A collaborative network for first responders: Lessons from the CapWIN case

It is increasingly important for government agencies to collaborate across jurisdictional and functional boundaries. Interorganizational systems supporting interagency collaboration must accommodate a wide range of factors from the external environment and participating organizations as part of their design and operation. This paper presents the findings from a case study of CapWIN, a collaborative network created to enable first responders to share information across jurisdictional and functional boundaries as they work together during emergencies and other critical events. The study examines how aspects of the external environment and the agency context impeded or facilitated the CapWIN collaborative network and the interorganizational system (IOS) that supports it. We identify factors affecting information sharing and collaborative processes, and describe how these factors interact to enable and constrain an IOS. The paper concludes with suggestions for further research on the interplay of environmental, organizational, and technical aspects of interagency collaboration networks as they evolve over time.     

The value and impact of information provided through library services for patient care: a systematic review

OBJECTIVE: An updated systematic review was carried out of research studies looking at the value and impact of library services on health outcomes for patients and time saved by health professionals. METHODS: A comprehensive systematic search was undertaken of the published literature to September 2003 in ERIC, LISA, MEDLINE, PREMEDLINE, EMBASE, the Cochrane Controlled Trials Register and Google. Some handsearching was carried out, reference lists were scanned and experts in the field were contacted. Twenty-eight research studies of professionally led libraries for health-care staff, including clinical librarian projects, met the inclusion criterion of at least one health or 'time saved' outcome. Papers were critically appraised using internationally accepted criteria. Data were extracted and results were summarised using a narrative format as the studies were heterogeneous and precluded a statistical analysis. RESULTS: There is evidence of impact from both traditional and clinical librarian services. The higher quality studies of traditional services measured impacts of 37-97% on general patient care, 10-31% on diagnosis, 20-51% on choice of tests, 27-45% on choice of therapy and 10-19% on reduced length of stay. Four studies of clinical librarian projects suggested that professionals saved time as a result of clinical librarian input, and two of these studies showed evidence of cost-effectiveness. However, the clinical librarian studies were generally smaller, with poorer quality standards. CONCLUSIONS: Research studies suggest that professionally led library services have an impact on health outcomes for patients and may lead to time savings for health-care professionals. The available studies vary greatly in quality but the better quality studies also suggest positive impacts. Good practice can be gathered from these studies to guide the development of a pragmatic survey for library services that includes the direct effects for patients among the outcome measures.     

Modern dietary guidelines for healthy pregnancy; maximising maternal and foetal outcomes and limiting excessive gestational weight gain

Abstract

Maternal dietary habits influence maternal and foetal health, representing a pathway for intervention to maximise pregnancy outcomes. Advice on energy intake is provided on a trimester basis, with no additional calories required in the first trimester and an additional 340?kcal?d^?1 and 452?kcal?d^?1 needed for the second and third trimesters. Energy intake depends on pre-gravid body mass index (BMI); underweight women are recommended an increase of 150, 200 and 300?kcal?d^?1 during the first, second and third trimester, normal weight women an increase of 0, 350 and 500?kcal?d^?1 and obese women an increase of 0, 450 and 350?kcal?day^?1. The recommendations for carbohydrate and protein intake are 175?g?d^?1 and 0.88–1.1?g?kgBM?d^?1, with no change to fat intake. The number of pre-gravid obese women is rising; therefore, we need to regulate weight in women of childbearing age and limit gestational weight gain to within the recommended ranges [overweight women 6.8–11.3?kg and obese women 5.0–9.1?kg]. This can be achieved using nutritional interventions, as dietary changes have been shown to help with gestational weight management. As pregnancy has been identified as a risk factor for the development of obesity, normal weight women should gain 11.5–16.0?kg during pregnancy. While some research has shown that dietary interventions help to regulate gestational weight gain and promote postpartum weight loss to some extent, future research is needed to provide safe and effective guidelines to maximise these effects, while benefitting maternal and foetal health.     

Designing a search strategy to identify and retrieve articles onevidence-based health care using MEDLINE

Thepractice of evidence-based health care requires that information on methodology be identifiedfrom databases such as MEDLINE. Up until this year there have been no designated medicalsubject headings (MeSH) for evidence-based health care. ‘EVIDENCE-BASEDMEDICINE’ appears as a MeSH term from 1997. The absence of designated MeSH forthis concept prior to 1997 provides a challenge to the searcher. This paper describes the creationof a MEDLINE search strategy to retrieve articles on the methods of evidence-based health carepublished prior to the introduction of the new term, where an optimal combination of free-textand MeSH terms is required to identify relevant material. The study examines both free-text andsubject heading searching and attempts an optimal balance of sensitivity and specificity. It beginsby examining separate free-text and subject heading searches. Sensitivity of the subject headingsearch was 33% and specificity 80%, while the free-text search produced asensitivity of 50% and a specificity of 67%. The final strategy, combining bothapproaches, was more successful with sensitivity reaching between 82 and 90% andspecificity 83%. It is therefore possible to devise a search strategy to retrieve articles on themethods of evidence-based health care with relatively successful rates of sensitivity andspecificity. The limitations of MEDLINE, however, necessitate the use of additional approachesin identifying articles on the methods of evidence-based health care.     

The Role of Extended Time and Item Content on a High‐Stakes Mathematics Test

The premise of a great deal of current research guiding policy development has been that accommodations are the catalyst for student performance differences. Rather than accepting this premise, two studies were conducted to investigate the influence of extended time and content knowledge on the performance of ninth‐grade students who took a statewide mathematics test with and without accommodations. Each study involved 1,250 accommodated students (extended time only) with learning disabilities and 1,250 nonaccommodated students demonstrating no disabilities. In Study One, a standard differential item functioning (DIF) analysis illustrated that the usual approach to studying the effects of accommodations contributes little to our understanding of the reason for performance differences across students. Next, a mixture item response theory DIF model was used to explore the most likely cause(s) for performance differences across the population. The results from both studies suggest that students for whom items were functioning differently were not accurately characterized by their accommodation status but rather by their content knowledge. That is, knowing students' accommodation status (i.e., accommodated or nonaccommodated) contributed little to understanding why accommodated and nonaccommodated students differed in their test performance. Rather, the data would suggest that a more likely explanation is that mathematics competency differentiated the groups of student learners regardless of their accommodation and/or reading levels.     

Interactive Influences of Perceived Social Contexts on the Reading Achievement of Urban Middle Schoolers with Learning Disabilities

This study examined the effects of social influences in the lives of an ethnically diverse sample of fifth through eighth grade students with and without learning disabilities (LD) using survey data and academic achievement scores collected in 19 Chicago public schools from 1993–1997. Similarities and differences in student perceptions of school, family, and peer group contexts were examined. In addition, longitudinal data were analyzed using hierarchical linear modeling (HLM) to identify contextual influences on changes in student reading achievement over time. Comparisons of student responses confirm and extend existing findings in the literature concerning the perceptions of students with LD of their social environments. In particular, having a learning disability was associated with consistent, mostly negative, effects on social relations across the contexts of students’ lives, regardless of gender, race, grade, and socioeconomic status. In addition, student perceptions of their friendship groups were found to have small, but significant, effects on their growth in reading achievement over the course of middle school. While students with and without LD had somewhat different views of their social contexts, the processes working within these environments appeared to affect their reading achievement in similar ways. The results suggest that careful attention should be paid to the social contexts of students’ lives when planning academic interventions.