ISBDD Model for Classification of Hyperspectral Remote Sensing Imagery.

The diverse density (DD) algorithm was proposed to handle the problem of low classification accuracy when training samples contain interference such as mixed pixels. The DD algorithm can learn a feature vector from training bags, which comprise instances (pixels). However, the feature vector learned by the DD algorithm cannot always effectively represent one type of ground cover. To handle this problem, an instance space-based diverse density (ISBDD) model that employs a novel training strategy is proposed in this paper. In the ISBDD model, DD values of each pixel are computed instead of learning a feature vector, and as a result, the pixel can be classified according to its DD values. Airborne hyperspectral data collected by the Airborne Visible/Infrared Imaging Spectrometer (AVIRIS) sensor and the Push-broom Hyperspectral Imager (PHI) are applied to evaluate the performance of the proposed model. Results show that the overall classification accuracy of ISBDD model on the AVIRIS and PHI images is up to 97.65% and 89.02%, respectively, while the kappa coefficient is up to 0.97 and 0.88, respectively.

Service-integration approaches for families with low income: a Families First Edmonton, community-based, randomized, controlled trial.

BACKGROUND: Increasing access to health and social services through service-integration approaches may provide a direct and sustainable way to improve health and social outcomes in low-income families. METHODS: We did a community-based randomized trial evaluating the effects of two service-integration practices (healthy family lifestyle and recreational activities for children) among low-income families in Alberta, Canada. These two practices in combination formed four groups: Self-Directed (no intervention), Family Healthy Lifestyle, Family Recreation, and Comprehensive (Family Healthy Lifestyle plus Family Recreation programs). The primary outcome was the total number of service linkages. RESULTS: We randomized 1168 families, 50 % of which were retained through the last follow-up visit. The number of service linkages for all three intervention groups was not significantly different from the number of linkages in the Self-Directed group (Comprehensive 1.15 (95 % CI 0.98-1.35), Family Healthy Lifestyle 1.17 (0.99-1.38), and Family Recreation 1.12 (0.95-1.32) rate ratios). However, when we explored the number of linkages by the categories of linkages, we found significantly more healthcare service linkages in the Comprehensive group compared to the Self-Directed group (1.27 (1.06-1.51)) and significantly more linkages with child-development services in the Family Healthy Lifestyle group compared to the Self-Directed group (3.27 (1.59-6.74)). The monthly hours of direct intervention was much lower than the assigned number of hours (ranging from 5 to 32 % of the assigned hours). CONCLUSIONS: Our findings are relevant to two challenges faced by policymakers and funders. First, if funds are to be expended on service-integration approaches, then, given the lack of intervention fidelity found in this study, policymakers need to insist, and therefore fund a) a well-described practice, b) auditing of that practice, c) retention of family participants, and d) examination of family use and outcomes. Second, if child-development services are widely required and are difficult for low-income families to access, then current policy needs to be examined. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00705328 . Registered on 24 June 2008.

Community-Based Participatory Research: Ameliorating Conflict When Community and Research Practices Meet.

BACKGROUND: Community-based participatory research (CBPR) is "a collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each brings." Yet working collaboratively throughout the research process is easier said than done. OBJECTIVES: To illustrate what happens when community partners' and research partners' "unique strengths" or ways of working collide, and the lessons learned from the process partners used to work through their differences. METHODS: An exploratory qualitative method was used to answer the research question, "How do community and research partners resolve conflict embedded in conventional community and research practices?" LESSONS LEARNED AND CONCLUSIONS: When new partners join an established CBPR partnership, it is important to begin by getting to know the new partner rather than with the tasks that need to be accomplished. Furthermore, when conflict is pervasive, partners should move away from discussions and work together on a concrete task together.

The protocol for the Families First Edmonton trial (FFE): a randomized community-based trial to compare four service integration approaches for families with low-income.

BACKGROUND: Families with low incomes experience an array of health and social challenges that compromise their resilience and lead to negative family outcomes. Along with financial constraints, there are barriers associated with mental and physical health, poorer education and language. In addition, vulnerable populations experience many services as markedly unhelpful. This combination of family and service barriers results in reduced opportunities for effective, primary-level services and an increased use of more expensive secondary-level services (e.g., emergency room visits, child apprehensions, police involvement). A systematic review of effective interventions demonstrated that promotion of physical and mental health using existing service was critically important. METHODS/DESIGN: The Families First Edmonton Trial (FFE) tests four service integration approaches to increase use of available health and social services for families with low-income. It is a randomized, two-factor, single-blind, longitudinal effectiveness trial where low-income families (1168) were randomly assigned to receive either (1) Family Healthy Lifestyle plus Family Recreation service integration (Comprehensive), (2) Family Healthy Lifestyle service integration, (3) Family Recreation service integration, or (4) existing services. To be eligible families needed to be receiving one of five government income assistance programs. The trial was conducted in the City of Edmonton between January 2006 and August 2011. The families were followed for a total of three years of which interventional services were received for between 18 and 24 months. The primary outcome is the number of family linkages to health and social services as measured by a customized survey tool "Family Services Inventory". Secondary outcomes include type and satisfaction with services, cost of services, family member health, and family functioning. Where possible, the measures for secondary outcomes were selected because of their standardization, the presence of published norming data, and their utility as comparators to other studies of low-income families. As an effectiveness trial, community and government partners participated in all committees through a mutually agreed upon governance model and helped manage and problem solve with researchers. DISCUSSION: Modifications were made to the FFE trial based on the pragmatics of community-based trials. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT00705328.

An inter-institutional collaboration: transforming education through interprofessional simulations.

An inter-institutional partnership of four post-secondary institutions and a health provider formed a learning community with the goal of developing, implementing and evaluating interprofessional learning experiences in simulation-based environments. The organization, education and educational research activities of the learning community align with the institutional and instructional reforms recommended by the Lancet Commission on Health Professional Education for the 21st century. This article provides an overview of the inter-institutional collaboration, including the interprofessional simulation learning experiences, instructor development activities and preliminary results from the evaluation.

Establishing therapeutic relationships with vulnerable and potentially stigmatized clients.

Grounded theory was employed to elucidate how public health nurses (PHNs) develop therapeutic relationships with vulnerable and potentially stigmatized clients, specifically, single mothers living in low-income situations. We named the emerging theoretical model Targeting Essence: Pragmatic Variation of the Therapeutic Relationship, after discovering that although PHNs strove to achieve relational goals, their attention was primarily focused on the goal of ascertaining concerns foremost on the hearts and minds of mothers, and that PHNs had to accomplish these goals within short practice timeframes. The study's focused context elicited a nuanced explanation of the dynamic relationship-building process derived from subjective relationship experiences of PHNs and single mothers living in low-income situations. We believe Targeting Essence will serve as an effectual relationship-building model, enabling PHNs to know essentially what mothers want and need, and enabling mothers to know essentially that their PHN can be trusted not to render judgment.

Midline location of tumour is a risk factor for postoperative vomiting in children requiring posterior fossa tumour resection.

Children requiring posterior fossa brain tumour surgery form a unique and significant neuro-oncology population. Postoperative vomiting (POV) is a problem for these children. Also, severe vomiting that is refractory to treatment has been seen clinically in these children, but it is not well described in the literature. A subgroup of children requiring surgery for posterior fossa brain tumours (n=153) from a larger six-year retrospective chart audit (n=249) at two Canadian children's hospitals were reviewed for the presence of no, mild, moderate, and severe POV. Inter-rater reliability was established at 94% following a blinded process of comparing POV severity rankings between two data collector/researchers. Discrepancies were resolved through discussion in order to establish a consensus severity score. Findings from multivariable logistic regression analyses indicated that when age and intraoperative use of ondansetron were controlled for, the location of a tumour in a midline location had no overall effect (adjusted OR=1.37, 95% confidence interval: 0.64-2.96, p=0.43), but greater odds of severe vomiting (adjusted OR=7.08, 95% confidence interval: 2.56-19.64, p<0.001). These results support theories of modulation of vomiting by the medullary midline and clinical observations that children with midline posterior fossa tumours are at greater risk for severe refractory vomiting. The development of clinical practice guidelines and further research to study the effectiveness of novel, multimodal antiemetic therapies are required for this patient population.

Children's vomiting following posterior fossa surgery: A retrospective study.

BACKGROUND: Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated. METHODS: A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting. RESULTS: The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to <17) were less likely to vomit by 120 hours after surgery than other age groups; those who received desflurane, when compared to all other volatile anesthetics, were more likely to vomit, yet the use of ondansetron with desflurane decre kelihood. Children who had intraoperative ondansetron were more likely to vomit in the final multivariable model (perhaps because of its use, in the clinical judgment of the anesthesiologist, for children considered at risk). Children who started vomiting in the first 24 hours were more likely to be school age (groups 4 to <7 and 7 to <12) and receive desflurane. Nausea was not well documented and was therefore not analyzed. CONCLUSION: The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

Merging social networking environments and formal learning environments to support and facilitate interprofessional instruction.

This study describes the redesign of an interprofessional team development course for health science students. A theoretical model is hypothesized as a framework for the redesign process, consisting of two themes: 1) the increasing trend among post-secondary students to participate in social networking (e.g., Facebook, Second Life) and 2) the need for healthcare educators to provide interprofessional training that results in effective communities of practice and better patient care. The redesign focused on increasing the relevance of the course through the integration of custom-designed technology to facilitate social networking during their interprofessional education. Results suggest that students in an educationally structured social networking environment can be guided to join learning communities quickly and access course materials. More research and implementation work is required to effectively develop interprofessional health sciences communities in a combined face-to-face and on-line social networking context.

Prognostic models and risk scores: can we accurately predict postoperative nausea and vomiting in children after craniotomy?

Postoperative nausea and vomiting (PONV) is a problem for many children after craniotomy. Prognostic models and risk scores help identify who is at risk for an adverse event such as PONV to help guide clinical care. The purpose of this article is to assess whether an existing prognostic model or risk score can predict PONV in children after craniotomy. The concepts of transportability, calibration, and discrimination are presented to identify what is required to have a valid tool for clinical use. Although previous work may inform clinical practice and guide future research, existing prognostic models and risk scores do not appear to be options for predicting PONV in children undergoing craniotomy. However, until risk factors are further delineated, followed by the development and validation of prognostic models and risk scores that include children after craniotomy, clinical judgment in the context of current research may serve as a guide for clinical care in this population.

Integration of e-learning technologies in an interprofessional health science course.

BACKGROUND: Advances in information and communication technology are influencing instructional formats and delivery modes for post secondary teaching and learning. AIMS: The purpose of this study was to determine whether interprofessional team process skills traditionally taught in a small group face-to-face classroom setting could be taught in a blended learning environment; without compromising the pedagogical approach and collaborative Group Investigation Model (Sharan & Sharan 1992) used in the course. METHOD: A required interprofessional team development course designed to teach health science students (Medicine, Nursing, Pharmacy, Occupational Therapy, Physical Therapy, Dentistry, Dental Hygiene, Medical Laboratory Science, and Nutrition) team process skills was redesigned from a 100% face-to-face delivery format to a blended learning format where 70% of the instruction was delivered using a new synchronous virtual classroom technology (Elluminate www.elluminate.com) in conjunction with asynchronous technology (WebCT). It was hypothesized there would be no significant difference between the blended learning format and the traditional face-to-face format in the development of interprofessional team knowledge, skills and attitudes. The two formats were evaluated on demographic information, computer experience, and interprofessional team attitudes, knowledge and skills. RESULTS: The three main findings are: (a) no significant differences between student groups on achieving team process skills, (b) an observation of differences between the groups on team dynamics, and (c) a more positive achievement of course learning objectives perceived by students in the blended learning class. CONCLUSIONS: The results provide evidence to support our blended learning format without compromising pedagogy. They also suggest that this format enhances students' perceptions of their learning.

Effectiveness of teaching an early parenting approach within a community-based support service for adolescent mothers.

A single blind, pre-test, post-test design was used to test the effectiveness of the Keys to Caregiving Program in enhancing adolescent mother-infant interactions. Participants were sequentially allocated to groups in order of referral. The outcome was the enhancement of maternal and infant behaviors that exhibited mutual responsiveness as measured by the Nursing Child Assessment Teaching Scale. Issues with recruitment and collaboration with the community agencies made achieving a desirable sample size difficult. Pre-tests and post-tests were completed for 13 participants. While the sample size was insufficient to confidently establish whether or not the Keys to Caregiving produced a between groups treatment effect, mothers within the treatment group evidenced significantly greater contingent responsiveness over time than those within the control group.

Resilience in Afghan children and their families: a review.

Resilience enables individuals to survive the horrors of war and other such tragedies. This article draws on personal reflections of living in the post-Taliban period in Afghanistan and a review of the literature to explore resilience processes that may be present in the Afghan population. Adverse factors that Afghan children and families face include: destruction of infrastructure, danger, traumatic experiences, post traumatic stress disorder, political and ideological commitment. The protective factors that may have enabled them to survive, and subsequently rebuild in the face of multiple challenges are absolute faith in Allah (God), family support and community support. Understanding more about the kinds of adversities they face and the nature of their protective processes gives healthcare professionals a basis for working with them to improve their health and wellbeing.

Health literacy as an empowerment tool for low-income mothers.

Health literacy commonly refers to the extent to which one can access and accurately interpret healthcare information. Statistics reveal that limited health literacy is prevalent among those of lower socioeconomic status. When working with low-income mothers, it is recommended in this article that healthcare professionals operationalize a broader conceptualization of health literacy than assessment of reading levels and translating knowledge of risk factors for illness and disease. Nutbeam's continuum of functional, interactive, and critical health literacy directs healthcare professionals to expand their health education mandate to encompass equipping low-income mothers with the necessary knowledge and skills to gain control over their lives and optimize the healthy development of their children. Tenets from social cognitive theory, principles from interdependence theory, and strategies from Freire's empowerment education model are integral to successful progression along Nutbeam's health literacy continuum.

A meeting of minds: interdisciplinary research in the health sciences in Canada.

Brought together by the newly formed Canadian Academy of Health Sciences (CAHS), recognized national leaders in the 6 health sciences disciplines consider the environment for conducting interdisciplinary health research (IDHR) in Canada. Based on first-hand knowledge and thoughtful reflection, the authors argue that although much progress has been made in support of IDHR in Canada, the practical experience of researchers does not always bear this out. This article examines government, industry and academia to identify the cultural and structural characteristics that demand, promote or prevent IDHR in each sector. At its heart is the question, How can universities best support and enhance IDHR, not only for the benefit of science, but also to meet the growing needs of industry and government for intellectual capital? Focusing on the predominant health sciences disciplines, the authors define IDHR as a team of researchers, solidly grounded in their respective disciplines, who come together around an important and challenging health issue, the research question for which is determined by a shared understanding in an interactive and iterative process. In addition, they suggest that IDHR is directly linked to translational research, which is the application of basic science to clinical practice and the generation of scientific questions through clinical observation. This analysis of academic, industry and government sectors is not intended to offer rigorous data on the current state of IDHR in Canada. Rather, the goal is to stimulate research-policy dialogue by suggesting a number of immediate measures that can help promote IDHR in Canada. Recommended measures to support IDHR are aimed at better resourcing and recognition (by universities and granting agencies), along with novel approaches to training, such as government-and industry-based studentships. In addition, we recommend that professional organizations reconsider their policies on publication and governance. Although intended to maintain professional scopes of practice, these policies also serve to entrench disciplinary boundaries in research. We conclude by suggesting a number of research questions for a more rigorous assessment of the climate for IDHR in Canada. We call for an inventory and comparative analysis of academic centres, institutes and consortiums in Canada that strive to facilitate IDHR; an examination of the impact of professional organizations on health research, and on IDHR in particular; and a systematic review of research training opportunities that promote IDHR, with a view to identifying and replicating proven models.

Performance profile of an outcome measure: morbidity assessment index for newborns.

OBJECTIVE: Few tools have been optimised for use over the entire spectrum of neonatal morbidity and standardised for use in perinatal population and community health studies. The objective of this study was to determine the performance profile of the recently developed morbidity assessment index for newborns (MAIN score). This score was designed as a discriminative index of morbidity for the entire population of babies delivered >28 weeks gestation without a major congenital anomaly. DESIGN AND SETTING: MAIN score items were extracted retrospectively from the health records of 2892 consecutively born babies delivered beyond 28 weeks gestation in Edmonton area hospitals between June and December of 1999. MAIN RESULTS: The mean MAIN score in the general newborn population was 70.3 (95% confidence intervals 64.2 to 76.4). With the MAIN score tool, 84.6% of newborns scored from 0 to 150 (no/minimal morbidity), 11.3% from 151 to 500 (mild), 3.1% from 501 to 800 (moderate), and 1% had >800 (severe) score. The MAIN score tool was sufficiently sensitive to detect significant effects of low gestational age, low birth weight, male sex, caesarean delivery, tertiary hospital delivery, twins/triplets, non-vertex presentation, prenatal illicit drug use, and medical complications of pregnancy. CONCLUSION: The MAIN score fulfills the need for a simple, universal, yet sensitive and robust tool to provide a numerical index of early neonatal outcomes of prenatal care and adverse prenatal exposures in babies delivered beyond 28 weeks gestation. The performance of the MAIN score agrees well with the current medical awareness regarding the impact of adverse prenatal exposures on newborn morbidity.

Randomized controlled trial of a family problem-solving intervention.

Adaptive problem solving contributes to individual and family health and development. In this article, the effect of the cooperative family learning approach (CFLA) on group family problem solving and on cooperative parenting communication is described. A pretest or posttest experimental design was used. Participant families were recruited from Head Start programs and exhibited two or more risk factors. Participant preschool children were screened to have two or more developmental delays. Direct behavioral observation measures were used to determine group family problem solving and cooperative parenting communication outcomes. Few group family problem-solving behaviors were coded, and they displayed little variability. However, intervention parents increased the length of time they played and extended the cooperative parent-child interactions. The evidence shows that CFLA has the potential to enhance parental-modeling of cooperative behavior while engaged in play activities with preschoolers. Direct measurement of group family problem solving was difficult. Solutions are suggested.

Deciding on surgery: supporting parents of infants with craniosynostosis.

Families face a difficult decision when choosing whether or not to have surgery for their infant with isolated craniosynostosis. While the skull deformity may not affect the child's physical health, growth, or development, it may have psychosocial impacts on a child's social-emotional development, self-esteem, and interpersonal interactions. Parents are challenged to balance surgical risks with potentially positive effects on their child's psychosocial health. The purpose of this research study was to explore parental decision-making related to surgery for isolated craniosynostosis, and to identify strategies that facilitate their decision-making. A thematic content analysis of focus group interview data revealed four themes that encapsulated the process of parental decision-making. The decision for some parents was agonizing. However, others found the decision relatively straightforward. In all cases, parents spent time thinking and gathering information. Certain critical events helped parents make their decision. Parents identified a number of strategies that would be helpful to the decision-making process.