While the long-term outcomes and functional benefit should be considered, preoperative frailty assessment can be predictive of perioperative complications and disposition in this population.
