Software resources that make the most sense

Use whatever software resources make the most sense (Tableau, Excel, R, etc.) given that you are working with more than 500 time series.

1.Plot all the series (an advanced data visualization tool is recommended) – what type of components are visible? Are the series similar or different? Check for problems such as missing values and possible errors.

  1. Partition the series into training and validation, so that the last 4 years are in the validation period for each series. What is the logic of such a partitioning? What is the disadvantage?
  2. Generate naive forecasts for all series for the validation period. For each series, create forecasts with horizons of 1,2,3, and 4 years ahead (Ft+1, Ft+2, Ft+3, and Ft+4).
  3. Among the measures MAE, Average error, MAPE and RMSE, which are suitable if we plan to combine the results for the 518 series?
  4. For each series, compute MAPE of the naive forecasts once for the training period and once for the validation period.
  5. The performance measure used in the competition is Mean Absolute Scaled Error (MASE). Explain the advantage of MASE and compute the training and validation MASE for the naive forecasts.
  6. Create a scatterplot of the MAPE pairs, with the training MAPE on the x-axis and the validation MAPE on the y-axis. Create a similar scatter plot for validation MASE vs. MAPE. Now examine both plots. What do we learn? How does performance differ between the training and validation periods? How does performance range across series?
  7. The competition winner, Lee Baker, used an ensemble of three methods:
    • Naive forecasts multiplied by a constant trend (global/local trend: “globally tourism has grown “at a rate of 6% annually.”)
    • Linear regression
    • Exponentially-weighted linear regression
    (a) Write the exact formula used for generating the first method, in the form Ft+k=…(k=1,2,3,4).
    (b) What is the rational behind multiplying the naive forecasts by a constant? (Hint: think empirical and domain knowledge)
    (c) What should be the dependent variable and the predictors in a linear regression model for these data? Explain.
    (d) Fit the linear regression model to the first five series and compute forecast errors for the validation period.
    (e) Before choosing a linear regression, the winner described the following process
    “I examined fitting a polynomial line to the data and using the line to predict future values. I tried using first through fifth order polynomials to find that the lowest MASE was obtained using a first order polynomial (simple regression line). This best fit line was used to predict future values. I also kept the [R2] value of the fit for use in blending the results of the predictor.”
    What are two flaws in this approach?
    (f) If we were to consider exponential smoothing, what particular type(s) of exponential smoothing are reasonable candidates?
    (g) The winner concludes with possible improvements, one being “an investigation into how to come up with a blending [ensemble] method that doesn’t use as much manual tweaking would also be of benefit.” Can you suggest methods or an approach that would lead to easier automation of the ensemble step?

(h) The competition focused on minimizing the average MAPE of the next four values across all 518 series. How does this goal differ from goals encountered in practice when considering tourism demand? Which steps in the forecasting process would likely be different in a real-life tourism forecasting scenario?

Sample Solution

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. Nursing Theories and Nursing Practice.

Reflect upon the events that are taking place in healthcare today (Covid-19 Pandemic). Which theorist would you select to
construct a framework for care of your staff and patients? Please explain why with examples.
Think about some of the concepts involved. Examples include fear, isolation, family separation, being
pregnant and exposed to the virus, psychological issues, guilt, impacted care standards.

Sample Solution

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the principal science of public health

Chapter 5

Epidemiology

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

 

Epidemiology Is …

… the study of the distribution and determinants of health and disease in human populations

(Harkness, 1995)

… the principal science of public health

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Historical Perspective

Investigations of disease pattern in the community; comparing people who had disease or who remained healthy

Person-Place-Time Model

Person: “Who” factors, such as demographic characteristics, health, and disease status

Place: “Where” factors, such as geographic location, climate and environmental conditions, political and social environment

Time: “When” factors, such as times of day, week, or month and secular trends over months and year

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Different Types of Epidemiology

Descriptive Epidemiology

Study of the amount and distribution of disease

Used by public health professionals

Identified patterns frequently indicate possible causes of disease

Analytic Epidemiology

Examine complex relationships among the many determinants of disease

Investigation of the causes of disease, or etiology

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Epidemiological Triangle

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Figure 5-1

 

Agent of Disease (Etiologic Factors)

Nutritive elements

Excesses, deficiencies

Chemical agents

Poisons, allergens

Physical agents

Ionizing radiation, mechanical

Infectious agents

Metazoa, protozoa, bacteria, fungi, rickettsia, viruses

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Host Factors–Intrinsic Factors (Susceptibility, or Response to Agent)

Genetic

Age

Sex

Ethnic group

Physiological state

Prior immunological experience

Active/, passive

Intercurrent or preexisting disease

Human behavior

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Environmental Factors— Extrinsic Factors…

… influence existence of the agent, exposure, or susceptibility to agent

Physical environment

Biological environment

Human populations, flora, fauna

Socioeconomic environment

Occupation, urbanization and economic development, disruption

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Wheel Model of Human-Environment Interaction

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Figure 5-2

Redrawn from Mausner JS, Kramer S: Mausner and Bahn epidemiology: an introductory text, ed 2, Philadelphia, 1985, Saunders.

 

Web of Causation

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Figure 5-3

From Friedman GD: Primer of epidemiology, ed 4, New York, 1994, McGraw-Hill.

 

Ecosocial Approach

Emphasize the role of evolving macro-level socioenvironmental factors along with microbiological process in understanding health and illness (Smith & Lincoln, 2011)

Challenges the more individually focused risk factor approach to understanding disease origins

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Calculation of Rates

Rates are arithmetic expressions that help practitioners consider a count of an event relative to the size of the population from which it is extracted

Number of health events in a specified period

Population in same area in same specified period

Proportion multiplied by a constant (k)

For example, the rate can be the number of cases of a disease occurring for every 1000, 10,000 or 100,000 people in the population

Can make meaningful comparisons

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Morbidity Rates

Incidence rates

New cases or conditions

Attack rate

Number of new cases of those

exposed to the disease

Prevalence rates

All cases of a specific

disease or condition at

a given time

 

 

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Prevalence Pot The relationship between incidence and prevalence

Figure 5-4

Redrawn from Morton RF, Hebel JR, McCarter RJ: A study guide to epidemiology and biostatistics, ed 3, Gaithersburg, MD, 1990, Aspen Publishers.

 

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Morbidity Rates (Cont.)

 

 

Incidence Rate

 

 

 

 

 

 

 

 

 

 

Prevalence Rate

Number of existing cases Total Population  _____

 

 

 

 

 

 

 

 

Number of new cases _in given time period Population at risk in same time period ___75___ 4000–250

× 1000

= 0.02

0.02 × 1,000 = 20 per 1000 per time period

250

4000

= 0.0625

0.0625 × 1000 = 62.5 per 1000

 

Mortality Rates (routinely collected birth and death rates)

Other rates

Crude rates

Age-specific rates

Age-adjusted rates or standardization of rates

Proportionate mortality ratio (PMR)

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Number of deaths in year Total population size _1720_ 200,000

× 100,000

= 0.0086

Number of births in year Total population size _2900_ 200,000

× 100,000

= 0.0145

 

Concept of Risk

Risk—probability of an adverse event

Risk factor

Refers to the specific exposure factor

Often external to the individual

Attributable risk

Estimate of the disease burden in a population

Relative risk ratio

Divide the incidence rate of disease in the exposed population by the incidence rate of disease in the nonexposed population.

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Use of Epidemiology

Disease prevention

Primary prevention

Health promotion and specific prevention

Secondary and tertiary prevention

Establishing causality

Screening

Surveillance

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Use of Epidemiology (Cont.)

Health services

Used to describe the distribution of disease and its determinants in populations

Study population health care delivery

Evaluate use of community health services

Nurses must apply findings in practice

Incorporate results into prevention programs for communities and at-risk populations

Extend application into major health policy decisions

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Community health nurses should exercise “social responsibility” in applying epidemiological findings, but this will require the active involvement of the consumer.

Community health nurses collaborating with community members can combine epidemiological knowledge and aggregate-level strategies to affect change on the broadest scale.

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Epidemiological Methods

Descriptive epidemiology

Focuses on the amount and distribution of health and health problems within a population

Analytic epidemiology

Investigates the causes of disease by determining why a disease rate is lower in one population group than in another

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Analytic Epidemiology

Observational studies

Descriptive purposes

Etiology of disease

No manipulation by investigator

Cross-sectional studies

Sometimes called prevalence or correlational studies

Examine relationships between potential causal factors and disease at a specific time

Impossible to make causal inferences

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Analytic Epidemiology (Cont.)

Retrospective studies

Compare individuals with a particular condition or disease with those who do not have the disease

Data collection extends back in time

Prospective studies

Monitor a group of disease-free individuals to determine if and when disease occurs

Cohort shares a common experience within a defined time period

Monitors cohort for disease development

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Analytic Epidemiology (Cont.)

Experimental design

Also called a Randomized Clinical Trial (RCT)

Subjects assigned to experimental or control group

Apply experimental methods to test treatment and prevention strategies

Ethical considerations with human subject rights review

Also useful for investigating chronic disease prevention

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Community Health Education

Chapter 8

Community Health Education

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

 

Health Education …

… is any combination of learning experiences designed to predispose, enable, and reinforce voluntary behavior conducive to health in individuals, groups or communities.

– Green and Kreuter, 2004

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Health Education’s Goals

To understand health behavior and to translate knowledge into relevant interventions and strategies for health enhancement, disease prevention, and chronic illness management

To enhance wellness and decrease disability

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Health Education’s Goals (Cont.)

Attempts to actualize the health potential of individuals, families, communities, and society

Includes a broad and varied set of strategies aimed at influencing individuals within their social environment for improved health and well-being

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Learning Theories

Humanistic theory helps individuals develop their potential in a self-directing and holistic manner.

Cognitive theory recognizes the brain’s ability to think, feel, learn, and solve problems; theorists in this area train the brain to maximize these functions.

Social learning is based on behavior that explains and enhances learning through the concepts of efficacy, outcome expectation, and incentives.

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Adult Learners

Need to know

Concept of self

Experience

Readiness to learn

Orientation to learning

Motivation

 

– Knowles (1980, 1989)

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Health Education Models

Health Belief Model (HBM)

Perceived susceptibility

Perceived severity

Perceived benefits

Perceived barriers

Self-efficacy

Demographics

Cues to action

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Health Education Models (Cont.)

Health Promotion Model (HPM)

Individual characteristics and behaviors

Prior behaviors, personal factors

Behavior—specific cognitions and affect

Activity-related affect, interpersonal influences, situational factors, commitment to plan of action, perceived self-efficacy, immediate competing demands and preferences, perceived benefits of health-promoting behaviors, perceived barriers to health-promoting behaviors

Behavioral outcome

Health-promoting behavior

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Model of Health Education Empowerment

… nurses cannot assign power and control to the individual within the community but rather … the “power” must be taken on by the individual and community with the nurse guiding this dynamic process.

– Van Wyk, 1999

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Model of Health Education Empowerment (Cont.)

Process includes examining

Education

Health literacy

Gender

Racism

Class

Recognizes the structural and foundational changes that are needed to elicit change for socially and politically disenfranchised groups

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Problem-Solving Education …

…centers on empowerment (Freire, 2005)

Allows active participation and ongoing dialogue

Encourages learners to be critical and reflective about health issues

Involves individuals as subjects, not objects

Increases health knowledge through a participatory group process

Involves activism on the part of the educator

Facilitator-educator is a resource person and is an equal partner with the other group members

Leads to sustainable lateral relationships

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Participatory Action Research (PAR)

Goal of PAR is social change

Embraces the use of community-based participatory methods

Participation and action from stakeholders and knowledge about conditions and issues helps to facilitate strategies reached collectively

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Community Empowerment

Community members take on greater power to create change

Based on community cultural strengths and assets

Attention must be given to collective rather than individual efforts to ensure that outcomes reflect voices of the community and truly make a difference in people’s lives

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The Nurse’s Role in Health Education

Become a partner with individuals and communities

Serve as catalyst for change

Activate ideas

Offer appropriate interventions

Identify resources

Facilitate group empowerment

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Framework for Developing Health Communications

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Figure 8-1

 

Health Education Model Stage I: Planning and strategy selection

Questions to Ask

Who is the intended audience?

What is known about the audience and from what sources?

What are the communication and education objectives and goals?

What evaluation strategies will the nurse use?

What are the issues of most concern?

What is the health issue of interest?

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Health Education Model Stage I: Planning and strategy selection (Cont.)

Collaborative Actions to Take

Review the available data.

Get community partners involved.

Obtain new data.

Determine perceptions of health problems.

Determine the community’s assets and strengths.

Identify underlying issues and knowledge gaps.

Establish goals and objectives.

Assess resources.

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Health Education Model Stage II: Developing and pretesting concepts, messages, and materials

Questions to Ask

What channels are best?

What formats should be used?

Are there existing resources?

How can the nurse present the message?

How will the intended audience react to the message?

Will the audience understand, accept, and use the message?

What changes may improve the message?

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Health Education Model Stage II: Developing and pretesting concepts, messages, and materials (Cont.)

Collaborative Actions to Take

Identify the messages and materials.

Decide whether to use existing materials or produce new ones.

Select channels and formats.

Develop relevant materials with the target audience.

Pretest the message and materials and obtain audience feedback.

 

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Health Education Model Stage III: Implementing the program

Questions to Ask

How should we launch the health education program?

How do we maintain interest and sustainability?

How can we use process evaluation?

What are the strengths of the health program?

How can we keep on track within timeline and budget?

How do we know if we have reached our intended audience?

How well did each step work (process evaluation)?

Are we maintaining good relationships with partners?

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Health Education Model Stage III: Implementing the program (Cont.)

Collaborative Actions to Take

Work with community organizations to enhance effectiveness.

Monitor and track progress.

Establish process evaluation measures.

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Health Education Model Stage IV: Assessing effectiveness and making refinements

Questions to Ask

What was learned?

How can outcome evaluation be used to assess effectiveness?

What worked well, and what did not work well?

Has anything changed about the intended audience?

How can we refine methods, channels, and formats?

What lessons were learned? What modifications could strengthen the health education activity?

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Health Education Model Stage IV: Assessing effectiveness and making refinements (Cont.)

Collaborative Actions to Take

Conduct outcome evaluations.

Reassess and revise goals and objectives.

Modify unsuccessful strategies or activities.

Generate continual support from community groups.

Provide justification for continuing/ending the program.

Summarize in an evaluation report.

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Health Literacy Definitions Evolved Over Time

National Literacy Act (1991)

Literacy is operationally defined as the ability to read and write at the fifth-grade reading level in any language and can be measured according to a continuum.

IOM Report (2004)

The capacity to obtain, interpret, and understand basic health information and services and the competence to use such information and services to enhance health

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In 1999, the AMA’s Report of the Council on Scientific Affairs reported that patients with the most health care needs are often the least able to read and understand information that would enable them to function successfully within

the health care system.

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Health Literacy

 

Health Literacy (Cont.)

Health literacy is about empowerment …

Having access to information, knowledge, and innovations

Increasingly important for social, economic, and health development

A key public health issue in the delivery of safe, effective care

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Low Literacy

Increases the use of health care services

Decreases self-esteem; increases shame and stigma

Adversely affects outcomes and treatment of some medical conditions

Poses barriers to obtaining informed consent

Impacts participation in research

Leads to health care and linguistic isolation

Impedes patient-provider communication

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Literacy Concerns

Serious mismatch exists between the reading levels of materials and patient’s reading skills.

Materials often fail to incorporate the intended audience’s cultural beliefs, values, languages, and attitudes.

Low literacy prevents many from gaining the full benefits of health care.

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Literacy Concerns (Cont.)

Inability to read and understand instructions influences self-care abilities and health and wellness.

Individuals with very low literacy skills are at an increased risk for poor health, which contributes to health disparities.

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Levels for Interventions

Functional/basic literacy

Increasing basic reading/writing skills

Communicative/interactive literacy

Understanding and using information with providers

Critical literacy*

Analyzing and using information in life situations

 

*Most important because it increases empowerment and success in everyday situations

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Helpful Tips for Effective Teaching

Assess reading skills

Determine what client needs to know

Identify motivating factors

Stick with essentials

Set realistic goals and objectives

Use clear and concise language

Develop a glossary of common words

Space teaching over time

Personalize health messages

Incorporate methods of illustration, demonstration, and real-life examples

Give and get

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Helpful Tips for Effective Teaching (Cont.)

Summarize often

Be creative

Use appropriate resources and materials

Put patients at ease

Praise patients

Be encouraging

Allow time for questions

Employ teach-back methods

Remember that comprehension and understanding take time and practice

Conduct learner verification

Evaluate the teaching plan

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Assess Materials

Become a Wise Consumer and User

Evaluate health materials, including websites, before disseminating them

Materials should strengthen previous teaching

Materials should be used as an adjunct to health instruction

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Assessing the Relevancy of Health Materials

Do materials match the intended audience?

Are materials appealing and culturally and linguistically relevant?

Do they convey accurate and up-to-date information?

Are messages clear and understandable?

Do messages promote self-efficacy and motivation?

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Assessment of Reading Level

Assess reading levels of intended audience

Rapid estimate of adult literacy in medicine (REALM)

Single Item Literacy Screener (SILS)

Short Assessment of Health Literacy for Spanish-Speaking Adults (SAHLSA)

Assess readability of educational resources

SMOG readability formula

Flesch-Kincaid formula (on most computers)

Verify understanding of learner

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Role of Social Media

Numerous platforms now available

May reach diverse community constituents with important public health messages

Potential to…

Facilitate interactive communication

Increase sharing of health information

Personalize and reinforce health messages

Can empower community members to make informed health decisions

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