Implementing and growing a public health program that benefits society takes considerable time and effort. To ensure that positive outcomes are maintained over time, program managers and stakeholders should plan and implement activities to build sustainability capacity within their programs. We describe a 3-part sustainability planning process that programs can follow to build their sustainability capacity. First, program staff and stakeholders take the Program Sustainability Assessment Tool to measure their program’s sustainability across 8 domains. Next, managers and stakeholders use results from the assessment to inform and prioritize sustainability action planning. Lastly, staff members implement the plan and keep track of progress toward their sustainability goals. Through this process, staff can more holistically address the internal and external challenges and pressures associated with sustaining a program. We include a case example of a chronic disease program that completed the Program Sustainability Assessment Tool and engaged in program sustainability planning. ThrouThis article provides a step-by-step guide  for how The first step in assessing program sustainability capacity entails defining the program you wish to assess. The program is the main unit of analysis; thus, it is important that all participants have a clear understanding of the program they are assessing. This is especially important if external partners or stakeholders are invited to participate or if you are using the PSAT to assess a set of loosely organized activities or a coalition rather than a named program with prescribed activities. Defining what is meant by program ensures that everyone assesses the same set of activities ,14. The In the first step, you should identify the people who will complete the PSAT. Engaging the appropriate staff and stakeholders and ensuring you have organizational and programmatic leadership buy-in are essential for the success of the sustainability planning process ,8. We rehttps://sustaintool.org. There are 40 questions total (5 questions in each of the 8 domains)  . For eacIf you are using the sustaintool.org website, the site will automatically calculate the scores for each individual and for the group as a whole via an automated summary Sustainability Report. If you are analyzing the group results yourself, use the following steps:Question Scores: For each question for which you received responses, calculate the average score across all group members. For example, if you have 7 group members, calculate the average of 7 responses for each question. . Do not include “not able to answer” responses in calculating your averages.Domain Scores: Group your 40 question scores by domain. (You should have 5 scores in each domain.) Calculate the average across these 5 scores for each of the 8 domains.Calculate the average of your 8 domain scores.https://sustaintool.org/assess).Share your scores in a Sustainability Report . Consider where you might achieve the biggest payoff with the least amount of resources. Discuss which sustainability indicators are most modifiable for your program. Given your time and resources, prioritize the domain(s) or specific indicator(s) your team wants to address. Depending on your program’s context, certain domains and items may be more important than others. If it is very difficult to identify your program’s long-term goals or locate sufficient evaluation data to decide which program elements to drop, it may be wise for your team to begin by addressing the Strategic Planning and Program Evaluation domains.When developing an Action Plan that is based on the prioritized list, your team can make the plan as simple or as detailed as necessary. This sustainability plan will serve as a roadmap for building your program’s sustainability capacity and can provide institutional memory about why and how actions were determined and achieved. At a minimum, we suggest that your written plan for building sustainability capacity include the following items:a) Action steps for each priority domain. Action steps should clearly describe how you will address the priority sustainability areas you identified earlier (see Step B5). Be realistic in your action steps, keeping in mind the current political and organizational environment in which you are working  List of resources and stakeholders required to make action steps successful. To execute your sustainability plan, you may need specific resources, including time, money, space, materials, technology support, and in-kind resources. In addition, there may be specific staff, stakeholders, or partners who need to be involved in completing an action step. As you write the plan, identify the resources, people, or groups that are needed to accomplish outlined action steps. Consider the unique skills and resources that different partners and stakeholders contribute to your program and how they might help advance your sustainability efforts. Studies indicate that it is vital to have influential and proactive leaders and champions, both inside and outside of your program  Methods for tracking progress toward the completion of your action steps. Your sustainability plan should identify how you will monitor and track progress on each action step. Consider the metrics you will use to measure success. Having a tracking process determined in advance ensures that you document your progress appropriately.As you build your plan, try to foresee any opposition you may face along the way, internally and externally . DiscussDeveloping a sustainability plan is not a one-time effort. Your team must continue working together to implement the plan over the weeks and months following the assessment. Use the plan to guide the ongoing management of program activities. Discuss the action steps and activities with program staff and stakeholders by providing periodic updates and collectively brainstorming solutions to challenges encountered along the way ,8. MonitBuilding your program’s sustainability capacity will take time. Assessing your program’s sustainability capacity, identifying strengths and challenges, and taking concrete steps to improve your sustainability capacity are all essential steps in this process. Consider completing the PSAT annually as part of yearly progress reporting and compare the scores to monitor improvements . CelebraIn the spring of 2011, a state health department faced a number of rapid changes, including the possibility of integrating numerous chronic disease programs within the unit. With continued funding uncertain, one of the chronic disease program directors decided to organize a team of staff and unit managers to complete the PSAT and assess their program’s sustainability capacity.Team members completed the PSAT as a group. After reviewing the program’s Sustainability Report, the group quickly recognized the need to involve stakeholders in this process. The group reached out to the health department’s upper management to ensure that they understood the department’s priorities and how these might impact the chronic disease program. Key community partners, coalition members, and other health department program managers were also invited to take part in the sustainability planning process.The team committed a considerable amount of time to the planning. First, the team completed a visioning process that included a review of the program’s mission and overall purpose with a focus on the desired outcomes. This process helped determine which program components were necessary to maintain the program and sustain its benefits over time. Next, the team reviewed their Sustainability Report and agreed to address the Communications domain first. Program staff believed they had done a poor job of demonstrating their accomplishments over the last 3 years, which was reflected in low scores on the following Communications indicators:The program has communication strategies to secure and maintain public support.Program staff communicates the need for the program to the public.The program demonstrates its value to the public.The scores indicated that the program’s communications had been haphazard and reactionary instead of strategically planned; communications efforts also did not make use of current technology. The team saw that increasing communication capacity would be critical for documenting their success and reach to funders (currently and in the future), engaging stakeholders, and ultimately promoting their long-term sustainability.Through the planning process, the team realized that the lack of a dedicated communications manager limited their ability to market and publicize the program’s vision, generate public support, and engage new partners. Because the program did not have funds to hire a dedicated communications manager, the team developed 4 communications-focused action steps to improve their sustainability capacity in this area . For eacThe team developed a database to track the progress of their action steps. The team decided to monitor and reassess their sustainability capacity during their annual reporting cycle to ensure continued improvement of their sustainability capacity.The chronic disease program staff benefited from the sustainability planning process in a number of ways. First, it provided an overview of their current sustainability strengths and weaknesses. Second, it helped them determine which program elements they intended to sustain for the long term. Third, it facilitated the development of a vision and mission for the program to reference and use as they monitored the progress of their actions. Lastly, the Communications Action Plan enabled them to demonstrate their accomplishments, tell their story, and build connections to support their sustainability beyond dollars.Many factors affect a public health program’s capacity for sustainability. Although funding is important, other factors such as strong organizational support, partnerships, and communications can help make a program more competitive for funding, more successful in program work, and better able to weather challenges.The PSAT and planning process provide public health programs and their partners with a reliable method for rating their programs’ capacity for sustainability. This method is unique in that programs are able to identify their areas of strength and weakness across a range of sustainability factors and then make informed decisions about where to concentrate efforts.One advantage of the PSAT is that it is a simple, user-friendly tool that can be used in multiple settings and fields; already, more than 550 public health practitioners and managers at the community and state levels have used the PSAT to assess their programs . Howeverhttps://sustaintool.org, along with more information about this transition.A slightly modified version of the PSAT was rolled out in late 2013. In this PSAT V2, items within the Political Support domain were adapted and the domain name was changed to Environmental Support . The updWe hope that those who follow these steps will gain a greater understanding of how to engage their program teams in an assessment of their program’s capacity for sustainability and in sustainability action planning. To ensure the long-term success and impact of public health programs, managers and practitioners must engage in ongoing sustainability assessment and planning.


Wearing a brace or performing exercises are well-known methods of conservative treatment of adult scoliosis. However, the combination of these two methods has not been investigated.Based on the practice of wearing a scoliosis brace immediately after exercising to stabilize the stretch effect at the ligaments and the intervertebral disks, the purIn April 2009, the study began with 144 adult scoliosis patients: 123 women and 21 men with an average age of 40.8 years (spanning 19– 84 years). The average scoliosis Cobb angle was 40.6° (18°-87.5°). All patients had a degree of pain and had been fitted with a Rigo-Cheneau brace, prescribed for at least eight hours per day after completing minimum 50 minute daily minimum of a combination of Schroth[Ten of the 144 patients 26% did not follow the program, 26% followed the program for a few months, 23% inadequately followed the program and 25% accurately followed the program. Following treatment, 68% of the patients had no pain and 67% had improvement in posture and appearance. In 53% of the patients, the Cobb angle improved from 9% to 23%, 18% had no improvement and 29% had an aggravation from 7% to 15%.The combination of brace and exercises yielded excellent results. In general, we noted that, in some cases, only exercises or brace alone decreased pain and/or improved posture, but the most improvement was achieved using both, with the brace worn longer than eight hours per day following the exercises. The combination of Schroth and SEAS methods, selectively to every patient, maximized the results. Since adults have so many obligations, the program was difficult for them to follow, which is why so many abandoned treatment, despite the benefits.


With the increasing use of Traditional Chinese Medicine (TCM) in the West, Qigong has gained popularity for a variety of chronic health issues. However, there is a paucity of available literature that has systematically described the details and teaching strategies of Qigong. The purpose of this paper is three-fold: to demonstrate how to structure lesson content, to provide efficient teaching strategies, and to increase understanding of the underlying mechanisms of such programs’ potential benefits.A comprehensive literature review and a five-step process based on a theoretical framework  were used to develop a Health Qigong for Children program. The procedures include: (1) identifying the program, (2) developing educational strategies, (3) teaching pilot lessons, (4) consulting experts, and (5) drafting the curriculum.Sixteen theme-based lesson plans were generated based on two traditional Health Qigong forms. Five promising teaching strategies were synthesized: (1) using theme-based lesson plans, (2) building mind-body connections, (3) balancing repetition and creativity, (4) interweaving pictures, stories, volunteers, and teamwork, and (5) involving parents and school teachers. Suggestions from an expert panel and student volunteers were solicited and incorporated into the program, that is, changing TCM-Based names for each Qigong movement into new names related to plants, animals, or interesting objects, and integrating some fun facts about the plants or animals into each lesson.The use of a theoretical framework was not only innovative but also effective. The Health Qigong for Children program has been successfully applied at several local elementary schools. Theme-based lessons and effective teaching strategies helped the Health Qigong program to be fun and age-appropriate for children. Suggestions from experts in a variety of fields strengthened the program design. The newly developed curriculum needs to be replicated with larger and various pediatric populations.


Internet interventions may provide opportunities for low threshold counseling using feedback to guide and support health behavior, including increased physical activity. Research shows that overweight and obese adolescents are less physically active than their peers of normal weight. There are good reasons to believe that Internet-based interventions may be particularly suitable for motivating adolescents to increase physical activity, but we need to gain further knowledge of what features are effective and how to design such interventions.To describe the process of development and evaluation of usability of a Web-based program for increasing physical activity in overweight adolescents.Informed by the self-determination theory, motivational interviewing, and perspectives on self-regulation, this intervention was developed in a stepwise process by an interdisciplinary team of researchers, designers, developers, and representatives from the target group. An iterative qualitative usability testing approach  was applied in 2 sequences, first in the lab and second in the field, to assess how adolescents (aged 12-16 years) used and experienced the program and to make adjustments to the program based on evaluation of their response.The following components were included in the program: self-monitoring through planning and registration of physical activity and graphical response on progress, autonomy supportive individual Web-based counseling, forum for social support, and relevant age-adjusted information about physical activity. The first usability test resulted in adjustments related mainly to making the content and aim of the different features more visible and explicit. The second test evaluated the program with adjustments from the first test, revealing that the program was well accepted by the participants and only small aesthetic adjustments had to be made to complete the final version of the Internet program, Young & Active.Thorough preparation, with clear theory foundation and close monitoring in the developmental phase, as well as contribution and iterative evaluation from the target group, is essential to create a user-friendly and engaging program. The efficacy of the program will be evaluated in a controlled trial. Investigations point to a decrease in physical activity (PA) from childhood to adolescence . AdolescRecent research suggests that Internet technology is a promising way to change a person’s health behavior and therefore provide opportunities for low threshold counseling using feedback to guide and support health behavior . It mighAn Internet program called Young & Active was developed aimed at motivating overweight adolescents aged 13-14) to increase and maintain PA and thereby enhance their fitness and health-related quality of life. The intervention study is built upon the framework for researching complex interventions given by the Medical Research Council [-14 to inExtensive use of theory and inclusion of behavior change techniques is important in Internet interventions to increase effectiveness . The preConsidering the age of the target group, we wanted to develop a program with self-explanatory and time-efficient functions . This inThe intervention includes daily registration and narratives on PA by the adolescents along with weekly individual Web counseling from trained health counselors. The initial components of Young & Active and their main content are outlined in Young & Active focuses on how adolescents can find their own source of motivation for increasing and maintaining PA. It is proven that the intervention in itself is motivating to use in the sense that the end users choose to visit, use, and revisit it . We aimeThe process of development of Young & Active covered the following steps, including preparation, specification, development, usability testing in 2 different settings, evaluation, and adjustments .The preparation step included choice of theoretical framework and mapping of user needs related to physical activity and use of Internet. Risk analyses were made with assistance from the Department of Information Technology at Oslo and Akershus University College of Applied Sciences to assure that potential threats to the anonymity of the adolescents were accounted for. A detailed specification of requirements for the program was developed. An interdisciplinary team of health and education researchers, graphical designers, and application developers formed the project group.Based on risk analyses and specification of requirements, the outlined content was transformed into wireframes  to visualize and illustrate the link between text and graphics and interactive features. Development started with ideas being picked from well-established websites for adolescents with functions such as forums, ask-the-expert, and information on sexuality, health, and adolescence in general for instance. Design, language, use of symbols, and site architecture were studied. Representatives from the target group of adolescents (n=4), strategically sampled from an ongoing project for obese youth, participated in a workshop to help decide on design, content, and functionalities. The workshop was an informal setting with open discussions on the presented wireframes. Comments and suggestions from the adolescents were noted and included in the ongoing developmental process when found relevant.An iterative qualitative usability testing approach with observation, a questionnaire, and focus group interview was used to assess how the participants use and experience the intervention. Usability tests were carried out in 2 sequences, first in a lab setting and second in the field, over a period of 2 weeks. The Honeycomb model  served aAs mentioned, the aim of the tests in lab and in field was to assess how adolescents in the target group used and experienced the prepared intervention. For this reason, strategic sampling was conducted among adolescents who were expected to give valuable information. The number of participants was decided upon according to an appraisal of achieved saturation of qualitative information about usability . In ordeThe first test (lab) was carried out in 2 groups of a total of 7 adolescents (aged 12-13 years), recruited from a school and a project for obese adolescents respectively, and took about 90 minutes per group. At this point, the program contained all the main functions except to the forum and feedback page. The participants initially received brief information about Young & Active. Listed tasks then guided them through the different parts of the program. Each participant was observed by one of the members of the project group. Following the practical tasks, the adolescents filled in the questionnaires. Finally, focus group interviews were conducted in both groups.To perform technical evaluation, to assess how the users respond to using the program over time, and to get a more thorough evaluation after adjustments based on the first usability test, the Young & Active program was tested over a period of 2 weeks. From an exercise group for overweight and obese youths, 8 adolescents (aged 14-16 years) were recruited. Informed consent to participate was given by the adolescents and their parents. The participants first met with the researchers for an informal conversation focusing on feelings, thoughts, and experiences with different forms of PA. The conversation was informed by the MI approach  and was The combination of questionnaires, observations, and focus group interviews was used to triangulate data to control and support the different findings, as the discussions in the focus groups were used to broaden and support the outcomes of observation and questionnaires. After each of the 2 tests, data from the questionnaires were summarized. Answers from the open-ended questions from the questionnaire and notes from observations and interviews were analyzed as text, using simple content analysis . These dThe first part of the development process resulted in a draft with suggestions on name of the program, logo, color scheme, and page layout, including the content and placement of different functions distributed. A flow diagram of the Young & Active program as it was initially planned, showing the main content, interactive features and the links between the different pages, is provided in No changes were made to this structure during development, and the pages described in The workshop participants liked the suggested name of the program. Colors and graphics, especially the smiley logo, met with approval. The participants focused on the advantages of using smileys in the communication as a way of making it easier to express feelings and the communication more effective. The benefits of written self-determined goals and detailed plans for activity were emphasized, but the adolescents did not immediately understand what kind of information the PA-registration page required. It was obvious that thorough explanation and specific examples were necessary to get a quick understanding of the different functions. The participants saw the advantages of bonding with other adolescents in the program to exchange experiences and opinions and to ask questions. On the info page, the adolescents indicated they would prefer to read about activity alternatives and how to make healthy food. Feedback on the wireframes was mainly positive. Suggestions on changes and supplements to graphics, features, content, and functionality from the workshop were incorporated in further development of the program.The participants of both lab and field tests had a computer at home and regarded themselves as competent computer users. All of the participants in the field test used Young & Active at home in one way or another during the test period, meaning that they made at least 1 registration in the diary, posted in the forum, or sent a message to the counselors via the message system. Most of the participants  made regular, frequent registrations and used the diary, while 1 participant got ill, 1 had an ankle injury and 1 responded “this program is not for me, but I am sure others will find it useful”. This last participant joined in on the survey and interview, while the other 2 infrequent users did not.The participants in the lab test had no problems logging in or navigating among pages. They tended to ask for help rather than using help buttons with explanatory text. All participants found relevant leisure sports activities, but did not intuitively choose activities for the entire day and week . This occurred both when planning and making registrations in the diary. In the plan, the adolescents found it inconvenient to have to select days one by one for activities performed every weekday, such as walking to school. Searching through lists of activities in the plan and the diary were shown to be time consuming.The most important adjustments after the first usability test concerned making the content and the aim of the different features more visible to the users. This included choosing bold headings, making short introduction texts for every task and creating more visible help-buttons with pop-up texts for specific explanations and tips.Observation during introduction of the program and the 2-week test period revealed that the participants in the second usability test very quickly grasped the different functions of the program. Due to the short test period, none of the adolescents made changes in their activity plan, but 2 participants supplemented their goals for activity. The 5 active users made registrations according to their activity plan and added other less regular activities if relevant. They estimated registration to take less than 5 minutes. All active users wrote in the diary, some almost every day and others less frequently. Except for minor bugs, no technical problems occurred that compromised use of the program in the field.Visual design refers to the informants’ impressions of how the program looks and how they find the colors, fonts, illustrations, and layout. Both groups in the lab test approved of the color scheme, the program smiley logo that has not been seen by some participants before, the design in general, and found it appropriate for both boys and girls. Participants in the second usability test also approved of the design and graphics and the smileys in particular. However, they had complaints on both visual and functional design of the forum. It did not appeal to them aesthetically, as the text fields were too spacious and the profile smileys too large.All in all, the participants in the lab test commented positively on the content of the program. They appreciated the opportunity to plan and log activity, but were mainly concerned with goals, plans and registration of sports activities and exercise, not PA in general. Some suggested pop-up text with tips on what to write about in the diary. The adolescents easily made goals for PA, although some were unsure about how specific the goals had to be and thus asked for help. The participants reported liking the info page, noting that it was understandable and the issues were relevant, but several of the informants asked for more facts about effects of exercise and more pictures and videos to illustrate the information.No significant changes had to be made to the content after the lab test, other than adding pop-up boxes with tips, more pictures, and more fact-oriented information on the info page. Some requests were rejected due to security demands  and time and budgetary constraints (exercise videos).), but could be given more often. All in all, the informants found the content of the program interesting and uncomplicated.The adolescents participating in the usability test in field had no problems making goals, plans, and registering in the diary, but asked for more options for activities during school time . They appreciated the opportunity to reflect on their daily activities and the day in general, but requested a less structured diary with fewer leading questions and 1 single text field with an open question (“How was your day?”) instead of 3 fields with more specific questions. The info pages, both text and illustrations, were reported to be fine. Feedback from counselors was valued  reported that Young & Active might contribute to making them more active. Based on this response we made the operations for registering activities more intuitive and time efficient, and made it possible to backdate within the same week so registrations did not have to be made every day.In the field test, the youngest adolescents (age 14) were most positive regarding how useful and interesting the program was, giving comments like, “it made me more conscious about PA”, “the program proves that I am more active than I think I am”, “I liked the program, registrations are fun, I would like to continue to use it”. The older adolescents (age 16) were more uncertain, commenting that, “it takes some time and it is hard to remember to register, so I am not sure if I would have liked to use the program over time”.Only minor adjustments were made after the usability test in the field. These included better marking of feedback from the counselor, less spacious commentary fields in the forum, and 1 instead of 3 text fields and questions in the diary. Procedures for feedback once a week remained, but an initial personalized message by the message system was included in the intervention procedures. We also picked up responses from the preliminary workshop and positive feedback in the tests regarding the smileys, and added a function for choosing a smiley to supplement the narratives in the diary for expressing the “mood of the day”. Technical adjustments and subsequent tests were made to reassure stability independent of browser.The end result of the development and usability testing was a program that included the components as described, but with cleaner design, clearer instructions, and more intuitive and time-efficient functions. See This article describes the development and results of usability testing of Young & Active, an Internet intervention specifically designed to increase PA in overweight adolescents. A sample of representatives from the target group participated in the development and usability testing, and gave valuable suggestions regarding design, content, and functionality. Accessing the intervention website and actually using it is essential for an Internet intervention to succeed, that is, to induce behavior change . To chooAdolescents are considered familiar with many online programs and are well aware of their preferences regarding layout, graphic appearance, colors, illustrations, fonts, and so on. Feedback from the workshop and usability tests reassured us that the adolescents liked the design, and particularly the use of specially designed smileys, which originated from well-known emoticons (emotion icons), in the logo and profile. Such emoticons can be regarded as non-verbal cues and are considered a creative and salient way to add expression to strict text ,45. AlthThe workshop indicated that explicit descriptions, clear intentions, and logic procedures of the different functions of the program are most important. In spite of this being focused in the following development, the first usability test still uncovered challenges with the understanding of the function of the different tasks . Literature on how to write for Web emphasizes the importance of making short, concise texts with meaningful sub-headings and one idea per paragraph . Use of In addition to appreciation and understanding of the practical use of the program, it is essential that the adolescents find the program useful and that they acknowledge and value the aim of the intervention , which iComputer-based interventions have several advantages. These include the benefits of standardization, tailoring, data collection, testing of theory, and practical use . StandarMore extensive use of theory has been associated with larger effect sizes , howeverThe potentially biggest disadvantage for an Internet intervention such as Young & Active is its limited lifetime. The speed of development of Internet-based programs is vast and there is reason to believe that adolescent users are not particularly faithful in that their preferences shift rapidly. Considering the time-consuming process of development and testing in a research setting, it is a challenge to create a program that has not outlived itself before meeting its audience. Through development and usability testing of the program, we have taken into account the preferences of the target group and hope that this ensured a program that is relevant for the time being. Technology is constantly developing, and new innovative applications appear, which in time will threaten to outdate the design and functions of Young & Active. Nevertheless, the ongoing study will add to the testing of our theoretically informed, individualized, computerized intervention and if the chosen characteristics are suited to promote behavior change.This study highlights the importance of thorough preparation with explicit theory foundation in the developmental phase and iterative usability testing throughout program development. Most important is the engagement from a sample population for ensuring that the users like, understand, and value the program. Integrating such feedback from the target group is highly valuable in the developmental process and increases the chances of making a potentially effective program. The final usability test showed that the program was well accepted by the participants and can be considered ready for further evaluation in a controlled trial.


Although the Internet is a promising medium to offer lifestyle interventions to large amounts of people at relatively low costs and effort, actual exposure rates of these interventions fail to meet the high expectations. Since public health impact of interventions is determined by intervention efficacy and level of exposure to the intervention, it is imperative to put effort in optimal dissemination. The present project attempts to optimize the dissemination process of a new online computer tailored generic lifestyle program by carefully studying the adoption process and developing a strategy to achieve sustained use of the program.A prospective study will be conducted to yield relevant information concerning the adoption process by studying the level of adoption of the program, determinants involved in adoption and characteristics of adopters and non-adopters as well as satisfied and unsatisfied users. Furthermore, a randomized control trial will be conducted to the test the effectiveness of a proactive strategy using periodic e-mail prompts in optimizing sustained use of the new program.Closely mapping the adoption process will gain insight in characteristics of adopters and non-adopters and satisfied and unsatisfied users. This insight can be used to further optimize the program by making it more suitable for a wider range of users, or to develop adjusted interventions to attract subgroups of users that are not reached or satisfied with the initial intervention. Furthermore, by studying the effect of a proactive strategy using period prompts compared to a reactive strategy to stimulate sustained use of the intervention and, possibly, behaviour change, specific recommendations on the use and the application of prompts in online lifestyle interventions can be developed.NTR1786 and Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL2723506809/MEC0903016).Dutch Trial Register  Due to its high accessibility and its potential to reach large numbers of people, the Internet is considered to be a promising medium in the field of health promotion for offering tailored and targeted behaviour change programs to the general public -5. Over Since public health impact of interventions is determined by their efficacy and exposure in the target group ,25, it iThe current project aims at optimizing exposure rates of a combination of several effective online CT programs, targeting physical activity, fruit and vegetable consumption, smoking and alcohol consumption, offered through the Internet. This combined CT program will be integrated in the Dutch Adult Health Monitor, a monitoring tool used by all Regional Public Health Service (RPHS) in the Netherlands in order to assess different aspects of general health and health related topics at fixed points in time. This integration will result in an online program that respondents of the Dutch Adult Health Monitor can turn to in order to obtain detailed and personalized information regarding their current health behaviour status, as well as personalized advice on how to improve their health by focusing on the key health behaviours.Several theories underline the importance of different processes to foster effective diffusion of interventions ,32. ThesCurrently computer tailored interventions are offered reactively to the public, implying a passive approach in which users themselves must undertake action in order to benefit from the intervention . Prior rpro-active approach using periodic e-mail prompts in order to obtain sustained use of the intervention over time will be studied in a randomized control trial.In order to optimally disseminate the program, the present research project will thoroughly investigate adoption of an online CT lifestyle program and development of strategies to achieve sustained use. First, studying the adoption process will yield results on the level of adoption, determinants involved in adoption and characteristics of adopters and non-adopters as well as satisfied and unsatisfied users. A strategy aimed at increased and sustained level of use will be designed and tested. On that account the efficacy of a The current project emphasizes the processes of first use (adoption) and re-use of a combined computer tailored online lifestyle program, by examining each process in a single study. First, a general description of the CT program will be provided, before proceeding to the detailed description of the separate studies.NTR1768).The current project is approved by the Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL27235.068.09/MEC 09-03-016), and is registered with the Dutch Trial Register  [fruit and vegetable intake, measured by the Short Questionnaire for Fruit and Vegetable Intake [alcohol consumption, measured by the Dutch Quantity-Frequency-Variability Questionnaire (QFV) [smoking, measured by the abbreviated version of the Fagerström Test for Nicotine Dependence [The Adult Health Monitor takes place with an interval of four years and serves as a monitoring tool used by the RPHS's to assess the overall level of health in the Dutch population by approaching a representative sample of the population to fill out a questionnaire assessing different aspects of general health  and health related topics  . Physica(SQUASH) , fruit ae Intake ,42, alcore (QFV)  and smokpendence . ResultsIntegrating the new CT program into the Adult Health Monitor may have several benefits. Firstly, it can enable the RPHS's to optimize their public health education task; besides solely monitoring health behaviour, the RPHS's now have an opportunity to provide people with personalized advice on how to change their health behaviours. Furthermore, it may provide the random sample of adults included in the Adult Health Monitor an incentive for their participation and might serve as a cue to action for them to positively change their health behaviour. Since the current CT program is embedded in the Adult Health Monitor of the Provinces of Limburg, Brabant and Zeeland, with an approximate total reach of 100.000 inhabitants, this integration also provides an important access point for reaching a considerably large segment of the Dutch population with a lifestyle intervention.The CT program uses a step-by-step approach to guide people towards behaviour change. After online completion of the Adult Health Monitor people are informed in detail on the embedded program and the accompanied studies. People that indicate to be interested in the program are subsequently linked to the program. During their first visit demographic data  and personal data concerning the target health behaviours, acquired through the Adult Health Monitor questionnaire, are transferred to the CT program and used to inform people on the current status of their health behaviours by comparing these to Dutch public health guidelines  or two (men) glasses of alcohol a day and non-smoking). In case of discrepancies, people are alerted and provided assistance in changing their health behaviour(s) with help of CT advices available per behaviour.Changing health behaviours with help of computer tailoring is the main component of the program. A CT module is available per health behaviour and within each module people have the opportunity to obtain personalized advices regarding the opted health behaviour. All health behavioural advices are adapted to individuals' characteristics by considering demographic, behavioural and social-cognitive variables ,45,46. SMessage content and algorithms of the CT advices are based on prior theory and evidence based CT interventions on physical activity, fruit and vegetable intake, alcohol consumption and smoking cessation ,37,38,48The main goal of the first study is to assess the level of first time use of the new CT program, frequency of use, level of satisfaction with the new CT program by participants of the Adult Health Monitor 2009 and determinants of adoption and use. Furthermore, characteristics of users and non-users and satisfied and unsatisfied users will be investigated.This is a prospective study, employing a longitudinal design. At baseline participants of the Adult Health Monitor interested in the new CT program receive feedback concerning their current health behaviour. In case of a negative discrepancy between the status of their current health behaviours and public health guidelines set for these behaviours participants are stimulated to change these behaviours with help of the CT program. During a period of three months, use of the CT program is monitored anonymously resulting in a detailed overview of number of first visits, revisits, and the specific health behaviours selected.The research sample consists of Dutch adults participating in the Adult Health Monitor 2009 of the Dutch Provinces of Limburg, Brabant and Zeeland. The RPHS's will invite a representative sample of inhabitants of the provinces North-Brabant, Zeeland and Limburg (+/- 100.000) by mail to participate in the Monitor. Participants will be offered the opportunity to fill out a written questionnaire, which is included, or to complete an online version of the Monitor questionnaire. Electronic completion will be highly encouraged since the new CT program is an online program only accessible for respondents participating via the Internet. Based on previous experiences with this Monitor it is expected that a response rate of approximately 33% will be reached, indicating that about 33.000 respondents will fill out the Adult Health Monitor.online version are introduced to the new embedded program, which is free of charge and consists of an opportunity to receive CT feedback about their health behaviour. Participants indicating to be interested in the new program will be asked to leave their e-mail address and receive an e-mail including an invitation to log in to the CT program with a personal login code and password approximately three weeks after completion of the Monitor. After logging on to the program participants receive detailed information on the goal and the content of both studies described in this protocol. After receiving this information, participants are asked to fill out an online informed consent form. Only those participants that consent to participation are directed to the new service. Subsequently, data on demographics and the five health behaviours obtained through the Monitor are transported to the new program, resulting in a personal overview in which an individual's current health behaviour status is compared to the guidelines set for these health behaviours. Within the program, five modules generating CT health advice are available to assist participants in changing their current health behaviour status when needed. Once respondents decide to leave the CT program after their first visit, they will be asked to fill out an additional questionnaire to assess their satisfaction with the program and their intention to revisit the program again in the near future  and one item assessing overall satisfaction .Intention to re-use the CT program is assessed by using a 10 point intention scale ('I intend to use this CT program again in the near future').To measure the adoption level of the new CT program focus will be on level of first use, demographic and behavioural characteristics of users and non-users, satisfaction with the program, characteristics of satisfied and unsatisfied users, intention to re-visit the program and frequency of re-visits. In order to measure level of first use of the program, two dichotomous variables will be created; one indicating whether participants initiate a behaviour change module and one indicating whether participants finish the module. Initiating a module is labelled as "yes" when people fill out the first question of this module, which is the question concerning intention to change the specific health behaviour. Completion of a module is labelled as "yes" when people also fill out the final question of the module. Re-visiting of the program will be assessed monitoring whether participants log in to the program within a three month period after baseline (0 = yes/1 = no). Re-visits to the program will be measured by comparing the dates of log-in to the baseline date.First, general descriptive statistics will be used to describe personal characteristics of the participants, as well as main findings concerning current health behaviour status, adherence to the public health guidelines and socio-cognitive characteristics. Second, logistic regression analyses will be conducted with initiation of a module, completion of a module and revisiting of the program as dependent variables. Demographics, such as gender, height, weight, marital status, religious background, ethnicity, educational level, current work status, income, health behaviour status and cognitions (measured at baseline) are included in the model as predictors.The aim of this study is to test the effect of using a proactive approach (i.e. periodic e-mail prompting) on revisiting of the program compared to a reactive approach. Furthermore, the efficacy of these approaches with regard to behaviour change will be studied.The second study consists of a randomized control trial (RCT) including one experimental group. A design with a baseline measurement and three follow-up measurements  measuring health behaviour status, intention to change, cognitive variables and planning abilities, will be used to compare the experimental condition (use of a proactive technique) to a control condition (use of a reactive approach).The research sample consists of individuals that participate in the Dutch Adult Health Monitor and that decide to pay a first visit to the new CT program. After logging in to the program at baseline and consenting to participation by filling out an online informed consent form, participants are randomly assigned to one of the two conditions. People in the experimental condition are reminded proactively via e-mail every three months for a period of 18 months to visit the CT program in order to obtain iterative feedback concerning their health behaviour status and additional CT advice, whereas people in the control condition do not receive any additional prompts and are only encouraged to re-visit the program in the future at baseline. All participants will be invited by e-mail for the follow-up measurements at 6, 12 and 18 months .Interested participants are directed through the Adult Health Monitor to the new program, where they can log in to the program with a personal username and password. After signing in to the program, participants will be randomly allocated to either the control condition or the experimental condition. Randomization will occur at the respondent level by means of a computer software randomization device. Blinding of participants is not possible, since participants will take notice of the fact that they receive additional e-mail prompts or not.The primary outcome measures are re-visits to the program and level of behaviour change. Program revisits are objectively monitored for a total period of eighteen months. Recordings will be done anonymously and will yield information about the number of times the program is visited, the duration of each visit (in minutes) and which specific behaviours are most frequently selected. Level of behavioural change is assessed by studying participants' adherence to public health guidelines set for these behaviours (0 = not complying with recommendations/1 = complying with recommendations).Secondary outcome measures include overall tobacco use (number of cigarettes/day), level of physical activity (minutes/day), and overall level of fruit (pieces/day), vegetables (grams/day) and alcohol consumption (glasses/day). Furthermore, socio-cognitive measures, such as intention, attitude, social influence, self efficacy, action and coping planning will be measured.With regard to re-visits to the program (first primary outcome measure), it is estimated that approximately 50% of the respondents of the no-prompting condition will visit the site more often than four times . It is estimated that in the prompting condition 70% of the respondents will visit the site more than four times. Power calculations reveal that in order to be able to detect this difference with a power of 80% (p = .05) at least 186 persons per condition are needed. Taking into account potential attrition, it is proposed to collect the data of 250 persons per cell.p-value of .05. It is estimated that, in order to detect this significant difference in quit rates, 219 smoking persons per cell are needed, resulting in a total of 438 smokers [The second primary outcome measure is the level of health behaviour change. The current program entails a total of five health behaviours. Therefore, with regard to the assessment of behaviour change (second outcome measure), estimations for finding effects will be based on smoking, since this behaviour results in the most conservative power calculations. Approximately 25% to 30% of the population smoke . Power e smokers . To be aFirst, general descriptive statistics will be used to describe personal characteristics of the participants, as well as findings concerning current health behaviour status, adherence to the public health guidelines and socio-cognitive characteristics. Second, logistic regression analyses will be conducted with re-visits to the program and level of behaviour change as dependent variables. Furthermore, linear regression analyses will be conducted with number of re-visits, duration of re-visits and number of behaviours selected as dependent variables. Demographics, such as gender, height, weight, marital status, religious background, ethnicity, educational level, current work status, and income, health behaviour status and cognitions (measured at baseline) will be included in the model as predictors of the dependent variables.Although the Internet is a promising medium to offer lifestyle interventions , it is nadoption of the intervention and development of a strategy to achieve sustained use of the intervention over time [Since optimal dissemination largely depends on the processes of actual ver time , each prver time . TherefoCT: Computer tailoring; RPHS: Regional Public Health Service; SQUASH: Short QUestionnaire to ASsess Health-enhancing physical activity; QFV: Quantity-Frequency-Variability questionnaire.The authors declare that they have no competing interests.FS significantly contributed to writing this paper, while LvO, DS, MvA, SK and HdV were involved in revising the manuscript. The project design was developed by HdV. All authors were involved in implementing the project. All authors have approved of the version to be published.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/480/prepub


Integrating the best available evidence into program standards is essential if system-wide improvements in the delivery of community-based mental health services are to be achieved. Since the beginning of the Assertive Community Treatment (ACT) program movement, program standards have included a role for the community. In particular, ACT program standards have sought to ensure that members of the local community are involved in governance and that former clients participate in service delivery as "Peer Support Specialists". This paper reports on the extent to which ACT program standards related to community participation have been implemented and identifies barriers to full compliance.Qualitative and quantitative data were collected through a telephone survey of ACT Program Coordinators in Ontario, Canada, using a census sample of the existing 66 ACT programs. A thematic approach to content analysis was used to analyze respondents' qualitative comments. Quantitative data were analyzed using SPSS 16.0 and included means, frequencies, independent t-tests and Pearson Correlations.An 85% response rate was achieved. Of the 33 program standards, the two that received the lowest perceived compliance ratings were the two standards directly concerning community participation. Specifically, the standard to have a functioning Community Advisory Body and the standard requiring the inclusion of a Peer Support Specialist. The three major themes that emerged from the survey data with respect to the barriers to fully implementing the Community Advisory Body were: external issues; standard related issues; and, organizational/structural related issues. The three major themes concerning barriers to implementing the Peer Support Specialist role were: human resource related issues; organizational/structural related issues; and, standard related issues.The reasons for low compliance of ACT programs with community participation standards are complex and are tied to structural and human resources barriers  as well as to the requirements of the standards themselves. In order for improvements to the mental health system to be achieved there is a need to identify and address these barriers. Failure to do so will result in less than optimal client, family and economic efficiency outcomes. Integrating the best available evidence into program standards and practice is essential if system-wide improvements in the delivery of community-based mental health services are to be achieved. In the case of Assertive Community Treatment (ACT) programs, a second iteration of program standards has recently been developed in Ontario, Canada to facilitate the evidence-based delivery of these programs which are designed to provide community-based services to individuals with serious, persistent mental illness. Features of the ACT approach include: delivery of comprehensive services in individuals' immediate communities and homes; individualized treatment plans; access to services 24 hours a day, seven days a week; and, services provided by a collaborative team of multi-disciplinary experts. ACT program standards are developed to help ensure that treatment programs are implemented in a manner consistent with evidence-based practice. These standards typically include criteria for such functions as: organizational structure and communications; required staffing; procedures for intake, admission and discharge; maintenence of client records; clinical services; and community participation.At the core of the ACT model's "community-based" philosophy is not only the delivery of services in the community but also the participation of members of the community in the governance of the program and the delivery of services. The use of community members in providing oversight to program operations (both as members of the Board of Directors and in an advisory capacity) has been a long-standing practice for organizations delivering community-based services, however, the use of "consumer providers" in the delivery of services, or "peer support specialists" as they are referred to in ACT programs, is a relatively recent phenomenon. Community participation activities have been identified as important elements in facilitating mental health recovery -4 which Community Advisory Bodies and Peer Support Specialists. The article then outlines the study's methodology and results, followed by an analysis and discussion of the major barrriers to implementation of the two community participation standards.The purpose of this article is to report on the extent to which ACT programs in Ontario, Canada have implemented program standards relating to community participation and to examine specific barriers which may be inhibiting full compliance with these standards. We specifically examine the use of community advisory bodies (CAB) and the requirement that a peer support specialist be a member of each ACT team. For both of these standards we identify, from the Program Coordinator's perspective, the perceived levels of compliance with these standards, and how essential they believe these standards are to the effective functioning of their ACT program. This article begins with some background on the ACT model, its formal adoption in Ontario, and the two program standards that most directly relate to community participation - Mental health reform has been a high priority on the public policy agenda of most Ontario governments since the 1980s as is evident by the array of government reports produced -9. Much Over the years, a major focus of mental health reform initiatives worldwide has been, and continues to be, a shift from institutional to community-based services. To facilitate this shift in Ontario, in the late 1990s the Ontario government began to divest itself of provincially owned psychiatric hospitals. As an alternative, the government directed more funds towards community-based care. By 1998 the Ontario government formally endorsed the use of ACT programs as a mechanism to reduce acute hospitalizations and support the provision of services to individuals with serious mental illness in the community .ACT programs in Ontario are intended not only to provide community-based care but are to be sponsored by an organization within the immediate community. A community organization, usually a hospital or a not-for-profit health care organization, identifies the need for an ACT program within its community and applies to the Ministry of Health and Long Term Care for funding approval to operate an ACT program. If Ministry approval is granted, funds for the operation of the ACT program are administered through the sponsoring agency which is responsible for the operation of the program in accordance with program standards.The approach on which the ACT program model is based originated in the United States in the early 1970s . This coSeveral measurment scales have been developed as a means to assess fidelity to ACT program standards -16. The (1) for whom a program is intended; (2) the required services; (3) the type of staff/numbers needed to competently provide the services; and, 4) the intended benefits/outcomes for the clients receiving the services. Program standards are used to establish costs and are used for program monitoring and compliance purposes  shall also reflect the diversity of the local population  doesn't work". Table The three major themes that emerged from the interviews with respect to the barriers to fully implementing the Community Advisory Body were: external issues; standard related issues; and, organizational/structural related issues. Fifty-one Program Coordinators provided a total of 165 reasons for lack of full compliance to this standard. These reasons for non-compliance range from simply "47) t(= p < .001).The standard regarding the provision of peer support services through the use of a Peer Support Specialist received the second lowest compliance rating of the 33 standards, with a mean of 6.2 . Sixteen of the Program Coordinators (29%) rated their ACT program's level of compliance with this standard as "1" . However, when asked to indicate how essential this standard was to the effective functioning of the ACT Program, it was rated much higher . The difference between the means for level of compliance and how essential respondents felt the standard to be was highly significant (Urban ACT programs (n = 45) are doing slightly better than their rural (n = 11) counterparts at complying with this standard, although on average neither group is fully compliant. Specifically, the mean on the 10-point scale for urban ACT programs was 6.2 , while the mean for rural programs was 5.2 . The difference in means is not statistically significant. However, the rural Program Coordinators felt this standard was slightly more important to the functioning of the program than did the urban Program Coordinators, with means of 8.7 and 7.8 respectively .we are resolving union issues" to "having trouble recruiting". Table The three major themes that emerged from the interviews with respect to the barriers to fully implementing the Peer Support Specialist role were: human resource related issues; organizational/structural related issues; and, standard related issues. Forty-seven respondents provided a total of 73 comments regarding barriers to full compliance with the standard for Peer Support Specialists. The reasons provided for non-compliance range from "Pearson correlations were used to examine the association between the perceived compliance with, and the perceived level of importance of, the two community participation standards Table . The fouTable r = .36, p < .05).Additionally, a positive and significant correlation was found between perceived sponsoring organization support and the level of importance ascribed to having a CAB ; concurrent mental health and addiction disorder services ; social/interpersonal and leisure skill training ; family-centred services, including education, conflict resolution, and related support ; and, performance improvement and program evaluation which includes criteria and methods for assessing client outcomes, client and family satisfaction, and fidelity to the ACT model .Finally, significant and positive correlations were found between level of compliance with the standard to have a CAB and with each of the standards related to the provision of: crisis assessment and intervention, 24 hours a day, seven days a week  composed of representatives from the immediate community, and a Peer Support Specialist as a member of each ACT Team. Despite efforts to implement evidence-based ACT program standards, there remains substantial variation in the extent to which individual programs comply with both of these community participation standards, a finding consistent with past research on ACT programs in other jurisdictions . In thisWhile our results revealed a wide range of reasons provided for ACT teams failing to fully comply with the two standards requiring the community's participation  perceived support from the sponsoring agency was correlated with higher (lower) perceived compliance to the standard.Sponsoring agency support (or lack of support) was much less of an issue when it came to the use of Peer Support Specialists. Opposition tended to be more passive as some ACT programs were left to set their own staffing priorities. Not surprisingly, Peer Support Specialists seemed to be more expendable than other health care providers when staffing decisions had to be made.The major limitation to this study is that we collected data only from the perspective of the ACT Program Coordinators. It would be advantageous to have data from an independent source (outside audit) to compare results with those of the Program Coordinators. There was, however, very limited availability of such information. Data representing the views of other ACT team members would also provide useful additional information. Another potential problem, since this was a telephone survey asking respondents to provide ratings and comments regarding a wide variety of program activities, was that of inaccurate recall on the part of respondents. We minimized this potential problem by (1) sending all respondents a hard copy of the survey document prior to the actual telephone interview, and (2) calling prior to the survey to see if they had questions or needed clarification about any of the survey items. It was anticipated that social desirability bias might introduce error to the study, but since there was such wide dispersion of responses to each of the rating questions (compliance and importance), it seems that this was not a problem.Regardless of the country or regional jurisdiction which is using the ACT model, the results of this study point to the need for identifying barriers to the implementation of community participation program standards if implementation is to be successful and the delivery of these programs is to be evidence-based. Given that the resistance to implementing standards related to the inclusion of Community Advisory Bodies and Peer Support Specialists is both internal to the ACT programs and within the sponsoring agencies, an effort to address both areas is required. One possible approach to improving implementation of community participation standards may lie in improving the education of ACT program administrators and team members about the evidence supporting the use of the various standards . While eThe authors declare that they have no competing interests.


The paradigm-shifting clinical success of imatinib in the treatment of chronic myeloid leukemia (CML) established continuous inhibition of the BCR-ABL1 oncoprotein as a design principle for ABL1 tyrosine kinase inhibitors. However, once-daily dosing with the second-generation ABL1 inhibitor dasatinib, which features a short serum half-life of only 3-5 h, was found to be clinically effective despite apparent transient BCR-ABL1 inhibition [Previous work by our group and others demonstrated that apoptosis commitment after potent, transient target inhibition can be recapitulated using in vitro inhibitor washout protocols -4. One hCancer Research [In the June 1, 2013 issue of Research , we provOur findings reveal that even slightly attenuated restoration of BCR-ABL1 signaling correlates with apoptosis commitment and that intracellular retention of ABL1 tyrosine kinase inhibitors above a quantifiable threshold is important in mediating this effect Figure . Other gAddressing these and similar questions will further inform design requirements for ABL1 tyrosine kinase inhibitors in CML. It appears clear that metabolic half-life must continue to be taken into account when designing kinase inhibitors, dampening the promise of the oncogenic shock concept. By extension, monitoring intracellular drug levels by LC-MS/MS may be informative, especially for short serum half-life kinase inhibitors such as dasatinib. The cumulative effort to distill the essential properties of effective small-molecule kinase inhibitors will accelerate identification and development of targeted therapies with improved efficacy and tolerability for CML and other malignancies.


The authors would like to add the following to their financial disclosure: "The study is also a Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions."


M = 4.8 earthquake recorded in the Aeolian Archipelago on 16, August, 2010, by means of the region-time-length (RTL) algorithm. This earthquake triggered landslides at Lipari; a rock fall on the flanks of the Vulcano, Lipari, and Salina islands, and some damages to the village of Lipari. The RTL algorithm is widely used for investigating precursory seismicity changes before large and moderate earthquakes. We examined both the spatial and temporal characteristics of seismicity changes in the Aeolian Archipelago region before the M = 4.8 earthquake. The results obtained reveal 6-7 months of seismic quiescence which started about 15 months before the earthquake. The spatial distribution shows an extensive area characterized by seismic quiescence that suggests a relationship between quiescence and the Aeolian Archipelago regional tectonics.We investigated the seismicity patterns associated with an  The quiescence of seismic activity has been defined as the notable decrease in the seismic activity against the average background. Temporal seismic observations have shown trends of seismic quiescence preceding large and moderate events , 2. SuccThis method may evidence a decrease (quiescence) or an increase (activation) in the seismic activity against the average background . The RTLThe Aeolian Archipelago  is locatIt can be subdivided into three sectors with a different structural and tectonic evolution . In the These volcanoes are aligned along a lithospheric NNW-SSE fault system, the Aeolian-Tindari-Letojanni fault system  with rigM = 5.5 (15/04/1978) and M = 5.7 (28/05/1980) , one represents the event with the highest magnitude recorded. In this study, the region-time-length (RTL) algorithm has been implemented to the catalogue of earthquakes which occurred in the period from 2000 to 2010 and we discuss the phases of seismic activation and quiescence preceding the M = 4.8 event in 2010.The seismicity recorded from 1999 to 2011 comprises events with Since the late ‘70s, continuous seismic monitoring activity in the Aeolian Archipelago has been performed by a permanent seismic network made up of a few analogical 3C stations. Starting from the ‘80s, the network was augmented with other stations deployed over the entire Aeolian Archipelago and equipped with short-period seismometers, having a natural frequency of 1 Hz. During 2005 and 2007, almost all the stations were replaced by new digital 24-bit ones, equipped with broadband (40 s) three-component sensors, with a dynamic range of 144 dB. To date, the Aeolian permanent seismic network, managed by INGV-CT , consists of 12 three-component digital seismic stations . In ordeWe considered an area of 100 × 80 km with a latitude between 38.00 and 38.85 and a longitude of 14.00 and 15.30. The dataset used in this study comprises 1680 crustal earthquakes recorded from August 1999 to 2011 with magnitude 1.0 ≤ Md ≤ 4.8, whose location, performed for surveillance purposes, is obtained by using the Hypoellipse code  Figure . The meaThe main event of the catalogue occurred at 12.54 GMT of the 16, August, 2010, when Aeolian Archipelago was shaken by an earthquake of an estimated 4.8 magnitude. The hypocenter of the earthquake was situated 8 km west-south-west of the island of Vulcano at a depth of 13.0 km b.s.l. . The earR (region around the earthquake epicenter), T (time), and L (rupture length). The fundamental idea of RTL algorithm is to assign a weighting RTL value to a given spatiotemporal value , which comes from events occurring in a prescribed space-time window within the characteristic distance and time. An RTL parameter is defined as the product of R, T, and L describing the influence weights of location, occurrence time, and magnitude asli is the rupture dimension (a function of magnitude Mi); ti is the occurrence time of the ith earthquake; ri is the distance from the position  to the epicenter of the ith event; r0 and t0 are the characteristic distance and time associated with the spatiotemporal criteria; do is the cut-off depth; and n is the number of events satisfying the following criterion:The analysis of the earthquake dataset has been performed by using the well-established method known as RTL algorithm , 8 whichMi ≥ Mmin ; ri ≤ Rmax = 2ro; and t − ti = Tmax = 2to.li the following expression is used [Rbk, Tbk, and Lbk are the background values of R, T, and L, respectively, obtained as the expected values in the time interval considered for the analyzed position. RTL parameter describes the deviation from the background level of seismicity and is expressed in units of the standard deviation. A negative RTL value indicates a lower seismicity and a positive RTL value indicates a higher seismicity compared to the background. Clearly, both a temporal and a spatial analysis of RTL can be performed and some authors often use the spatial average value for the RTL parameters calling it Q parameter [R, T, L, and Q parameters has been implemented in the MATLAB environment (For the rupture dimension  is used :(2)li=earameter . The algironment , allowinThe RTL analysis needs to be applied to declustered catalogues, where aftershocks are removed . In orderfact, the factor for the interaction radius of dependent event, τmin, the look-ahead time for un-clustered events in days, τmax, the maximum look-ahead time for clustered events in days, and P, a measure of the confidence that the next event in the sequence is being observed.The Reasenberg algorithm defines a seismic sequence as a chain of events linked to each other by spatial and temporal windows. The variables are rfact = 10, τmin = 1, τmax = 10, and P = 0.95) obtaining a catalogue of 1324 events.For declustering we used the default parameters  of 30 km.We calculated the RTL and rameters , 13, tha0, Huang  adopted M = 5.0) in a small area (20 km × 30 km), tried different values for parameters adopting the following values: r0 = 10 km, t0 = 25 days, and d0 = 20 km.Shashidhar et al. , for modM = 4.8) and the 1, January, 2008–15, August, 2010 (958 days), period.In order to obtain the RTL, we have considered location of the 16, August, earthquake  are not more than 30 km deep  and we t and t0 . RTL alg and t0 ; we adopalso ran  the RTL Q parameter around the epicenter of the 16, August, 2010, earthquake. The seismic quiescence spans the June–December 2009 period, ending 8-9 months before the M = 4.8 earthquake.In many parts of the world, the RTL method has been used for larger regions and longer seismic catalogues, obtaining valid observations on the quiescence phenomenon prior to large earthquakes , 40. In M ≤ 3.8 earthquakes located nearby (10–15 km) the M = 4.8 epicenter. Moreover some modest and rapid negative changes are also visible.Figures All these short-time variations may be related to an imperfect removing of the aftershocks in the catalogue and/or to the adopted parameters.Six-seven-month quiescence ending 8-9 months before the earthquake is in accordance with duration of the quiescence (0.6 to 3 years) and time shift from the end of the quiescence to the earthquake (0 to 2.9 years) was found by Gentili  for seveQ parameter in the quiescence period (June–December 2009) for the entire area  comprises a sector around Vulcano island. The M = 4.8 earthquake occurred in this area, which is about 4 km west of the pixel with lower (−3.3) Q value. However, an area between Salina and Filicudi of ca. 80 km2 and a small sector (ca. 40 km2) in the north of Sicily also show negative Q values. Areas covered by the quiescence agree with sectors affected by Sisifo and Tindari-Letojanni fault system.The main area covered by the quiescence  spatial distribution which comprises the triggered zone. However the area covered by the quiescence seems large in order to affirm that the method presented here is an effective tool of improving the significance and reliability of earthquake precursors.The results obtained reveal a seismic quiescence phase before an These features are consistent with the results obtained by different authors by using RTL worldwide and encourage us to improve RTL analyses on other earthquakes by testing different parameters in order to evaluate the future possibility of moderate earthquake occurrence in this region that could also have an impact on the volcanic system of Vulcano.


This paper reports a linear programming approach for placement of applicants to study programs developed and implemented at the college of Business & Economics, Bahir Dar University, Bahir Dar, Ethiopia. The approach is estimated to significantly streamline the placement decision process at the college by reducing required man hour as well as the time it takes to announce placement decisions. Compared to the previous manual system where only one or two placement criteria were considered, the new approach allows the college’s management to easily incorporate additional placement criteria, if needed. Comparison of our approach against manually constructed placement decisions based on actual data for the 2012/13 academic year suggested that about 93 percent of the placements from our model concur with the actual placement decisions. For the remaining 7 percent of placements, however, the actual placements made by the manual system display inconsistencies of decisions judged against the very criteria intended to guide placement decisions by the college’s program management office. Overall, the new approach proves to be a significant improvement over the manual system in terms of efficiency of the placement process and the quality of placement decisions. The placement of applicants for undergraduate and graduate studies in various academic programs is one of the decision problems that administrators in universities regularly deal with. Given that applicants’ preferences for programs are not matched with capacities of available programs, administrators have used one or more criteria, along with applicants’ preferences, in an effort to best satisfy applicants’ interests while meeting other academic standards. In essence, the placement problem is a problem of allocation of limited intake capacities of academic programs or departments among applicants while trying to best satisfy the interest of applicants. When the placement decision involves hundreds of applicants using multiple criteria, it becomes a demanding problem to tackle manually.This has been the experience at the College of Business and Economics of Bahir Dar University (CoBE hereafter) in recent years due to the increasing number of applicants. The current placement approach has become too laborious a placement approach, even when only one or two criteria are used to determine which applicants get placed in their more preferred programs of studies. The process is highly demanding in terms of staff time required to decide on placements. For instance, announcement of placement of more than 800 applicants to six undergraduate programs during the 2012/2013 academic year took about a week.To rectify the situation, we developed a simple linear program based decision support system that can perform placement of applicants in a matter of a few seconds once the relevant data are entered. Though the model underlying our approach is related to models developed in related applications J: = set of academic programs K: = set of placement criteria T: = set of cutoff points G: = set of component objectives Kt: = {k ϵ K: k = criterion for which cutoff point t ϵ T is applicable}The parameters in our model are the following:Uj: = maximum intake capacity of program jLj: = minimum number of applicants required to be placed in program jsik: = applicant i’s score on criterion k ij = 1,2,…,n)pij: = applicant i’s preference rating for program j . Thus, for instance, assuming six open programs for enrollment, if it’s required that applicants who scored 350 and above marks on college entrance examination be placed in programs of their first (rating of 6) or second (rating of 5) preference, the criterion cutoff point is 350 and the preference cutoff point is 5.The final and fourth component of our objective function represents the desire to minimize the cost of placements of applicants who fall short of the minimal requirements of entry specified in terms of minimum score on a criterion for a program. This is formulated as:We combine these four components into a single objective function.The model presented above is what Pentico  refers tOur model is easily usable with many alternative placement criteria and weighting schema. Whatever the number of criteria and weighting schema used, however, college administrators should deliberate and agree on a set of objective and measurable criteria that will be used for placement of applicants in programs. The chosen criteria may depend on the objective of placement decisions.Another contentious issue is the construction of the intake capacity parameters of the programs. Previously the capacity of departments was arbitrarily decided. This used to be the cause of conflicts among departments. Because students’ preference rankings tend to be skewed in favor of one or two programs, some political activity is involved to convince administrators to place applicants in programs even if that is against the interest of applicants. The real gap here is the absence of any standard that justifiably determines the number of students each program can enroll. Defining ex ante the criteria and formula for capacity determination will be of much help in this regard.At CoBE, there are no formal mechanisms to determine the effective intake capacities of programs. In the case of placements for undergraduate programs reported below, the simple rule applied was that a minimum of a class size of applicants be placed in each of the six programs offered at CoBE. Satisfying this, any number of eligible applicants can be placed in a program. Though this is problematic in principle , experience suggests this simple rule is usually adequate. Applicants’ preferences, though skewed towards a few programs, tend to be distributed across programs without causing too much imbalance between capacity and enrolment for any one program.In this section we present test results constructed with our model based on actual placement data for the 2012/13 academic year and compare the results with actual placement decisions. The placement decision support system we developed at CoBE is designed to support placement decisions both at undergraduate and graduate levels offered in any of the formats . However, the placement decision for the regular undergraduate programs has the largest problem size mainly due to the larger number of applicants in this format. For this reason, the system has found its greatest value in making placement decisions for the regular undergraduate programs. Currently, six undergraduate programs are offered in the regular program format. The experimental test results presented below concern placements made in these programs for the 2012/13 academic year at CoBE. The six undergraduate programs offered at CoBE are Accounting & Finance (ACT), Economics (ECO), Logistics & Supply Chain Management (LOG), Management (MGT), Marketing Management (MKT) and Tourism and Hotel Management (TOR). The experimental results are based on a study conducted as part of the development of the placement decision support system at CoBE and is officially approved by the academic commission (AC) of the College of Business & Economics of Bahir Dar University.The process of placement at CoBE is briefly as follows. Every New Academic Year (the middle of September), students who have fulfilled the minimum requirements for college entry are assigned to broad study fields  along with the specific universities where they pursue their studies by a body designated for this task at the Ethiopian Ministry of Education. The appropriate academic units within the universities then use their own criteria to place the students assigned to them in the various undergraduate study programs they offer. At CoBE only one criterion (aside from preferences of students) has been considered in placement of applicants in regular undergraduate programs: marks earned on college entrance examination by applicants. We are not suggesting here that applicants’ preference ratings for programs are not considered. Rather, applicants’ college entrance examination marks make the difference as to who gets placed in his or her more preferred program of study.The placement decision process at CoBE is significantly an iterative process in which the value of even some of the attributes (such as capacity of programs) that would have been fixed a priori in our optimization model are also decision variables. For this reason distilling consistent principles underlying the process was difficult. Through discussions with the program manager of the college we were able to identify crude general guidelines underlying the actual placement decision process, as summarized below.The actual placement decisions were made on the basis of applicants’ marks which determine which students get placed in their more preferred programs.Getting applicants placed in the programs of their higher preference ratings, as far as possible, was considered the main objective.Applicants who scored 325 and above marks on the national college entrance examination must be placed in their most preferred programs, in spite of capacity and other considerations.For two applicants with the same preference rating for a given program, if one of them has a higher mark than the second, the applicant with higher marks should preempt the applicant with lower marks.For two applicants with different marks if the preference ratings of the applicants for a given program are also different, for the program under consideration the applicant with lower marks may preempt the applicant with higher marks only if the applicant with lower marks has given a higher preference rating for the program than did the applicant with higher marks. Thus, in this case there is substitution between marks and preference.A minimum of a class size of applicants must be placed in each of the six programs As will be shown below, the actual placement decisions were largely consistent with regard to these guidelines. Nonetheless, about 7 percent of actual placements showed inconsistencies.Conversion of preference rankings to preference points was necessary to make the preference rankings of applicants for the six programs suitable to our analysis. Applicants have filled out a form indicating their choices of programs by simply writing their preference ranks for their top three preferred programs. We converted these into numerical values. Our preference rating schema assigns rating points of 6, 5 and 4 for the first, second, and third choices of programs, respectively. Since applicants were not required to rank all programs for their preferences, if a program is not in the top three preference list of an applicant, we have no data about the applicant’s preference ranking for this program. For this reason we assumed equal rankings  for the remaining three programs that are not included in an applicant’s top three preference list. The distribution of applicants’ preference rankings for the programs is summarized in Table The preferences are concentrated in favor of three programs - ACT, ECO and MGT. A better way to understand the preferences of applicants for the six programs is based on our preference point assignments. Note that if a program is the first choice of all 812 applicants, the program’s aggregate preference points will be 4872. Thus, we can compare preferences of applicants for programs relative to this maximum possible aggregate preference value . Quadrant I is the number of placements such that applicants placed and applicants not placed in a given program have the same marks but those not placed ranked that program higher than those placed. Indicated in quadrant III and quadrant IV are number of applicants for which placements in a program seem arbitrary in that when two applicants have different marks and both choose a program equally (quadrant III) or the applicant with higher marks also has stronger preference for the program (quadrant IV), the actual placement gives priority to the applicant with lower marks, which is against the very guiding principles discussed above.Looking back again to Table An even more interesting insight as to what might have gone into the actual placement process is suggested when we consider the standard deviations of the marks for the two groups of placements. The standard deviation of marks is consistently smaller, department by department, for those placements on which the actual and our model’s placements differ. The same holds true when we also consider the overall standard deviation for the two groups. The placements on which our model and the manual system don’t agree have a significantly lower standard deviation. But this may indicate that for applicants with lower marks, the decision makers were supposed to concern themselves not only with lower marks but also marginally smaller differences of marks among these students. This makes the task even more difficult because smaller margins are much more difficult to assess. Thus, this adds to the likelihood that decisions of placements for applicants with lower marks are apt to be inaccurate.In contrast, the coefficients in our model’s objective function easily handle such requirements. This makes our model even more compelling Table .Table 8Finally, looking at Table In this paper we presented a linear programming placement model that is already approved and to be applied for actual placement decisions starting with this academic year at the college of business and economics, Bahir Dar University. The test results based on actual placement data indicated that our model proves to produce at least as much quality of output as the manual system. Nonetheless, in a deeper sense, our model is even superior as it can be easily adjusted to strike a desirable tradeoff between the various criteria used to decide on placements. All these gains, when considered along with the significant efficiency gains that our placement model entails, suggest the potential value of management science in improving decision making in Ethiopian higher learning institutions. We hesitate little to encourage adoption of our model in other similar institutions in the country.Written informed consent was obtained from the program manager of the College of Business & Economics for the publication of this report and any accompanying information.