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Sample records for improving service delivery

  1. 76 FR 24339 - Streamlining Service Delivery and Improving Customer Service

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-02

    ... Delivery and Improving Customer Service By the authority vested in me as President by the Constitution and...). However, with advances in technology and service delivery systems in other sectors, the public's... Federal Government has a responsibility to streamline and make more efficient its service delivery...

  2. Models To Improve Service Delivery. Chapter 8.

    ERIC Educational Resources Information Center

    1996

    This collection of papers presented at a 1996 conference on children's mental health focuses on models to improve service delivery. Papers have the following titles and authors: (1) "Empirical Evaluation of an Alternative to Hospitalization for Youth Presenting Psychiatric Emergencies" (Scott W. Henggeler); (2) "An Experimental Study of the…

  3. From service delivery to solution delivery: commissioning for health improvement.

    PubMed

    Shircore, Richard; Ladbury, Patrick

    2009-11-01

    The further division of responsibilities between commissioners and providers in England will have far-reaching consequences and opportunities for developing and enhancing health improvement. Commissioners will have the opportunity to craft local solutions to local issues. To be effective, these local responses need to tackle the core determinants of health and to build the social capital that is at the heart of all communities that enjoy high standards of health. This paper argues that the new arrangements mark an evolution of the Beveridge model of healthcare (centralized, top down and professionally prescribed) to a post-Beveridge model characterized by it being decentralized, localized and utilizing professional skills in the pursuit of client and community satisfaction and engagement rather than a narrowly defined professional perspective. This paper indicates some of the key conceptual changes commissioners need to employ to take advantage of the emerging opportunities. It is argued that the new arrangements will only be fully effective if commissioners of health improvement programmes ensure they factor in health promotion and social marketing expertise, both in the strategic and operational phases of commissioning. Finally, predictions are made about changes in the values and characteristics of current health improvement organizations. PMID:19994646

  4. Improving the delivery of veterinary services in India.

    PubMed

    Rao, S V N; Rasheed Sulaiman, V; Natchimuthu, K; Ramkumar, S; Sasidhar, P V K

    2015-12-01

    In pursuit of effective veterinary service delivery, the objectives of this study were threefold: (i) reduce the shortage of technical personnel in veterinary universities (VUs) and animal husbandry departments (AHDs), (ii) identify collaborative areas between VUs and AHDs, and (iii) build the capacity of the veterinary and animal husbandry sector. Primary data were collected from all the 16 veterinary colleges and AHDs in five south Indian states on: (i) student intake and the out-turn of veterinary graduates, (ii) technical personnel--existing and required at various levels, (iii) specific areas of collaboration where VUs and AHDs need each other and can extend support to each other, and (iv) areas in which university faculty and field veterinarians would benefit from further training. Two focus group discussions were held with top administrators of VUs and AHDs to collect qualitative data. The results revealed that there are not enough veterinary graduates to meet the needs of the system and that there is a shortage of faculty, field veterinarians and para-veterinarians. Both focus groups identified areas for collaboration and capacity building to improve veterinary service delivery. The results conclusively demonstrated that India's veterinary service delivery is constrained, not due to a lack of organisations or programmes, but due to the inability of the organisations to collaborate with each other. To improve the effectiveness of veterinary service delivery it will be necessary to: admit more graduate students, support the establishment of new colleges; recruit faculty, field veterinarians and para-veterinarians; remandate the Directorates of Extension at VUs to develop linkages with AHDs; allocate funds ('special central grants') for infrastructure development to all AHDs and veterinary colleges; establish one model veterinary college that follows international standards on veterinary education and create four regional academic staff training colleges

  5. Program Integration: An Alternative for Improving County Rural Human Services Delivery. Technical Paper No. 13.

    ERIC Educational Resources Information Center

    Center for Rural Pennsylvania, Harrisburg.

    This report examines program integration as a way to improve the delivery of rural human services in Pennsylvania. A panel of policymakers, human services providers, and representatives of state agencies identified barriers to effective rural human services delivery and generated policy recommendations. Most county-based human services in…

  6. Strengthening national health systems for improving efficiency of health service delivery in Nepal.

    PubMed

    Shakya, H S; Adhikari, S; Gurung, G; Pant, S; Aryal, S; Singh, A B; Sherpa, M G

    2012-05-01

    The success of Nepal's community-based health programmes in promoting maternal and child health has been achieved due to an overall improvement in service delivery facilities and health support systems. This article assesses the progress made by the Government of Nepal in improving health service delivery by introducing three key components: an improved health logistics management, facility-based maternal and neonatal health services, and decentralized health facility management. PMID:23034370

  7. Post-Soviet transition: improving health services delivery and management.

    PubMed

    Antoun, Joseph; Phillips, Frank; Johnson, Tricia

    2011-01-01

    During the post-Soviet transition of the last 2 decades, ex-Communist countries of the Eastern Bloc, including eastern and central Europe, the Soviet Union, and its satellite and aligned states, have undergone major health system reforms. Many health systems of those countries--previously adopting a Soviet-type Semashko model--are currently called "in transition," as reform agendas, such as shifting to a Bismarck, Beveridge, or mixed financing scheme or adopting new health delivery management policies, are still in development. In this article, we first review common characteristics of Semashko health systems (the predominant health system of Communist countries during the Soviet era) and then discuss the "new public management" principles that ex-Communist countries have recently started to adopt with various degrees of success. We then illustrate experiences with these principles using 2 case studies, from Russia and Albania, and propose health policy options for both cases. Based on a review of the literature and on the our work experience in Russia and Albania, we found that the 2 ex-Semashko systems have not fully capitalized on expected positive outcomes of new public management principles due to low local healthcare financing levels, depreciated healthcare infrastructure and operational capacities, overlapping and contradicting ideology and policies of the former and newer health systems, and finally, lack of leadership that has successful experience with these principles. In the case of pharmaceutical pricing, reimbursement, and access in Russia, we show how a well-intentioned but suboptimally designed and managed pharmaceutical coverage scheme has suffered moral hazard and adverse selection and has adversely impacted the new public management promise of efficient medicine coverage. In the case of Albania, the delayed investment in human resource reform within a depreciated and underfinanced delivery system has adversely affected the implementation of new

  8. Improving Bilingual Service Delivery in Catholic Schools through Two-Way Immersion

    ERIC Educational Resources Information Center

    Scanlan, Martin; Zehrbach, Gareth

    2010-01-01

    Catholic elementary schools underserve Latino students, especially those who are bilingual. This paper presents a conceptual argument for Catholic elementary schools to improve this by pursuing the two-way immersion model of bilingual service delivery in Spanish and English. The argument is presented in three stages. First, we show that Catholic…

  9. Efficacy of a Process Improvement Intervention on Delivery of HIV Services to Offenders: A Multisite Trial

    PubMed Central

    Shafer, Michael S.; Dembo, Richard; del Mar Vega-Debién, Graciela; Pankow, Jennifer; Duvall, Jamieson L.; Belenko, Steven; Frisman, Linda K.; Visher, Christy A.; Pich, Michele; Patterson, Yvonne

    2014-01-01

    Objectives. We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. Methods. As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. Results. The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. Conclusions. Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments. PMID:25322311

  10. Improved Service Delivery and Cost Effective Framework for e-Governance in India

    NASA Astrophysics Data System (ADS)

    Kumar, Puneet; Kumar, Dharminder; Kumar, Narendra

    2013-07-01

    In current era, the involvement of technologies like virtualization, consolidation and cloud computing, and adoption of free and open source software in designing and deploying e-governance that can reduce the total cost associated with and hence the financial burden abide by the state and central governments. The success of any e-governance project depends upon its utilization by the intended group and so there accessibility needs to be enhanced drastically by reengineered framework. Here, we design an Improved Service Delivery and Cost Effective Framework for e-Governance that will be useful for success of e-governance projects and the delivery mechanism in India by using free and open access software for development and deployment of e-governance applications, virtualization and consolidation techniques for management of e-services and cloud computing for enhancing the accessibility of services.

  11. Constraints in animal health service delivery and sustainable improvement alternatives in North Gondar, Ethiopia.

    PubMed

    Kebede, Hassen; Melaku, Achenef; Kebede, Elias

    2014-01-01

    Poor livestock health services remain one of the main constraints to livestock production in many developing countries, including Ethiopia. A study was carried out in 11 districts of North Gondar, from December 2011 to September 2012, with the objective of identifying the existing status and constraints of animal health service delivery, and thus recommending possible alternatives for its sustainable improvement. Data were collected by using pre-tested questionnaires and focus group discussion. Findings revealed that 46.34% of the responding farmers had taken their animals to government veterinary clinics after initially trying treatments with local medication. More than 90.00% of the clinical cases were diagnosed solely on clinical signs or even history alone. The antibacterial drugs found in veterinary clinics were procaine penicillin (with or without streptomycin), oxytetracycline and sulphonamides, whilst albendazole, tetramisole and ivermectin were the only anthelmintics. A thermometer was the only clinical aid available in all clinics, whilst only nine (45.00%) clinics had a refrigerator. In the private sector, almost 95.00% were retail veterinary pharmacies and only 41.20% fulfilled the requirement criteria set. Professionals working in the government indicated the following problems: lack of incentives (70.00%), poor management and lack of awareness (60.00%) and inadequate budget (40.00%). For farmers, the most frequent problems were failure of private practitioners to adhere to ethical procedures (74.00%) and lack of knowledge of animal diseases and physical distance from the service centre (50.00%). Of all responding farmers, 58.54% preferred the government service, 21.14% liked both services equally and 20.33% preferred the private service. Farmers' indiscriminate use of drugs from the black market (23.00%) was also mentioned as a problem by private practitioners. Sustainable improvement of animal health service delivery needs increased awareness for all

  12. Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care*

    PubMed Central

    MacPherson, Peter; Munthali, Chigomezgo; Ferguson, Jane; Armstrong, Alice; Kranzer, Katharina; Ferrand, Rashida A; Ross, David A

    2015-01-01

    Objectives Adolescents living with HIV face substantial difficulties in accessing HIV care services and have worse treatment outcomes than other age groups. The objective of this review was to evaluate the effectiveness of service delivery interventions to improve adolescents' linkage from HIV diagnosis to antiretroviral therapy (ART) initiation, retention in HIV care and adherence to ART. Methods We systematically searched the Medline, SCOPUS and Web of Sciences databases and conference abstracts from the International AIDS Conference and International Conference on AIDS and STIs in Africa (ICASA). Studies published in English between 1st January 2001 and 9th June 2014 were included. Two authors independently evaluated reports for eligibility, extracted data and assessed methodological quality using the Cochrane risk of bias tool and Newcastle–Ottawa Scale. Results Eleven studies from nine countries were eligible for review. Three studies were randomised controlled trials. Interventions assessed included individual and group counselling and education; peer support; directly observed therapy; financial incentives; and interventions to improve the adolescent-friendliness of clinics. Most studies were of low to moderate methodological quality. Conclusions This review identified limited evidence on the effectiveness of service delivery interventions to support adolescents' linkage from HIV diagnosis to ART initiation, retention on ART and adherence to ART. Although recommendations are qualified because of the small numbers of studies and limited methodological quality, offering individual and group education and counselling, financial incentives, increasing clinic accessibility and provision of specific adolescent-tailored services appear promising interventions and warrant further investigation. PMID:25877007

  13. Improving the quality of workers' compensation health care delivery: the Washington State Occupational Health Services Project.

    PubMed

    Wickizer, T M; Franklin, G; Plaeger-Brockway, R; Mootz, R D

    2001-01-01

    This article has summarized research and policy activities undertaken in Washington State over the past several years to identify the key problems that result in poor quality and excessive disability among injured workers, and the types of system and delivery changes that could best address these problems in order to improve the quality of occupational health care provided through the workers' compensation system. Our investigations have consistently pointed to the lack of coordination and integration of occupational health services as having major adverse effects on quality and health outcomes for workers' compensation. The Managed Care Pilot Project, a delivery system intervention, focused on making changes in how care is organized and delivered to injured workers. That project demonstrated robust improvements in disability reduction; however, worker satisfaction suffered. Our current quality improvement initiative, developed through the Occupational Health Services Project, synthesizes what was learned from the MCP and other pilot studies to make delivery system improvements. This initiative seeks to develop provider incentives and clinical management processes that will improve outcomes and reduce the burden of disability on injured workers. Fundamental to this approach are simultaneously preserving workers' right to choose their own physician and maintaining flexibility in the provision of individualized care based on clinical need and progress. The OHS project then will be a "real world" test to determine if aligning provider incentives and giving physicians the tools they need to optimize occupational health delivery can demonstrate sustainable reduction in disability and improvements in patient and employer satisfaction. Critical to the success of this initiative will be our ability to: (1) enhance the occupational health care management skills and expertise of physicians who treat injured workers by establishing community-based Centers of Occupational

  14. Will more inputs improve the delivery of health services? Analysis of district vaccination coverage in Pakistan.

    PubMed

    Loevinsohn, Benjamin; Hong, Rathavuth; Gauri, Varun

    2006-01-01

    In order to determine whether physical resources or technical inputs can make a difference to the delivery of health services, we carried out a study that examined the large variation in district level vaccination coverage in Pakistan. Vaccination coverage was assessed by district-wise cluster surveys and the predictor variables were collected from census data and from a survey of 99 district health offices. Information was collected on basic supplies, physical infrastructure, management, training, socio-economic variables, and a variety of other indicators. Univariate and multivariate analyses were carried out. A model including female literacy rate, TV ownership, and provincial dummies explained 48% of the variation in DTP3 coverage. Very few of the other variables examined were significantly correlated to coverage. Possible explanatory variables like adequacy of syringe and vaccine supply, the number of vaccinators per capita, recent training of managers, frequency of supervision, availability of micro-plans, and turnover of managers were not correlated with coverage. While the Government of Pakistan has ensured that many physical resources and technical inputs have been provided to the district health offices, this does not appear able to explain the relatively low overall coverage or the variation between districts. Bolder initiatives and innovations are likely needed to improve delivery of basic health services. PMID:16604848

  15. 3 CFR 13571 - Executive Order 13571 of April 27, 2011. Streamlining Service Delivery and Improving Customer...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...-service options accessed by the Internet or mobile phone and improved processes that deliver services... service channels (such as online, phone, in-person, and mail services); (e) streamlining agency...

  16. Improving service delivery by evaluation of the referral pattern and capacity in a clinical genetics setting.

    PubMed

    McCann, Emma; Baines, Elizabeth A; Gray, Jonathon R; Procter, Annie M

    2009-08-15

    Quality improvement in specialist services such as clinical genetics is challenging largely due to the complexity of the service and the difficulty in obtaining accurate, reproducible, and measurable data. The objectives were to evaluate the pattern of referrals to the All Wales Medical Genetics Service (AWMGS) North Wales Genetics team based in three separate hospitals, define the capacity of the team and implement change to improve equity, timeliness and efficiency of care delivery to patients. The methodology required collating the monthly referral rates retrospectively for each center over a 2.5-year period and plotting on statistical process control charts. Process mapping of the referral process in each center was undertaken, differences documented and a common pathway implemented. "Did not attend" and "time to first appointment" rates were also measured in one center. PDSA methodology was used to implement "patient focused booking." The results show that the range for referral rates in any given month for each center was 3-33 referrals. The range for referral rate for the whole team was 18-64 per month. Since January 2004 the average number of monthly referrals to the North Wales service has increased by 50%. The potential range in monthly referrals varies between centers and the range of the variability has also increased also in two out of the three centers. Introduction of Patient Focused Booking reduced the "Failed to Attend" rate and 100% of patients were offered a choice of appointments. In addition 100% had a first face-to-face contact within 6 weeks if they chose. The measurement of improvement involved firstly introducing a series of continuous measures to provide a baseline for the process prior to the implementation of any changes and secondly to indicate the impact of the changes following implementation. The measures implemented included process (referrals numbers, percentage of patients offered a choice of appointments), outcome (percentage of

  17. Improving consistency and quality of service delivery: implications for the addiction treatment field.

    PubMed

    Knott, Anne Marie; Corredoira, Rafael; Kimberly, John

    2008-09-01

    Addiction treatment providers face serious problems in delivering consistent, high-quality services over time. Among those providers with multiple treatment sites, there is also intersite variability. This is a serious problem in the addiction field, likely to be made worse as new technologies are introduced and/or as there is industry consolidation (Corredoira, R., Kimberly, J. (2006) Industry evolution through consolidation: Implications for addiction treatment. Journal of Substance Abuse Treatment 31, 255-265.). Although serious, these problems in managing and monitoring to assure consistent service quality have been faced by many other industries. Here, we review evidence from research in other industries regarding three different forms of management (vertical integration, franchising, and licensing) across a chain of individual service providers. We show how each management form affects the level, consistency, and improvement of service delivery over time. In addition, we discuss how such performance advantages affect customer demand as well as regulatory endorsement of the consolidated firm and its approach. PMID:18082996

  18. Improving Service Delivery: Investigating the Role of Information Sharing, Job Characteristics, and Employee Satisfaction

    ERIC Educational Resources Information Center

    Bontis, Nick; Richards, David; Serenko, Alexander

    2011-01-01

    Purpose: The purpose of this study is to propose and test a model designed to investigate the impact of job characteristics, employee satisfaction, and information sharing on two key indicators of quality service delivery, such as worker perceptions of their efficiency and customer focus. Design/methodology/approach: During the project, 9,060…

  19. 22 CFR 96.41 - Procedures for responding to complaints and improving service delivery.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... provides expedited review of such complaints that are time-sensitive or that involve allegations of fraud... it makes systematic efforts to improve its adoption services as needed. The agency or person...

  20. Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya.

    PubMed

    Alexander, Kelly T; Dreibelbis, Robert; Freeman, Matthew C; Ojeny, Betty; Rheingans, Richard

    2013-09-01

    Water, sanitation, and hygiene (WASH) programs in schools have been shown to improve health and reduce absence. In resource-poor settings, barriers such as inadequate budgets, lack of oversight, and competing priorities limit effective and sustained WASH service delivery in schools. We employed a cluster-randomized trial to examine if schools could improve WASH conditions within existing administrative structures. Seventy schools were divided into a control group and three intervention groups. All intervention schools received a budget for purchasing WASH-related items. One group received no further intervention. A second group received additional funding for hiring a WASH attendant and making repairs to WASH infrastructure, and a third group was given guides for student and community monitoring of conditions. Intervention schools made significant improvements in provision of soap and handwashing water, treated drinking water, and clean latrines compared with controls. Teachers reported benefits of monitoring, repairs, and a WASH attendant, but quantitative data of WASH conditions did not determine whether expanded interventions out-performed our budget-only intervention. Providing schools with budgets for WASH operational costs improved access to necessary supplies, but did not ensure consistent service delivery to students. Further work is needed to clarify how schools can provide WASH services daily. PMID:23981878

  1. A Promising Step for Improving Career Service Delivery: Comment on Sampson et al. (2000).

    ERIC Educational Resources Information Center

    Jepsen, David A.

    2000-01-01

    Presents a positive response to Sampson et al.'s article (this issue [2000]) describing a cognitive-information processing (CIP) framework useful for improving career services. Asserts that the authors strike an appropriate tone of optimism and caution that matches the article author's own experience as a practitioner and a teacher of the CIP…

  2. Policy strategies to improve maternal health services delivery and outcomes in Anambra State, Nigeria.

    PubMed

    Ezeonwu, Mabel

    2014-01-01

    Pregnancy and childbirth present major health risks for Nigerian women. Key maternal mortality measures indicate that the risks are high. Despite improvement efforts, the country has made insufficient progress in reaching the United Nations' millennium development goal of decreasing maternal mortality by 75% by 2015. The author in this qualitative descriptive study explores the perspectives of experienced nurse leaders on policy strategies to improve maternal health in Nigeria. In this study, the author suggests that removal of financial barriers to access and utilization of health services, spousal and family inclusiveness in plan of care, and health systems-related physical and human infrastructural improvements constitute critical policy approaches. PMID:24911182

  3. Designing a theory-informed, contextually appropriate intervention strategy to improve delivery of paediatric services in Kenyan hospitals

    PubMed Central

    2013-01-01

    Background District hospital services in Kenya and many low-income countries should deliver proven, effective interventions that could substantially reduce child and newborn mortality. However such services are often of poor quality. Researchers have therefore been challenged to identify intervention strategies that go beyond addressing knowledge, skill, or resource inadequacies to support health systems to deliver better services at scale. An effort to develop a system-oriented intervention tailored to local needs and context and drawing on theory is described. Methods An intervention was designed to improve district hospital services for children based on four main strategies: a reflective process to distill root causes for the observed problems with service delivery; developing a set of possible intervention approaches to address these problems; a search of literature for theory that provided the most appropriate basis for intervention design; and repeatedly moving backwards and forwards between identified causes, proposed interventions, identified theory, and knowledge of the existing context to develop an overarching intervention that seemed feasible and likely to be acceptable and potentially sustainable. Results and discussion In addition to human and resource constraints key problems included failures of relevant professionals to take responsibility for or ownership of the challenge of pediatric service delivery; inadequately prepared, poorly supported leaders of service units (mid-level managers) who are often professionally and geographically isolated and an almost complete lack of useful information for routinely monitoring or understanding service delivery practice or outcomes. A system-oriented intervention recognizing the pivotal role of leaders of service units but addressing the outer and inner setting of hospitals was designed to help shape and support an appropriate role for these professionals. It aims to foster a sense of ownership while

  4. Chemical Abstracts' Document Delivery Service.

    ERIC Educational Resources Information Center

    Rollins, Stephen

    1984-01-01

    The Document Delivery Service offered by Chemical Abstracts is described in terms of the DIALORDER option on the Dialog information retrieval system, mail requests, and requests transmitted through OCLC's Interlibrary Loan system. Transmission costs, success rates, delivery rates, and other considerations in utilizing the service are included.…

  5. The Bankruptcy of Service Delivery.

    ERIC Educational Resources Information Center

    Seeley, David S.

    The dominant concept of public education at present can be described as a "service delivery" model. The public wants its children educated, delegates the job to a government agency (the schools), and holds that agency responsible for the delivery of educational services. The problems in public education, however, will not be solved by holding the…

  6. A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

    PubMed Central

    2013-01-01

    Background The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. Method We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. Results Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. Conclusions In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case. PMID:23819721

  7. The research agenda for improving health policy, systems performance, and service delivery for tuberculosis control: a WHO perspective.

    PubMed Central

    Nunn, Paul; Harries, Anthony; Godfrey-Faussett, Peter; Gupta, Raj; Maher, Dermot; Raviglione, Mario

    2002-01-01

    The development of WHO's DOTS strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation and improvement of operational research in this area. From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multicountry projects that were also concerned with health policy and the needs of health systems. The results are now being put into practice by national TB control programmes. In 1998 an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multidrug resistance. An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article. We discuss the prerequisites for success, the shortcomings of this WHO- supported programme, and future challenges and needs. PMID:12132005

  8. The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review.

    PubMed

    Olisemeke, B; Chen, Y F; Hemming, K; Girling, A

    2014-12-01

    We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis. PMID:24888629

  9. Managing Quality by Action Research--Improving Quality Service Delivery in Higher Education as a Marketing Strategy.

    ERIC Educational Resources Information Center

    Corbitt, Brian

    1998-01-01

    Describes two action research projects undertaken at an Australian university to improve quality of services to foreign students and improve the institution's image through word of mouth, or informal marketing. Each project, although small, facilitated changes or improvements to a targeted service. The role of management in empowering employees…

  10. A GIS-based methodology for improving needle exchange service delivery

    PubMed Central

    Davidson, Peter J.; Scholar, Shoshanna; Howe, Mary

    2010-01-01

    Background A variety of legal, social and logistical factors can prevent individuals from accessing formal needle exchange programs. One common solution to this problem is satellite exchange, which involves collaborating with people who already use an exchange to deliver needles and other supplies to those unable to access the exchange. While this approach can be very successful, one potential problem is that those most willing to deliver needles to their peers are often members of social networks that are already well connected with the needle exchange, leading to duplication of effort. In this paper we describe a simple and novel method for identifying groups of people who are demonstrably in need of improved access to needles, and for re-targeting efforts to meet the needs of those people. The method described was piloted at the Homeless Youth Alliance, San Francisco, USA, and further refined at Clean Needles Now, Los Angeles, USA. Methods People accessing needle exchange sites were asked to participate in a survey with two questions: “where were you and what time was it last time someone borrowed a needle from you?” and “where were you and what time was it last time you had to borrow a needle from someone else?” Responses were geocoded, and maps produced showing ‘hotspots’ where people were frequently finding themselves without needles. Results Satellite needle exchange was refined from an ad-hoc activity into one which focused on delivering needles to those with empirically demonstrable need. Maps produced in the process also proved valuable in discussions with local officials and other agencies about funding, as well as needle provision policy and practices. Conclusion We describe a method for rapidly assessing, describing, and responding to unmet and under-met need among injecting drug users. The method is particularly well-suited to organizations with extremely limited resources. PMID:21112757

  11. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention

    PubMed Central

    Ambia, Julie; Mandala, Justin

    2016-01-01

    Introduction The success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Methods Selected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Results Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I2=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I2=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I2=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I2=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Conclusions Our findings indicate that mobile phone

  12. New Reference: Diversifying Service Delivery.

    ERIC Educational Resources Information Center

    Garner, Imogen

    This paper describes the experiences of a recent change process that focused on the delivery of reference services at the University of Western Australia (UWA). UWA reference librarians felt that they could not fulfill all of their duties while working from the reference desk for a significant period of time each day; they wanted time away from…

  13. Improving Access to Emergency Contraception Pills through Strengthening Service Delivery and Demand Generation: A Systematic Review of Current Evidence in Low and Middle-Income Countries

    PubMed Central

    Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

    2014-01-01

    Objectives Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. Methods A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Findings Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. Conclusion There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP. PMID:25285438

  14. Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo

    PubMed Central

    2009-01-01

    Background Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP). Methods Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. Results None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Conclusions Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for

  15. 77 FR 44306 - Service Delivery Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-27

    ... ADMINISTRATION Service Delivery Plan AGENCY: Social Security Administration (SSA). ACTION: Notice; request for comments. SUMMARY: We are requesting public input as we develop our Service Delivery Plan (SDP). We...) Deliver quality disability decisions and services; (2) provide quality service to the public; (3)...

  16. 78 FR 15797 - Service Delivery Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-12

    ... provide the best possible service. (77 FR 44306 (2012)). We have incorporated those suggestions into this... ADMINISTRATION Service Delivery Plan AGENCY: Social Security Administration (SSA). ACTION: Notice; request for comments. SUMMARY: We are requesting public input as we finalize our Service Delivery Plan (SDP)....

  17. 42 CFR 460.98 - Service delivery.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Service delivery. 460.98 Section 460.98 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... medical, health, and social services that integrate acute and long-term care. (2) These services must...

  18. Using a registry to improve immunization delivery.

    PubMed

    Kairys, Steven W; Gubernick, Ruth S; Millican, Adrienne; Adams, William G

    2006-07-01

    The NJIPSP was successful in encouraging a group of small urban practices to adopt the use of immunization registry and to transform immunization delivery from a mechanistic well-child service to a visible, monitored process of care. The project represents a unique combination of technology, public-private collaboration, and well-established quality improvement techniques. The change process involved the whole office as a team in adopting new immunization delivery roles and services. The greatest barrier to acceptance of the registry was (and continues to be) the need for manual data entry as the primary source of data collection, rather than electronic data transfer from other systems. The manual entry of data was labor intensive for participating practices and affected data measurement. Despite this barrier, however, the majority of practices substantially improved the quality of their immunization delivery practices in multiple areas. The rapid movement of primary care practices toward some form of electronic record may reduce this barrier and increase the percentage of practices willing to use a community registry. Practices that engaged collectively in the change process gained momentum from the group effort. Equally important was the public health partnership that helped identify and reduce improvement obstacles. Sustainability of practice-based immunization changes will rely, in part, on the registry's ease of use and the continued visibility of public health at the practice level. Active practice level collaboration by public health adds great value to change efforts. We believe that the best possible immunization delivery relies on both technology (registries and the EMR) and effective office systems. Projects like the NJIPSP are models for systems that integrate technology, practice change, and quality improvement, and their success has the potential to foster the spread of this approach to other primary care practices (especially in New Jersey). The

  19. Health Service Delivery in Developing Countries

    ERIC Educational Resources Information Center

    Benyoussef, Amor

    1977-01-01

    Reviews recent work dealing with methodological and technical issues in health and development; presents examples of the application of social sciences, including health demography and economics, in questions of health services delivery; and analyzes delivery of health services to rural and nomadic populations in Africa, Asia, and Latin America.…

  20. Male engagement as a strategy to improve utilization and community-based delivery of maternal, newborn and child health services: evidence from an intervention in Odisha, India

    PubMed Central

    2015-01-01

    Background In response to persistently poor levels of maternal, newborn and child health (MNCH) in rural India, the National Rural Health Mission (NRHM) was launched to support the provision of accessible, affordable and quality health care in deprived and underserved communities. The Accredited Social Health Activists (ASHAs), local women, are trained as health promoters to generate demand for, and facilitate access to MNCH care in their communities. While they are also expected to provide husbands of expectant women with information on MNCH care and family planning, their reach to the husbands is limited. The aim of this study is to describe the influence of a male engagement project on the utilization and community-based delivery of MNCH care in a rural district of the country. Methods We used qualitative data from the evaluation of a project which recruited and trained male Community Health Workers (CHWs) known as Male Health Activists (MHAs) to complement the work of ASHAs and target outreach to men. This paper uses data from in-depth interviews (IDIs) with ASHAs (n=11), Anganwadi Workers (AWWs) (n=4) and Auxiliary Nurse Midwives (ANMs) (n=2); with women who had delivered at home, community health center or district hospital in the few months preceding the date of the interview (n=11); and with husbands of these women (n=7). Results Participants’ responses are broadly organized around the facilitation of ASHAs’ work by MHAs, and male engagement activities undertaken by MHAs. More specifically, the narratives reflected gender-based divisions of work and space in three core areas of delivery and use of MNCH services: escorting women to health centers for facility-based deliveries; mobilizing women and children to attend Village Health and Nutrition Days and Immunization Days; and raising awareness among men on MNCH and family planning. Conclusion This study sheds light on male engagement as a strategy to improve the delivery, access and uptake of maternal

  1. A case study using a patient satisfaction survey to improve the delivery and effectiveness of drug addiction treatment services: marketing implications and organizational impact.

    PubMed

    Hogan, Beth; Hershey, Lewis; Ritchey, Steven

    2007-01-01

    Drug abuse and addiction continues to negatively impact many lives in this country. The United States health care system has grappled with how to best serve this vulnerable population. Since the personal and societal costs of addiction are high, all recent iterations of the United States strategic health plans (such as Healthy People 2010) have prioritized this area for improvement. At the local level, health care providers who care for those with addictions are challenged with shrinking insurance coverage for services, a difficult patient population, lack of treatment options, growing ranks of indigent patients, as well as a plethora of additional management challenges. It is known that successful treatment is integrally linked with patient satisfaction with services. The most critical factors in successful addiction treatment (from a patient's perspective) are (1) their belief that the counselor cares about them and, (2) their belief that they can recover. This paper reports a case study in the use of a patient satisfaction survey as a quality management/service refinement tool within a methadone treatment setting. Results indicate that the use of the survey itself provides patients with a tangible cue supporting the presence of the critical success factors. Further, the use of a survey provides a baseline for future measurements and trending. The paper concludes with a discussion of the marketing and organizational implications of incorporating the patient satisfaction survey into the ongoing delivery program for addiction services. PMID:19042522

  2. Commercial Document Delivery Services "Challenged" as EBSCO Drops Service.

    ERIC Educational Resources Information Center

    Machovec, George S.

    1998-01-01

    Discusses the EBSCO decision to stop its traditional commercial document delivery business. High prices for copyright clearance, government subsidized services, electronic formats available on the Internet, Web-based services, and consortium-based licensing activities are discussed as influencing the market for document delivery. (LRW)

  3. 42 CFR 460.98 - Service delivery.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Service delivery. 460.98 Section 460.98 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  4. 42 CFR 460.98 - Service delivery.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Service delivery. 460.98 Section 460.98 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  5. 42 CFR 460.98 - Service delivery.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Service delivery. 460.98 Section 460.98 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  6. The Possible Relationship of the California Master Plan for Special Education to the State Department of Education Bureau of Pupil Personnel Services Plan for Improvement of Guidance Services in California Relative to Delivery of Services to Handicapped Pupils: Who's On First?

    ERIC Educational Resources Information Center

    Mendocino County Office of Education, Ukiah, CA.

    Service delivery to handicapped pupils is discussed in regard to the relationship between the California Master Plan for Special Education (see EC 062 915) and the Bureau of Pupil Personnel's Plan for Improvement of Guidance Services. The goals, benefits and limitations of both plans are described; and each plan is examined and compared in terms…

  7. Toward an Improved Regional Delivery System for Special Education Support Services in Massachusetts: Resource Linking System. Concept Paper.

    ERIC Educational Resources Information Center

    Lavin, Richard J.; And Others

    Proposed is a regional (Northeast) model to stimulate and draw together local and state services in a Resource Linking System for special education. It is explained that the model would provide the following five functions: appraisal of teachers' training needs, management and development of materials, field-based inservice training for teachers…

  8. Models for Improving the Delivery of Services to: Underachieving Gifted Students. Research & Demonstration Series in Gifted Education.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Special Education.

    This report describes three model demonstration projects in Ohio school districts which focused on identifying types of gifted underachievers and providing them with services through unique instructional models. Provided for each program is information on: identifying characteristics (district, location, school population, project director);…

  9. The leadership of communities in HIV service delivery.

    PubMed

    Barr, David; Odetoyinbo, Morolake; Mworeko, Lillian; Greenberg, Julia

    2015-07-01

    HIV treatment and prevention strategies are life-long endeavours, requiring not only comprehensive, high-quality, consistent and equitable medical services but also appropriate political and cultural milieus to be effective. Communities directly affected by HIV offer a unique expertise and understanding in developing services to meet the needs of people seeking out and utilizing HIV treatment, prevention and support services. Through their organizations and networks, and through partnerships with health systems, these communities provide leadership, services and advocacy to ensure the delivery of high-quality, comprehensive services to meet the needs of diverse populations affected by HIV. This article describes integrated approaches to service delivery in which affected communities play a key role in the development and implementation of HIV programmes. Further scale-up of these approaches to care can improve overall quality, reduce stigma and discrimination, increase demand for services and improve retention in care. PMID:26102622

  10. Using Quality Concepts to Improve Reference Services.

    ERIC Educational Resources Information Center

    Brown, Janet Dagenais

    1994-01-01

    Discusses how to improve library reference service, especially the effective delivery of accurate answers, based on a program at Wichita State University (Kansas) that used concepts of quality from business and organizational management. Topics addressed include customers and customer service, and methods of reference service evaluation. (Contains…

  11. 76 FR 77483 - Nationwide Change in Postal Delivery Service Standards

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-13

    ... Nationwide Change in Postal Delivery Service Standards AGENCY: Postal Regulatory Commission. ACTION: Notice... pair service standards would be modified to move overnight delivery to 2-day delivery, and to move a portion of 2-day delivery to 3-day delivery. Id. at 1. Although changes to service standards...

  12. Personalizing knowledge delivery services: a conceptual framework

    NASA Technical Reports Server (NTRS)

    Majchrzak, Ann; Chelleppa, Ramnath K.; Cooper, Lynne P.; Hars, Alexander

    2003-01-01

    Consistent with the call of the Minnesota Symposium for new theory in knowledge management, we offer a new conceptualization of Knowledge Management Systems (KMS) as a portfolio of personalized knowledge delivery services. Borrowing from research on online consumer behavior, we describe the challenges imposed by personalized knowledge delivery services, and suggest design parameters that can help to overcome these challenges. We develop our design constructs through a set of hypotheses and discuss the research implications of our new conceptualization. Finally, we describe practical implications suggested by our conceptualization - practical suggestions that we hope to gain some experience with as part of an ongoing action research project at our partner organization.

  13. 22 CFR 228.24 - Other delivery services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Other delivery services. 228.24 Section 228.24... for USAID Financing § 228.24 Other delivery services. No source or nationality rules apply to other delivery services, such as export packing, loading, commodity inspection services, and services of...

  14. The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis

    PubMed Central

    Free, Caroline; Phillips, Gemma; Watson, Louise; Galli, Leandro; Felix, Lambert; Edwards, Phil; Patel, Vikram; Haines, Andy

    2013-01-01

    Background Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. Methods and Findings We searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990–Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05–1.07, I2 = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89–1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94–1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature. Conclusions The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold

  15. Human Services Course Delivery Systems.

    ERIC Educational Resources Information Center

    Soong, Robert K.; And Others

    This paper deals with various teaching methods and techniques currently is use in junior colleges in the Chicago area including traditional as well as innovative methods. The basic assumption is that teaching and learning are both essential aspects of the same system. The human services field is defined as encompassing the basic area of social…

  16. Document Delivery Services: Today's Electronic Scriptoria.

    ERIC Educational Resources Information Center

    Sabosik, Patricia E.

    1992-01-01

    Discusses document delivery services in the light of new technology. Topics addressed include the historical influences of the printing press; the influence of microcomputers on the publishing industry; copyright issues; the changing role of publishers, researchers, and academic librarians; information partnerships among publishers, librarians,…

  17. Rural Gifted Education: Enhancing Service Delivery.

    ERIC Educational Resources Information Center

    Lewis, Joan D.

    Devising appropriate service delivery for gifted individuals is never an easy task and is especially challenging in rural areas. Characteristics of rural schools may be both barriers and benefits to gifted education. Limited numbers may mean that programming options for gifted students are unfeasible, but small schools and classes make…

  18. Full Service Document Delivery: Our Likely Future.

    ERIC Educational Resources Information Center

    Saldinger, Jeffrey

    1984-01-01

    Focuses on five issues of central concern to full-service document suppliers (provide on-demand delivery of any material, without limitations of subject, document type, or publication date) and their clients: end user access, ownership versus access, cooperation of all document suppliers, technology, and speed of access. (EJS)

  19. 78 FR 16753 - Service Delivery Plan; Correction

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-18

    ... ADMINISTRATION Service Delivery Plan; Correction AGENCY: Social Security Administration. ACTION: Notice; request... Federal Register of March 12, 2013, in FR Doc. 2013-05595, on page 15797, in the third column; in the SUMMARY caption insert the following hyper-links. In the first sentence after the words,...

  20. A Comparison of Service Delivery Models for Special Education Middle School Students Receiving Moderate Intervention Services

    ERIC Educational Resources Information Center

    Jones-Mason, Keely S.

    2012-01-01

    In an effort to improve academic performance for students receiving special education services, a large urban school district in Tennessee has implemented Integrated Service Delivery Model. The purpose of this study was to compare the performance of students receiving instruction in self-contained classrooms to the performance of students…

  1. 22 CFR 201.32 - Suppliers of delivery services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Suppliers of delivery services. 201.32 Section... COMMODITY TRANSACTIONS FINANCED BY USAID Responsibilities of Suppliers § 201.32 Suppliers of delivery services. (a) Performance of the service contract. The supplier of delivery services financed by...

  2. 39 CFR 761.6 - Delivery of Postal Service securities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 39 Postal Service 1 2014-07-01 2014-07-01 false Delivery of Postal Service securities. 761.6 Section 761.6 Postal Service UNITED STATES POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.6 Delivery of Postal Service securities. A Reserve...

  3. 39 CFR 761.6 - Delivery of Postal Service securities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 39 Postal Service 1 2011-07-01 2011-07-01 false Delivery of Postal Service securities. 761.6 Section 761.6 Postal Service UNITED STATES POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.6 Delivery of Postal Service securities. A Reserve...

  4. 39 CFR 761.6 - Delivery of Postal Service securities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Delivery of Postal Service securities. 761.6 Section 761.6 Postal Service UNITED STATES POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.6 Delivery of Postal Service securities. A Reserve...

  5. 39 CFR 761.6 - Delivery of Postal Service securities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 39 Postal Service 1 2013-07-01 2013-07-01 false Delivery of Postal Service securities. 761.6 Section 761.6 Postal Service UNITED STATES POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.6 Delivery of Postal Service securities. A Reserve...

  6. 39 CFR 761.6 - Delivery of Postal Service securities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 39 Postal Service 1 2012-07-01 2012-07-01 false Delivery of Postal Service securities. 761.6 Section 761.6 Postal Service UNITED STATES POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.6 Delivery of Postal Service securities. A Reserve...

  7. Effectiveness of Ng'adakarin Bamocha model in improving access to ante-natal and delivery services among nomadic pastoralist communities of Turkana West and Turkana North Sub-Counties of Kenya

    PubMed Central

    Jillo, Jillo Ali; Ofware, Peter Obonyo; Njuguna, Susan; Mwaura-Tenambergen, Wanja

    2015-01-01

    Introduction Access to maternal and child health care services among the nomadic pastoralists community in Kenya and African continent in general is unacceptably low. In Turkana, only 18.1% of the women had seen a nurse or a midwife for antenatal care during pregnancy while only 1.3% of pregnant women reported delivery at health facilities in 2005. Ng'adakarin BAMOCHA model, based on migratory routes of the Turkana pastoralists and container clinics was adopted in 2007 to improve access to maternal and child health services by the nomads. Methods A cross-sectional study design was used to establish the effectiveness of Ng'adakarin BAMOCHA model on accessibility and uptake of ante-natal care and delivery services. A total of 360 households and 400 households were interviewed for pre-intervention and post-intervention respectively. The study compared the pre-intervention and post-intervention findings. Structured questionnaires and focus group discussion were used for data collection. Results There was no improvement in the fourth ante-natal care visits between pre-intervention and post-intervention groups at 119(51.5%) and 111(41.9%) respectively (p < 0.05). Knowledge of the community on the importance of ANC visits improved from 60%-72% with significance level of p < 0.05. There was a significant increase 6%-17% of deliveries under a skilled health worker (p < 0.05). TBA assisted deliveries increased from 7.5%- 20.2% with a p < 0.05. There was significant reduction in home deliveries from 89.5%-79.5% with a p < 0.05. Conclusion The Ng'adakarin Bamocha model had a positive effect on the improving maternal health care among the nomadic pastoralist community in Turkana. PMID:26301007

  8. Media delivery and media service overlays

    NASA Astrophysics Data System (ADS)

    Wee, Susie

    2005-03-01

    Multimedia communication and streaming media services will become mainstream network infrastructure applications in the coming decade. However, there are many challenges that must be overcome. These challenges include the Internet"s limited ability to handle real-time, low-latency media streams, the need for media security, and an uncertainty of the killer app. The nature of these challenges lends itself to enabling technology innovations in the media delivery and media processing space. Specifically, we envision an overlay infrastructure that supports networked media services that couple media delivery with in-network media processing. The media overlay should be programmable to allow rapid deployment of new applications and services and manageable so as to support the evolving requirements of the resulting usage models. Furthermore, the media overlay should allow for the delivery of protected media content for applications that have security requirements. A properly architected infrastructure can enable real-time multimedia communication and streaming media services in light of the inherent challenges.

  9. Telerehabilitation: An Adjunct Service Delivery Model For Early Intervention Services

    PubMed Central

    Cason, Jana

    2011-01-01

    Early Intervention (EI) services for children birth through two years of age are mandated by Part C of the Individuals with Disabilities Education Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telerehabilitation has the potential to build capacity among caregivers and local providers as well as promote family-centered services through remote consultation. This article provides an overview of research related to telerehabilitation and early intervention services; discusses the feasibility of telerehabilitation within traditional EI service delivery models; examines telecommunications technology associated with telerehabilitation; and provides hypothetical case examples designed to illustrate potential applications of telerehabilitation in early intervention. PMID:25945179

  10. Improving: Services for Children

    ERIC Educational Resources Information Center

    Her Majesty's Inspectorate of Education, 2008

    2008-01-01

    This guide to self-evaluation and improvement builds upon the advice given in the publication "A Guide to Evaluating Services for Children and Young People Using Quality Indicators" (HMIE, 2006) (A summary of the quality indicators is reproduced in Appendix I). Local authorities, agencies and professionals who have responsibilities for providing…

  11. 77 FR 10033 - Advisory Committee International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-21

    ... Committee International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... related to international postal and delivery services of interest to Advisory Committee members and...

  12. 77 FR 24758 - Advisory Committee International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-25

    ... Committee International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... postal and delivery services of interest to Advisory Committee members and the public. For...

  13. Planning and Implementing Augmentative Communication Service Delivery, 2: Proceedings of the National Planners Conference on Assistive Device Service Delivery.

    ERIC Educational Resources Information Center

    Coston, Caroline A., Ed.

    The document consists of 30 author contributed chapters concerned with augmentative communication service delivery. Chapter titles and authors are: "Communication Options for Persons Who Cannot Speak: Planning for Service Delivery" (David Beukelman); "Planning Service Delivery Systems" (Roland Hahn II); "Planning Ohio's Augmentative Communication…

  14. 78 FR 41305 - Collect on Delivery (COD)-Service Features

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-10

    ... INFORMATION: The Postal Service published a notice of proposed rulemaking on May 31, 2013 (78 FR 32612-32613... 111 Collect on Delivery (COD)--Service Features AGENCY: Postal Service TM . ACTION: Final rule... proposed rule were received, the Postal Service will adopt the proposed changes to Collect on Delivery...

  15. Making Decisions about Service Delivery in Early Childhood Programs

    ERIC Educational Resources Information Center

    Case-Smith, Jane; Holland, Terri

    2009-01-01

    Purpose: This article presents a rationale for specialized services personnel to use fluid models of service delivery and explains how specialized services personnel make decisions about the blend of service delivery methods that will best serve a child. Method: The literature on occupational therapy, physical therapy, and speech-language…

  16. 22 CFR 201.13 - Eligibility of delivery services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Approval Application, have neither been suspended nor debarred under USAID Regulation 8, 22 CFR part 208... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Eligibility of delivery services. 201.13... for USAID Financing § 201.13 Eligibility of delivery services. (a) General. Delivery of...

  17. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...

  18. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...

  19. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...

  20. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...

  1. 42 CFR 136a.15 - Health Service Delivery Areas.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...

  2. Graduate Student Services: A Study of the Delivery of Services at the Location Where Students Matriculate

    ERIC Educational Resources Information Center

    Burlison, John G.

    2010-01-01

    This dissertation investigates and explores the best method for the delivery of graduate student services. Essentially, there are two methods for delivery of these services. They can be delivered by virtue of centralization or decentralization. Decentralized delivery, for the purpose of this dissertation is the delivery of graduate student…

  3. Engaging children and parents in service design and delivery.

    PubMed

    Bedford Russell, A R; Passant, M; Kitt, H

    2014-12-01

    The involvement of all user groups, including children, young people (CYP) and their parents, encourages people to take responsibility for healthier lifestyle behaviours, improves treatment compliance and leads to more appropriate use of healthcare resources. Initiatives to engage CYP in the UK are gathering momentum, but significant improvements are still needed. There is a national drive from the department of health (DH) and NHS England, strategic clinical networks, operational delivery networks (including newborn networks), charities, parent groups and a number of other bodies to embed CYP involvement in service design and delivery. User engagement and patient choice, is underpinned by the NHS outcomes framework, and a myriad of other DH and NHS England policies and practice frameworks. It is now everybody's business. PMID:25053734

  4. Electrostatic Surface Modifications to Improve Gene Delivery

    PubMed Central

    Shmueli, Ron B.; Anderson, Daniel G.

    2010-01-01

    Importance of the field Gene therapy has the potential to treat a wide variety of diseases including genetic diseases and cancer. Areas covered in this review This review introduces biomaterials used for gene delivery and then focuses on the use of electrostatic surface modifications to improve gene delivery materials. These modifications have been used to stabilize therapeutics in vivo, add cell-specific targeting ligands, and promote controlled release. Coatings of nanoparticles and microparticles as well as non-particulate surface coatings are covered in this review. Electrostatic principles are crucial for the development of multilayer delivery structures fabricated by the layer-by-layer method. What the reader will gain The reader will gain knowledge about the composition of biomaterials used for surface modifications and how these coatings and multilayers can be utilized to improve spatial control and efficiency of delivery. Examples are shown for the delivery of nucleic acids, including DNA and siRNA, to in vitro and in vivo systems. Take home message The versatile and powerful approach of electrostatic coatings and multilayers will lead to the development of enhanced gene therapies. PMID:20201712

  5. Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions

    PubMed Central

    2013-01-01

    Background There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a ‘life worth living’). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. ‘Autonomy’ is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. Methods This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work

  6. Delivery of satellite based broadband services

    NASA Astrophysics Data System (ADS)

    Chandrasekhar, M. G.; Venugopal, D.

    2007-06-01

    Availability of speedy communication links to individuals and organizations is essential to keep pace with the business and social requirements of this modern age. While the PCs have been continuously growing in processing speed and memory capabilities, the availability of broadband communication links still has not been satisfactory in many parts of the world. Recognizing the need to give fillip to the growth of broadband services and improve the broadband penetration, the telecom policies of different counties have placed special emphasis on the same. While emphasis is on the use of fiber optic and copper in local loop, satellite communications systems will play an important role in quickly establishing these services in areas where fiber and other communication systems are not available and are not likely to be available for a long time to come. To make satellite communication systems attractive for the wide spread of these services in a cost effective way special emphasis has to be given on factors affecting the cost of the bandwidth and the equipment. As broadband services are bandwidth demanding, use of bandwidth efficient modulation technique and suitable system architecture are some of the important aspects that need to be examined. Further there is a need to re-look on how information services are provided keeping in view the user requirements and broadcast capability of satellite systems over wide areas. This paper addresses some of the aspects of delivering broadband services via satellite taking Indian requirement as an example.

  7. Integrated delivery systems focus on service delivery after capitation efforts stall.

    PubMed

    2005-03-01

    Integrated delivery systems focus on service delivery after capitation efforts stall. Integrated delivery systems are going through changes that are focusing the provider organizations more on delivering care than managing risk, says Dean C. Coddington, one of the leading researchers into capitated organizations and a senior consultant with McManis Consulting in Denver. PMID:15889632

  8. Rehabilitation Technology Service Delivery, 1: A Practical Guide.

    ERIC Educational Resources Information Center

    RESNA: Association for the Advancement of Rehabilitation Technology, Washington, DC.

    The guide consists of six author contributed chapters and is intended to aid in the development of new rehabilitation technology service delivery programs as well as increasing the effectiveness of existing programs. The first chapter, by Roger Smith, describes and evaluates seven models of service delivery in rehabilitation technology. Chapter 2,…

  9. Leadership Dynamics Promoting Systemic Reform for Inclusive Service Delivery

    ERIC Educational Resources Information Center

    Scanlan, Martin

    2009-01-01

    This article presents a multicase study of two systems of schools striving to reform service delivery systems for students with special needs. Considering these systems as institutional actors, the study examines what promotes the understanding and implementation of special education service delivery within a system of schools in a manner that…

  10. Development, Implementation, and Evaluation of the Apollo Model of Pediatric Rehabilitation Service Delivery

    ERIC Educational Resources Information Center

    Camden, Chantal; Swaine, Bonnie; Tetreault, Sylvie; Bergeron, Sophie; Lambert, Carole

    2013-01-01

    This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical…

  11. Improving governance to improve oral health: addressing care delivery systems.

    PubMed

    Batchelor, Paul

    2012-09-01

    The evolving role of the state in the provision of health care has seen the adoption of new management philosophies to ensure that goals set for the system are reached. In particular, the term New Public Management (NPM) has tended to dominate reforms to help address perceived shortcomings in public sector services. NPM is based on the use of freemarket type arrangements as a mechanism to solve problems, the control of which provides new challenges. One particular challenge that has arisen from the combination of NPM with the large number of agencies involved in care provision is that of addressing the issues arising from the improved understanding of the determinants of health. This has led to the evolution of differing care arrangements across differing sectors at all levels. If resources are to be used as intended, the control of delivery systems to oversee their use must exist. The overarching term for such activity is â governance. This paper provides an overview of the issues that arise for addressing governance of oral health care and the subsequent challenges that face those responsible for ensuring compliance. PMID:22976573

  12. Low–dose RUTF protocol and improved service delivery lead to good programme outcomes in the treatment of uncomplicated SAM: a programme report from Myanmar

    PubMed Central

    James, Philip T; Van den Briel, Natalie; Rozet, Aurélie; Israël, Anne-Dominique; Fenn, Bridget; Navarro-Colorado, Carlos

    2015-01-01

    The treatment of uncomplicated severe acute malnutrition (SAM) requires substantial amounts of ready-to-use therapeutic food (RUTF). In 2009, Action Contre la Faim anticipated a shortfall of RUTF for their nutrition programme in Myanmar. A low-dose RUTF protocol to treat children with uncomplicated SAM was adopted. In this protocol, RUTF was dosed according to beneficiary's body weight, until the child reached a Weight-for-Height z-score of ≥−3 and mid-upper arm circumference ≥110 mm. From this point, the child received a fixed quantity of RUTF per day, independent of body weight until discharge. Specific measures were implemented as part of this low-dose RUTF protocol in order to improve service quality and beneficiary support. We analysed individual records of 3083 children treated from July 2009 to January 2010. Up to 90.2% of children recovered, 2.0% defaulted and 0.9% were classified as non-responders. No deaths were recorded. Among children who recovered, median [IQR] length of stay and weight gain were 42 days [28; 56] and 4.0 g kg–1 day–1 [3.0; 5.7], respectively. Multivariable logistic regression showed that children older than 48 months had higher odds of non-response to treatment than younger children (adjusted odds ratio: 3.51, 95% CI: 1.67–7.42). Our results indicate that a low-dose RUTF protocol, combined with specific measures to ensure good service quality and beneficiary support, was successful in treating uncomplicated SAM in this setting. This programmatic experience should be validated by randomised studies aiming to test, quantify and attribute the effect of the protocol adaptation and programme improvements presented here. PMID:25850698

  13. Low-dose RUTF protocol and improved service delivery lead to good programme outcomes in the treatment of uncomplicated SAM: a programme report from Myanmar.

    PubMed

    James, Philip T; Van den Briel, Natalie; Rozet, Aurélie; Israël, Anne-Dominique; Fenn, Bridget; Navarro-Colorado, Carlos

    2015-10-01

    The treatment of uncomplicated severe acute malnutrition (SAM) requires substantial amounts of ready-to-use therapeutic food (RUTF). In 2009, Action Contre la Faim anticipated a shortfall of RUTF for their nutrition programme in Myanmar. A low-dose RUTF protocol to treat children with uncomplicated SAM was adopted. In this protocol, RUTF was dosed according to beneficiary's body weight, until the child reached a Weight-for-Height z-score of ≥-3 and mid-upper arm circumference ≥110 mm. From this point, the child received a fixed quantity of RUTF per day, independent of body weight until discharge. Specific measures were implemented as part of this low-dose RUTF protocol in order to improve service quality and beneficiary support. We analysed individual records of 3083 children treated from July 2009 to January 2010. Up to 90.2% of children recovered, 2.0% defaulted and 0.9% were classified as non-responders. No deaths were recorded. Among children who recovered, median [IQR] length of stay and weight gain were 42 days [28; 56] and 4.0 g kg(-1) day(-1) [3.0; 5.7], respectively. Multivariable logistic regression showed that children older than 48 months had higher odds of non-response to treatment than younger children (adjusted odds ratio: 3.51, 95% CI: 1.67-7.42). Our results indicate that a low-dose RUTF protocol, combined with specific measures to ensure good service quality and beneficiary support, was successful in treating uncomplicated SAM in this setting. This programmatic experience should be validated by randomised studies aiming to test, quantify and attribute the effect of the protocol adaptation and programme improvements presented here. PMID:25850698

  14. 78 FR 32612 - Collect on Delivery (COD)-Service Features

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-31

    ... From the Federal Register Online via the Government Publishing Office POSTAL SERVICE 39 CFR Part 111 Collect on Delivery (COD)--Service Features AGENCY: Postal Service\\TM\\. ACTION: Proposed rule. SUMMARY: Effective July 28, 2013, the Postal Service TM proposes to revise Mailing Standards of the...

  15. Analyzing IT Service Delivery in an ISP from Nicaragua

    NASA Astrophysics Data System (ADS)

    Flores, Johnny; Rusu, Lazar; Johanneson, Paul

    This paper presents a method for analyzing IT service delivery and its application in an Internet Service Provider (ISP). The method proposed is based on ITIL-processes and case study technique; it includes questionnaires for gathering information, semi-structured interviews, focus groups and documents as sources of information for recognition of factual information. The method application allows to the ISP determines its practices and limitations of the IT Service Delivery.

  16. Making government work: Electronic delivery of Federal services

    NASA Astrophysics Data System (ADS)

    1993-09-01

    Federal, State, and local governments face the challenge of delivering better services faster and at less cost at a time when demand is growing and budgets are tighter. Computer and telecommunication technologies offer a number of near-term opportunities for delivering Federal services electronically in partnership with State/local agencies and the private sector. To assure that these technologies benefit all citizens - not just the affluent and highly educated - will require Congress to pay special attention to policy and oversight. It will also require agencies to be innovative and skillful in introducing new electronic delivery systems. The Office of Technology Assessment's (OTA's) assessment of electronic service delivery was requested by Senator John Glenn, Chairman, Senate Committee on Governmental Affairs. This report provides Congress with alternative strategies for improving the performance of government by using modern information technologies. The report offers new perspectives to Congress as it considers reauthorizing the Paperwork Reduction Act and responds to the Administration's 'National Performance Review' and 'National Information Infrastructure' initiatives. More broadly, the report will contribute to the public debate over the role of information technology in reinventing government.

  17. User engagement in the delivery and design of maternity services.

    PubMed

    Patel, Nashita; Rajasingam, Daghni

    2013-08-01

    User engagement is defined as a mutual exchange of information between the patient and the health professional, which has shown to improve patient experience as well as outcomes. Engaging the patient is vital for the healthcare system to remain sustainable. The National Health Service has attempted to incorporate and enhance patient engagement in the delivery of maternity services for the last decade. The financial crisis, changing socio-demographic status, increase in birth rate and public expectations-engaging the patient to take responsibility of their own health has not been achieved. Through in-depth examinations of these barriers we are able to draw conclusions as to why current policies have failed and recommend potential solutions. PMID:23768954

  18. Spatial service delivery system for smart licensing & enforcement management

    NASA Astrophysics Data System (ADS)

    Wahap, N. A.; Ismail, N. M.; Nor, N. M.; Ahmad, N.; Omar, M. F.; Termizi, A. A. A.; Zainal, D.; Noordin, N. M.; Mansor, S.

    2016-06-01

    Spatial information has introduced a new sense of urgency for a better understanding of the public needs in term of what, when and where they need services and through which devices, platform or physical locations they need them. The objective of this project is to value- add existing license management process for business premises which comes under the responsibility of Local Authority (PBT). Manipulation of geospatial and tracing technology via mobile platform allows enforcement officers to work in real-time, use a standardized system, improve service delivery, and optimize operation management. This paper will augment the scope and capabilities of proposed concept namely, Smart Licensing/Enforcement Management (SLEm). It will review the current licensing and enforcement practice of selected PBT in comparison to the enhanced method. As a result, the new enhanced system is expected to offer a total solution for licensing/enforcement management whilst increasing efficiency and transparency for smart city management and governance.

  19. PACS and diagnostic imaging service delivery--a UK perspective.

    PubMed

    Sutton, Laurence N

    2011-05-01

    This review sets out the current position with regard to the implementation of PACS throughout the United Kingdom and the impact this has had on improving patient care. In December 2007 England had implemented full hospital-wide PACS in all hospitals: a major achievement in the relatively short time period of three years. The different approaches used by each country of the UK to achieve full national PACS are described in addition to the current issues with the sharing of images and reports across different healthcare organisations with regard to technical solutions, clinical safety and governance. The review gives insight into the changing methods of service delivery to address increasing demand pressures on diagnostic imaging services and how the national PACS implementation, specifically in England, has made a significant contribution to measures to improve efficiencies. The role of Teleradiology is discussed in the context of supporting local patient services rather than undermining them and the concept of cross-healthcare reporting 'Grids' is described. Finally, in the summary it is recognised that the vast wealth of knowledge accumulated during the national implementations has placed the UK in a strong position to facilitate full national data sharing across all healthcare organisations to improve patient care. PMID:21600402

  20. Process Improvement: Customer Service.

    PubMed

    Cull, Donald

    2015-01-01

    Utilizing the comment section of patient satisfaction surveys, Clark Memorial Hospital in Jeffersonville, IN went through a thoughtful process to arrive at an experience that patients said they wanted. Two Lean Six Sigma tools were used--the Voice of the Customer (VoC) and the Affinity Diagram. Even when using these tools, a facility will not be able to accomplish everything the patient may want. Guidelines were set and rules were established for the Process Improvement Team in order to lessen frustration, increase focus, and ultimately be successful. The project's success is driven by the team members carrying its message back to their areas. It's about ensuring that everyone is striving to improve the patients' experience by listening to what they say is being done right and what they say can be done better. And then acting on it. PMID:26571974

  1. A Universal Design Approach to Government Service Delivery: The Case of ChileAtiende.

    PubMed

    Sandoval, Leonardo

    2016-01-01

    A common challenge for government administrations that aim to improve the delivery of information and services to citizens is to go beyond a government-centred approach. By focusing on citizens and the needs of a wide range of citizens, Universal Design (UD) can help to increase the effectiveness, efficiency and satisfaction of government services. This paper examines the case of an internationally recognised Chilean government service delivery programme inspired by UD principles known as ChileAtiende ("ChileService"). A brief account of its creation and current status is provided. PMID:27534348

  2. The Role of Libraries in eHealth Service Delivery in Australia

    ERIC Educational Resources Information Center

    Rao, Sarada

    2009-01-01

    eHealth is an emerging service sector which has great potential to improve health care delivery to rural and remote communities, facilitate health surveillance, and promote health education and research. Despite the critical need for eHealth services in Australia based on the challenges of distance and human resources, its utility has yet to be…

  3. Improvement of Job Placement Services.

    ERIC Educational Resources Information Center

    Mount San Antonio Community Coll. District, Walnut, CA.

    The Improvement of Job Placement Services Project was undertaken to examine and strengthen job placement services and programs in the California community colleges. Specific objectives of the project were to: (1) select and convene a 12-member representative advisory committee to oversee project operations working with the California Placement…

  4. Improving and Extending Rural Library Services in Idaho.

    ERIC Educational Resources Information Center

    Weatherby, James B.; And Others

    This study of rural libraries in Idaho was designed to identify appropriate alternative local revenue sources to support library services as well as ways of improving the coordination and delivery of library services in the state and extending library access to unserved areas. Data were gathered from U.S. Bureau of the Census reports and special…

  5. University Educational Service Delivery Strategy in a Changing World: Implications for Ethical Values and Leadership Integrity in Nigeria

    ERIC Educational Resources Information Center

    Akintayo, D. I.

    2008-01-01

    This paper examined university educational service delivery strategy in a changing world as it affects ethical values and leadership integrity in Nigeria. This was for the purpose of determining appropriate strategies for improving the quality of service delivery system in Nigerian universities. The paper submits that the quality and quantity of…

  6. 42 CFR 460.98 - Service delivery.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... services. (3) Restorative therapies, including physical therapy and occupational therapy. (4) Personal care and supportive services. (5) Nutritional counseling. (6) Recreational therapy. (7) Meals. (d) Pace..., national origin, religion, sex, age, sexual orientation, mental or physical disability, or source...

  7. 22 CFR 228.55 - Delivery services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... case of bulk cargoes and large cargoes carried by liners; (2) Eligible vessels provide liner service... countries to be authorized by the waiver provide liner service without transshipment; (3) Eligible vessels... port handling facilities; (5) Eligible vessels do not provide liner service from the port of...

  8. 22 CFR 228.55 - Delivery services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... case of bulk cargoes and large cargoes carried by liners; (2) Eligible vessels provide liner service... countries to be authorized by the waiver provide liner service without transshipment; (3) Eligible vessels... port handling facilities; (5) Eligible vessels do not provide liner service from the port of...

  9. 78 FR 773 - Hartford Financial Services Group, Inc., Commercial/Actuarial/Information Delivery Services (IDS...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration Hartford Financial Services Group, Inc., Commercial/Actuarial/ Information Delivery Services (IDS)/Corporate & Financial Reporting Group, Hartford, CT; Notice of...

  10. Organizing Services in Rural Communities: Moving toward Service Integration and Flexible Specialization. Part I: Models for Organizing Service Delivery.

    ERIC Educational Resources Information Center

    O'Looney, John

    1993-01-01

    Explores options for human service delivery and related organizational change in rural areas. Addresses the unique context and distinctive features of rural service delivery, urban service professionalism and fragmentation, and potential advantages of traditional integrated rural systems. Discusses eight models derived from combinations of three…

  11. United Parcel Service Evaluates Hybrid Electric Delivery Vans (Fact Sheet)

    SciTech Connect

    Not Available

    2010-02-01

    This fact sheet describes how the National Renewable Energy Laboratory's Fleet Test and Evaluation team evaluated the 12-month, in-service performance of six Class 4 hybrid electric delivery vans - fueled by regular diesel - and six comparable conventional diesel vans operated by the United Parcel Service.

  12. Using patients’ experiences of adverse events to improve health service delivery and practice: protocol of a data linkage study of Australian adults age 45 and above

    PubMed Central

    Walton, Merrilyn; Smith-Merry, Jennifer; Harrison, Reema; Manias, Elizabeth; Iedema, Rick; Kelly, Patrick

    2014-01-01

    Introduction Evidence of patients’ experiences is fundamental to creating effective health policy and service responses, yet is missing from our knowledge of adverse events. This protocol describes explorative research redressing this significant deficit; investigating the experiences of a large cohort of recently hospitalised patients aged 45 years and above in hospitals in New South Wales (NSW), Australia. Methods and analysis The 45 and Up Study is a cohort of 265 000 adults aged 45 years and above in NSW. Patients who were hospitalised between 1 January and 30 June 2014 will be identified from this cohort using data linkage and a random sample of 20 000 invited to participate. A cross-sectional survey (including qualitative and quantitative components) will capture patients’ experiences in hospital and specifically of adverse events. Approximately 25% of respondents are likely to report experiencing an adverse event. Quantitative components will capture the nature and type of events as well as common features of patients’ experiences. Qualitative data provide contextual knowledge of their condition and care and the impact of the event on individuals. Respondents who do not report an adverse event will report their experience in hospital and be the control group. Statistical and thematic analysis will be used to present a patient perspective of their experiences in hospital; the characteristics of patients experiencing an adverse event; experiences of information sharing after an event (open disclosure) and the other avenues of redress pursued. Interviews with key policymakers and a document analysis will be used to create a map of the current practice. Ethics and dissemination Dissemination via a one-day workshop, peer-reviewed publications and conference presentations will enable effective clinical responses and service provision and policy responses to adverse events to be developed. PMID:25311039

  13. Toward improving the oral health of Americans: an overview of oral health status, resources, and care delivery. Oral Health Coordinating Committee, Public Health Service.

    PubMed Central

    1993-01-01

    Dental and oral diseases may well be the most prevalent and preventable conditions affecting Americans. More than 50 percent of U.S. children, 96 percent of employed U.S. adults, and 99.5 percent of Americans 65 years and older have experienced dental caries (also called cavities). Millions of Americans suffer from periodontal diseases and other oral conditions, and more than 17 million Americans, including 10 million Americans 65 years or older, have lost all of their teeth. Preventive dental services are known to be effective in preventing and controlling dental diseases. Unfortunately, groups at highest risk for disease--the poor and minorities--have lower rates of using dental care than the U.S. average. Cost is the principal barrier to dental care for many Americans. Of the $38.7 billion spent for dental services in 1992, public programs, including Medicaid, paid for less than 4 percent of dental expenditures. More than 90 percent of care was paid for either out-of-pocket by dental consumers or through private dental insurance. Americans are at risk for other oral health problems as well. Oropharyngeal cancer strikes approximately 30,000 Americans each year and results in an estimated 8,000 deaths annually. Underlying medical or handicapping conditions, ranging from rare genetic diseases to more common chronic diseases, affect millions of Americans and can lead to oral health problems. Among persons with compromised immune systems, oral diseases and conditions can have a significant impact on health. Oral diseases and conditions, though nearly universal, can be prevented easily and controlled at reasonable cost.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8265750

  14. Collaborative Service Delivery: From Instruction to Implementation

    ERIC Educational Resources Information Center

    Lundblom, Erin Elizabeth Gill

    2012-01-01

    Legal mandates, educational reform, and professional policy changes, have emphasized the need to promote the integration of services for students with communication impairments within the general education curriculum. However, speech-language pathologists (SLPs) continue to report the provision of primarily pull-out services with intervention…

  15. 77 FR 65581 - Verizon Business Networks Services, Inc., Senior Analyst, Service Program Delivery (SA-SPD...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-29

    ... Employment and Training Administration Verizon Business Networks Services, Inc., Senior Analyst, Service Program Delivery (SA-SPD), Including Workers Whose Wages Were Paid Under MCI Communication Services, Inc..., 2012, applicable to workers and former workers of Verizon Business Network Services, Inc.,...

  16. The Public Health Service action plan to improve access to immunization services. The Interagency Committee to Improve Access to Immunization Services.

    PubMed Central

    1992-01-01

    The Public Health Service's Interagency Committee to Improve Access to Immunization Services (ICI) has responsibility for improving the immunization protection of the nation's children and other vulnerable populations. ICI's Action Plan to Improve Access to Immunization Services sets 14 goals with 120 action steps for improving immunization services nationwide by (a) increasing coordination among Federal health, income, housing, education, and nutrition programs; (b) reducing policy and management barriers that limit access to delivery systems, and (c) strengthening the delivery infrastructure. To accomplish the goals of the plan, there is a $72.0 million increase in funding appropriated in fiscal year 1992 specifically for this purpose. The President's Budget for fiscal year 1993 includes a $24.5 million increase for continued program implementation. The additional resources will be used to address delivery and access problems, which have been determined to be the primary factors limiting immunization for many children. PMID:1594732

  17. Wheeled mobility (wheelchair) service delivery: scope of the evidence.

    PubMed

    Greer, Nancy; Brasure, Michelle; Wilt, Timothy J

    2012-01-17

    Identifying the appropriate wheelchair for a person who needs one has implications for both disabled persons and society. For someone with severe locomotive problems, the right wheelchair can affect mobility and quality of life. However, policymakers are concerned about the increasing demand for unnecessarily elaborate chairs. The Office of Inspector General, U.S. Department of Health and Human Services, issued 4 reports between 2009 and 2011 detailing fraud and misapplication of Medicare funds for powered wheelchairs, more than a decade after similar concerns were first raised by 4 contractors who process claims for durable medical equipment. Subsequent concerns have arisen about whether some impaired persons who need wheeled mobility devices may now be inappropriately denied coverage. A transparent, evidence-based approach to wheeled mobility service delivery (the matching of mobility-impaired persons to appropriate devices and supporting services) might lessen these concerns. This review describes the process of wheeled mobility service delivery for long-term wheelchair users with complex rehabilitation needs and presents findings from a survey of the literature (published and gray) and interviews with key informants. Recommended steps in the delivery process were identified in textbooks, guidelines, and published literature. Delivery processes shared many commonalities; however, no research supports the recommended approaches. A search of bibliographic databases through March 2011 identified 24 studies that evaluated aspects of wheeled mobility service delivery. Most were observational, exploratory studies designed to determine consumer use of and satisfaction with the process. The evidence base for the effectiveness of approaches to wheeled mobility service delivery is insufficient, and additional research is needed to develop standards and guidelines. PMID:22250145

  18. Challenging Heterosexism in College Health Service Delivery.

    ERIC Educational Resources Information Center

    McKee, Michael B.; And Others

    1994-01-01

    Explores how HIV/AIDS, substance abuse, violence and hate crimes, suicide, and heterosexism all adversely affect the physical and emotional health of nonheterosexual college students. College health services must assume a leadership role in combatting all forms of oppression by actively incorporating and addressing the unique needs of…

  19. Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh.

    PubMed

    El Arifeen, Shams; Christou, Aliki; Reichenbach, Laura; Osman, Ferdous Arfina; Azad, Kishwar; Islam, Khaled Shamsul; Ahmed, Faruque; Perry, Henry B; Peters, David H

    2013-12-14

    In Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms. Continued development of innovative, community-based strategies of health-service delivery, and adaptation of new technologies, are needed to address neglected and emerging health challenges, such as increasing access to skilled birth attendance, improvement of coverage of antenatal care and of nutritional status, the effects of climate change, and chronic disease. Past experience should guide future efforts to address rising public health concerns for Bangladesh and other underdeveloped countries. PMID:24268607

  20. Comparison of Delivery Strategies for Pharmacogenetic Testing Services

    PubMed Central

    Moaddeb, Jivan

    2013-01-01

    The number and use of pharmacogenetic tests to assess a patient’s likelihood of response or risk of an adverse event is expanding across medical specialties and becoming more prevalent. During this period of development and translation, different approaches are being investigated to optimize delivery of pharmacogenetic services. In this paper, we review preemptive and point-of-care delivery approaches currently implemented or being investigated and discuss the advantages and disadvantages of each approach. The continued growth in knowledge about the genetic basis of drug response combined with development of new and cheaper testing technologies and electronic medical records will impact future delivery systems. Regardless of delivery approach, the currently limited knowledge of health professionals about genetics generally or PGx specifically will remain a major obstacle to utilization. PMID:24384556

  1. Nursing Services Delivery Theory: an open system approach

    PubMed Central

    Meyer, Raquel M; O’Brien-Pallas, Linda L

    2010-01-01

    meyer r.m. & o’brien-pallas l.l. (2010)Nursing services delivery theory: an open system approach. Journal of Advanced Nursing66(12), 2828–2838. Aim This paper is a discussion of the derivation of the Nursing Services Delivery Theory from the application of open system theory to large-scale organizations. Background The underlying mechanisms by which staffing indicators influence outcomes remain under-theorized and unmeasured, resulting in a ‘black box’ that masks the nature and organization of nursing work. Theory linking nursing work, staffing, work environments, and outcomes in different settings is urgently needed to inform management decisions about the allocation of nurse staffing resources in organizations. Data sources A search of CINAHL and Business Source Premier for the years 1980–2008 was conducted using the following terms: theory, models, organization, organizational structure, management, administration, nursing units, and nursing. Seminal works were included. Discussion The healthcare organization is conceptualized as an open system characterized by energy transformation, a dynamic steady state, negative entropy, event cycles, negative feedback, differentiation, integration and coordination, and equifinality. The Nursing Services Delivery Theory proposes that input, throughput, and output factors interact dynamically to influence the global work demands placed on nursing work groups at the point of care in production subsystems. Implications for nursing The Nursing Services Delivery Theory can be applied to varied settings, cultures, and countries and supports the study of multi-level phenomena and cross-level effects. Conclusion The Nursing Services Delivery Theory gives a relational structure for reconciling disparate streams of research related to nursing work, staffing, and work environments. The theory can guide future research and the management of nursing services in large-scale healthcare organizations. PMID:20831573

  2. Health Care Delivery Performance: Service, Outcomes, and Resource Stewardship

    PubMed Central

    Cowing, Michelle; Davino-Ramaya, Carrie M; Ramaya, Krishnan; Szmerekovsky, Joseph

    2009-01-01

    As competition intensifies within the health care industry, patient satisfaction and service quality are providing the evidentiary basis for patient outcomes. We propose a conceptual model of three interrelated areas, service, health outcomes, and resource stewardship, all affected by the clinician-patient relationship. Our model considers the perspectives of the health care organization, the clinician, and the patient to define a more comprehensive measure of health care delivery performance. Research and managerial aspects, including implementation, are discussed. PMID:20740107

  3. The Future of Telecommunications Technologies for the Delivery of Human Services.

    ERIC Educational Resources Information Center

    Dordick, Herbert S.; Goldman, Ronald J.

    The use of telecommunications technologies has been encouraged to improve quality and reduce costs of human services delivery; however, the adoption rate has been disappointing. This paper reviews the model found most useful for the analysis of barriers to the adoption of telecommunications technologies. Characteristics which have been found to be…

  4. Teaching for Competence in the Delivery of Direct Services.

    ERIC Educational Resources Information Center

    Council on Social Work Education, New York, NY.

    Enhancing practitioner competence in the delivery of direct services continues to be a prime concern of social work practitioners and educators alike. This document contains 11 articles that pertain to teaching direct intervention theories and skills. Joseph D. Anderson writes on games social work educators' play in teaching practice theories;…

  5. California Integrated Service Delivery Evaluation Report. Phase I

    ERIC Educational Resources Information Center

    Moore, Richard W.; Rossy, Gerard; Roberts, William; Chapman, Kenneth; Sanchez, Urte; Hanley, Chris

    2010-01-01

    This study is a formative evaluation of the OneStop Career Center Integrated Service Delivery (ISD) Model within the California Workforce System. The study was sponsored by the California Workforce Investment Board. The study completed four in-depth case studies of California OneStops to describe how they implemented the ISD model which brings…

  6. The Effect of Leadership on Service Delivery in Universities

    ERIC Educational Resources Information Center

    Zvavahera, Promise

    2013-01-01

    This study was aimed at assessing leadership effectiveness on service delivery at the University of Namibia and all its campuses throughout the country. The study was carried out during the month of February 2013. The methodology consisted of document analysis, interviews through face to face, video and tele-conferencing. Purposive sampling was…

  7. Lessons Learned from a Tiered Service Delivery Implementation Project

    ERIC Educational Resources Information Center

    Johnson, Evelyn S.; Pool, Juli L.; Carter, Deborah R.

    2012-01-01

    Tiered models of service delivery for both academics and behavior are being increasingly adopted across the nation, and discussions of how to implement these models effectively and simultaneously are growing. In this article, the authors share some lessons learned from a 2-year implementation project to implement a comprehensive (both academic and…

  8. Supervision in Bilingual Counseling: Service Delivery, Training, and Research Considerations

    ERIC Educational Resources Information Center

    Fuertes, Jairo N.

    2004-01-01

    This article reviews selected literature on the topics of bilingual and multicultural counseling and supervision and provides a framework for understanding salient issues in the delivery of bilingual services. It also presents practical interventions and ideas for future empirical work in this area.

  9. Service Delivery for Mexican-American Children. Coursebook.

    ERIC Educational Resources Information Center

    Tijerina, Andres A.

    A special curriculum to be used in training sessions on Mexican American culture was developed to assist Texas Department of Human Resources personnel with service delivery for Mexican American children. Designed to heighten awareness in caseworkers and other personnel on the cultural variables affecting their relationship with Mexican American…

  10. 7 CFR 652.6 - Department delivery of technical services.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Department delivery of technical services. 652.6 Section 652.6 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES... USDA Federal assistance rules and requirements for competency, quality, and selection, as...

  11. 7 CFR 652.6 - Department delivery of technical services.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 6 2013-01-01 2013-01-01 false Department delivery of technical services. 652.6 Section 652.6 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES... USDA Federal assistance rules and requirements for competency, quality, and selection, as...

  12. 7 CFR 652.6 - Department delivery of technical services.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 6 2014-01-01 2014-01-01 false Department delivery of technical services. 652.6 Section 652.6 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES... USDA Federal assistance rules and requirements for competency, quality, and selection, as...

  13. 7 CFR 652.6 - Department delivery of technical services.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 6 2012-01-01 2012-01-01 false Department delivery of technical services. 652.6 Section 652.6 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES... USDA Federal assistance rules and requirements for competency, quality, and selection, as...

  14. 7 CFR 652.6 - Department delivery of technical services.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Department delivery of technical services. 652.6 Section 652.6 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES... requirements for competency, quality, and selection, as appropriate. Any contract, contribution...

  15. The Delivery of Alcoholism Services: Meeting Whose Needs?

    ERIC Educational Resources Information Center

    Christmas, June J.

    Of grave concern to all who are involved in the delivery of health and mental health services are two recently-observed trends in the drug and alcohol abusing population: the emergence of formerly hidden individuals in need of treatment (among them women, children and the elderly), and the increasing incidence and severity of emotional problems…

  16. A Multi-organisational Approach to Service Delivery

    NASA Astrophysics Data System (ADS)

    Purchase, Valerie; Mills, John; Parry, Glenn

    Who is involved in delivering a service? There has been growing recognition in a wide variety of contexts that service is increasingly being delivered by multi-rather than single-organisational entities. Such recognition is evident not only in our experience but in a number of areas of literature including strategy development, core competence analysis, operations and supply chain management, and is reflected in and further facilitated by ICT developments. Customers have always been involved in some degree in the process of value delivery and such involvement is increasing to include complex co-creation of value. Such interactions are challenging when they involve individual customers, however, this becomes ever more challenging when the 'customer' is another organisation or when there are multiple 'customers'. Within this chapter we will consider some of the key drivers for a multi-organisational approach to service delivery; examine the ways in which the parties involved in service co-creation have expanded to include multiple service providers and customers; and finally, identify some of the challenges created by a multi-organisational approach to service delivery.

  17. 78 FR 8596 - Hartford Financial Services Group, Inc., Commercial/Actuarial/ Information Delivery Services (IDS...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    .../ Information Delivery Services (IDS)/Corporate & Financial Reporting Group, Hartford, CT; Notice of Negative... was published in the Federal Register on January 4, 2013 (78 FR 773). The Hartford-IDS Group...

  18. Links among Social Status, Service Delivery Mode, and Service Delivery Preference in LD, Low-Achieving, and Normally Achieving Elementary-Aged Children.

    ERIC Educational Resources Information Center

    Le Mare, Lucy; de la Ronde, Marie

    2000-01-01

    Relations among social status, current service delivery, and service delivery preferences were examined in 42 students with learning disabilities (LD), 40 low-achieving, and 42 average/high-achieving students in grades 2-4 and 6-7. Most students preferred pullout service to in-class service. Only among LD students were self- and peer-rated social…

  19. 78 FR 57671 - Advisory Committee on International Postal and Delivery Services; Membership Renewals

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-19

    ... experts on international postal and delivery services. Members are not compensated for their service... Committee on International Postal and Delivery Services; Membership Renewals AGENCY: Department of State... international postal and private-sector delivery services. The Advisory Committee on International Postal...

  20. Libraries and E-Commerce: Improving Information Services and Beyond.

    ERIC Educational Resources Information Center

    Harris, Lesley Ellen

    2000-01-01

    Explains e-commerce and discusses how it can be used by special libraries. Highlights include library goals; examples of successful uses of e-commerce; how e-commerce can improve information services, including access to information, new information resources, delivery of information, and broadening information markets; and developing an…

  1. A proposed Next Generation Service Delivery Platform (NG-SDP) for eHealth domain.

    PubMed

    Andriopoulou, Foteini Gr; Lazarou, Nicolaos G; Lymberopoulos, Dimitrios K

    2012-01-01

    Nowadays, providing healthcare personalized services in user's intelligent space is an important issue for improving personal health, supporting predictive care and saving medical costs. In this paper, we propose an architecture for the Next Generation Service Delivery Platform (NG-SDP), suitable for composing and delivering personalized healthcare services. The core component of NG-SDP is a Context Decision Making Enabler (CDME) that assesses user contextual and bio information to yield personalized services. A prototype implementation of the proposed NG-SDP is also demonstrated. Finally a real case study demonstrates the CDME performance. PMID:23367312

  2. Delivery of a Clinical Genomics Service

    PubMed Central

    Newman, William G.; Black, Graeme C.

    2014-01-01

    Over the past five years, next generation sequencing has revolutionised the discovery of genes responsible for rare inherited diseases previously resistant to traditional discovery techniques. This review considers how this new technology is being introduced into clinical practice to aid diagnosis and improve the clinical management of individuals and families affected by rare diseases where access to genetic testing was previously limited. We compare and contrast the different approaches that have been adopted including panel based tests, exome and genome sequencing. We provide insights from our own clinical practice demonstrating the challenges and benefits of this new technology. PMID:25383561

  3. Citizen participation in community mental health center service delivery.

    PubMed

    Riley, W

    1981-01-01

    Citizen involvement in CMHC service delivery has two bases: (a) volunteerism and (b) identification with clients and citizens who may need services. This identification is expressed two ways, as cultural similarity to clients or social activism in their behalf. Paraprofessionals have been portrayed as a major mechanism. Current practice shows some discrepancy from the theoretical program goals. While CMHCs include an appreciable number of volunteers and mental health workers with less than a BA degree, the extent to which they augment services with community or social activism values is doubtful. PMID:7226740

  4. Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria

    PubMed Central

    Dahiru, Tukur; Oche, Oche Mansur

    2015-01-01

    Introduction Utilization of antenatal care, institutional delivery and postnatal care services in Nigeria are poor even by african average. Methods We analysed the 2013 Nigeria DHS to determine factors associated with utilization of these health MCH indicators by employing both bivariate and multivariate logistic regressions. Results Overall, 54% of women had at least four ANC visits, 37% delivered in health facility and 29% of new born had postnatal care within two of births. Factors that consistently predict the utilization of the three MCH services are maternal and husband's level education, place of residence, wealth level and parity. Antenatal care strongly predicts both health facility delivery (OR = 2.16, 95%CI: 1.99-2.34) and postnatal care utilization (OR = 4.67, 95%CI: 3.95-5.54); while health facility delivery equally predicting postnatal care (OR = 2.84, 95%CI: 2.20-2.80). Conclusion Improving utilization of these three MCH indicators will require targeting women in the rural areas and those with low level of education as well as creating demand for health facility delivery. Improving ANC use by making it available and accessible will have a multiplier effect of improving facility delivery which will lead to improved postnatal care utilization. PMID:26587168

  5. Computerized satellite delivery service: redefines central service and promotes nursing satisfaction.

    PubMed

    Haney, W

    1989-01-01

    Since its implementation in 1986, the Computerized Satellite Delivery Service at Saint Anthony's has contributed to improved efficiency in both the nursing and supply staffs. The system is easily modified, and has influenced other departments such as dietary to develop mechanisms to provide greater support to nursing service. Since the floor technician's role crosses many departmental boundaries, and this job function necessitates communication and facilitates interaction, thereby encouraging a team approach to health care. The implementation of programs which allow nursing staff to devote more time to patient care should be the basis on which any hospital service department operates. By providing a more efficient handling of support services, a closer working relationship between nursing and ancillary departments can be developed. Given the restrictions and limitations that surround many aspects of providing health care in today's society, it is inevitable that a "high tech", "high touch" approach to our efforts will prove not only financially viable, but will also support the basics for networking job satisfaction into the hospital environment. PMID:10293356

  6. Improving Instructional Delivery: Reflections on Student Feedback

    ERIC Educational Resources Information Center

    Oliveira, Lisa C.

    2013-01-01

    Teachers work countless hours preparing instruction for their students with the best intentions in mind. Each day many students enter into these classrooms to experience the delivery of the prepared instruction, yet their perceptions do not always match those of their teachers. The purpose of this research study is to develop and pilot a student…

  7. Contracting for Management: Assessing Management Capacity under Alternative Service Delivery Arrangements

    ERIC Educational Resources Information Center

    Brown, Trevor; Potoski, Matt

    2006-01-01

    Contracting critics suggest that when governments outsource, they reduce their capacity to produce services and manage service delivery. In this paper, we decompose the service delivery decision into service production and service management components. When governments contract for service production, they may also choose to contract for a…

  8. Improving policies for caregiver respite services.

    PubMed

    Rose, Miriam S; Noelker, Linda S; Kagan, Jill

    2015-04-01

    This paper provides a template for the decade ahead regarding the delivery, supply, and funding of caregiver respite services. Policy changes are needed to address these issues as concerns about our country's ability to meet future caregiving needs are growing along with our aging population. Federal initiatives and state-level policies and programs affecting respite are reviewed and directions for policy advancement are highlighted. Much more work is needed to educate caregivers and the general public about the necessity for respite beginning early in the caregiving career to prevent burnout and other adverse effects. Because it is unlikely that there will be a sufficient number of direct-care workers to replace unpaid caregivers, improved policies are needed to ensure that their situation is sustainable through increased availability of high-quality respite and other services vital to caregiver health and well-being. Among the 2015 White House Conference on Aging's priorities in the next decade, policies on long-term services and supports will require focused attention on family caregivers and the direct-care workforce to strengthen their ability to give care now and support their own physical, emotional, and financial needs in the future. PMID:26035607

  9. Transforming health care service delivery and provider selection.

    PubMed

    Reiner, Bruce I

    2011-06-01

    Commoditization pressures in medicine have risked transforming service provider selection from "survival of the fittest" to "survival of the cheapest." Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented performance metrics which provide patients with objective data related to individual service provider quality, safety, cost-efficacy, efficiency, and customer service. These performance metrics could in turn be customized to the individual preferences and health care needs of each individual patient, thereby providing an objective methodology for service provider selection while empowering health care consumers. PMID:21468775

  10. Investigation of the mediating effects of IT governance-value delivery on service quality and ERP performance

    NASA Astrophysics Data System (ADS)

    Tsai, Wen-Hsien; Chou, Yu-Wei; Leu, Jun-Der; Chao Chen, Der; Tsaur, Tsen-Shu

    2015-02-01

    This study aimed to explore the mediating effects of IT governance (ITG)-value delivery in the relationships among the quality of vendor service, the quality of consultant services, ITG-value delivery and enterprise resource planning (ERP) performance. The sampling of this research was acquired from a questionnaire survey concerning ERP implementations in Taiwan. In this survey, 4366 questionnaires were sent to manufacturing and service companies listed in the TOP 5000: The Largest Corporations in Taiwan 2009. The results showed that an ERP system will exhibit a decreased error rate and improved performance if ERP system vendors and consultants provide good service quality. The results also demonstrated that significant relationships exist among the quality of vendor service, the quality of consultant services and value delivery. The contribution of this article is twofold. First, it found that value delivery provides an effective measure of ERP performance under an ITG framework. Second, it provides evidence of the partial mediating effects of value delivery between service quality and ERP performance. In other words, if enterprises want to improve ERP performance, they need to consider factors such as value delivery and the quality of a vendor/consultant's service.

  11. 76 FR 59768 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE Advisory Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice... the meeting of the Advisory Committee on International Postal and Delivery Services scheduled...

  12. Service Provider Combinations and the Delivery of Early Intervention Services to Children and Families

    ERIC Educational Resources Information Center

    Raspa, Melissa; Hebbeler, Kathleen; Bailey, Donald B., Jr.; Scarborough, Anita A.

    2010-01-01

    Using data from the National Early Intervention Longitudinal Study, this study provides a framework for characterizing the delivery of early intervention services based on the combinations of service providers who work with infants and toddlers with disabilities and their families. Five groups of providers were identified. Results showed that the…

  13. Service Delivery Rules and the Distribution of Local Government Services: Three Detroit Bureaucracies

    ERIC Educational Resources Information Center

    Jones, Bryan D.; And Others

    1978-01-01

    Argues that the routinized procedures governing delivery of local public services influence distribution of services to citizens by three municipal agencies in Detroit. Agencies are the Department of Parks and Recreation, the Sanitation Division, and the Environmental Enforcement Division of the Environmental Protection and Maintenance Department.…

  14. Women's perceptions of antenatal, delivery, and postpartum services in rural Tanzania

    PubMed Central

    Mahiti, Gladys Reuben; Mkoka, Dickson Ally; Kiwara, Angwara Dennis; Mbekenga, Columba Kokusiima; Hurtig, Anna-Karin; Goicolea, Isabel

    2015-01-01

    Background Maternal health care provision remains a major challenge in developing countries. There is agreement that the provision of quality clinical services is essential if high rates of maternal death are to be reduced. However, despite efforts to improve access to these services, a high number of women in Tanzania do not access them. The aim of this study is to explore women's views about the maternal health services (pregnancy, delivery, and postpartum period) that they received at health facilities in order to identify gaps in service provision that may lead to low-quality maternal care and increased risks associated with maternal morbidity and mortality in rural Tanzania. Design We gathered qualitative data from 15 focus group discussions with women attending a health facility after child birth and transcribed it verbatim. Qualitative content analysis was used for analysis. Results ‘Three categories emerged that reflected women's perceptions of maternal health care services: “mothers perceive that maternal health services are beneficial,” “barriers to accessing maternal health services” such as availability and use of traditional birth attendants (TBAs) and the long distances between some villages, and “ambivalence regarding the quality of maternal health services” reflecting that women had both positive and negative perceptions in relation to quality of health care services offered’. Conclusions Mothers perceived that maternal health care services are beneficial during pregnancy and delivery, but their awareness of postpartum complications and the role of medical services during that stage were poor. The study revealed an ambivalence regarding the perceived quality of health care services offered, partly due to shortages of material resources. Barriers to accessing maternal health care services, such as the cost of transport and the use of TBAs, were also shown. These findings call for improvement on the services provided. Improvements

  15. Institutional Change in Delivery of Dental Services: A Marketing Perspective

    PubMed Central

    Capon, Noel

    1982-01-01

    The recent appearance and growth of new delivery systems for dental services is examined from a marketing perspective. Analysis reveals that the growth of low priced, high throughput operations is consistent not only with marketing principles, but with the development of American retail institutions in general. Options for independent dentists in the face of this new competitive environment are discussed. (Am J Public Health 1982; 72:679-683.) PMID:7091457

  16. Student Delivery of Health Services to Students: A Longitudinal Analysis.

    ERIC Educational Resources Information Center

    Martin, Gary L.; And Others

    1981-01-01

    Student health aide programs for college students have been instrumental in nutrition improvement, medication compliance, general preventive medicine, and in aiding in the mental health delivery system. In this study, headaches and upper respiratory infections constituted a significant percentage of the total visits to the health aide. (JN)

  17. Comprehensive Service Delivery through Senior Centers and Other Community Focal Points: A Resource Manual.

    ERIC Educational Resources Information Center

    National Council on the Aging, Inc., Washington, DC.

    This manual provides information on factors particularly relevant to focal point service delivery such as cooperative planning, interagency linkages, shared service delivery, accountability, and community relationships. An introduction describes what community focal points for service delivery are and how they are intended to fit into community…

  18. 75 FR 8425 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-24

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... international postal and delivery services of interest to Advisory Committee members and the public....

  19. 78 FR 8683 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... postal and delivery services of interest to Advisory Committee members and the public. For...

  20. 76 FR 15028 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-18

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... related to international postal and delivery services of interest to Advisory Committee members and...

  1. 75 FR 57102 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-17

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... related to international postal and delivery services of interest to Advisory Committee members and...

  2. 76 FR 54829 - Advisory Committee On International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-02

    ... Committee On International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice... International Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of... related to international postal and delivery services that are of interest to Advisory Committee...

  3. 78 FR 55773 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice; FACA... Postal and Delivery Services. This Committee has been formed in fulfillment of the provisions of the 2006... delivery services of interest to Advisory Committee members and the public. FOR FURTHER INFORMATION...

  4. 29 CFR 4000.26 - What if I use a commercial delivery service?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false What if I use a commercial delivery service? 4000.26... § 4000.26 What if I use a commercial delivery service? (a) In general. Your filing or issuance date is the date you deposit your submission or issuance with the commercial delivery service if you meet...

  5. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false What are the basic components of an NFJP service delivery strategy? 669.310 Section 669.310 Employees' Benefits EMPLOYMENT AND TRAINING... are the basic components of an NFJP service delivery strategy? The NFJP service delivery strategy...

  6. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false What are the basic components of an NFJP service delivery strategy? 669.310 Section 669.310 Employees' Benefits EMPLOYMENT AND TRAINING... are the basic components of an NFJP service delivery strategy? The NFJP service delivery strategy...

  7. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false What are the basic components of an NFJP service delivery strategy? 669.310 Section 669.310 Employees' Benefits EMPLOYMENT AND TRAINING... are the basic components of an NFJP service delivery strategy? The NFJP service delivery strategy...

  8. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What are the basic components of an NFJP service delivery strategy? 669.310 Section 669.310 Employees' Benefits EMPLOYMENT AND TRAINING... the basic components of an NFJP service delivery strategy? The NFJP service delivery strategy...

  9. Improvement in the Geofencing Service Interface Using Indoor Positioning Systems and Mobile Sensors

    NASA Astrophysics Data System (ADS)

    Nakagawa, M.

    2013-11-01

    The current state of location-based services provides spatial information delivery for mobile users based on position data taken from GPS sensors. However, sometimes the spatial information delivery service includes unwanted information. In particular, push-based or passive information delivery has a high probability that users receive unwanted information. We propose a new spatial information delivery to improve the integrity of spatial information delivery. We conducted an experiment using an Indoor Messaging System and an accelerometer, and concluded that our methodology can detect user behavior without accessing personal information and reduce the amount of spam information.

  10. Improving vaccine delivery using novel adjuvant systems.

    PubMed

    Pichichero, Michael E

    2008-01-01

    Adjuvants have been common additions to vaccines to help facilitate vaccine delivery. With advancements in vaccine technology, several adjuvants which activate immune specific responses have emerged. Available data show these adjuvants elicit important immune responses in both healthy and immunocompromised populations, as well as the elderly. Guidelines for the use and licensure of vaccine adjuvants remain under discussion. However, there is a greater understanding of the innate and adaptive immune response, and the realization of the need for immune specific adjuvants appears to be growing. This is a focused review of four adjuvants currently in clinical trial development: ASO4, ASO2A, CPG 7907, and GM-CSF. The vaccines including these adjuvants are highly relevant today, and are expected to reduce the disease burden of cervical cancer, hepatitis B and malaria. PMID:18398303

  11. Viability of healthcare service delivery alternatives for the Australian mining sector.

    PubMed

    Williams, Patricia A H; Giles, Margaret

    2012-01-01

    The changing and demanding nature of the mining workforce in rural and remote Australia brings unique challenges to the delivery of healthcare services. In an attempt to control costs whilst delivering cost effective and quality healthcare, new models of delivery must be considered. For a workforce that is fly-in/fly-out, the provision of healthcare is problematic given the lack of consistency in location. A cost-benefit framework is analysed comparing three models of service provision using travel to a major location, locum services and remote health monitoring. Ultimately, new models of care must be considered to address the issues of increasing workforce turnover, to cater for rising healthcare costs, and to improve the health of such communities. PMID:23138092

  12. Are clinical audits enough to bring about improvement in overall health care delivery?

    PubMed

    Rajani, Amin; Sohail, Syed M

    2014-01-01

    This study was conducted to explore the entire spectrum of initiatives that have evolved globally over time in health care delivery mechanisms. The quality improvement initiatives that have been reviewed were undertaken at the department of radiology at a tertiary care teaching hospital in the developing world. This article reveals that conducting only clinical audits is not enough to bring about improvements in the health care delivery processes. It also illustrates examples of other initiatives that combine to enable sustainable, safe and high quality health care services for the patients whom we serve. PMID:24938030

  13. Exploring barriers to the delivery of cervical cancer screening and early treatment services in Malawi: some views from service providers

    PubMed Central

    Munthali, Alister C; Ngwira, Bagrey M; Taulo, Frank

    2015-01-01

    Background Cervical cancer is the most common reproductive health cancer in Malawi. In most cases, women report to health facilities when the disease is in its advanced stage. In this study, we investigate service providers’ perceptions about barriers for women to access cervical cancer screening and early treatment services in Malawi. Methods We conducted in-depth interviews with 13 district coordinators and 40 service providers of cervical cancer screening and early treatment services in 13 districts in Malawi. The study was conducted in 2012. The district coordinators helped the research team identify the health facilities which were providing cervical cancer screening and early treatment services. Results Almost all informants reported that cervical cancer was a major public health problem in their districts and that prevention efforts for this disease were being implemented. They were aware of the test and treat approach using visual inspection with acetic acid (VIA). They, however, said that the delivery of cervical cancer screening and early treatment services was compromised because of factors such as gross shortage of staff, lack of equipment and supplies, the lack of supportive supervision, and the use of male service providers. Informants added that the lack of awareness about the disease among community members, long distances to health facilities, the lack of involvement of husbands, and prevailing misperceptions about the disease (eg, that it is caused by the exposure to the VIA process) affect the uptake of these services. Conclusion While progress has been made in the provision of cervical cancer screening and early treatment services in Malawi, a number of factors affect service delivery and uptake. There is a need to continue creating awareness among community members including husbands and also addressing identified barriers such as shortage of staff and supplies in order to improve uptake of services. PMID:25848229

  14. Pricing: A Normative Strategy in the Delivery of Human Services.

    ERIC Educational Resources Information Center

    Moore, Stephen T.

    1995-01-01

    Discusses a normative strategy toward pricing human services, which will allow providers to develop pricing strategies within the context of organizational missions, goals, and values. Pricing is an effective tool for distributing resources and improving efficiency, and can be used as a tool for encouraging desired patterns of service utilization.…

  15. Critical Issues in the Delivery of Local Government Services in Rural America.

    ERIC Educational Resources Information Center

    Doeksen, Gerald A.; Peterson, Janet

    Technological changes, an increase in demand for quality community services, and environmental controls have created conditions of continual change in the delivery of rural services. This report summarizes economic theory on community service delivery, reviews economic literature on specific community services, and identifies research gaps and…

  16. Pharmacological Drug Delivery Strategies for Improved Therapeutic Effects: Recent Advances.

    PubMed

    Savaliya, Reema; Singh, Poornima; Singh, Sanjay

    2016-01-01

    The latest pharmacologic research has resulted number of new molecules with the potential to modernize the prevention or treatment of different complex diseases, including cancer. The therapeutics generally include moieties such as proteins, drugs and genes, etc. Current activities in the pharmacological field include the development of novel drug-delivery systems to overcome pharmacokinetic glitches such as limited bioavailability, unwanted distribution, drug resistant, and stability, etc. Therefore, to address these issues various biotechnological and pharmacological techniques has been introduced. However, effective drug delivery with improved efficacy remains challenging. This review is focused towards different strategies such as physical and biological methods for efficacious delivery at desired tissues and even sub-cellular targeting. Emphasis is also given about nanotechnology based drug or gene delivery strategies and co-delivery of drug-drug; gene-gene or combinations of drug-gene, etc. are the current cuttingedge methods, which are under clinical or pre-clinical stage of research. Uses of biodegradable materials, such as liposomes and polymeric particles are another class of drug delivery vehicles, which have shown tremendous success, are also discussed. Towards the end, future directions of pharmacological drug delivery methods have also been summarized. PMID:26654439

  17. 77 FR 41877 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-16

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice, FACA... Postal and Delivery Services (the Advisory Committee). This Committee has been formed in fulfillment of... delivery matters. Public input: Any member of the public interested in providing public input to...

  18. Context Matters: Practitioner Perspectives on Immunization Delivery Quality Improvement Efforts.

    PubMed

    Gingold, Janet A; Briccetti, Christine; Zook, Kathleen; Gillespie, Catherine W; Gubernick, Ruth S; Moon, Rachel Y; Fu, Linda Y

    2016-08-01

    Uneven adherence to immunization guidelines might leave some communities vulnerable to outbreaks of vaccine-preventable diseases. To examine factors related to implementation of immunization delivery best practices, we analyzed responses to monthly surveys and debriefing interviews from 16 diverse pediatric practices engaged in a year-long virtual learning collaborative. The collaborative provided a toolkit, online learning sessions, performance feedback, and conference calls with a quality improvement coach. Participants used iterative plan-do-study-act cycles to implement self-selected changes in immunization practices. Descriptive statistics were applied to quantitative data; qualitative data were analyzed using a framework approach. Impediments to implementing guidelines included difficulties with electronic record systems, rigid management structures, competing priorities, and parental resistance. Facilitators included linkage with regional immunization registries, positive social interactions, and performance feedback. Findings suggest that improving immunization delivery requires not only awareness of recommendations and training in improvement methods but also efforts to ameliorate contextual factors that impede immunization delivery. PMID:26743455

  19. Great Service Pays: A Model for Service Delivery in an Academic Music Library

    ERIC Educational Resources Information Center

    Wilson, Andrew M.

    2007-01-01

    Special-subject libraries can be particularly intimidating for casual and seasoned patrons alike. Music libraries, with their variety of materials, formats, and vocabularies, can present particular challenges for the user. With this proposal for a model of service delivery, as well as many tips gained through experience working the front-of-house…

  20. Rethinking Library Service: Improving the User Experience with Service Blueprinting

    ERIC Educational Resources Information Center

    Pretlow, Cassi; Sobel, Karen

    2015-01-01

    Service blueprinting is a process that businesses use for analyzing and improving service. Originally presented in the Harvard Business Review in 1984, it has retained a strong following ever since. At present, it is experiencing a revival at numerous academic institutions. The authors of this article present the process of service blueprinting.…

  1. Customer's Perceptions and Intentions on Online Travel Service Delivery: An Empirical Study in China

    NASA Astrophysics Data System (ADS)

    Li, Hongxiu; Suomi, Reima

    With the wide adoption of e-commerce in travel and tourism industry, the Internet has become an important travel service delivery channel, and traditional travel agency has been under severe disintermediation threat. This paper reports on a survey conducted to explore the Chinese consumer's current usage of the Internet as the channel to search travel information and to book travel services. It also investigates customer's future intentions on using the Internet to book travel services. This paper aims to examine whether there are difference between different consumer segments in terms of gender and age, and to find the hypothesis of disintermediation or intermediation in travel industry. The results indicates that online travel service delivery has grown as a popular direct distribution channel in travel industry, but more of the customers still turn to the traditional travel agencies, which support both the disintermediation and intermediation in travel industry. The results also reveal that online travel services provided by travel service providers still need to be improved since the number of online bookers is declined. This paper concludes by discussing the limitation of this study and highlighting areas for the future research in online travel service field.

  2. Improving drug delivery to solid tumors: priming the tumor microenvironment.

    PubMed

    Khawar, Iftikhar Ali; Kim, Jung Ho; Kuh, Hyo-Jeong

    2015-03-10

    Malignant transformation and growth of the tumor mass tend to induce changes in the surrounding microenvironment. Abnormality of the tumor microenvironment provides a driving force leading not only to tumor progression, including invasion and metastasis, but also to acquisition of drug resistance, including pharmacokinetic (drug delivery-related) and pharmacodynamic (sensitivity-related) resistance. Drug delivery systems exploiting the enhanced permeability and retention (EPR) effect and active targeting moieties were expected to be able to cope with delivery-related drug resistance. However, recent evidence supports a considerable barrier role of tumors via various mechanisms, which results in imperfect or inefficient EPR and/or targeting effect. The components of the tumor microenvironment such as abnormal tumor vascular system, deregulated composition of the extracellular matrix, and interstitial hypertension (elevated interstitial fluid pressure) collectively or cooperatively hinder the drug distribution, which is prerequisite to the efficacy of nanoparticles and small-molecule drugs used in cancer medicine. Hence, the abnormal tumor microenvironment has recently been suggested to be a promising target for the improvement of drug delivery to improve therapeutic efficacy. Strategies to modulate the abnormal tumor microenvironment, referred to here as "solid tumor priming" (vascular normalization and/or solid stress alleviation leading to improvement in blood perfusion and convective molecular movement), have shown promising results in the enhancement of drug delivery and anticancer efficacy. These strategies may provide a novel avenue for the development of new chemotherapeutics and combination chemotherapeutic regimens as well as reassessment of previously ineffective agents. PMID:25526702

  3. Improving Child Protection Services to Children under Ten Who Display Sexually Reactive Behaviors.

    ERIC Educational Resources Information Center

    Verstraete, Patricia A.

    This practicum was designed to improve Child Protective Services in a western state to sexually reactive children under the age of 10 by targeting four areas of the service delivery system: screening, assessment, treatment, and foster care. A panel of agency staff from all service areas researched, designed, proposed, and implemented changes…

  4. Telerehabilitation for service delivery in speech-language pathology.

    PubMed

    Theodoros, Deborah G

    2008-01-01

    Communication disorders in adults and children can have a significant effect on their quality of life and on that of their families. Speech-language pathologists face several challenges in providing assessment and treatment services to such people. Challenges include facilitating equitable access to services and providing appropriate management within a changing social and economic context. Telerehabilitation has the potential to deliver services in the home or local community via videoconferencing and through interactive computer-based therapy activities. This form of service delivery has the capacity to optimize functional outcomes by facilitating generalization of treatment effects within the person's everyday environment, and enable monitoring of communication and swallowing behaviours on a long-term basis. A number of image-based telerehabilitation applications have been used in the management of adult neurogenic speech and language disorders, stuttering, voice disorders, speech and language disorders in children, laryngectomy and swallowing dysfunction. Further development of such applications and other computer-based therapies, cost-benefit and cost-effectiveness analyses, and professional education are needed if telerehabilitation is to become an integral part of speech-language pathology practice. PMID:18632993

  5. Nanoemulsion: for improved oral delivery of repaglinide.

    PubMed

    Akhtar, Juber; Siddiqui, Hefazat Hussain; Fareed, Sheeba; Badruddeen; Khalid, Mohammad; Aqil, Mohammed

    2016-07-01

    Repaglinide (RPG) is a fast-acting prandial glucose regulator. It acts by stimulating insulin release from pancreatic β-cells. Recurrent dosing of RPG before each meal is burdensome remedy. Hence the plan of the present study was to evaluate nanoemulsion as a hopeful carrier for RPG for persistent hypoglycemic effect. The drug was incorporated into oil phase of nanoemulsion to give improved biopharmaceutical properties as compared to the lipid-based systems. Pseudo ternary phase diagrams were prepared by aqueous titration method. Formulations were selected at a difference of 5% w/w of oil from the o/w nanoemulsion region of phase diagrams. The optimized nanoemulsion formulation constituted sefsol-218 (5% v/v) as an oil phase, 30% v/v of Tween-80 and transcutol as a surfactant and co-surfactant to restrain nanodroplet size and low viscosity and distilled water (65%). In vitro dissolution studies showed higher drug release (98.22%), finest droplet size (76.23 nm), slightest polydispersity value (0.183), least viscosity (21.45 cps) and immeasurable dilution capability from the nanoemulsion as compared with existing oral tablet formulation. The optimized RPG nanoemulsion formulation showed better hypoglycemic effect in comparison to tablet formulation in experimental diabetic rats. No significant variations were also observed in the optimized formulation when subjected to accelerated stability study at different temperature and relative humidity over a period of 3 months. PMID:27187792

  6. 45 CFR 50.5 - Waivers for the delivery of health care service.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Waivers for the delivery of health care service. 50.5 Section 50.5 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION U.S... for the delivery of health care service. In determining whether to request a waiver for an...

  7. 45 CFR 50.5 - Waivers for the delivery of health care service.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 1 2012-10-01 2012-10-01 false Waivers for the delivery of health care service. 50.5 Section 50.5 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION U.S... for the delivery of health care service. In determining whether to request a waiver for an...

  8. 45 CFR 50.5 - Waivers for the delivery of health care service.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 1 2013-10-01 2013-10-01 false Waivers for the delivery of health care service. 50.5 Section 50.5 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION U.S... for the delivery of health care service. In determining whether to request a waiver for an...

  9. 77 FR 2340 - Advisory Committee on International Postal and Delivery Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-17

    ... Committee on International Postal and Delivery Services AGENCY: Department of State. ACTION: Notice of... the renewal of the charter of the Advisory Committee on International Postal and Delivery Services in... oversight of foreign policy related to international postal services and other international...

  10. Legal and Jurisdictional Problems in the Delivery of SRS Child Welfare Services on Indian Reservations.

    ERIC Educational Resources Information Center

    Baumheier, Edward C.; And Others

    Due to various factors, legal and jurisdictional issues often hinder the administration and delivery of Social and Rehabilitation Service (SRS) services on reservations. Focusing on child welfare programs, legal and jurisdictional problems concerning the delivery of SRS services on reservations and the means of coping with them were explored…

  11. Continue Service Improvement at CERN Computing Centre

    NASA Astrophysics Data System (ADS)

    Barroso Lopez, M.; Everaerts, L.; Meinhard, H.; Baehler, P.; Haimyr, N.; Guijarro, J. M.

    2014-06-01

    Using the framework of ITIL best practises, the service managers within CERN-IT have engaged into a continuous improvement process, mainly focusing on service operation. This implies an explicit effort to understand and improve all service management aspects in order to increase efficiency and effectiveness. We will present the requirements, how they were addressed and share our experiences. We will describe how we measure, report and use the data to continually improve both the processes and the services being provided. The focus is not the tool or the process, but the results of the continuous improvement effort from a large team of IT experts providing services to thousands of users, supported by the tool and its local team. This is not an initiative to address user concerns in the way the services are managed but rather an on-going working habit of continually reviewing, analysing and improving the service management processes and the services themselves, having in mind the currently agreed service levels and whose results also improve the experience of the users about the current services.

  12. Interventions to improve delivery of isoniazid preventive therapy: an overview of systematic reviews

    PubMed Central

    2014-01-01

    Background Uptake of isoniazid preventive therapy (IPT) to prevent tuberculosis has been poor, particularly in the highest risk populations. Interventions to improve IPT delivery could promote implementation. The large number of existing systematic reviews on treatment adherence has made drawing conclusions a challenge. To provide decision makers with the evidence they need, we performed an overview of systematic reviews to compare different organizational interventions to improve IPT delivery as measured by treatment completion among those at highest risk for the development of TB disease, namely child contacts or HIV-infected individuals. Methods We searched the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (DARE), and MEDLINE up to August 15, 2012. Two authors used a standardized data extraction form and the AMSTAR instrument to independently assess each review. Results Six reviews met inclusion criteria. Interventions included changes in the setting/site of IPT delivery, use of quality monitoring mechanisms (e.g., directly observed therapy), IPT delivery integration into other healthcare services, and use of lay health workers. Most reviews reported a combination of outcomes related to IPT adherence and treatment completion rate but without a baseline or comparison rate. Generally, we found limited evidence to demonstrate that the studied interventions improved treatment completion. Conclusions While most of the interventions were not shown to improve IPT completion, integration of tuberculosis and HIV services yielded high treatment completion rates in some settings. The lack of data from high burden TB settings limits applicability. Further research to assess different IPT delivery interventions, including those that address barriers to care in at-risk populations, is urgently needed to identify the most effective practices for IPT delivery and TB control in high TB burden settings. PMID:24886159

  13. Recommendations for Improving Intervener Services

    ERIC Educational Resources Information Center

    National Consortium on Deaf-Blindness, 2012

    2012-01-01

    The U.S. Department of Education's Office of Special Education Programs (OSEP) recognizes the current challenges faced by states and schools relative to the provision of high-quality intervener services for children who are deaf-blind. To respond to these challenges, OSEP asked the National Consortium on Deaf-Blindness (NCDB) to conduct an…

  14. Scheduled vs. on-demand service for a fast package delivery system

    NASA Astrophysics Data System (ADS)

    Martin, Jared; Palmer, Kurt; Chan, Martin; Karasi, Anand; Glas, Dylan

    1999-01-01

    Fast Package Delivery refers to the transportation of freight over transpacific distances in a period of hours, and provides opportunity for synergistic development with reusable launch vehicle and HSCT technologies. Previous analyses of this topic have not recognized the bifurcation in the market and system requirements of a Fast Package Delivery service. This market is dichotomized as scheduled service, for less urgent items, operating similar to existing delivery services, and on-demand service, a charter type system for extremely time-sensitive commodities such as assembly line parts. Each of these solutions to the Fast Package Delivery issue has different market and system characteristics.

  15. Alternate Service Delivery Models in Cancer Genetic Counseling: A Mini-Review.

    PubMed

    Buchanan, Adam Hudson; Rahm, Alanna Kulchak; Williams, Janet L

    2016-01-01

    Demand for cancer genetic counseling has grown rapidly in recent years as germline genomic information has become increasingly incorporated into cancer care, and the field has entered the public consciousness through high-profile celebrity publications. Increased demand and existing variability in the availability of trained cancer genetics clinicians place a priority on developing and evaluating alternate service delivery models for genetic counseling. This mini-review summarizes the state of science regarding service delivery models, such as telephone counseling, telegenetics, and group counseling. Research on comparative effectiveness of these models in traditional individual, in-person genetic counseling has been promising for improving access to care in a manner acceptable to patients. Yet, it has not fully evaluated the short- and long-term patient- and system-level outcomes that will help answer the question of whether these models achieve the same beneficial psychosocial and behavioral outcomes as traditional cancer genetic counseling. We propose a research agenda focused on comparative effectiveness of available service delivery models and how to match models to patients and practice settings. Only through this rigorous research can clinicians and systems find the optimal balance of clinical quality, ready and secure access to care, and financial sustainability. Such research will be integral to achieving the promise of genomic medicine in oncology. PMID:27242960

  16. Alternate Service Delivery Models in Cancer Genetic Counseling: A Mini-Review

    PubMed Central

    Buchanan, Adam Hudson; Rahm, Alanna Kulchak; Williams, Janet L.

    2016-01-01

    Demand for cancer genetic counseling has grown rapidly in recent years as germline genomic information has become increasingly incorporated into cancer care, and the field has entered the public consciousness through high-profile celebrity publications. Increased demand and existing variability in the availability of trained cancer genetics clinicians place a priority on developing and evaluating alternate service delivery models for genetic counseling. This mini-review summarizes the state of science regarding service delivery models, such as telephone counseling, telegenetics, and group counseling. Research on comparative effectiveness of these models in traditional individual, in-person genetic counseling has been promising for improving access to care in a manner acceptable to patients. Yet, it has not fully evaluated the short- and long-term patient- and system-level outcomes that will help answer the question of whether these models achieve the same beneficial psychosocial and behavioral outcomes as traditional cancer genetic counseling. We propose a research agenda focused on comparative effectiveness of available service delivery models and how to match models to patients and practice settings. Only through this rigorous research can clinicians and systems find the optimal balance of clinical quality, ready and secure access to care, and financial sustainability. Such research will be integral to achieving the promise of genomic medicine in oncology. PMID:27242960

  17. Mental Health and Service Delivery Systems for Black Women.

    ERIC Educational Resources Information Center

    Smith, Elsie H.

    1981-01-01

    Examines mental health issues, especially alcoholism, suicide, and social depression, related to the counseling of Black women. Recommends improved mental health services, counselor/clinical training programs, and additional research focusing on the causes of stress among Black women. (Author/MW)

  18. Health workforce governance: Processes, tools and actors towards a competent workforce for integrated health services delivery.

    PubMed

    Barbazza, Erica; Langins, Margrieta; Kluge, Hans; Tello, Juan

    2015-12-01

    A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance. To aid health system stewards in their governing role, this review seeks to provide an overview of processes, tools and actors for strengthening health workforce competencies. It draws from a purposive and multidisciplinary review of literature, expert opinion and country initiatives across the WHO European Region's 53 Member States. Through our analysis, we observe distinct yet complementary roles can be differentiated between health services delivery and the health system. This understanding is a necessary prerequisite to gain deeper insight into the specificities for strengthening health workforce competencies in order for governance to rightly create the institutional environment called for to foster alignment. Differentiating between the contribution of health services and the health system in the strengthening of health workforce competencies is an important distinction for achieving and sustaining health improvement goals. PMID:26489924

  19. Improving delivery of primary care for vulnerable migrants

    PubMed Central

    Pottie, Kevin; Batista, Ricardo; Mayhew, Maureen; Mota, Lorena; Grant, Karen

    2014-01-01

    Abstract Objective To identify and prioritize innovative strategies to address the health concerns of vulnerable migrant populations. Design Modified Delphi consensus process. Setting Canada. Participants Forty-one primary care practitioners, including family physicians and nurse practitioners, who provided care for migrant populations. Methods We used a modified Delphi consensus process to identify and prioritize innovative strategies that could potentially improve the delivery of primary health care for vulnerable migrants. Forty-one primary care practitioners from various centres across Canada who cared for migrant populations proposed strategies and participated in the consensus process. Main findings The response rate was 93% for the first round. The 3 most highly ranked practice strategies to address delivery challenges for migrants were language interpretation, comprehensive interdisciplinary care, and evidence-based guidelines. Training and mentorship for practitioners, intersectoral collaboration, and immigrant community engagement ranked fourth, fifth, and sixth, respectively, as strategies to address delivery challenges. These strategies aligned with strategies coming out of the United States, Europe, and Australia, with the exception of the proposed evidence-based guidelines. Conclusion Primary health care practices across Canada now need to evolve to address the challenges inherent in caring for vulnerable migrants. The selected strategies provide guidance for practices and health systems interested in improving health care delivery for migrant populations. PMID:24452576

  20. Global Document Delivery, User Studies, and Service Evaluation: The Gateway Experience

    ERIC Educational Resources Information Center

    Miller, Rush; Xu, Hong; Zou, Xiuying

    2008-01-01

    This study examines user and service data from 2002-2006 at the East Asian Gateway Service for Chinese and Korean Academic Journal Publications (Gateway Service), the University of Pittsburgh. Descriptive statistical analysis reveals that the Gateway Service has been consistently playing the leading role in global document delivery service as well…

  1. Interagency Cooperation--An Investigation of Human Service Agencies Collaboration in the Delivery of Services and Amenities to Rural Citizens in Clinton County New York.

    ERIC Educational Resources Information Center

    Gore, Jane S.; Nelson, Helen Y.

    Assuming that one way to meet the needs and to improve the delivery of services and amenities to isolated rural citizens is through increased interagency collaboration, an obective of this research was to explore stimuli and deterrents to such cooperative efforts. Thirty organizations (23 public groups, 4 private non-profit, and 3 private) serving…

  2. Look Through Patients' Eyes to Improve the Delivery of Care.

    PubMed

    2016-07-01

    By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction. Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes. Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right. The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures. PMID:27434940

  3. Closed-loop insulin delivery: towards improved diabetes care.

    PubMed

    Kumareswaran, Kavita; Evans, Mark L; Hovorka, Roman

    2012-02-01

    The prevalence of type 1 diabetes is escalating worldwide. Novel therapies and management strategies are needed to reduce associated morbidity. Aggressive blood glucose lowering using conventional insulin replacement regimens is limited by the risk of hypoglycemia. Even the most motivated patients may struggle to manage day-to-day variability in insulin requirements. The artificial pancreas or closed-loop insulin delivery may improve outcomes, building on recent technological progress and combining continuous glucose monitoring with insulin pump therapy. So far, closed-loop prototypes have been evaluated under controlled conditions suggesting improved glucose control and a reduced risk of hypoglycemia. Limitations include suboptimal accuracy and reliability of continuous glucose monitors and delays associated with subcutaneous insulin delivery. Outpatient evaluation is required as the next step, leading to deployment into clinical practice. PMID:22369975

  4. Overcoming cellular and tissue barriers to improve liposomal drug delivery

    NASA Astrophysics Data System (ADS)

    Kohli, Aditya G.

    Forty years of liposome research have demonstrated that the anti-tumor efficacy of liposomal therapies is, in part, driven by three parameters: 1) liposome formulation and lipid biophysics, 2) accumulation and distribution in the tumor, and 3) release of the payload at the site of interest. This thesis outlines three studies that improve on each of these delivery steps. In the first study, we engineer a novel class of zwitterlipids with an inverted headgroup architecture that have remarkable biophysical properties and may be useful for drug delivery applications. After intravenous administration, liposomes accumulate in the tumor by the enhanced permeability and retention effect. However, the tumor stroma often limits liposome efficacy by preventing distribution into the tumor. In the second study, we demonstrate that depletion of hyaluronan in the tumor stroma improves the distribution and efficacy of DoxilRTM in murine 4T1 tumors. Once a liposome has distributed to the therapeutic site, it must release its payload over the correct timescale. Few facile methods exist to quantify the release of liposome therapeutics in vivo. In the third study, we outline and validate a simple, robust, and quantitative method for tracking the rate and extent of release of liposome contents in vivo. This tool should facilitate a better understanding of the pharmacodynamics of liposome-encapsulated drugs in animals. This work highlights aspects of liposome behavior that have prevented successful clinical translation and proposes alternative approaches to improve liposome drug delivery.

  5. Systematic Collective Action To Improve Media Services in a High School Library.

    ERIC Educational Resources Information Center

    McLellan, Francis R.

    This practicum was designed to improve a high school education media center through systematic collective action. The goal was to improve delivery of education media services by: (1) improving material conditions; (2) developing collaboration between education media specialists and academic teachers; and (3) involvement of the entire learning…

  6. Expanding services in a shrinking economy: desktop document delivery in a dental school library

    PubMed Central

    Gushrowski, Barbara A

    2011-01-01

    Question: How can library staff develop and promote a document delivery service and then expand the service to a wide audience? Setting: The setting is the library at the Indiana University School of Dentistry (IUSD), Indianapolis. Method: A faculty survey and a citation analysis were conducted to determine potential use of the service. Volume of interlibrary loan transactions and staff and equipment capacity were also studied. Main results: IUSD Library staff created a desktop delivery service (DDSXpress) for faculty and then expanded the service to practicing dental professionals and graduate students. The number of faculty using DDSXpress remains consistent. The number of practicing dental professionals using the service is low. Graduate students have been quick to adopt the service. Conclusion: Through careful analysis of capacity and need for the service, staff successfully expanded document delivery service without incurring additional costs. Use of DDSXpress is continually monitored, and opportunities to market the service to practicing dental professionals are being investigated. PMID:21753911

  7. General service incandescent lamp with improved efficiency

    SciTech Connect

    Berlec, I.

    1985-06-18

    A high efficiency general service incandescent lamp is disclosed. The disclosed improved general service incandescent lamp has an outer and an inner envelope. The inner envelope has a relatively small housing containing a halogen gas and a relatively high pressure efficient fill-gas and in which a low voltage filament is spatially disposed therein.

  8. Improving Service Management in Campus IT Operations

    ERIC Educational Resources Information Center

    Wan, Stewart H. C.; Chan, Yuk-Hee

    2008-01-01

    Purpose: This paper aims at presenting the benefits from implementing IT service management (ITSM) in an organization for managing campus-wide IT operations. In order to improve the fault correlation from business perspectives, we proposed a framework to automate network and system alerts with respect to its business service impact for proactive…

  9. Controlled Delivery of Zoledronate Improved Bone Formation Locally In Vivo

    PubMed Central

    Peng, Jiang; Lu, Qiang; Wang, Yu; Wang, Aiyuan; Guo, Quanyi; Gao, Xupeng; Xu, Wenjing; Lu, Shibi

    2014-01-01

    Bisphosphonates (BPs) have been widely used in clinical treatment of bone diseases with increased bone resorption because of their strong affinity for bone and their inhibition of bone resorption. Recently, there has been growing interest in their improvement of bone formation. However, the effect of local controlled delivery of BPs is unclear. We used polylactide acid-glycolic acid copolymer (PLGA) as a drug carrier to deliver various doses of the bisphosphonate zoledronate (Zol) into the distal femur of 8-week-old Sprague-Dawley rats. After 6 weeks, samples were harvested and analyzed by micro-CT and histology. The average bone mineral density and mineralized bone volume fraction were higher with medium- and high-dose PLGA-Zol (30 and 300 µg Zol, respectively) than control and low-dose Zol (3 µg PLGA-Zol; p<0.05). Local controlled delivery of Zol decreased the numbers of osteoclast and increased the numbers of osteoblast. Moreover, local controlled delivery of medium- and high-dose Zol accelerated the expression of bone-formation markers. PLGA used as a drug carrier for controlled delivery of Zol may promote local bone formation. PMID:24618585

  10. The Whole PIC Catalog: Organization, Planning and Service Delivery Options under JTPA.

    ERIC Educational Resources Information Center

    National Alliance of Business, Inc., Washington, DC.

    This handbook illustrates and discusses organizational options for the delivery of employment and training services within service delivery areas (SDAs) mandated by the Job Training Partnership Act (JTPA) of 1982. Addressed primarily to members of private industry councils (PICs), representatives of local governments, and employment and training…

  11. Opening the Black Box: Exploring the Effect of Transformation on Online Service Delivery in Local Governments

    NASA Astrophysics Data System (ADS)

    van Veenstra, Anne Fleur; Zuurmond, Arre

    To enhance the quality of their online service delivery, many government organizations seek to transform their organization beyond merely setting up a front office. This transformation includes elements such as the formation of service delivery chains, the adoption of a management strategy supporting process orientation and the implementation of enterprise architecture. This paper explores whether undertaking this transformation has a positive effect on the quality of online service delivery, using data gathered from seventy local governments. We found that having an externally oriented management strategy in place, adopting enterprise architecture, aligning information systems to business and sharing activities between processes and departments are positively related to the quality of online service delivery. We recommend that further research should be carried out to find out whether dimensions of organizational development too have an effect on online service delivery in the long term.

  12. The role of short messaging service in supporting the delivery of healthcare: An umbrella systematic review.

    PubMed

    Househ, Mowafa

    2016-06-01

    Short messaging service (SMS) messages may present a convenient and cost-effective method to support healthcare interventions. This work assesses the effects of short messaging service on various healthcare interventions found in systematic reviews. The search strategy was based on two key concepts: short messaging service and healthcare delivery. The initial search was conducted in December 2012 and was updated in June 2013. Of the 550 identified references, 13 systematic reviews met the inclusion criteria, of which 8 were published in peer-reviewed journals and 5 were retrieved from the Cochrane library. Data analysis shows that low to moderate research evidence exists on the benefits of short messaging service interventions for appointment reminders, promoting health in developing countries and preventive healthcare. In many interventions, however, there were a few studies that were of high quality, and most of the studies were rated from low to moderate quality or had no rating at all. Healthcare organizations, policy makers, or clinicians using short messaging service messages to support healthcare interventions should (1) implement interventions that have been found to work in healthcare settings, (2) continue evaluating short messaging service interventions that have not been adequately assessed, and (3) improve collaboration between various healthcare entities to develop studies targeted at specific populations to evaluate the long-term impact of short messaging service on healthcare outcomes. PMID:25038203

  13. 76 FR 4726 - Avaya Global Services, AOS Service Delivery, Worldwide Services Group, Including Workers Whose...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-26

    .... The notice was published in the Federal Register on November 8, 2010 (75 FR 68622). At the request of... workers are related to the supply of service desk/help desk services providing the first level...

  14. Using a Transdisciplinary Service Delivery Model to Increase Parental Involvement with Special Education Students

    ERIC Educational Resources Information Center

    Cross, Robert J.

    2007-01-01

    Too often special education services are provided in a piece-by-piece fashion with individual support staff members each scheduling service to the child once or twice a week. Travel time and case-load numbers prohibit getting significant service time and frequency to the student. The literature suggests that transdisciplinary service delivery is…

  15. Strengthening district health service management and delivery through internal contracting: lessons from pilot projects in Cambodia.

    PubMed

    Khim, Keovathanak; Annear, Peter Leslie

    2013-11-01

    Following a decade of piloting different models of contracting, in mid-2009 the Cambodian Ministry of Health began to test a form of 'internal contracting' for health care delivery in selected health districts (including hospitals and health centers) contracted by the provincial health department as Special Operating Agencies (SOAs) and provided with greater management autonomy. This study assesses the internal contracting approach as a means for improving the management of district health services and strengthening service delivery. While the study may contribute to the emerging field now known as performance-based financing, the lessons deal more broadly with the impact of management reform and increased autonomy in contrast to traditional public sector line-management and budgeting. Carried out during 2011, the study was based on: (i) a review of the literature and of operational documents; (ii) primary data from semi-structured key informant interviews with 20 health officials in two provinces involved in four SOA pilot districts; and (iii) routine data from the 2011 SOA performance monitoring report. Five prerequisites were identified for effective contract management and improved service delivery: a clear understanding of roles and responsibilities by the contracting parties; implementation of clear rules and procedures; effective management of performance; effective monitoring of the contract; and adequate and timely provision of resources. Both the level and allocation of incentives and management bottlenecks at various levels continue to impede implementation. We conclude that, in contracted arrangements like these, the clear separation of contracting functions (purchasing, commissioning, monitoring and regulating), management autonomy where responsibilities are genuinely devolved and accepted, and the provision of resources adequate to meet contract demands are necessary conditions for success. PMID:23489889

  16. Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana

    PubMed Central

    D'Ambruoso, Lucia; Abbey, Mercy; Hussein, Julia

    2005-01-01

    Background This study was undertaken to investigate women's accounts of interactions with health care providers during labour and delivery and to assess the implications for acceptability and utilisation of maternity services in Ghana. Methods Twenty-one individual in-depth interviews and two focus group discussions were conducted with women of reproductive age who had delivered in the past five years in the Greater Accra Region. The study investigated women's perceptions and experiences of care in terms of factors that influenced place of delivery, satisfaction with services, expectations of care and whether they would recommend services. Results One component of care which appeared to be of great importance to women was staff attitudes. This factor had considerable influence on acceptability and utilisation of services. Otherwise, a successful labour outcome and non-medical factors such as cost, perceived quality of care and proximity of services were important. Our findings indicate that women expect humane, professional and courteous treatment from health professionals and a reasonable standard of physical environment. Women will consciously change their place of delivery and recommendations to others if they experience degrading and unacceptable behaviour. Conclusion The findings suggest that inter-personal aspects of care are key to women's expectations, which in turn govern satisfaction. Service improvements which address this aspect of care are likely to have an impact on health seeking behaviour and utilisation. Our findings suggest that user-views are important and warrant further investigation. The views of providers should also be investigated to identify channels by which service improvements, taking into account women's views, could be operationalised. We also recommend that interventions to improve delivery care should not only be directed to the health professional, but also to general health system improvements. PMID:16372911

  17. The Leadership Role in Transitioning an Urban Secondary School from a Traditional Service Delivery Model to a Co-Teaching Service Delivery Model for Students with Disabilities: A Phenomenological Case Study

    ERIC Educational Resources Information Center

    McDonald, Ginni E.

    2013-01-01

    This research studies the leadership role in transitioning from a traditional service delivery model to a co-teaching service delivery model for students with disabilities. While there is an abundant amount of information on the service delivery model of co-teaching, sustaining co-teaching programs, and effective co-teaching programs for students…

  18. Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach

    PubMed Central

    2012-01-01

    Background The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes. The study was conducted in six provinces in the Republic of Kenya. Methods The study used a non-randomized design comparing measures of key service delivery indicators addressed by health teams receiving leadership and management training (the intervention) against measures in comparison areas not receiving the intervention. Measurements were taken at three time periods: baseline, endline, and approximately six months post intervention. At the district level, health-service coverage was computed. At the facility level, the percentage change in the number of client visits was computed. The t-test was used to test for significance. Results Results showed significant increases in health-service coverage at the district level (p = <0.05) in the intervention teams compared to the comparison teams. Similarly, there were significant increases in the number of client visits at the facility level in the intervention group versus comparison facilities (P < 0.05). Conclusions Strengthening the leadership and management skills of health teams, through team-based approaches focused on selected challenges, contributed to improved health service delivery outcomes and these improvements were sustained at least for six months. PMID:22931468

  19. Controlled Delivery of FK506 to Improve Nerve Regeneration.

    PubMed

    Labroo, Pratima; Ho, Scott; Sant, Himanshu; Shea, Jill; Gale, Bruce K; Agarwal, Jay

    2016-09-01

    Autologous nerve grafts are the current "gold standard" for repair of large nerve gaps. However, they cause morbidity at the donor nerve site, only a limited amount of nerve can be harvested, and there is the potential for mismatches in size and fascicular patterns between the nerve stumps and the graft. Nerve conduits are a promising alternative to autografts and can act as guidance cues for the regenerating axons and allow for tension free bridging, without the need to harvest donor nerve. Separately, FK506, and FDA-approved small molecule, has been shown to enhance axon growth and peripheral nerve regeneration. This article describes the design of a novel drug delivery apparatus integrated with a poly lactic-co-glycolic acid (PLGA)-based nerve guide conduit for controlled local delivery of FK506. An FK506 dosage curve was acquired to determine the minimum in vitro concentration for optimal axonal outgrowth of dorsal root ganglion (DRG) cells, then PLGA devices were designed and tested in a diffusion chamber, and finally the bioactivity of the released media was evaluated by measuring axon growth in DRG cells exposed to the media for 72 h. The combined drug delivery nerve guide was able to release FK506 for 20 days at concentrations (1-20 ng/mL) that were shown to enhance DRG axon growth. Furthermore, the released FK506 was bioactive and able to enhance DRG axon growth. The combined drug delivery nerve guide can release FK506 for extended periods of time and enhance axon growth, and has the potential to improve nerve regeneration after a peripheral nerve injury. PMID:27058050

  20. Evaluating and improving neonatal transport services.

    PubMed

    Ratnavel, Nandiran

    2013-11-01

    Interfacility transport is a necessary part of hospital care. Neonates often need to access specialist input at different sites necessitating a reliable transfer process. Services have evolved significantly over the last ten years to meet this need. This followed the recognition that ad hoc arrangements were unreliable and often unsafe. Services have significantly improved during this time. Attention has been paid to training, clinical governance, disseminating best practice, setting standards, ring fenced funding and supporting parents. Transport teams have become integral to neonatal network function and quality and performance of transport services needs to be evaluated. National audit creates useful team comparisons and identifies outlier status allowing closer inspection of variations between services. Work is needed in the form of external appraisal in order to maintain service standards. PMID:24094330

  1. Improving P2P live-content delivery using SVC

    NASA Astrophysics Data System (ADS)

    Schierl, T.; Sánchez, Y.; Hellge, C.; Wiegand, T.

    2010-07-01

    P2P content delivery techniques for video transmission have become of high interest in the last years. With the involvement of client into the delivery process, P2P approaches can significantly reduce the load and cost on servers, especially for popular services. However, previous studies have already pointed out the unreliability of P2P-based live streaming approaches due to peer churn, where peers may ungracefully leave the P2P infrastructure, typically an overlay networks. Peers ungracefully leaving the system cause connection losses in the overlay, which require repair operations. During such repair operations, which typically take a few roundtrip times, no data is received from the lost connection. While taking low delay for fast-channel tune-in into account as a key feature for broadcast-like streaming applications, the P2P live streaming approach can only rely on a certain media pre-buffer during such repair operations. In this paper, multi-tree based Application Layer Multicast as a P2P overlay technique for live streaming is considered. The use of Flow Forwarding (FF), a.k.a. Retransmission, or Forward Error Correction (FEC) in combination with Scalable video Coding (SVC) for concealment during overlay repair operations is shown. Furthermore the benefits of using SVC over the use of AVC single layer transmission are presented.

  2. Micro-fractional epidermal powder delivery for improved skin vaccination

    PubMed Central

    Chen, Xinyuan; Kositratna, Garuna; Zhou, Chang; Manstein, Dieter; Wu, Mei X.

    2014-01-01

    Skin vaccination has gained increasing attention in the last two decades due to its improved potency compared to intramuscular vaccination. Yet, the technical difficulty and frequent local reactions hamper its broad application in the clinic. In the current study, micro-fractional epidermal powder delivery (EPD) is developed to facilitate skin vaccination and minimize local adverse effects. EPD is based on ablative fractional laser or microneedle treatment of the skin to generate microchannel (MC) arrays in the epidermis followed by topical application of powder drug/vaccine-coated array patches to deliver drug/vaccine into the skin. The novel EPD delivered more than 80% sulforhodamine b (SRB) and model antigen ovalbumin (OVA) into murine, swine, and human skin within 1 hour. EPD of OVA induced anti-OVA antibody titer at a level comparable to intradermal (ID) injection and was much more efficient than tape stripping in both delivery efficiency and immune responses. Strikingly, the micro-fractional delivery significantly reduced local side effects of LPS/CpG adjuvant and BCG vaccine, leading to complete skin recovery. In contrast, ID injection induced severe local reactions that persisted for weeks. While reducing local reactogenicity, EPD of OVA/LPS/CpG and BCG vaccine generated a comparable humoral immune response to ID injection. EPD of vaccinia virus encoding OVA induced significantly higher and long-lasting interferon γ-secreting CD8+ T cells than ID injection. In conclusion, EPD represents a promising technology for needle-free, painless skin vaccination with reduced local reactogenicity and improved immunogenicity. PMID:25135790

  3. Perspectives of HIV agencies on improving HIV prevention, treatment, and care services in the USA.

    PubMed

    Khosla, Nidhi; Zachary, Iris

    2016-10-01

    HIV healthcare services in the USA are made available through a complex funding and delivery system. We present perspectives of HIV agencies on improvements that could lead to an ideal system of HIV prevention, treatment and care. We conducted semi-structured interviews with representatives from 21 HIV agencies offering diverse services in Baltimore, MD. Thematic analysis revealed six key themes: (1) Focusing on HIV prevention, (2) Establishing common entry-points for services, (3) Improving information availability, (4) Streamlining funding streams, (5) Removing competitiveness and (6) Building trust. We recommend that in addition to addressing operational issues regarding service delivery and patient care, initiatives to improve HIV service systems should address underlying social issues such as building trust. PMID:26875546

  4. Patient Satisfaction with Methadone Maintenance Treatment in Vietnam: A Comparison of Different Integrative-Service Delivery Models

    PubMed Central

    Tran, Bach Xuan; Nguyen, Long Hoang; Phan, Huong Thu Thi; Latkin, Carl A.

    2015-01-01

    Background Patient satisfaction is an important component of quality in healthcare delivery. To inform the expansion of Methadone Maintenance Treatment (MMT) services in Vietnam, we examined the satisfaction of patients with regards to different services delivery models and identified its associated factors. Methods We interviewed 1,016 MMT patients at 5 clinics in Hanoi and Nam Dinh province. The modified SATIS instrument, a 10-item scale, was used to measure three dimensions: “Services quality and convenience”, “Health workers’ capacity and responsiveness” and “Inter-professional care”. Results The average score was high across three SATIS dimensions. However, only one third of patients completely satisfied with general health services and treatment outcomes. Older age, higher education, having any problem in self-care and anxiety/depression were negatively associated with patient’s satisfaction. Meanwhile, patients receiving MMT at clinics, where more comprehensive HIV and general health care services were available, were more likely to report a complete satisfaction. Conclusion Patients were highly satisfied with MMT services in Vietnam. However, treatment for drug users should go beyond methadone maintenance to address complicated health demands of drug users. Integrating MMT with comprehensive HIV and general health services together with improving the capacity of health workers and efficiency of services organisation to provide interconnected health care for drug users are critical for improving the outcomes of the MMT program. PMID:26556036

  5. Improved Biochemical Strategies for Targeted Delivery of Taxoids

    PubMed Central

    Ganesh, Thota

    2008-01-01

    Paclitaxel (Taxol ®) and docetaxel (Taxotere ®) are very important anti-tumor drugs in clinical use for cancer. However, their clinical utility is limited due to systemic toxicity, low solubility and inactivity against drug resistant tumors. To improve chemotherapeutic levels of these drugs, it would be highly desirable to design strategies which bypass the above limitations. In this respect various prodrug and drug targeting strategies have been envisioned either to improve oral bioavailability or tumor specific delivery of taxoids. Abnormal properties of cancer cells with respect to normal cells have guided in designing of these protocols. This review article records the designed biochemical strategies and their biological efficacies as potential taxoid chemotherapeutics. PMID:17419065

  6. A Relational Goal-Oriented Model of Optimal Service Delivery to Children and Families

    ERIC Educational Resources Information Center

    King, Gillian

    2009-01-01

    This article presents a Relational Goal-Oriented Model of Service Delivery to Children with physical or mental health difficulties and their families. This research-informed and practice-relevant model provides a broad understanding of what effective service provision entails and requires from practitioners and service organizations. The model…

  7. Gigabit network-based three-dimensional trial service on media delivery platform

    NASA Astrophysics Data System (ADS)

    Kim, Nac-Woo; Son, Seung-Chul; Lee, Byung-Tak

    2011-09-01

    Recently, as effective demand for high-quality, large-capacity content such as three-dimensional (3D), multiangle, and gigabit-web has increased, a network infrastructure capable of satisfying future broadcast and communication service requirements is required. In this paper, we introduce a convergence service based on a gigabit network and then propose a technique for delivering gigabit 3D content. Here, the term 3D content delivery technique refers to an overlay-multicast-based distributed service platform that is comprised of a media relay agent and a management server. The service platform is designed to back up both live video and file-based video streaming. Using this platform, we can provide 3D remote education and 3D multiangle services via 3D-based video streaming between a service provider and service consumers dispersed at different locations. To evaluate our 3D content delivery technique, we run a series of trials of gigabit network-based 3D trial services to service subscribers. Then, we conduct a survey to measure user satisfaction with the 3D delivery service and simulated network and service quality. From experimental results, we confirm that this type of distributed service platform can be used as the delivery framework for applications such as realistic 3D-based seminars or 3D video conferences.

  8. Assessing the Impact of a Quality Improvement Intervention on Diabetes Self- Management Education Services Provided by Local Health Departments

    PubMed Central

    Dearinger, Angela T.; Ingram, Richard C.; Pendley, Robin P.; Wilding, Sarah

    2015-01-01

    Background As the burden of diabetes continues to overwhelm the public health system, there is increased demand on local health departments (LHDs) to improve public health services. Quality improvement (QI) techniques have been shown to be an effective means to improve the delivery of services by LHDs. Purpose To evaluate the extent to which the adoption of organizational quality improvement (QI) strategies influences the delivery and outreach of Diabetes Self- Management Education (DSME) services provided by LHDs. Methods A change facilitation model which included QI team development and on- site QI training and facilitation was delivered to 6 LHDs who provide DSME during 2010-2011. After training, each LHD developed and implemented a QI project to improve the outreach and delivery of DSME services. Pre- and post- intervention surveys were administered to evaluate the extent of change in DSME outreach and delivery. Results The number of individuals who completed an entire course of DSME increased by > 100%, and 14% more diabetics attended DSME on a monthly basis. Half of LHDs reported receiving increased numbers of referrals per month, and 15% more healthcare providers referred diabetic patients to the LHD for DSME. Conclusions Participation in COACH 4 DM led to improvements in the LHD QI infrastructure, and in the outreach and delivery of services to diabetic patients. The techniques used during COACH-4 DM are applicable to a wide variety of contexts and may be an effective tool to improve the delivery of other clinical and community preventive services. PMID:24237923

  9. Educational Audiology: A Comparison of Service Delivery Systems Utilized by Missouri Schools.

    ERIC Educational Resources Information Center

    Allard, J. Brad; Golden, Diane Cordry

    1991-01-01

    Comparison of three audiology service delivery systems--(1) school-based audiology within the district, (2) non-school-based audiology in the community, and (3) school-based audiology in a remote community--found the local school-based delivery system superior on various quality indicators. (Author/DB)

  10. Astrobotic: Commercial Service for Lunar Resource Payload Delivery

    NASA Astrophysics Data System (ADS)

    Thornton, J.; Huber, S.; Peterson, K.; Hendrickson, D.

    2015-10-01

    This paper describes how commercial delivery is enabling access to the Moon for resource payloads. Topics addressed: impediments to resource development, commercial approaches to delivering resource payloads, and traction seen with the market.

  11. A Brief Introduction of Assistive Technology Service Delivery System in Republic of Korea.

    PubMed

    Lim, MyungJoon; Jung, SungMin

    2015-01-01

    Social participation of People with Disability in Republic of Korea has been grown last few years. Also demand of Assistive Technology has been increased as well. Responding these needs, the public benefits of Assistive Technology Device in Republic of Korea in 2014 was USD 1.7 billion which had been increased by 27 percent during the last five years. Despite an increase in the budget, effort to build Assistive Technology Service Delivery System (ATSDS) was not enough. Therefore, Ministry of Health and Welfare in Korea decided to build ATSDS in Republic of Korea in 2009. In this paper, the process of establishing ATSDS and 2014 outcomes of ATSDS are presented in details. For more than six years efforts of establishing national-wide ATSDS, nine Assistive Technology Centers were actively running in their delivery of service in 2014. As of 2014 outcomes of ATSDS, 14,056 cases were delivered through nine Assistive Technology Centers. The presence of ATSDS proved increase in accessibility for Assistive Technology for People with Disability followed by improvement of the quality of life of them. PMID:26294599

  12. Utilization of institutional delivery service at Wukro and Butajera districts in the Northern and South Central Ethiopia

    PubMed Central

    2014-01-01

    Background Ethiopia has one of the highest maternal mortality in the world. Institutional delivery is the key intervention in reducing maternal mortality and complications. However, the uptake of the service has remained low and the factors which contribute to this low uptake appear to vary widely. Our study aims to determine the magnitude and identify factors affecting delivery at health institution in two districts in Ethiopia. Methods A community based cross sectional household survey was conducted from January to February 2012 in 12 randomly selected villages of Wukro and Butajera districts in the northern and south central parts of Ethiopia, respectively. Data were collected using a pretested questionnaire from 4949 women who delivered in the two years preceding the survey. Results One in four women delivered the index child at a health facility. Among women who delivered at health facility, 16.1% deliveries were in government hospitals and 7.8% were in health centers. The factors that significantly affected institutional delivery in this study were district in which the women lived (AOR: 2.21, 95% CI: 1.28, 3.82), women age at interview (AOR: 1.96, 95% CI: 1.05, 3.62), women’s education (AOR: 3.53, 95% CI: 1.22, 10.20), wealth status (AOR: 16.82, 95% CI: 7.96, 35.54), women’s occupation (AOR: 1.50, 95% CI: 1.01, 2.24), antenatal care (4+) use (AOR: 1.77, 95% CI: 1.42, 2.20), and number of pregnancies (AOR: 0.25, 95% CI: 0.18,0.35). We found that women who were autonomous in decision making about place of delivery were less likely to deliver in health facility (AOR: 0.38, 95% CI: 0.23,0.63). Conclusions Institutional delivery is still low in the Ethiopia. The most important factors that determine use of institutional delivery appear to be women education and household economic status. Women’s autonomy in decision making on place of delivery did not improve health facility delivery in our study population. Actions targeting the disadvantaged, improving

  13. AAV Hybrid Serotypes: Improved Vectors for Gene Delivery

    PubMed Central

    Choi, Vivian W.; McCarty, Douglas M.; Samulski, R. Jude

    2006-01-01

    In recent years, significant efforts have been made on studying and engineering adeno-associated virus (AAV) capsid, in order to increase efficiency in targeting specific cell types that are non-permissive to wild type (wt) viruses and to improve efficacy in infecting only the cell type of interest. With our previous knowledge of the viral properties of the naturally occurring serotypes and the elucidation of their capsid structures, we can now generate capsid mutants, or hybrid serotypes, by various methods and strategies. In this review, we summarize the studies performed on AAV retargeting, and categorize the available hybrid serotypes to date, based on the type of modification: 1) transcapsidation, 2) adsorption of bi-specific antibody to capsid surface, 3) mosaic capsid, and 4) chimeric capsid. Not only these hybrid serotypes could achieve high efficiency of gene delivery to a specific targeted cell type, which can be better-tailored for a particular clinical application, but also serve as a tool for studying AAV biology such as receptor binding, trafficking and genome delivery into the nucleus. PMID:15975007

  14. Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement

    PubMed Central

    Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R.

    2016-01-01

    ABSTRACT Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39–95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67–100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67–100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo. PMID:27391996

  15. Closing the delivery gaps in pediatric HIV care in Togo, West Africa: using the care delivery value chain framework to direct quality improvement.

    PubMed

    Fiori, Kevin; Schechter, Jennifer; Dey, Monica; Braganza, Sandra; Rhatigan, Joseph; Houndenou, Spero; Gbeleou, Christophe; Palerbo, Emmanuel; Tchangani, Elfamozo; Lopez, Andrew; Bensen, Emily; Hirschhorn, Lisa R

    2016-03-01

    Providing quality care for all children living with HIV/AIDS remains a global challenge and requires the development of new healthcare delivery strategies. The care delivery value chain (CDVC) is a framework that maps activities required to provide effective and responsive care for a patient with a particular disease across the continuum of care. By mapping activities along a value chain, the CDVC enables managers to better allocate resources, improve communication, and coordinate activities. We report on the successful application of the CDVC as a strategy to optimize care delivery and inform quality improvement (QI) efforts with the overall aim of improving care for Pediatric HIV patients in Togo, West Africa. Over the course of 12 months, 13 distinct QI activities in Pediatric HIV/AIDS care delivery were monitored, and 11 of those activities met or exceeded established targets. Examples included: increase in infants receiving routine polymerase chain reaction testing at 2 months (39-95%), increase in HIV exposed children receiving confirmatory HIV testing at 18 months (67-100%), and increase in patients receiving initial CD4 testing within 3 months of HIV diagnosis (67-100%). The CDVC was an effective approach for evaluating existing systems and prioritizing gaps in delivery for QI over the full cycle of Pediatric HIV/AIDS care in three specific ways: (1) facilitating the first comprehensive mapping of Pediatric HIV/AIDS services, (2) identifying gaps in available services, and (3) catalyzing the creation of a responsive QI plan. The CDVC provided a framework to drive meaningful, strategic action to improve Pediatric HIV care in Togo. PMID:27391996

  16. Factors impacting the use of antenatal care and hospital child delivery services: a case study of rural residents in the Enshi Autonomous Prefecture, Hubei Province, China.

    PubMed

    Zhang, Yin; Chen, Minxing; Lu, Jun; Hao, Mo; Zhang, Changli; Sun, Mei; Li, Xiaohong; Chang, Fengshui

    2015-01-01

    This study was undertaken to understand the factors that impact whether rural women obtain antenatal care (ANC) and choose to use hospital delivery services in central and western China. We chose to conduct field research with the rural residents in Hubei Province through a combination of random sampling and purposive sampling methods. A mixed method approach was taken to analyze the factors impacting the use of ANC and hospital delivery services from the perspective of the villagers. Our results indicate that the quality of the available ANC services is poor. In particular, women who have special circumstances and unplanned pregnancies or who become pregnant prior to marriage are confronted with inadequate ANC and hospital child delivery services. The factors that impact whether women use or not use ANC and hospital delivery services and that cause women to choose hospital or home delivery can be understood at three levels: macro, middle, and micro. We strongly suggest that the policies and projects that promote maternal healthcare in rural areas be sustained with an added focus on including women with special circumstances. Village doctors can be enlisted to regularly visit pregnant women at home and to provide extra explanation about the ANC services available and the purpose of maternal healthcare. These findings and suggestions can be used by local health providers and decision-makers to improve the quality of ANC and hospital delivery services. PMID:24446091

  17. Overview on gastroretentive drug delivery systems for improving drug bioavailability.

    PubMed

    Lopes, Carla M; Bettencourt, Catarina; Rossi, Alessandra; Buttini, Francesca; Barata, Pedro

    2016-08-20

    In recent decades, many efforts have been made in order to improve drug bioavailability after oral administration. Gastroretentive drug delivery systems are a good example; they emerged to enhance the bioavailability and effectiveness of drugs with a narrow absorption window in the upper gastrointestinal tract and/or to promote local activity in the stomach and duodenum. Several strategies are used to increase the gastric residence time, namely bioadhesive or mucoadhesive systems, expandable systems, high-density systems, floating systems, superporous hydrogels and magnetic systems. The present review highlights some of the drugs that can benefit from gastroretentive strategies, such as the factors that influence gastric retention time and the mechanism of action of gastroretentive systems, as well as their classification into single and multiple unit systems. PMID:27173823

  18. Environmental Monitoring System for Home-Delivery Service of Packages by Using MEMS Sensors

    NASA Astrophysics Data System (ADS)

    Fujita, Takayuki; Masaki, Kentaro; Maenaka, Kazusuke

    Nowadays, home-delivery services of packages are imperative in everyday life. These service industries are trying to provide cheaper, faster and safer service. However, package condition and handling during transportation are not disclosed to a customer. In this study, we realized a prototype system by MEMS technology for measuring the environmental conditions around a package for home-delivery service. The system includes barometric pressure, temperature, relative humidity and three dimensional acceleration (shock) sensing devices, as well as an interface circuitry. The system is a size of 115 × 54 × 10 mm3 and a weight of 50 g. We measured the package conditions during the transportation by three Japanese domestic home-delivery services, and using data mining, we were able to obtain a representation of the package's circumstances.

  19. Measuring the Delivery of Special Education Services in a Large Urban District: Lessons from the Los Angeles Unified School District

    ERIC Educational Resources Information Center

    Harr, Jenifer J.; Oliver, Deborah F.; Ramanathan, Arun; Socias, Miguel

    2008-01-01

    Special education service delivery is often the source of disputes between parents and districts and an issue in special education class-action lawsuits. Despite these controversies, there has been little large-scale research on the delivery of services. This study represents a large-scale assessment of the delivery of special education services…

  20. Road Sediment Production and Delivery: Processes, Rates, and Possible Improvements

    NASA Astrophysics Data System (ADS)

    MacDonald, Lee; Ramos-Scharron, Carlos; Coe, Drew; Stafford, Alexander; Welsh, Matthew; Korte, Abby; Libohova, Zamir; Brown, Ethan; James, Cajun

    2013-04-01

    -dominated area. Connectivity was less than 20% in permeable volcanics in California and coarse-textured soils in the Colorado Front Range. Road-stream crossings accounted for most of the connected segments, as in temperate forests drainage rills and sediment plumes rarely extend for more than 50 m. Few studies have quantified the effects of unpaved roads on watershed-scale sediment yields, but in northern California the estimated sediment yield was 1.4 Mg yr-1 per kilometer of road, while in Colorado the long-term, chronic sediment production from roads was estimated to be about 1 Mg km-2 yr-1. On St. John roads were estimated to increase watershed-scale sediment production by 3-9 times, indicating that the road sediments are a critical stressor to near-shore coral reefs. Relatively simple management actions can greatly reduce sediment production and delivery from unpaved roads, but the necessary improvements are constrained by the lack of political will and funding.

  1. Northeast Conference on Rural HIV Service Delivery (Burlington, Vermont, October 23-24, 2000). Summary Report.

    ERIC Educational Resources Information Center

    McKinney, Martha M.

    The Northeast Conference on Rural HIV Service Delivery was attended by 51 health and social service professionals, people with HIV, and federal and state health officials with expertise or interest in developing HIV care capacity in rural areas. Low population density, low prevalence of HIV/AIDS, rugged topography and climate, and limited health…

  2. When Special Education Trumps ESL: An Investigation of Service Delivery for ELLs with Disabilities

    ERIC Educational Resources Information Center

    Kangas, Sara E. N.

    2014-01-01

    Through an ethnographic study of one suburban elementary school, the delivery of services to English language learners (ELLs) with disabilities was investigated. The data analysis revealed that often disability-related and English as a Second Language (ESL) services were in contention, as scheduling, teacher expertise, school culture, and ESL…

  3. Going the Extra Mile: Designing a Delivery Service for Remote Borrowers

    ERIC Educational Resources Information Center

    Long, Dallas

    2009-01-01

    This article documents the development of delivery services of library materials to remote borrowers at Milner Library, Illinois State University. Responding to a university mandate and guidelines for distance learning authored by the Association of College and Research Libraries, the Access Services librarians at Milner Library investigated the…

  4. Early Childhood Service Delivery for Families Living with Childhood Disability: Disabling Families through Problematic Implicit Ideology

    ERIC Educational Resources Information Center

    Breen, Lauren J.

    2009-01-01

    The aim of this paper is to unpack the implicit ideology underpinning early childhood service delivery for families living with childhood disability. The family as the unit of care is central to the philosophy and practice of early childhood services. However, the practice of family-centred care can be problematic; it is based upon neo-liberal…

  5. Speech-Language Pathologists' Perceptions of Integrated Service Delivery in School Settings.

    ERIC Educational Resources Information Center

    Elksnin, Linda K.; Capilouto, Gilson J.

    1994-01-01

    This survey of 31 speech-language pathologists who had adopted or were considering adopting integrated service delivery models examined their perceptions of their expertise; classroom teacher expertise; types of speech and language services provided in classrooms; characteristics of students served; and advantages and disadvantages of integrated…

  6. Mental Health Services for People with Intellectual Disability: Challenges to Care Delivery

    ERIC Educational Resources Information Center

    Chaplin, Eddie; O'Hara, Jean; Holt, Geraldine; Bouras, Nick

    2009-01-01

    The commissioning and provision of mental health services for people with intellectual disability is often complex and characterised by different service delivery models. This paper looks at the current situation 7 years after the White Paper, Valuing People (From words into action: London learning disabilities strategic framework, Department of…

  7. Perceptions of International Students on Service Quality Delivery in a Malaysian Public University

    ERIC Educational Resources Information Center

    Njie, Baboucarr; Asimiran, Soaib; Baki, Roselan

    2012-01-01

    Purpose: The purpose of this study is to explore the perceptions of international students of service quality delivery (SQD) in a Malaysian public university. Design/methodology/approach: The study was limited to the University's immediate physical environment and its associated human and systems-based services. The physical environment in this…

  8. Improved delivery of the natural anticancer drug tetrandrine.

    PubMed

    Shi, Chen; Ahmad Khan, Saeed; Wang, Kaiping; Schneider, Marc

    2015-02-01

    The study aims at designing a nanoparticle-based delivery system to improve the efficacy of the natural compound tetrandrine against lung cancer. Nanoparticles from poly(lactic-co-glycolic acid) (PLGA) were prepared by the emulsion solvent diffusion method and characterized for their physicochemical properties and drug-loading efficiency. Furthermore, the cellular uptake and the anti-cancerous activity was studied on A549 cell line. To investigate the surface properties and uptake, three different stabilizers were used to analyze the effect on size and zeta potential of nanoparticles as well as the effect on the cellular uptake. Nanoparticles in the size range of 180-200 nm with spherical shape were obtained with polyvinyl alcohol (PVA), Pluronic-F127 (PF127) and didodecyldimethylammonium bromide (DMAB), 2%, 1% and 0.1%, respectively. An entrapment efficiency of 50-60% with a loading of 1.5-2% was observed. In vitro release profile at pH 7.4 PBS solution showed a consistent release over 168 h. All particle systems showed an improved performance over the pure drug at the same drug concentration. DMAB stabilized particles demonstrated the most pronounced effect against A549 cells compared to pure drug while PVA stabilized particles were least effective in terms of antitumor activity. PMID:25510598

  9. What family support specialists do: examining service delivery.

    PubMed

    Wisdom, Jennifer P; Lewandowski, R Eric; Pollock, Michele; Acri, Mary; Shorter, Priscilla; Olin, S Serene; Armusewicz, Kelsey; Horwitz, Sarah; Hoagwood, Kimberly E

    2014-01-01

    This study describes services provided by family support specialists (FSS), peer advocates in programs for children with serious psychiatric conditions, to delineate differences between recommended components of FSS services and services actually provided. An analysis of qualitative interview and observational data and quantitative survey data from 63 staff at 21 mental health programs in New York identified that FSS and other staff have generally similar ideas about FSS services, and that these perceptions of activities are generally congruent with what FSS actually did. Implications of findings are discussed in the context of developing competencies and quality indicators for FSS. PMID:24174330

  10. What Family Support Specialists Do: Examining Service Delivery

    PubMed Central

    Wisdom, Jennifer P.; Lewandowski, R. Eric; Pollock, Michele; Acri, Mary; Shorter, Priscilla; Olin, S. Serene; Armusewicz, Kelsey; Horwitz, Sarah; Hoagwood, Kimberly E.

    2013-01-01

    This study describes services provided by family support specialists (FSS), peer advocates in programs for children with serious psychiatric conditions, to delineate differences between recommended components of FSS services and services actually provided. An analysis of qualitative interview and observational data and quantitative survey data from 63 staff at 21 mental health programs in New York identified that FSS and other staff have generally similar ideas about FSS services, and that these perceptions of activities are generally congruent with what FSS actually did. Implications of findings are discussed in the context of developing competencies and quality indicators for FSS. PMID:24174330

  11. Optimizing information technology to improve sexual health-care delivery: public and patient preferences.

    PubMed

    Ross, J D C; Copas, A; Stephenson, J; Fellows, L; Gilleran, G

    2007-07-01

    Information and communication technology (ICT) has the potential to improve the quality of care and efficiency in sexual health clinics, but its introduction requires input not only from health-care professionals and ICT specialists but also from service users and potential future users. In this study, views on ICT in relation to the delivery of sexual health services were assessed using a structured interview in two groups - a community sample of young people and a clinic sample of existing patients. In all, 542 community interviewees and 202 clinic patients participated. About 75% of respondents had access to the Internet and overall 60% reported that the self-collection of a sexual history on an electronic form was acceptable. Black Caribbean individuals had significantly less access to the Internet and a lower acceptance of electronic data collection. For booking an appointment, the majority of patients reported the telephone (community sample 93%, clinic sample 96%) or attending in person (community sample 77%, clinic sample 54%) to be acceptable, with a smaller proportion choosing email (community sample 10%, clinic sample 27%) or the Internet (community sample 7%, clinic sample 11%). Electronic booking was significantly less acceptable to Black Caribbean respondents. Although new technologies offer the opportunity to improve the quality of sexual health services, patient preferences and differences between groups in access to technology also need to be considered when services are reconfigured. PMID:17623499

  12. Increased Service Delivery and Adaptation to Occupational Stress.

    ERIC Educational Resources Information Center

    Schnabel, John F.; Simoni, Joseph J.

    Effective response by community service agencies to clientele needs is an essential part of community development. A personnel screening instrument, a model for predicting different types of adaptation to occupational stress, is suggested as a means of increasing the responsiveness of service agencies to their local communities. Proposing the use…

  13. Improving thermocouple service life in slagging gasifiers

    SciTech Connect

    Bennett, James P.; Kwong, Kyei-Sing; Powell, Cynthia A.; Thomas, Hugh; Krabbe, Rick

    2005-01-01

    The measurement of temperature within slagging gasifiers for long periods of time is difficult/impossible because of sensor failure or blockage of inputs used to monitor gasifier temperature. One of the most common means of temperature measurement in a gasifier is physically, through the use of thermocouples in a gasifier sidewall. These units can fail during startup, standby, or during the first 40-90 days of gasifier service. Failure can be caused by a number of issues; including thermocouple design, construction, placement in the gasifier, gasifier operation, and molten slag attack of the materials used in a thermocouple assembly. Lack of temperature control in a gasifier can lead to improper preheating, slag buildup on gasifier sidewalls, slag attack of gasifier refractories used to line a gasifier, or changes in desired gas output from a gasifier. A general outline of thermocouple failure issues and attempts by the Albany Research Center to improve the service life of thermocouples will be discussed.

  14. The Clinical Delivery of Pharmacogenetic Testing Services: A Proposed Partnership between Genetic Counselors and Pharmacists

    PubMed Central

    Mills, Rachel; Haga, Susanne B.

    2013-01-01

    One of the basic questions in the early uses of pharmacogenetic (PGx) testing revolves around the clinical delivery of testing. Because multiple health professionals may play a role in the delivery of PGx testing, various clinical delivery models have begun to be studied. We propose that a partnership between genetic counselors and pharmacists can assist clinicians in the delivery of comprehensive PGx services. Based on their expert knowledge of pharmacokinetics and pharmacodynamics, pharmacists can facilitate the appropriate application of PGx test results to adjust medication use as warranted and act as a liaison to the healthcare team recommending changes in medication based on test results and patient input. Genetic counselors are well-trained in genetics as well as risk communication and counseling methodology, but have limited knowledge of pharmaceuticals. The complementary knowledge and skill set supports the partnership between genetic counselors and pharmacists to provide effective PGx testing services. PMID:23746189

  15. Supporting Early Childhood Special Education Personnel for Itinerant Service Delivery through a State-Level Technical Assistance Project

    ERIC Educational Resources Information Center

    Nelson, Chelie; Lindeman, David P.; Stroup-Rentier, Vera Lynne

    2011-01-01

    An itinerant service delivery model takes early intervention and special education services to environments where young children with disabilities participate in their communities. Reconciliation of the mismatch that often occurs between recommended and actual practice requires support at all levels of the service delivery system, including…

  16. 45 CFR 60.14 - Reporting civil judgments related to the delivery of a health care item or service.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... civil judgments related to the delivery of a health care item or service. (a) Who must report. Federal..., providers, or suppliers related to the delivery of a health care item or service (regardless of whether the... of a health care item or service. 60.14 Section 60.14 Public Welfare DEPARTMENT OF HEALTH AND...

  17. 45 CFR 60.14 - Reporting civil judgments related to the delivery of a health care item or service.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... civil judgments related to the delivery of a health care item or service. (a) Who must report. Federal..., providers, or suppliers related to the delivery of a health care item or service (regardless of whether the... of a health care item or service. 60.14 Section 60.14 Public Welfare Department of Health and...

  18. 45 CFR 61.9 - Reporting civil judgments related to the delivery of a health care item or service.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... judgments related to the delivery of a health care item or service. (a) Who must report. Federal and State... practitioners related to the delivery of a health care item or service (regardless of whether the civil judgment... of a health care item or service. 61.9 Section 61.9 Public Welfare DEPARTMENT OF HEALTH AND...

  19. 45 CFR 61.9 - Reporting civil judgments related to the delivery of a health care item or service.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... judgments related to the delivery of a health care item or service. (a) Who must report. Federal and State... practitioners related to the delivery of a health care item or service (regardless of whether the civil judgment... of a health care item or service. 61.9 Section 61.9 Public Welfare DEPARTMENT OF HEALTH AND...

  20. Architecture For Delivery Of Broadband Services To The Residence

    NASA Astrophysics Data System (ADS)

    Coathup, Larry; Goddard, G. W.; McEachern, James; Bears, James

    1990-01-01

    This paper presents a technology and architecture perspective of the cost of evolving today's copper access network, optimized for POTS, to a fiber access network providing both narrowband and broadband services. Architectures are assessed using application studies based on cost models for actual routes in North America. This study identifies three architectures as serious candidates (i.e., close to copper in cost) for providing POTS service in 1992: the double star, the active pedestal and the star-bus.

  1. Delivery of health services in Arab countries: a review.

    PubMed

    Kronfol, N M

    2012-12-01

    This paper reviews the essential components of health care delivery systems in Arab countries and their development over the past 3 decades. The changes and challenges which evolved during the last half of the 20th century have had a significant impact on health systems and on health outcomes. An adequate network of hospitals and primary health care facilities has been established in most Arab countries of the Region. The increased participation of civil society has impacted positively on health systems. However, the main challenge is represented by the move towards market economies. In many developing economies, macroeconomic reforms have often necessitated cuts in public spending on social sectors. Cost-sharing policies have been implemented in order to compensate for diminishing government budgets allocated to health. However, this is not to minimize the enormous strides that have been made in all countries nor the important challenges that need to be addressed. PMID:23301398

  2. Improving the monitoring of immunization services in Kyrgyzstan.

    PubMed

    Weeks, R M; Svetlana, F; Noorgoul, S; Valentina, G

    2000-09-01

    Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but the new approach

  3. Physician Practice Patterns and Variation in the Delivery of Preventive Services

    PubMed Central

    Litaker, David

    2007-01-01

    Background Strategies to improve preventive services delivery (PSD) have yielded modest effects. A multidimensional approach that examines distinctive configurations of physician attributes, practice processes, and contextual factors may be informative in understanding delivery of this important form of care. Objective We identified naturally occurring configurations of physician practice characteristics (PPCs) and assessed their association with PSD, including variation within configurations. Design Cross-sectional study. Participants One hundred thirty-eight family physicians in 84 community practices and 4,046 outpatient visits. Measurements Physician knowledge, attitudes, use of tools and staff, and practice patterns were assessed by ethnographic and survey methods. PSD was assessed using direct observation of the visit and medical record review. Cluster analysis identified unique configurations of PPCs. A priori hypotheses of the configurations likely to perform the best on PSD were tested using a multilevel random effects model. Results Six distinct PPC configurations were identified. Although PSD significantly differed across configurations, mean differences between configurations with the lowest and highest PSD were small (i.e., 3.4, 7.7, and 10.8 points for health behavior counseling, screening, and immunizations, respectively, on a 100-point scale). Hypotheses were not confirmed. Considerable variation of PSD rates within configurations was observed. Conclusions Similar rates of PSD can be attained through diverse physician practice configurations. Significant within-configuration variation may reflect dynamic interactions between PPCs as well as between these characteristics and the contexts in which physicians function. Striving for a single ideal configuration may be less valuable for improving PSD than understanding and leveraging existing characteristics within primary care practices. PMID:17356985

  4. Integrating Technology into Service Delivery (ITSD) Project: Final Report.

    ERIC Educational Resources Information Center

    Schoech, Dick; And Others

    The emerging field of assistive technology offers employment and independent living for people with disabilities. However, agency staff, people with disabilities, and their guardians often spend substantial time finding appropriate technological solutions. The integration of technology into the existing service system is needed to maximize scarce…

  5. Needs Assessment and the Design of Service Delivery Systems.

    ERIC Educational Resources Information Center

    Gill, Stephen Joel; Fruehling, James A.

    1979-01-01

    Current demands on college counselors for systematic, accountable designs for student development services has required action without the necessary tools. One of these necessary tools is a needs assessment methodology. A methodology for needs assessment is discussed. An example is described. (Author)

  6. A Resource Management Framework for Designing Rural Service Delivery Programs.

    ERIC Educational Resources Information Center

    Allen, James; Seekins, Tom

    As many as 15 million people living in rural areas report one or more long-term impairments that significantly affect their quality of life. In general, disabled people living in rural areas receive fewer services than do people in urban areas. For example, counties in Montana with the largest population centers received significantly more…

  7. Service Delivery Complexities: Early Intervention for Children with Physical Disabilities

    ERIC Educational Resources Information Center

    Ziviani, Jenny; Darlington, Yvonne; Feeney, Rachel; Rodger, Sylvia; Watter, Pauline

    2013-01-01

    Early intervention (EI) for children with physical disabilities is advocated as a means of enhancing child outcomes and family functioning. The issues confronted by service providers in delivering this support have received relatively little attention. The purpose of this study was to gain an understanding of the experiences of frontline EI staff…

  8. Addressing Coparenting in the Delivery of Psychological Services to Children

    ERIC Educational Resources Information Center

    Lee, Catherine M.; Hunsley, John

    2006-01-01

    In this article we highlight recent changes in fathers' roles and argue that research on parenting has focused disproportionately on the role of mothers. We then describe ways that fathers may be overlooked in psychological services providing parent training and summarize preliminary evidence that the inclusion of fathers may enhance long-term…

  9. Liposomal voriconazole (VOR) formulation for improved ocular delivery.

    PubMed

    de Sá, Fernando Augusto Pires; Taveira, Stephânia Fleury; Gelfuso, Guilherme Martins; Lima, Eliana Martins; Gratieri, Taís

    2015-09-01

    Treating infectious eye diseases topically requires a drug delivery system capable of overcoming the eye's defense mechanisms, which efficiently reduce the drug residence time right after its administration, therefore reducing absorption. In order to try to surpass such administration issues and improve life quality for patients with fungal keratitis, liposomal voriconazol (VOR) formulations were prepared. Formulations were composed of soy phosphatidylcholine (PC) containing or not 1,2-dioleoyl-3-trimethylammonium-propane (DOTAP) and cholesterol. Liposomes were characterized by their drug entrapment efficiency (EE), drug recovery (DR), average diameter (size) and polydispersivity index (PdI). In vitro mucosal interaction and irritancy levels, ex vivo permeation, as well as the short-term stability were also assessed. Liposomal VOR formulation produced with 7.2:40mM VOR:PC showed to be the most promising formulation: mean size of 116.6±5.9nm, narrow PdI (0.17±0.06), negative zeta potential (∼-7mV) and over 80% of EE and yield, remaining stable for at least 30 days in solution and 90 days after lyophilization. This formulation was classified as 'non-irritant' after HET-CAM's test and was able to deliver about 47.85±5.72μg/cm(2) of VOR into porcine cornea after 30min of permeation test. Such drug levels are higher than the minimal inhibitory concentrations (MIC) of several fungi species isolated from clinical cases of corneal keratitis. Overall results suggest VOR can be effectively incorporated in liposomes for potential topical treatment of fungal keratitis. PMID:26123854

  10. Evaluating and improving patient-specific QA for IMRT delivery

    NASA Astrophysics Data System (ADS)

    Yan, Guanghua

    2009-12-01

    Modern radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) and newly-emerging volumetric modulated arc therapy (VMAT) aim to deliver highly conformal radiation dose to the target volume while sparing nearby critical organs as much as possible with the complex motion of multi-leaf collimator (MLC) leaves. Pre-treatment patient specific quality assurance (QA) has become an essential part of IMRT in making sure the delivered dose distributions agree with the planned ones. This dissertation evaluates the performance of current patient-specific QA process and proposes solutions to improve its sensitivity, accuracy and efficiency. In step and shoot IMRT, the study on the sensitivity of patient-specific QA to minor MLC errors reveals tighter criterion such as 2%/2mm must be employed to detect systematic MLC positioning errors of 2 mm. However, such criterion results in low average passing rate which leads to excessive false alarms, mainly due to inadequate treatment planning system (TPS) beam modeling on beam penumbra. An analytical deconvolution approach is proposed to recover true photon beam profiles to obtain a true beam model which significantly improves agreement between calculated and measured dose distributions. Thus a tighter criterion could be employed to enhance the sensitivity of patient-specific QA to minor errors in the delivery system. Measurement based patient-specific IMRT QA is a time-consuming process. A fast and accurate independent planar dose calculation algorithm is proposed to replace measurement based QA. The algorithm analytically models photons coming out from the accelerator and computes dose distribution from first principles. Accuracy of the algorithm is validated against 2D diode array measurements. The algorithm is found to be fast and accurate enough to replace time consuming measurement based QA. Patient-specific QA for VMAT differs significantly from step and shoot IMRT due to the increased use of dynamic

  11. Improving queuing service at McDonald's

    NASA Astrophysics Data System (ADS)

    Koh, Hock Lye; Teh, Su Yean; Wong, Chin Keat; Lim, Hooi Kie; Migin, Melissa W.

    2014-07-01

    Fast food restaurants are popular among price-sensitive youths and working adults who value the conducive environment and convenient services. McDonald's chains of restaurants promote their sales during lunch hours by offering package meals which are perceived to be inexpensive. These promotional lunch meals attract good response, resulting in occasional long queues and inconvenient waiting times. A study is conducted to monitor the distribution of waiting time, queue length, customer arrival and departure patterns at a McDonald's restaurant located in Kuala Lumpur. A customer survey is conducted to gauge customers' satisfaction regarding waiting time and queue length. An android app named Que is developed to perform onsite queuing analysis and report key performance indices. The queuing theory in Que is based upon the concept of Poisson distribution. In this paper, Que is utilized to perform queuing analysis at this McDonald's restaurant with the aim of improving customer service, with particular reference to reducing queuing time and shortening queue length. Some results will be presented.

  12. Abundance of common species, not species richness, drives delivery of a real-world ecosystem service.

    PubMed

    Winfree, Rachael; Fox, Jeremy W; Williams, Neal M; Reilly, James R; Cariveau, Daniel P

    2015-07-01

    Biodiversity-ecosystem functioning experiments have established that species richness and composition are both important determinants of ecosystem function in an experimental context. Determining whether this result holds for real-world ecosystem services has remained elusive, however, largely due to the lack of analytical methods appropriate for large-scale, associational data. Here, we use a novel analytical approach, the Price equation, to partition the contribution to ecosystem services made by species richness, composition and abundance in four large-scale data sets on crop pollination by native bees. We found that abundance fluctuations of dominant species drove ecosystem service delivery, whereas richness changes were relatively unimportant because they primarily involved rare species that contributed little to function. Thus, the mechanism behind our results was the skewed species-abundance distribution. Our finding that a few common species, not species richness, drive ecosystem service delivery could have broad generality given the ubiquity of skewed species-abundance distributions in nature. PMID:25959973

  13. Participatory Management: An Alternative in Human Service Delivery Systems

    ERIC Educational Resources Information Center

    Fallon, Kenneth P., Jr.

    1974-01-01

    Studies show that participatory management in the business field tends to improve employees' attitudes and performance, to lower costs, and to increase production. This paper describes the process of setting up democratic decision making in the welfare field. (SDH)

  14. Interim Project Results: United Parcel Service's Second-Generation Hybrid-Electric Delivery Vans (Fact Sheet)

    SciTech Connect

    Not Available

    2012-01-01

    This fact sheet describes the performance evaluation of United Parcel Service's second-generation hybrid-electric delivery vans. The Fleet Test and Evaluation Team at the National Renewable Energy Laboratory (NREL) is evaluating the 18-month, in-service performance of 11 of these vans along with 11 comparable conventional diesel vans operating in Minneapolis, Minnesota. As a complement to the field study, the team recently completed fuel economy and emissions testing at NREL's Renewable Fuels and Lubricants (ReFUEL) laboratory.

  15. The perceived impact of the National Health Service on personalised nutrition service delivery among the UK public.

    PubMed

    Fallaize, Rosalind; Macready, Anna L; Butler, Laurie T; Ellis, Judi A; Berezowska, Aleksandra; Fischer, Arnout R H; Walsh, Marianne C; Gallagher, Caroline; Stewart-Knox, Barbara J; Kuznesof, Sharon; Frewer, Lynn J; Gibney, Mike J; Lovegrove, Julie A

    2015-04-28

    Personalised nutrition (PN) has the potential to reduce disease risk and optimise health and performance. Although previous research has shown good acceptance of the concept of PN in the UK, preferences regarding the delivery of a PN service (e.g. online v. face-to-face) are not fully understood. It is anticipated that the presence of a free at point of delivery healthcare system, the National Health Service (NHS), in the UK may have an impact on end-user preferences for deliverances. To determine this, supplementary analysis of qualitative data obtained from focus group discussions on PN service delivery, collected as part of the Food4Me project in the UK and Ireland, was undertaken. Irish data provided comparative analysis of a healthcare system that is not provided free of charge at the point of delivery to the entire population. Analyses were conducted using the 'framework approach' described by Rabiee (Focus-group interview and data analysis. Proc Nutr Soc 63, 655-660). There was a preference for services to be led by the government and delivered face-to-face, which was perceived to increase trust and transparency, and add value. Both countries associated paying for nutritional advice with increased commitment and motivation to follow guidelines. Contrary to Ireland, however, and despite the perceived benefit of paying, UK discussants still expected PN services to be delivered free of charge by the NHS. Consideration of this unique challenge of free healthcare that is embedded in the NHS culture will be crucial when introducing PN to the UK. PMID:25812432

  16. Assessing the need for service improvement.

    PubMed

    Carter, Helen; Price, Lynda

    In order to ensure the service they offer is of an appropriate standard, nurses need to know how to assess its quality, identify the need for change, and implement and evaluate that change. This two-part series offers practical guidance on how to bring about an evidence-based change in practice, and how to demonstrate the success, or otherwise, of that change. It uses the example of an initiative undertaken to improve medicines management in a hospice to illustrate the process. The article also illustrates how work undertaken in changing practice can form part of the evidence submitted in the nurse revalidation process. Part 1 considers how to determine when a change in practice is needed, how to assess and measure current practice, and identify gaps or weaknesses. Part 2 will discuss how to find out why the current practice is falling short of the desired level, and how to go about implementing improvements and measuring the effect of changes. PMID:27071238

  17. Telehealth: A Rapidly Developing Service Delivery Model For Occupational Therapy

    PubMed Central

    Cason, Jana

    2014-01-01

    Over the past decade, the practice of occupational therapy has been increasingly influenced by technological advances in the use of information and communication technologies (ICT) and associated changes in health care policy. Emergent from this evolution is the application of telehealth to deliver occupational therapy services to a client who is in a different physical location than the provider. This article furnishes an overview of the evidence for telehealth use in occupational therapy, discusses key policy considerations, and provides resources to guide practitioners in the ethical use of telehealth. PMID:25945220

  18. Telehealth: a rapidly developing service delivery model for occupational therapy.

    PubMed

    Cason, Jana

    2014-01-01

    Over the past decade, the practice of occupational therapy has been increasingly influenced by technological advances in the use of information and communication technologies (ICT) and associated changes in health care policy. Emergent from this evolution is the application of telehealth to deliver occupational therapy services to a client who is in a different physical location than the provider. This article furnishes an overview of the evidence for telehealth use in occupational therapy, discusses key policy considerations, and provides resources to guide practitioners in the ethical use of telehealth. PMID:25945220

  19. Voluntary Medical Male Circumcision Scale-Up in Nyanza, Kenya: Evaluating Technical Efficiency and Productivity of Service Delivery

    PubMed Central

    Omondi Aduda, Dickens S.; Ouma, Collins; Onyango, Rosebella; Onyango, Mathews; Bertrand, Jane

    2015-01-01

    Background Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya’s context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. Objective To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. Design Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. Results Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350–5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959–4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). Conclusions Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings

  20. Local Governments, Tribal Governments and Service Delivery: A Unique Approach to Negotiated Problem Solving

    ERIC Educational Resources Information Center

    Goodman, Doug; McCool, Daniel C.; Hebert, F. Ted

    2005-01-01

    A unique attempt made in San Juan Country, Utah, to resolve conflict over service delivery is examined and an outline of the conflict resolution process is presented and the contemporary relationship between tribes and states is described. The impact of the county division proposal and the way it fits into the larger framework of conflict…

  1. Degree of Fit: University Students in Paid Employment, Service Delivery and Technology

    ERIC Educational Resources Information Center

    Anderson, Marilyn J.

    2006-01-01

    This study examines the ease of, and proficiency in, accessing web based technology, and the convenience (or otherwise) of service delivery in the facilitation of combining study with paid work for undergraduate students of James Cook University (JCU), Cairns Campus, Far North Queensland. Considering that the typical new millennium student is…

  2. Young Children with Disabilities in Israel: System of Early Intervention Service Delivery

    ERIC Educational Resources Information Center

    Shulman, Cory; Meadan, Hedda; Sandhaus, Yoram

    2012-01-01

    This article aims to analyze early intervention programs in Israel according to the Developmental Systems Model (Guralnick, 2001), in an attempt to identify strengths and areas for further development for service delivery for young children with disabilities in Israel. Early intervention in Israel is part of a comprehensive healthcare model…

  3. Privitization and Cutbacks: Social Work and Client Impressions of Service Delivery in Massachusetts.

    ERIC Educational Resources Information Center

    Motenko, Aluma Kopito; And Others

    1995-01-01

    Examines agencies in Massachusetts to determine social worker and client impressions of the effects of cutbacks on agency policy and service delivery. Results indicate increased demands on social workers for higher productivity levels, a deterioration of collaborative work environments, an inability to meet treatment goals, and demands for…

  4. Moral, Legal, and Functional Dimensions of Inclusive Service Delivery in Catholic Schools

    ERIC Educational Resources Information Center

    Scanlan, Martin

    2009-01-01

    Catholic school educators are morally compelled by Catholic social teaching to foster inclusive service delivery for students who have traditionally been marginalized in schools, including students in poverty, students of color, English language learners, and students with special needs. This article applies this moral context to analyze the legal…

  5. Problems and Strategies Regarding Regionalizing Service Delivery: Educational Collaboratives in Rural America.

    ERIC Educational Resources Information Center

    Helge, Doris

    A review of five studies by the National Rural Project determined the impact of educational collaboratives on rural special education, including types of educational collaboratives, variations within collaborative structures, benefits of collaboratives for rural special education, problems related to regional service delivery structures, and…

  6. Service Delivery and Related Issues at the Trace Research and Development Center.

    ERIC Educational Resources Information Center

    Smith, R. O.

    The environmental context of the Trace Center is first briefly described as background for a more detailed description of the center's service delivery activities in the field of rehabilitation/education technology. Trace serves four major functions in rehabilitation/education technology. As a nationally funded rehabilitation engineering center,…

  7. Program Intensity and Service Delivery Models in the Schools: SLP Survey Results

    ERIC Educational Resources Information Center

    Brandel, Jayne; Loeb, Diane Frome

    2011-01-01

    Purpose: School-based speech-language pathologists (SLPs) routinely work with team members to make recommendations regarding an intervention program's intensity and method of service delivery for children with speech and language impairments. In this study, student, SLP, and workplace characteristics that may influence SLPs' recommendations were…

  8. Speech-Language Pathologists' Comfort Levels in English Language Learner Service Delivery

    ERIC Educational Resources Information Center

    Kimble, Carlotta

    2013-01-01

    This study examined speech-language pathologists' (SLPs) comfort levels in providing service delivery to English language learners (ELLs) and limited English proficient (LEP) students. Participants included 192 SLPs from the United States and Guam. Participants completed a brief, six-item questionnaire that investigated their perceptions…

  9. Current Practices in Special Education Service Delivery and Differences between Instructional Settings

    ERIC Educational Resources Information Center

    Platt, Marguerite D.

    2013-01-01

    Despite nationwide advances in special education service delivery practices, disparities exist between the educational outcomes of students with disabilities versus students without disabilities. There is often disparity in teachers' roles and instructional practices in coteaching classrooms, as well as in their pullout resource classroom…

  10. Speech-Language Pathologist and General Educator Collaboration: A Model for Tier 2 Service Delivery

    ERIC Educational Resources Information Center

    Watson, Gina D.; Bellon-Harn, Monica L.

    2014-01-01

    Tier 2 supplemental instruction within a response to intervention framework provides a unique opportunity for developing partnerships between speech-language pathologists and classroom teachers. Speech-language pathologists may participate in Tier 2 instruction via a consultative or collaborative service delivery model depending on district needs.…

  11. Contribution of Professional School Counselors' Values and Leadership Practices to Their Programmatic Service Delivery

    ERIC Educational Resources Information Center

    Shillingford, M. Ann; Lambie, Glenn W.

    2010-01-01

    School counselors are called to be leaders to support the development of all students. The study in this article investigated the contributions of the values (Schwartz, 1992) and leadership practices (Posner & Kouzes, 1988) of 163 school counselors to their programmatic service delivery (Scarborough, 2005). Leadership practices made significant…

  12. Staff Recommendations Concerning the Delivery of Hepatitis-Related Services in County Health Departments

    ERIC Educational Resources Information Center

    Rainey, Jacquie

    2007-01-01

    Background: This paper describes a portion of a larger evaluation project of a state hepatitis prevention program. Purpose: The study explored the suggestions of key informants related to the delivery of hepatitis services in the state. Methods: Researchers conducted key informant interviews lasting 30 to 45 minutes. Results: Important findings…

  13. State Plan for the Delivery of Special Education Programs and Services.

    ERIC Educational Resources Information Center

    Michigan State Dept. of Education, Lansing.

    Michigan's plan for the development and delivery of comprehensive, quality education programs and services for handicapped children in the state is reported. The four major goals of the plan encompass not only the need for comprehensive special education programs, but also the organizational and communications structures necessary for the delivery…

  14. Legal Services Delivery at Public Institutions of Higher Education in a New England State

    ERIC Educational Resources Information Center

    Sargent, Frank A.

    2010-01-01

    While most university leaders have realized the need for having some form of legal services system in place, many struggle with what delivery method, in-house counsel or external law firms, to use (Santora & Kaplin, 2003). This study investigated why some colleges and universities employ in-house counsel, while others rely on private law firms.…

  15. Clients, Consumers, and Citizens: Using Market Mechanisms for the Delivery of Public Services.

    ERIC Educational Resources Information Center

    Pascal, Anthony H.

    The ethical and technical superiority of a consumer-oriented system for the delivery of many public services, as compared to a client-based system, is demonstrated. The meaning of planning in a modern democratic society is examined. From distinctions drawn between the meaning of private and public goods in economic theory, some useful categories…

  16. A Look at How Agencies Can Utilize Outcome and Performance Data To Enhance Service Delivery.

    ERIC Educational Resources Information Center

    Resources for Welfare Decisions, 2002

    2002-01-01

    This issue focuses on a variety of performance measurement and outcome data resources as they relate to evaluating service delivery performance in areas that include employment (welfare-to-work and performance bonuses for work participation) and child welfare, as well as some general Temporary Assistance to Needy Families program areas. It also…

  17. The network data delivery service: A real-time data connectivity system

    NASA Technical Reports Server (NTRS)

    Pardo-Castellote, Gerardo; Schneider, Stan

    1994-01-01

    A network data-sharing system, the Network Data Delivery Service (NDDS), is discussed. The NDDS system relies on a bipartite model consisting of the following: information producers (sources) and information consumers (sinks). The example provided by a dual-arm robotic system is examined.

  18. Refugee Children Traumatized by War and Violence: The Challenge Offered to the Service Delivery System.

    ERIC Educational Resources Information Center

    Benjamin, Marva P.; Morgan, Patti C.

    This document summarizes issues presented by 16 scholars, researchers, and practitioners from the United States and Canada at a conference on refugee children traumatized by war and violence and suggests a service delivery model for these children and their families. A large percentage of the legal and illegal immigrants who have entered the…

  19. The "P" Word: Productivity in the Delivery of Career Guidance Services

    ERIC Educational Resources Information Center

    Watts, A. G.; Dent, Gareth

    2006-01-01

    The case for more attention to productivity in career guidance delivery is related to the pressures both for greater public accountability and for increasing access to services without massive increases in resources. The term "productivity" is defined and its applications in a career guidance context are explored. Possible strategies for enhancing…

  20. 20 CFR 669.310 - What are the basic components of an NFJP service delivery strategy?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false What are the basic components of an NFJP service delivery strategy? 669.310 Section 669.310 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR NATIONAL FARMWORKER JOBS PROGRAM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT The National Farmworker Jobs...

  1. Local authorities, community and Private Operators Partnerships in small towns water service delivery in Ghana

    NASA Astrophysics Data System (ADS)

    Nyarko, K. B.; Oduro-Kwarteng, S.; Owusu-Antwi, P.

    This paper examines the performance of partnerships between local authorities (District Assemblies) and private operators (POs) in the community managed small towns’ water service delivery in Ghana. Since 2002, partnerships in the form of management contracts are increasing especially for towns with more than 10,000 inhabitants but there has been no systematic analysis of the partnerships. Using a case study approach based on five selected community managed piped systems; three under private operator partnerships and two under direct Community Ownership and Management as study controls, the study focused on the partnership development, partnership relationship between stakeholders and the outcome of the service. The study revealed that the partnership emerged as a result of the relatively large communities and/or the complexity of the systems. Water and Sanitation Development Boards (WSDBs) are community representatives with the responsibility of overseeing the management contracts with private operators or directly managing the water systems through hired operating staff. With time the management contracts have improved as some earlier defects have been corrected in subsequent contracts. Yet some contracts suffered post-contract opportunism, weak monitoring and regulation by the District Assembly (DA), political interference in tariffs setting and removal of WSDBs members after change of government. Conflicts between the DAs and the Water and Sanitation Development Boards (WSDBs) were common resulting in direct management by the District Assembly. The success or failure of the partnership is linked to degree of conflict resolution amongst the stakeholders as well as external factors. The study also discusses the outcome of the partnerships in relation to the quality of water service delivered.

  2. Improving service accessibility in service-oriented HIS.

    PubMed

    Babamir, Seyed Morteza; Arabfard, Masoud

    2012-12-01

    Nowadays, new trend in design and implementation of Hospital Information System (HIS) is towards using Web-based Service-Oriented Architecture (SOA). However, the standard SOA includes an insensitive service store through which the accessibility of some hospital services becomes difficult when their specification or network address are changed or missed. This paper discusses problems of insensitive service store and then presents a model where a sensitive service store is used to mitigate the problems. To show the efficiency of the proposed model, HIS of the Shahid Beheshti Hospital of Kashan including information systems of Admission, Outpatient, Ward, Pharmacy, Medical Document, Discharge and Insurance was designed and implemented with sensitive service store and its performance was considered. PMID:22898904

  3. Leading a change process to improve health service delivery.

    PubMed Central

    Bahamon, Claire; Dwyer, Joseph; Buxbaum, Ann

    2006-01-01

    In the fields of health and development, donors channel multiple resources into the design of new practices and technologies, as well as small-scale programmes to test them. But successful practices are rarely scaled up to the level where they beneficially impact large, impoverished populations. An effective process for change is to use the experiences of new practices gained at the programme level for full-scale implementation. To make an impact, new practices need to be applied, and supported by management systems, at many organizational levels. At every level, potential implementers and likely beneficiaries must first recognize some characteristics that would benefit them in the new practices. An effective change process, led by a dedicated internal change agent, comprises several well-defined phases that successively broaden and institutionalize the use of new practices. PMID:16917654

  4. Canadian Rural/Remote Primary Care Physicians Perspectives on Child/Adolescent Mental Health Care Service Delivery

    PubMed Central

    Zayed, Richard; Davidson, Brenda; Nadeau, Lucie; Callanan, Terrence S.; Fleisher, William; Hope-Ross, Lindsay; Espinet, Stacey; Spenser, Helen R.; Lipton, Harold; Srivastava, Amresh; Lazier, Lorraine; Doey, Tamison; Khalid-Khan, Sarosh; McKerlie, Ann; Stretch, Neal; Flynn, Roberta; Abidi, Sabina; St. John, Kimberly; Auclair, Genevieve; Liashko, Vitaly; Fotti, Sarah; Quinn, Declan; Steele, Margaret

    2016-01-01

    Introduction: Primary Care Physicians (PCP) play a key role in the recognition and management of child/adolescent mental health struggles. In rural and under-serviced areas of Canada, there is a gap between child/adolescent mental health needs and service provision. Methods: From a Canadian national needs assessment survey, PCPs’ narrative comments were examined using quantitative and qualitative approaches. Using the phenomenological method, individual comments were drawn upon to illustrate the themes that emerged. These themes were further analyzed using chi-square to identify significant differences in the frequency in which they were reported. Results: Out of 909 PCPs completing the survey, 39.38% (n = 358) wrote comments. Major themes that emerged were: 1) psychiatrist access, including issues such as long waiting lists, no child/adolescent psychiatrists available, no direct access to child/adolescent psychiatrists; 2) poor communication/continuity, need for more systemized/transparent referral processes, and need to rely on adult psychiatrists; and, 3) referral of patients to other mental health professionals such as paediatricians, psychologists, and social workers. Conclusions: Concerns that emerged across sites primarily revolved around lack of access to care and systems issues that interfere with effective service delivery. These concerns suggest potential opportunities for future improvement of service delivery. Implications: Although the survey only had one comment box located at the end, PCPs wrote their comments throughout the survey. Further research focusing on PCPs’ expressed written concerns may give further insight into child/adolescent mental health care service delivery systems. A comparative study targeting urban versus rural regions in Canada may provide further valuable insights. PMID:27047554

  5. Models for Effective Service Delivery in Special Education Programs

    ERIC Educational Resources Information Center

    Epler, Pam; Ross, Rorie

    2015-01-01

    Educators today are challenged with the task of designing curricula and standards for students of varying abilities. While technology and innovation steadily improve classroom learning, teachers and administrators continue to struggle in developing the best methodologies and practices for students with disabilities. "Models for Effective…

  6. Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study

    PubMed Central

    Arba, Mihiretu Alemayehu; Darebo, Tadele Dana; Koyira, Mengistu Meskele

    2016-01-01

    institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization. PMID:26986563

  7. Reorganizing pediatric rehabilitation services to improve accessibility: do we sacrifice quality?

    PubMed Central

    2010-01-01

    Background The impact of a pediatric rehabilitation service delivery reorganization to improve access to services on parents' and service providers' perception of service quality was evaluated. Child-, family-, service- and service provider-related characteristics possibly associated with these perceptions were explored. Methods Perceptions were measured using the Measure of Processes of Care tools and open ended questions before (2007), during (2008) and following (2009) service reorganization. Child and family characteristics, services received and service provider data were documented. Mean MPOC scores were compared over time (ANOVAs and Generalized Estimating Equations) and t-tests, correlations and ANOVAs determined whether the characteristics influenced scores. Results Families' (n = 222) and service providers' (n = 129) perceptions of quality were high in 2007 (3.67 to 6.31/7) and remained high over the next 2 years (p ≥ 0.16). Two MPOC domain scores (Respectful care and Providing general information) were consistently scored the highest (mean ≥ 5.66/7) and the lowest (mean ≤ 4.75/7), respectively. Families with more education and those with children 12-21 years old tended to attribute lower MPOC scores. Participants were generally satisfied with the new service model and recommendations included improving information exchange. Conclusions Results suggest that it is possible to reorganize pediatric rehabilitation services while maintaining quality. PMID:20687932

  8. The delivery of veterinary services to poorer communities: the case of rural Orissa, India.

    PubMed

    Ahuja, V; Morrenhof, J; Sen, A

    2003-12-01

    This paper presents the results of a field survey on use patterns and demand for clinical veterinary services in one of the poorest states of India, namely, Orissa. A demand function was estimated using Poisson regression and demand elasticities were obtained for various income groups. The survey shows that large numbers of households, including the poor, pay prices that are significantly higher than those prescribed. There is no targeting of cheaper services towards the poor. The analysis also suggests that for a given service and place of service, the poor actually paid more on a per veterinary visit basis. As a result, the rate of service utilisation was significantly lower for poor households. Demand analysis confirmed that the demand for veterinary services is not determined by subsidised service delivery, but by access to output markets and general awareness levels. In the light of these findings, the paper makes a number of recommendations for redefining the role of the Government in veterinary service delivery in Orissa. PMID:15005551

  9. Integrated Behavioral Health Services: Improving Access to Mental Health Care

    ERIC Educational Resources Information Center

    Sturm, Lynne A.; Perry, Deborah F.

    2007-01-01

    This article describes innovative service delivery models and clinical strategies that support the social-emotional development of young children and their families in the pediatric primary care setting. By understanding the trends affecting well-child care, early childhood providers will be better equipped to partner with their pediatric…

  10. The health maintenance organization strategy: a corporate takeover of health services delivery.

    PubMed

    Salmon, J W

    1975-01-01

    This paper presents a political economic framework for viewing the social organization of the delivery of health care servies and predicting a qualitatively different institutional configuration involving the health maintenance organization. The principal forces impacting American capitalism today are leading to a fundamental restructuring for increased social efficiency of the entire social welfare sector, including the health services industry. The method to achieve this restructuring involves health policy directed at raising the contribution to the social surplus from the delivery of health care services and eventual corporate domination. The health maintenance organization conceptualization is examined with suggestions as to how the HMO strategy promoted by the state leads to this corporate takeover. The mechanism and extent of the present corporate involvement are examined and implications of health services as a social control mechanism are presented. PMID:1230440

  11. Project Overview: United Parcel Service's Second-Generation Hybrid-Electric Delivery Vans (Fact Sheet)

    SciTech Connect

    Not Available

    2011-11-01

    This fact sheet describes UPS second generation hybrid-electric delivery vehicles as compared to conventional delivery vehicles. Medium-duty commercial vehicles such as moving trucks, beverage-delivery trucks, and package-delivery vans consume almost 2,000 gal of fuel per year on average. United Parcel Service (UPS) operates hybrid-electric package-delivery vans to reduce the fuel use and emissions of its fleet. In 2008, the National Renewable Energy Laboratory's (NREL's) Fleet Test and Evaluation Team evaluated the first generation of UPS' hybrid delivery vans. These hybrid vans demonstrated 29%-37% higher fuel economy than comparable conventional diesel vans, which contributed to UPS' decision to add second-generation hybrid vans to its fleet. The Fleet Test and Evaluation Team is now evaluating the 18-month, in-service performance of 11 second-generation hybrid vans and 11 comparable conventional diesel vans operated by UPS in Minneapolis, Minnesota. The evaluation also includes testing fuel economy and emissions at NREL's Renewable Fuels and Lubricants (ReFUEL) Laboratory and comparing diesel particulate filter (DPF) regeneration. In addition, a followup evaluation of UPS' first-generation hybrid vans will show how those vehicles performed over three years of operation. One goal of this project is to provide a consistent comparison of fuel economy and operating costs between the second-generation hybrid vans and comparable conventional vans. Additional goals include quantifying the effects of hybridization on DPF regeneration and helping UPS select delivery routes for its hybrid vans that maximize the benefits of hybrid technology. This document introduces the UPS second-generation hybrid evaluation project. Final results will be available in mid-2012.

  12. 20 CFR 652.208 - How are core services and intensive services related to the methods of service delivery described...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... described in § 652.207(b)(2)? Core services and intensive services may be delivered through any of the...-service; (b) Facilitated self-help service; and (c) Staff-assisted service. ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How are core services and intensive...

  13. Evaluation Study of a Broadband Multicasting Service over a Gigabit Ethernet Delivery Network

    NASA Astrophysics Data System (ADS)

    Stergiou, E.; Meletiou, G.; Vasiliadis, D. C.; Rizos, G. E.; Margariti, S. V.

    2008-11-01

    Multicasting networks are usually implemented for delivering audio and video. Consequently, the performance evaluation of a reliable multicasting architecture is useful in active delivery systems. In this paper we analyze and present a broadband multicasting system under an Internet environment using a typical IP multicasting mechanism. The test-bed multicasting scheme was based on both IGMP and MCOP protocols, where a Gigabit Ethernet was used as delivery network at client's segment. The evaluation study provides measurements for the two most significant performance metrics, the required Bandwidth and the Round Trip Time (RTT) of a packet versus the number of multicasting clients over 2.4 Mbps multicasting service rate.

  14. Getting It Right from the Start: Developing a Service Delivery Model for Non-Maintained Early Years Settings

    ERIC Educational Resources Information Center

    Dennis, Ruth

    2004-01-01

    In this paper, the author explores how Educational Psychology Services might respond to the requirement that they now deliver a service to all validated Early Years settings. In doing so, current service delivery to schools is critically examined and a number of difficulties identified. Five key elements to the development of such a service are…

  15. Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery

    PubMed Central

    Klemm, Alexandria; Li, Linda C.; Jones, C. Allyson

    2016-01-01

    Quality-based care is a hallmark of physical therapy. Treatment effectiveness must be evident to patients, managers, employers, and funders. Quality indicators (QIs) are tools that specify the minimum acceptable standard of practice. They are used to measure health care processes, organizational structures, and outcomes that relate to aspects of high-quality care of patients. Physical therapists can use QIs to guide clinical decision making, implement guideline recommendations, and evaluate and report treatment effectiveness to key stakeholders, including third-party payers and patients. Rehabilitation managers and senior decision makers can use QIs to assess care gaps and achievement of benchmarks as well as to guide quality improvement initiatives and strategic planning. This article introduces the value and use of QIs to guide clinical practice and health service delivery specific to physical therapy. A framework to develop, select, report, and implement QIs is outlined, with total joint arthroplasty rehabilitation as an example. Current initiatives of Canadian and American physical therapy associations to develop tools to help clinicians report and access point-of-care data on patient progress, treatment effectiveness, and practice strengths for the purpose of demonstrating the value of physical therapy to patients, decision makers, and payers are discussed. Suggestions on how physical therapists can participate in QI initiatives and integrate a quality-of-care approach in clinical practice are made. PMID:26089040

  16. The use of information and communications technology for health service delivery in Namibia: perspectives of the health service providers.

    PubMed

    Shivute, Meke I; Maumbe, Blessing M; Owei, Vesper T

    2008-01-01

    We surveyed health service providers in Namibia to find out how they used information and communication technologies (ICTs) to deliver health services to their patients. A structured questionnaire was administered to 21 health service providers in two regions of the country (one urban, one rural). There was overwhelming consensus among the health service providers that ICTs were very important, especially for medical services (100%). Ninety-one percent of health service providers viewed ICT as helping them to interact with other providers in other health institutions. The most commonly used ICT was the telephone, which was used in the admission areas of most health institutions (36%); the next most commonly used ICT was the PC (23%). The most commonly used channels for communication with patients were the telephone followed by TV. Some of the problems common to all health institutions in Namibia were poor budgetary resources and lack of basic infrastructure such as electricity or telephone lines. There is a need to promote ICT use for health service delivery and also to stimulate patients to use ICT to access health services and relevant information. PMID:18776072

  17. Mental Health Service Delivery Systems and Perceived Qualifications of Mental Health Service Providers in School Settings

    ERIC Educational Resources Information Center

    Dixon, Decia Nicole

    2009-01-01

    Latest research on the mental health status of children indicates that schools are key providers of mental health services (U.S. Department of Health and Human Services, 2003). The push for school mental health services has only increased as stakeholders have begun to recognize the significance of sound mental health as an essential part of…

  18. Community-Based Occupational Therapy Services for Children: A Quebec Survey on Service Delivery

    ERIC Educational Resources Information Center

    Cotellesso, Annie; Mazer, Barbara; Majnemer, Annette

    2009-01-01

    Community-based occupational therapy (OT) services are intended to promote social integration and minimize disability. The objective of this study was to describe community-based OT services for children in the province of Quebec, Canada. Specific aims included (a) to determine the proportion of Centres Locaux de Services Communautaires (CLSCs)…

  19. Improving Circulation Services through Staff Involvement

    ERIC Educational Resources Information Center

    Kisby, Cynthia M.; Kilman, Marcus D.

    2007-01-01

    The Circulation Services Department at the University of Central Florida Libraries reports on leadership and training initiatives that resulted in a number of service-enhancing projects implemented by a highly motivated and involved staff. Key elements in reinvigorating the department included a change in leadership philosophy, increased…

  20. Improving the Quality of Telephone Reference Service.

    ERIC Educational Resources Information Center

    Quinn, Brian

    1995-01-01

    Discusses telephone reference services in libraries. Topics include characteristics of quality phone reference; policies and guidelines for quality service; a survey of pertinent literature evaluating telephone reference; training; and technology for telephone reference, including cellular and cordless phones, electronic resources, and automated…

  1. Customer satisfaction: key to improved service planning

    SciTech Connect

    McAleer, L.J.; Dukich, T.

    1985-06-13

    This article focuses on the accurate measurement of customer needs and requirements for service-planning purposes. It is based on the assumption that providing maximum service value per dollar paid to the utility is a primary objective of utility managers. Using customer satisfaction and perceived service value as a basis for utility service and market planning offers several key benefits. However, in order to take advantage of these benefits, the process used to measure customer satisfaction must meet a number of criteria. A methodology that meets these requirements is the measurement of perceived value (MPV). This technique was developed by the Melior Group and has been successfully applied to more than 6000 consumers in a variety of service industries, including public utilities. The basics of MPV are described.

  2. Assembling nanoparticle coatings to improve the drug delivery performance of lipid based colloids

    NASA Astrophysics Data System (ADS)

    Simovic, Spomenka; Barnes, Timothy J.; Tan, Angel; Prestidge, Clive A.

    2012-02-01

    Lipid based colloids (e.g. emulsions and liposomes) are widely used as drug delivery systems, but often suffer from physical instabilities and non-ideal drug encapsulation and delivery performance. We review the application of engineered nanoparticle layers at the interface of lipid colloids to improve their performance as drug delivery systems. In addition we focus on the creation of novel hybrid nanomaterials from nanoparticle-lipid colloid assemblies and their drug delivery applications. Specifically, nanoparticle layers can be engineered to enhance the physical stability of submicron lipid emulsions and liposomes, satbilise encapsulated active ingredients against chemical degradation, control molecular transport and improve the dermal and oral delivery characteristics, i.e. increase absorption, bioavailability and facilitate targeted delivery. It is feasible that hybrid nanomaterials composed of nanoparticles and colloidal lipids are effective encapsulation and delivery systems for both poorly soluble drugs and biological drugs and may form the basis for the next generation of medicines. Additional pre-clinical research including specific animal model studies are required to advance the peptide/protein delivery systems, whereas the silica lipid hybrid systems have now entered human clinical trials for poorly soluble drugs.

  3. Challenges in researching violence affecting health service delivery in complex security environments.

    PubMed

    Foghammar, Ludvig; Jang, Suyoun; Kyzy, Gulzhan Asylbek; Weiss, Nerina; Sullivan, Katherine A; Gibson-Fall, Fawzia; Irwin, Rachel

    2016-08-01

    Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research

  4. An ICMR task force study of Prevention of Parent to Child Transmission (PPTCT) service delivery in India.

    PubMed

    Sinha, A; Roy, M

    2008-01-01

    A retrospective survey was conducted during August to December 2007 in 19 medical colleges of India to examine the functioning of the PPTCT service delivery. Data was extracted from records of the PPTCT centers for the year 2005-2006. HIV prevalence was higher than 2005 NACO figures in 11 out of 19 (57.8%) centers. There was wide variation in the proportion of women counseled & tested for HIV in different centers. Antenatal prophylaxis was practiced in 7 out of 19 (36.8%) centers. Overall intra-natal ART was provided to 52.8% of HIV positive women. Early newborn testing was available at 3 out of 19 (15.7%) centers. Improved counseling services are required for better case detection. PMID:19189821

  5. Leadership styles of service professionals aiding women of abuse: enhancing service delivery.

    PubMed

    Haeseler, Lisa Ann

    2013-01-01

    Leadership styles of service professionals--including social workers and teachers--in the area of family abuse were investigated. Leadership characteristics of the professionals were measured by their responses to a survey. Results indicated that the interviewed service professionals demonstrated productive leadership traits. Study findings are congruent with leadership styles described in the research. Holistic and collaborative services are required to enhance care for women of abuse, as their needs are multifaceted and complex. Specific leadership styles promote better care for women; leaders need to collaboratively initiate and deliver more interdisciplinary and unified service. PMID:23368994

  6. Location-based health information services: a new paradigm in personalised information delivery

    PubMed Central

    Boulos, Maged N Kamel

    2003-01-01

    Brute health information delivery to various devices can be easily achieved these days, making health information instantly available whenever it is needed and nearly anywhere. However, brute health information delivery risks overloading users with unnecessary information that does not answer their actual needs, and might even act as noise, masking any other useful and relevant information delivered with it. Users' profiles and needs are definitely affected by where they are, and this should be taken into consideration when personalising and delivering information to users in different locations. The main goal of location-based health information services is to allow better presentation of the distribution of health and healthcare needs and Internet resources answering them across a geographical area, with the aim to provide users with better support for informed decision-making. Personalised information delivery requires the acquisition of high quality metadata about not only information resources, but also information service users, their geographical location and their devices. Throughout this review, experience from a related online health information service, HealthCyberMap , is referred to as a model that can be easily adapted to other similar services. HealthCyberMap is a Web-based directory service of medical/health Internet resources exploring new means to organise and present these resources based on consumer and provider locations, as well as the geographical coverage or scope of indexed resources. The paper also provides a concise review of location-based services, technologies for detecting user location (including IP geolocation), and their potential applications in health and healthcare. PMID:12556243

  7. MATra - Magnet Assisted Transfection: combining nanotechnology and magnetic forces to improve intracellular delivery of nucleic acids.

    PubMed

    Bertram, J

    2006-08-01

    Recent efforts combining nanotechnology and magnetic properties resulted in the development and commercialization of magnetic nanoparticles that can be used as carriers for nucleic acids for in vitro transfection and for gene therapy approaches including DNA-based vaccination strategies. The efficiency of intracellular delivery is still a limiting factor for basic cell biological research and also for emerging technologies such as temporary gene silencing based on inhibitory RNA/siRNA. Nanotechnology has resulted in a variety of different nanostructures and especially nanoparticles as carriers in a wide range of new drug delivery systems for conventional drugs, recombinant proteins, vaccines and more recently nucleic acids. It is possible to combine superparamagnetic nanoparticles with magnetic forces to increase, direct and optimize intracellular delivery of biomolecules. This article discusses the main approaches in the field of magnet assisted transfection (MATra) focusing on the transfection or intracellular delivery of nucleic acids, although also suitable to improve the intracellular delivery of other biomolecules. PMID:16918404

  8. SOA-Based Model for Value-Added ITS Services Delivery

    PubMed Central

    Herrera-Quintero, Luis Felipe; Maciá-Pérez, Francisco; Marcos-Jorquera, Diego; Gilart-Iglesias, Virgilio

    2014-01-01

    Integration is currently a key factor in intelligent transportation systems (ITS), especially because of the ever increasing service demands originating from the ITS industry and ITS users. The current ITS landscape is made up of multiple technologies that are tightly coupled, and its interoperability is extremely low, which limits ITS services generation. Given this fact, novel information technologies (IT) based on the service-oriented architecture (SOA) paradigm have begun to introduce new ways to address this problem. The SOA paradigm allows the construction of loosely coupled distributed systems that can help to integrate the heterogeneous systems that are part of ITS. In this paper, we focus on developing an SOA-based model for integrating information technologies (IT) into ITS to achieve ITS service delivery. To develop our model, the ITS technologies and services involved were identified, catalogued, and decoupled. In doing so, we applied our SOA-based model to integrate all of the ITS technologies and services, ranging from the lowest-level technical components, such as roadside unit as a service (RSUAAS), to the most abstract ITS services that will be offered to ITS users (value-added services). To validate our model, a functionality case study that included all of the components of our model was designed. PMID:25019101

  9. SOA-based model for value-added ITS services delivery.

    PubMed

    Herrera-Quintero, Luis Felipe; Maciá-Pérez, Francisco; Marcos-Jorquera, Diego; Gilart-Iglesias, Virgilio

    2014-01-01

    Integration is currently a key factor in intelligent transportation systems (ITS), especially because of the ever increasing service demands originating from the ITS industry and ITS users. The current ITS landscape is made up of multiple technologies that are tightly coupled, and its interoperability is extremely low, which limits ITS services generation. Given this fact, novel information technologies (IT) based on the service-oriented architecture (SOA) paradigm have begun to introduce new ways to address this problem. The SOA paradigm allows the construction of loosely coupled distributed systems that can help to integrate the heterogeneous systems that are part of ITS. In this paper, we focus on developing an SOA-based model for integrating information technologies (IT) into ITS to achieve ITS service delivery. To develop our model, the ITS technologies and services involved were identified, catalogued, and decoupled. In doing so, we applied our SOA-based model to integrate all of the ITS technologies and services, ranging from the lowest-level technical components, such as roadside unit as a service (RSUAAS), to the most abstract ITS services that will be offered to ITS users (value-added services). To validate our model, a functionality case study that included all of the components of our model was designed. PMID:25019101

  10. Service providers’ perspectives, attitudes and beliefs on health services delivery for Aboriginal people receiving haemodialysis in rural Australia: a qualitative study

    PubMed Central

    Rix, Elizabeth F; Barclay, Lesley; Wilson, Shawn; Stirling, Janelle; Tong, Allison

    2013-01-01

    Objective Providing services to rural dwelling minority cultural groups with serious chronic disease is challenging due to access to care and cultural differences. This study aimed to describe service providers’ perspectives on health services delivery for Aboriginal people receiving haemodialysis for end-stage kidney disease in rural Australia. Design Semistructured interviews, thematic analysis Setting A health district in rural New South Wales, Australia Participants Using purposive sampling, 29 renal and allied service providers were recruited, including nephrologists, renal nurses, community nurses, Aboriginal health workers, social workers and managers. Six were Aboriginal and 23 non-Aboriginal. Results Improving cultural understanding within the healthcare system was central to five themes identified: rigidity of service design (outreach, inevitable home treatment failures, pressure of system overload, limited efficacy of cultural awareness training and conflicting priorities in acute care); responding to social complexities (respecting but challenged by family obligations, assumptions about socioeconomic status and individualised care); promoting empowerment, trust and rapport (bridging gaps in cultural understanding, acknowledging the relationship between land, people and environment, and being time poor); distress at late diagnosis (lost opportunities and prioritise prevention); and contending with discrimination and racism (inherent judgement of lifestyle choices, inadequate cultural awareness, pervasive multilevel institutionalised racism and managing patient distrust). Conclusions Service providers believe current services are not designed to address cultural needs and Aboriginality, and that caring for Aboriginal patients receiving haemodialysis should be family focused and culturally safer. An Aboriginal-specific predialysis pathway, building staff cultural awareness and enhancing cultural safety within hospitals are the measures recommended

  11. IMPROVEMENTS IN THE STATUS OF WOMEN AND INCREASED USE OF MATERNAL HEALTH SERVICES IN RURAL EGYPT

    PubMed Central

    CHIANG, CHIFA; HASSAN ELSHAIR, INASS HELMY; KAWAGUCHI, LEO; MONEIM FOUAD, NAWAL ABDEL; ABDOU, NAGAH MAHMOUD; HIGUCHI, MICHIYO; BANNA, SANEYA RIZK EL; AOYAMA, ATSUKO

    2012-01-01

    ABSTRACT This research investigated the association between the household status of women and their use of maternal health services in rural Egypt. Face-to-face interviews with a structured questionnaire to 201 married women were carried out in a village, posing questions about their health service utilization and their household socio-economic status. The association between service utilization and other variables was statistically analysed. Older ages at first marriage and higher education levels showed significant positive associations with the three outcome variables—regular antenatal care (ANC), deliveries attended by skilled health professionals, and deliveries at heath facilities—of the use of maternal health services. Women who had not experienced physical assaults by husbands and had knowledge of community activities were more likely to receive ANC regularly; however, there were no significant association with the other two outcome variables. Participation in household decision-making and availability of assistance with household chores had no significant linkage to the use of maternal health services. Marriages to husbands with secondary or higher levels of education and residence in extended families were significantly associated with greater maternal health service usage. Our results suggest that the improved status of women in the household and moral support from family members contributes to an increase in the use of maternal health services. PMID:23092096

  12. Building Rural Surgical Networks: An Evidence-Based Approach to Service Delivery and Evaluation.

    PubMed

    Kornelsen, Jude; Friesen, Randy

    2016-08-01

    Formalized rural health service delivery networks are emerging as an over-arching response to the attrition of rural surgical and maternity services in Canada. In effective networks, there is strong collaborative leadership, form follows function, core network elements are identified and site-specific variations are accommodated to meet the surgical needs of the population in each geographic catchment. The network catchment must reflect the natural alliances that already exist among health professionals, policy makers, health administrators, academic institutions and communities. Although each key stakeholder plays a key role in determining success, value is added through the synergistic interplay of all participants. PMID:27585024

  13. Service Delivery Experiences and Intervention Needs of Military Families with Children with ASD.

    PubMed

    Davis, Jennifer M; Finke, Erinn; Hickerson, Benjamin

    2016-05-01

    The purpose of this study was to describe the experiences of military families with children with autism spectrum disorder (ASD) specifically as it relates to relocation. Online survey methodology was used to gather information from military spouses with children with ASD. The finalized dataset included 189 cases. Descriptive statistics and frequency analyses were used to examine participant demographics and service delivery questions. Results indicated the larger sample of military spouses largely confirmed the experiences reported qualitatively in previous studies and contributed information that was previously unknown about variables associated with the access, availability, quality, and frequency of intervention services for military families with children with ASD. PMID:26780908

  14. The importance of uncertainties in scenario analyses--A study on future ecosystem service delivery in Flanders.

    PubMed

    Landuyt, Dries; Broekx, Steven; Engelen, Guy; Uljee, Inge; Van der Meulen, Maarten; Goethals, Peter L M

    2016-05-15

    Land use is rapidly changing and is significantly affecting ecosystem service delivery all around the world. The socio-economic context and political choices largely determine land use change. This land use change, driven by socio-economic pressures, will impact diverse elements of the environment including, for example, air quality, soil properties, water infiltration and food and wood production, impacts that can be linked to the provisioning of ecosystem services. To gain more insight into the effects of alternative socio-economic developments on ecosystem service delivery, land use change models are being coupled to ecosystem service delivery models to perform scenario analyses. Although the uncertainty of the results of these kind of scenario analyses are generally far from negligible, studies rarely take them into account. In this study, a cellular automaton land use change model is coupled to Bayesian belief network ecosystem service delivery models to facilitate the study of error propagation in scenario analysis. The proposed approach is applied to model the impact of alternative socio-economic developments on ecosystem service delivery in Flanders, Belgium and to assess the impact of land use allocation uncertainty on the uncertainty associated to future ecosystem service delivery. Results suggest that taking into account uncertainties may have an effect on policy recommendations that come out of the scenario analysis. However, in this study, uncertainties in the applied ecosystem service models were dominant, reducing the importance of accounting for land use allocation uncertainty. PMID:26930321

  15. TIGER -- A technology to improve the delivery capability of nuclear bombs and the survivability of the delivery aircraft

    SciTech Connect

    1980-12-31

    The TIGER (Terminal guided and Extended-Range) Program was initiated in 1972 to study improved delivery capabilities for stockpiled tactical nuclear bombs. The Southeast Asia conflict fostered the development of air-delivered standoff conventional weapons utilizing terminal guidance systems. SNL initiated the TIGER program to determine if current nuclear bombs could be provided with a similarly accurate standoff capabilities. These conventional weapon delivery techniques, while allowing highly accurate attack, generally require entering the target area at high altitude to establish line of sight to the target. In parallel with the TIGER program, system studies analyzed this concept and showed marked improvement in aircraft and weapon survivability with moderate standoff (10--20 km) if low level deliveries (60 m) could be accomplished. As a result of this work, the TIGER program was redirected in early 1974 to demonstrate a standoff bomb with good accuracy (90 m CEP) when delivered from low flying aircraft. This program redirection resulted in the selection of an inertial guidance system to replace the earlier terminal guidance systems. This program was called the Extended-Range Bomb (ERB). In May 1974, a joint Air Force/DOE study identified the desirability of having a single tactical weapon which could be employed against either fixed, preselected targets, or mobile battlefield targets. Studies conducted on the ERB system showed that the inertially guided weapon could fly not only the standoff mission but also a return-to-target mission against the mobile battlefield targets whose locations are not known accurately enough to use a standoff delivery. The ERB program evolved from these initial investigations into an exploratory program to develop the hardware and demonstrate the technology required to fly standoff and return-to-target trajectories. The application of this technology in the form of field retrofit kits to the B61 bomb is called TIGER II.

  16. Delivery of crop pollination services is an insufficient argument for wild pollinator conservation

    PubMed Central

    Kleijn, David; Winfree, Rachael; Bartomeus, Ignasi; Carvalheiro, Luísa G; Henry, Mickaël; Isaacs, Rufus; Klein, Alexandra-Maria; Kremen, Claire; M'Gonigle, Leithen K; Rader, Romina; Ricketts, Taylor H; Williams, Neal M; Lee Adamson, Nancy; Ascher, John S; Báldi, András; Batáry, Péter; Benjamin, Faye; Biesmeijer, Jacobus C; Blitzer, Eleanor J; Bommarco, Riccardo; Brand, Mariëtte R; Bretagnolle, Vincent; Button, Lindsey; Cariveau, Daniel P; Chifflet, Rémy; Colville, Jonathan F; Danforth, Bryan N; Elle, Elizabeth; Garratt, Michael P.D.; Herzog, Felix; Holzschuh, Andrea; Howlett, Brad G; Jauker, Frank; Jha, Shalene; Knop, Eva; Krewenka, Kristin M; Le Féon, Violette; Mandelik, Yael; May, Emily A; Park, Mia G; Pisanty, Gideon; Reemer, Menno; Riedinger, Verena; Rollin, Orianne; Rundlöf, Maj; Sardiñas, Hillary S; Scheper, Jeroen; Sciligo, Amber R; Smith, Henrik G; Steffan-Dewenter, Ingolf; Thorp, Robbin; Tscharntke, Teja; Verhulst, Jort; Viana, Blandina F; Vaissière, Bernard E; Veldtman, Ruan; Westphal, Catrin; Potts, Simon G

    2015-01-01

    There is compelling evidence that more diverse ecosystems deliver greater benefits to people, and these ecosystem services have become a key argument for biodiversity conservation. However, it is unclear how much biodiversity is needed to deliver ecosystem services in a cost-effective way. Here we show that, while the contribution of wild bees to crop production is significant, service delivery is restricted to a limited subset of all known bee species. Across crops, years and biogeographical regions, crop-visiting wild bee communities are dominated by a small number of common species, and threatened species are rarely observed on crops. Dominant crop pollinators persist under agricultural expansion and many are easily enhanced by simple conservation measures, suggesting that cost-effective management strategies to promote crop pollination should target a different set of species than management strategies to promote threatened bees. Conserving the biological diversity of bees therefore requires more than just ecosystem-service-based arguments. PMID:26079893

  17. The Chinese community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system

    PubMed Central

    2013-01-01

    Background Although the Chinese government put a lot of effort into promoting the community patient’s life satisfaction, there still lacked the holistic and systematic approaches to promote the community patient’s life satisfaction in various regions of China. On the basis of the literature, it was found that both the community patient’s assessment of community medical service and trust in community health delivery system were important considerations when the community patient comprehensively evaluated community medical service to generate life satisfaction. So this study was set up to test whether and to what extent the community patient’s assessments of various major aspects of community medical service/various major aspects of the community patient’s trust in community health delivery system influenced life satisfaction in whole China/in various regions of China. Methods In order to explore the situation of China’s community health delivery system before 2009 and provide a reference for China’s community health delivery system reform, the data that could comprehensively and accurately reflect the community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system in various regions of China was needed, so this study collaborated with the National Bureau of Statistics of China to carry out a large-scale 2008 national community resident household survey (N = 3,306) for the first time in China. And the specified ordered probit models were established to analyze the dataset from this household survey. Results Among major aspects of community medical service, the medical cost (particularly in developed regions), the doctor-patient communication (particularly in developed regions), the medical facility and hospital environment (particularly in developed regions), and the medical treatment process (particularly in underdeveloped regions) were all key considerations (p<0.05 for t statistics) in

  18. Manpower Placement: Service Delivery for the Hard-to-Employ. Policy Papers in Human Resources and Industrial Relations 21.

    ERIC Educational Resources Information Center

    Hasenfeld, Yeheskel

    The basic aim of this report is to suggest a strategic framework for the transformation of manpower placement services (MPS) from a reactive, precarious organization into an active and vital service delivery system. The main characteristics of MPS are analyzed from a systems perspective and organizational resources and structure of services for…

  19. Coproduction without Experts: A Study of People Involved in Community Health and Well-Being Service Delivery

    ERIC Educational Resources Information Center

    Ledger, Alison; Slade, Bonnie

    2015-01-01

    Coproduction (equal professional-public involvement in service delivery) has been widely promoted as a means of revolutionising health and social care. Service providers/professionals are tasked with working more in partnership with service users/clients, recognising their experiences and knowledge as critical to the success of the interaction.…

  20. [Nurses' and patients' experience of combined health service delivery to all population groups in a hospital].

    PubMed

    Poggenpoel, M; Uys, H; Botes, A; Dörfling, C; Greeff, M; Gross, E; Müller, M; Nolte, A

    1996-06-01

    In a community hospital in Gauteng, the hospital management had, on short notice, to provide combined health services to all population groups. In the past different health services were delivered to each population group. The integration of health service delivery was a sudden change. Based on this, research questions arose, namely: how do nurses and patients experience this change, and how could they be assisted to adjust to the change. The research objectives were twofold, namely: to explore and describe nurses and patients' experience of combined health delivery to all population groups and based on the results to make recommendations to assist them with adjustment to a combined health delivery system. An exploratory, descriptive and contextual research design was followed. Trustworthiness was ensured by applying Guba's approach. Phenomenological and individual focus interviews were conducted with forty nurses and patients who were selected purposively. Field notes were written after completion of each interview. The transcribed data was analysed by using Giorgi's and Kerlinger's methods combined. Results were discussed and a literature control completed. The most important conclusions reached were: there was an insufficient administrative structure in the hospital as a result of insufficient preparation for the combined health service delivery for all population groups; the whites' perception of different populations groups is based on an ethnocentric Western approach. This led to their experience of culture shock that resulted in feelings of anger/frustration, fear and sadness; the willingness of other populations groups to adjust to combined health service delivery led to their experience of happiness; there exists communication problems between population groups because of their not being able to communicate in their own language and the difference in communication styles; the verbalised Christian viewpoint and values of whites nurses and patients are not

  1. Applying GRA and QFD to Improve Library Service Quality

    ERIC Educational Resources Information Center

    Chen, Yen-Ting; Chou, Tsung-Yu

    2011-01-01

    This paper applied Grey Relational Analysis (GRA) to Quality Function Deployment (QFD) to identify service improvement techniques for an academic library. First, reader needs and their importance, and satisfaction degrees were examined via questionnaires. Second, the service improvement techniques for satisfying the reader needs were developed by…

  2. Still too far to walk: Literature review of the determinants of delivery service use

    PubMed Central

    Gabrysch, Sabine; Campbell, Oona MR

    2009-01-01

    Background Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. Methods We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. Results There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. Conclusion Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential

  3. Improving quality measures in the emergency services.

    PubMed

    Armitage, M; Flanagan, D

    2001-01-01

    A large and continuing increase in medical emergency admissions has coincided with a reduction in hospital beds, putting the acute medical services under great pressure. Increasing specialization among physicians creates a conflict between the need to cover acute unselected medical emergencies and the pressure to offer specialist care. The shortage of trained nursing staff and changes in the training of junior doctors and the fall in their working hours contribute to the changing role of the consultant physician. The organization of the acute medical service is of paramount importance and requires multi-disciplinary teamwork on an admissions unit with full support services. Excellent bed management is essential. There must be guidelines for all the common medical emergencies and all units must undertake specific audits of the acute medical service. Continuing professional development (CPD) and continuing medical education (CME) should reflect the workload of the physician; that is, it must include time specifically focused on acute medicine and general (internal) medicine, as well as the specialty interest. PMID:11383434

  4. Improving Library Services to the Aging.

    ERIC Educational Resources Information Center

    Moore, Bessie B.; Fisk, Carol Fraser

    1988-01-01

    Discussion of efforts by federal, state, and local government agencies to enhance the library resources and services available to older citizens highlights the roles of the National Commission on Libraries and Information Science (NCLIS) and the Administration on Aging (AoA), cooperative agreements, and descriptions of state and local programs.…

  5. A Comparison of Speech Sound Intervention Delivered by Telepractice and Side-by-Side Service Delivery Models

    ERIC Educational Resources Information Center

    Grogan-Johnson, Sue; Schmidt, Anna Marie; Schenker, Jason; Alvares, Robin; Rowan, Lynne E.; Taylor, Jacquelyn

    2013-01-01

    Telepractice has the potential to provide greater access to speech-language intervention services for children with communication impairments. Substantiation of this delivery model is necessary for telepractice to become an accepted alternative delivery model. This study investigated the progress made by school-age children with speech sound…

  6. Outplacement Services for Displaced Employees: Attitudes of Human Resource Managers Based on Differences in Internal and External Delivery

    ERIC Educational Resources Information Center

    Kilcrease, Kelly M.

    2013-01-01

    The results from a survey of 238 human resources executives from organizations that offer outplacement counseling (OPC) internally and 168 that offer it externally suggest that internal OPC delivery is inferior to external OPC delivery. The author found that most internal OPC organizations did not offer the 13 traditional OPC services, even when…

  7. Pathways and Progress in Improving Drug Delivery through the Intestinal Mucosa and Blood-Brain Barriers

    PubMed Central

    Laksitorini, Marlyn; Prasasty, Vivitri D.; Kiptoo, Paul K.; Siahaan, Teruna J.

    2015-01-01

    One of the major hurdles in developing therapeutic agents is the difficulty in delivering drugs through the intestinal mucosa and blood-brain barriers (BBB). The goal here is to describe the general structures of the biological barriers and the strategies to enhance drug delivery across these barriers. Prodrug methods used to improve drug penetration via the transcellular pathway have been successfully developed, and some prodrugs have been used to treat patients. The use of transporters to improve absorption of some drugs (e.g., antiviral agents) has also been successful in treating patients. Other methods, including (a) blocking the efflux pumps to improve transcellular delivery and (b) modulation of cell-cell adhesion in the intercellular junctions to improve paracellular delivery across biological barriers are still in the investigational stage. PMID:25418271

  8. Key Aspects of Health Policy Development to Improve Surgical Services in Uganda

    PubMed Central

    Luboga, Sam; Galukande, Moses; Mabweijano, Jacqueline; Jayaraman, Sudha

    2010-01-01

    Recently, surgical services have been gaining greater attention as an integral part of public health in low-income countries due to the significant volume and burden of surgical conditions, growing evidence of the cost-effectiveness of surgical intervention, and global disparities in surgical care. Nonetheless, there has been limited discussion of the key aspects of health policy related to surgical services in low-income countries. Uganda, like other low-income sub-Saharan African countries, bears a heavy burden of surgical conditions with low surgical output in health facilities and significant unmet need for surgical care. To address this lack of adequate surgical services in Uganda, a diverse group of local stakeholders met in Kampala, Uganda, in May 2008 to develop a roadmap of key policy actions that would improve surgical services at the national level. The group identified a list of health policy priorities to improve surgical services in Uganda. The priorities were classified into three areas: (1) human resources, (2) health systems, and (3) research and advocacy. This article is a critical discussion of these health policy priorities with references to recent literature. This was the first such multidisciplinary meeting in Uganda with a focus on surgical services and its output may have relevance to health policy development in other low-income countries planning to improve delivery of surgical services. PMID:20730430

  9. Improving families' nutrition knowledge through service learning.

    PubMed

    Roofe, Nina L

    2011-01-01

    Current research documents an increasing prevalence of pediatric obesity in the United States. Effective nutrition education programs are needed to affect this trend. This study pre-tested and post-tested kindergarten students and their families to evaluate the impact of a service learning nutrition education program. Changes in nutrition knowledge and home environment among kindergarten students and their parents who participated in a nutrition education program (treatment group) were compared with those who did not participate in the program (control group). The nutrition education program was developed and delivered by senior nutrition majors at an accredited 4-year university. Responses from a total of 156 parents and kindergarten children (treatment n = 79, control n = 77) out of 205 total kindergarten families (76% response rate) were analyzed to compare changes in knowledge and home environment. Results indicate an increase in the kindergarten children's knowledge and a decrease in the family's home obesigenic risk. These results provide support for the use of service learning to provide age-appropriate nutrition education programs to benefit the entire family. PMID:22138874

  10. Virtual Ethernet ring architecture for reliable Ethernet service delivery over SDH/SONET

    NASA Astrophysics Data System (ADS)

    Parikh, Anand

    2002-09-01

    With its low cost, ubiquity, and scale, Ethernet is the technology most widely envisioned to change the economics of packet service delivery for both carriers and their customers. This paper discusses a new architecture that simplifies and lowers the cost to deliver data services. By fully integrating Ethernet with existing SONET/SDH networks in a "Virtual Ethernet Ring," carriers can now provide a multipoint Ethernet service that can span long distances across multiple metro areas. This architecture leverages the plug-and-play advantages of Ethernet - auto-provisioning, broadcast and discovery, etc. - across a distributed wide area network. It provides the advantage of granular, software-provisioned bandwidth to the customer. It also provides SONET/SDH quality resilience with security and bandwidth guarantee. By incorporating protocol mediation technology, this architecture enables the migration from today's frame relay, ATM and IP services to a new generation of granular, readily scalable Ethernet services such as Ethernet Private Line, Ethernet Virtual Private Lines and Internet/Frame Relay/ATM/Access Services.

  11. Improving Internet Archive Service through Proxy Cache.

    ERIC Educational Resources Information Center

    Yu, Hsiang-Fu; Chen, Yi-Ming; Wang, Shih-Yong; Tseng, Li-Ming

    2003-01-01

    Discusses file transfer protocol (FTP) servers for downloading archives (files with particular file extensions), and the change to HTTP (Hypertext transfer protocol) with increased Web use. Topics include the Archie server; proxy cache servers; and how to improve the hit rate of archives by a combination of caching and better searching mechanisms.…

  12. Architectural Principles for Orchestration of Cross-Organizational Service Delivery: Case Studies from the Netherlands

    NASA Astrophysics Data System (ADS)

    van Veenstra, Anne Fleur; Janssen, Marijn

    One of the main challenges for e-government is to create coherent services for citizens and businesses. Realizing Integrated Service Delivery (ISD) requires government agencies to collaborate across their organizational boundaries. The coordination of processes across multiple organizations to realize ISD is called orchestration. One way of achieving orchestration is to formalize processes using architecture. In this chapter we identify architectural principles for orchestration by looking at three case studies of cross-organizational service delivery chain formation in the Netherlands. In total, six generic principles were formulated and subsequently validated in two workshops with experts. These principles are: (i) build an intelligent front office, (ii) give processes a clear starting point and end, (iii) build a central workflow application keeping track of the process, (iv) differentiate between simple and complex processes, (v) ensure that the decision-making responsibility and the overview of the process are not performed by the same process role, and (vi) create a central point where risk profiles are maintained. Further research should focus on how organizations can adapt these principles to their own situation.

  13. Web-based data delivery services in support of disaster-relief applications

    USGS Publications Warehouse

    Jones, B.K.; Risty, R.R.; Buswell, M.

    2003-01-01

    The U.S. Geological Survey Earth Resources Observation Systems Data Center responds to emergencies in support of various government agencies for human-induced and natural disasters. This response consists of satellite tasking and acquisitions, satellite image registrations, disaster-extent maps analysis and creation, base image provision and support, Web-based mapping services for product delivery, and predisaster and postdisaster data archiving. The emergency response staff are on call 24 hours a day, 7 days a week, and have access to many commercial and government satellite and aerial photography tasking authorities. They have access to value-added data processing and photographic laboratory services for off-hour emergency requests. They work with various Federal agencies for preparedness planning, which includes providing base imagery. These data may include digital elevation models, hydrographic models, base satellite images, vector data layers such as roads, aerial photographs, and other predisaster data. These layers are incorporated into a Web-based browser and data delivery service that is accessible either to the general public or to select customers. As usage declines, the data are moved to a postdisaster nearline archive that is still accessible, but not in real time.

  14. Assessing customer satisfaction for improving NOAA's climate products and services

    NASA Astrophysics Data System (ADS)

    Meyers, J. C.; Hawkins, M. D.; Timofeyeva, M. M.

    2009-12-01

    NOAA's National Weather Service (NWS) Climate Services Division (CSD) is developing a comprehensive climate user requirements process with the ultimate goal of producing climate services that meet the needs of NWS climate information users. An important part of this effort includes engaging users through periodical surveys conducted by the Claes Fornell International (CFI) Group using the American Customer Satisfaction Index (ACSI). The CFI Group conducted a Climate Services Satisfaction (CSS) Survey in May of 2009 to measure customer satisfaction with current products and services and to gain insight on areas for improvement. The CSS Survey rates customer satisfaction on a range of NWS climate services data and products, including Climate Prediction Center (CPC) outlooks, drought monitoring, and ENSO monitoring and forecasts, as well as NWS local climate data services. In addition, the survey assesses the users of the products to give the NWS insight into its climate customer base. The survey also addresses specific topics such as NWS forecast category names, probabilistic nature of climate products, and interpretation issues. The survey results identify user requirements for improving existing NWS climate services and introducing new ones. CSD will merge the survey recommendations with available scientific methodologies and operational capabilities to develop requirements for improved climate products and services. An overview of the 2009 survey results will be presented, such as users' satisfaction with the accuracy, reliability, display and functionality of products and services.

  15. Novel drug delivery strategies for improving econazole antifungal action.

    PubMed

    Firooz, Alireza; Nafisi, Shohreh; Maibach, Howard I

    2015-11-10

    Econazole is a commonly used azole antifungal in clinical treatment of superficial fungal infections. It is generally used as conventional cream and gel preparations under the brand names of Spectazole (United States), Ecostatin (Canada), Pevaryl (Western Europe). Treatment efficiency of antifungal drugs depends on their penetration through target layers of skin at effective concentrations. Econazole's poor water solubility limits its bioavailability and antifungal effects. Therefore, formulation strategies have been examined for delivering econazole through targeted skin sites. The present overview focuses on novel nano-based formulation approaches used to improve econazole penetration through skin for treatment of superficial fungal infections. PMID:26383840

  16. Normalization of tumour blood vessels improves the delivery of nanomedicines in a size-dependent manner

    PubMed Central

    Chauhan, Vikash P.; Stylianopoulos, Triantafyllos; Martin, John D.; Popović, Zoran; Chen, Ou; Kamoun, Walid S.; Bawendi, Moungi G.; Fukumura, Dai; Jain, Rakesh K.

    2012-01-01

    The blood vessels of cancerous tumours are leaky1–3 and poorly organized4–7. This can increase the interstitial fluid pressure (IFP) inside tumours and reduce blood supply to them, which impairs drug delivery8–9. Anti-angiogenic therapies – which “normalize” the abnormal blood vessels in tumours by making them less leaky – have been shown to improve the delivery and effectiveness of chemotherapeutics with low molecular-weights10, but it remains unclear whether normalizing tumour vessels can improve the delivery of nanomedicines. Here we show that repairing the abnormal vessels in mammary tumours, by blocking vascular endothelial growth factor (VEGF) receptor-2, improves the delivery of small nanoparticles (12nm diameter) while hindering the delivery of large nanoparticles (125nm diameter). We utilize a mathematical model to show that reducing vessel wall pore sizes through normalization decreases IFP in tumours, allowing small nanoparticles to enter them more rapidly. However, increased steric and hydrodynamic hindrances, also associated with smaller pores, make it more difficult for large nanoparticles to enter tumours. Our results further suggest that smaller (~12nm) nanomedicines are ideal for cancer therapy, owing to superior tumour penetration. PMID:22484912

  17. Use of process mapping in service improvement.

    PubMed

    Phillips, Joanna; Simmonds, Lorraine

    This article, the last of our three-part series on change management tools, analyses how process mapping can be used to show how processes are currently carried out and identify any changes that may improve the patient experience. The tool takes into account patient opinions so staff are able to see the pathway from patients' perspectives. It offers advice on how to write up the results and how they can be analysed to identify where changes can be made. PMID:23741910

  18. Delivery of active agents from chewing gum for improved remineralization.

    PubMed

    Dodds, M W J; Chidichimo, D; Haas, M S

    2012-09-01

    Most surrogate measures of caries were developed to test products containing fluoride, typically at relatively high and closely controlled oral concentrations. However, since the primary mechanism for the remineralization of early enamel caries lesions by chewing gum is through stimulation of saliva, delivering Ca and Pi to the demineralized enamel lesion, established methods may lack the sensitivity to detect the additional benefit of an active agent without the strong remineralizing potential of fluoride. Issues related to the release of active agents from the gum matrix, dilution in the saliva, and limited oral retention time, along with taste, safety, regulatory, and cost concerns, impose further limitations. This paper reviews the efficacy of some active agents used in chewing gum for improved remineralization and includes results from in situ testing of calcium-containing gums, including calcium lactate, tetracalcium phosphate/dicalcium phosphate anhydrous, calcium citrate/encapsulated phosphate, and a calcium lactate/sodium phosphate blend. Despite promising in vitro data from these agents, they did not provide consistently superior results from in situ testing. There is a need to develop better predictive in vitro models for chewing gum, as well as improved sensitivity of in situ models to discriminate relatively small amounts of remineralization against a background of high biological variability. PMID:22899681

  19. Community based service delivery: power and pathology: or, social rehabilitation is still a 'commie plot'.

    PubMed

    Gregory, R J

    2001-01-15

    Service delivery in the broad field of rehabilitation has been declining in quantity and quality for people with disabilities, the dispossessed, and others. The context, that is, our communities, has similarly been weakened. Meanwhile, the world's resources and wealth and talent flow freely up the hierarchies to the powers-that-be, the wealthy and the elite. In turn, these powerful people regard social action efforts to redress the underlying social, economic, and political imbalances as a 'Commie plot'. More, not less, social rehabilitation is needed to make human communities fit again. PMID:11213319

  20. Service Productivity How to Measure and Improve It?

    NASA Astrophysics Data System (ADS)

    den Hartigh, Erik; Zegveld, Marc

    Productivity is a key performance measure for service businesses and serves as a compass for measuring their innovativeness. In this chapter we present a tool for measuring productivity in service businesses. Improvements in service business productivity do not depend on industry, business size or business growth, but on the specific knowledge and competences of managers. Using case examples we show various ways of how managers can improve the productivity of their service businesses. They can do so by adopting a perspective of standardization, flexibility or individualization. Based on these perspectives, we provide a framework that shows how managers can improve service business productivity by coordinating strategic orientation, value creation and the configuration of business processes.

  1. New improved drug delivery technologies for pentacyclic triterpenes: a review.

    PubMed

    Soica, Codruta; Trandafirescu, Cristina; Danciu, Corina; Muntean, Danina; Dehelean, Cristina; Simu, Georgeta

    2014-01-01

    Phytochemicals are becoming more and more interesting in the field of therapeutic research, mainly in the treatment of chronic illnesses, due to the fact that many synthetic drugs cause important side effects that impact on pa- tient's life quality. Pentacyclic triterpenes are a class of compounds with several therapeutic effects and increasing impor- tance in cancer therapy; however, a major disadvantage is their low water solubility and bioavailability which leads to rather poor therapeutic results in vivo.Technological attempts to improve the pharmacokinetic profile of the main repre- sentatives of this class include the use of cyclodextrins, micro- and nanoemulsions, liposomes, polymeric nanoparticles, and nanocapsules. This paper is aimed to briefly summarize the most significant achievements in this field. PMID:25106907

  2. Improved efficiency and stability of secnidazole - An ideal delivery system.

    PubMed

    Khan, Salman; Haseeb, Mohd; Baig, Mohd Hassan; Bagga, Paramdeep Singh; Siddiqui, H H; Kamal, M A; Khan, Mohd Sajid

    2015-01-01

    Secnidazole (α,2-Dimethyl-5-nitro-1H-imidazole-1-ethanol) is a highly effective drug against a variety of G(+)/G(-) bacteria but with significant side effects because it is being used in very high concentration. In this study, gold nanoparticles (GNPS) were selected as a vehicle to deliver secnidazole drug at the specific site with more accuracy which made the drug highly effective at substantially low concentrations. The as-synthesized GNPs were capped with Human Serum Albumin (HSA) and subsequently bioconjugated with secnidazole because HSA provides the stability and improves the solubility of the bioconjugated drug, secnidazole. The quantification of covalently bioconjugated secnidazole with HSA encapsulated on enzymatically synthesized GNPs was done with RP-HPLC having SPD-20 A UV/VIS detector by using the C-18 column. The bioconjugation of GNPs with secnidazole was confirmed by Transmission Electron Microscopy (TEM) and Dynamic Light Scattering (DLS). The bioconjugated GNPs were characterized by UV-VIS spectroscopy, TEM, Scanning Electron Microscopy (SEM) and DLS. Zeta potential confirmed the stability and uniform distribution of particles in the emulsion of GNPs. The separation of bioconjugated GNPs, unused GNPs and unused drug was done by gel filtration chromatography. The minimal inhibitory concentration of secnidazole-conjugated gold nanoparticles (Au-HSA-Snd) against Klebsiella pneumonia (NCIM No. 2957) and Bacillus cereus (NCIM No. 2156) got improved by 12.2 times and 14.11 times, respectively, in comparison to pure secnidazole. Precisely, the MIC of Au-HSA-Snd against K. pneumonia (NCIM No. 2957) and B. cereus (NCIM No. 2156) were found to be 0.35 and 0.43 μg/ml, respectively whereas MIC of the pure secnidazole drug against the same bacteria were found to be 4.3 and 6.07 μg/ml, respectively. PMID:25561882

  3. Improving customer service. It's not just what's in the box.

    PubMed

    Redling, Robert

    2003-08-01

    Patient satisfaction scores can plummet when medical emergencies throw schedules into disarray or a receptionist ignores a patient at the front desk. Patients' expectations of good customer service have been shaped by technological conveniences and the concerted efforts of retailers, restaurants and other service providers. Physician leaders and administrators can improve customer service by paying more attention to organizational culture, physician behavior, staff incentives, hiring practices and team-building. PMID:12959055

  4. Towards a Formal Representation of Processes and Objects Regarding the Delivery of Telehealth Services: The Telehealth Ontology (TEON).

    PubMed

    Santana, Filipe; Schulz, Stefan; Campos, Amadeu; Novaes, Magdala A

    2015-01-01

    This study introduces ontological aspects concerning the Telehealth Ontology (TEON), an ontology that represents formal-ontological content concerning the delivery of telehealth services. TEON formally represents the main services, actors and other entity types relevant to telehealth service delivery. TEON uses the upper level ontology BioTopLite2 and reuses content from the Ontology for Biomedical Investigations (OBI). The services embedded in telehealth services are considered as essential as the common services provided by the health-related practices. We envision TEON as a service to support the development of telehealth systems. TEON might also enable the integration of heterogeneous telehealth systems, and provide a base to automatize the processing of telehealth-related content. PMID:26262407

  5. Decentralization Does Not Assure Optimal Delivery of PMTCT and HIV-Exposed Infant Services in a Low Prevalence Setting

    PubMed Central

    Edmonds, Andrew; Feinstein, Lydia; Okitolonda, Vitus; Thompson, Deidre; Kawende, Bienvenu; Behets, Frieda

    2016-01-01

    Background The consequences of decentralizing prevention of mother-to-child HIV transmission and HIV-exposed infant services to antenatal care (ANC)/labor and delivery (L&D) sites from dedicated HIV care and treatment (C&T) centers remain unknown, particularly in low prevalence settings. Methods In a cohort of mother–infant pairs, we compared delivery of routine services at ANC/L&D and C&T facilities in Kinshasa, Democratic Republic of Congo from 2010–2013, using methods accounting for competing risks (eg, death). Women could opt to receive interventions at 90 decentralized ANC/L&D sites, or 2 affiliated C&T centers. Additionally, we assessed decentralization’s population-level impacts by comparing proportions of women and infants receiving interventions before (2009–2010) and after (2011–2013) decentralization. Results Among newly HIV-diagnosed women (N = 1482), the 14-week cumulative incidence of receiving the package of CD4 testing and zidovudine or antiretroviral therapy was less at ANC/L&D [66%; 95% confidence interval (CI): 63% to 69%] than at C&T (88%; 95% CI: 83% to 92%) sites (subdistribution hazard ratio, 0.62; 95% CI: 0.55 to 0.69). Delivery of cotrimoxazole and DNA polymerase chain reaction testing to HIV-exposed infants (N = 1182) was inferior at ANC/L&D sites (subdistribution hazard ratio, 0.84; 95% CI: 0.76 to 0.92); the 10-month cumulative incidence of the package at ANC/L&D sites was 89% (95% CI: 82% to 93%) versus 97% (95% CI: 93% to 99%) at C&T centers. Receipt of the pregnancy (20% of 1518, to 64% of 1405) and infant (16%–31%) packages improved post decentralization. Conclusions Services were delivered less efficiently at ANC/L&D sites than C&T centers. Although access improved with decentralization, its potential cannot be realized without sufficient and sustained support. PMID:26262776

  6. Improved Prediction of Preterm Delivery Using Empirical Mode Decomposition Analysis of Uterine Electromyography Signals

    PubMed Central

    Ren, Peng; Yao, Shuxia; Li, Jingxuan; Valdes-Sosa, Pedro A.; Kendrick, Keith M.

    2015-01-01

    Preterm delivery increases the risk of infant mortality and morbidity, and therefore developing reliable methods for predicting its likelihood are of great importance. Previous work using uterine electromyography (EMG) recordings has shown that they may provide a promising and objective way for predicting risk of preterm delivery. However, to date attempts at utilizing computational approaches to achieve sufficient predictive confidence, in terms of area under the curve (AUC) values, have not achieved the high discrimination accuracy that a clinical application requires. In our study, we propose a new analytical approach for assessing the risk of preterm delivery using EMG recordings which firstly employs Empirical Mode Decomposition (EMD) to obtain their Intrinsic Mode Functions (IMF). Next, the entropy values of both instantaneous amplitude and instantaneous frequency of the first ten IMF components are computed in order to derive ratios of these two distinct components as features. Discrimination accuracy of this approach compared to those proposed previously was then calculated using six differently representative classifiers. Finally, three different electrode positions were analyzed for their prediction accuracy of preterm delivery in order to establish which uterine EMG recording location was optimal signal data. Overall, our results show a clear improvement in prediction accuracy of preterm delivery risk compared with previous approaches, achieving an impressive maximum AUC value of 0.986 when using signals from an electrode positioned below the navel. In sum, this provides a promising new method for analyzing uterine EMG signals to permit accurate clinical assessment of preterm delivery risk. PMID:26161639

  7. A model of continuous quality improvement for health service organisations.

    PubMed

    Thornber, M

    1992-01-01

    Continuous Quality Improvement (or Total Quality Management) is an approach to management originally used in manufacturing and now being applied in the health services. This article describes a model of Continuous Quality Improvement which has been used in NSW public and private hospitals. The model consists of Ten Key Elements. The first driving force of this model is 'defining quality in terms of customer expectations' of quality. The second driving force emphasises that 'quality improvement is a leadership issue'. Leaders are required to: coordinate staff participation in work process analysis; train staff in the customer service orientation; lead effective meetings and negotiate with both internal and external service partners. Increased staff motivation, quality improvement and reduction in running costs are seen to be the benefits of CQI for health service organisations. PMID:10117452

  8. Assessment and Improvement of Related Services (AIRS) Project. Final Report.

    ERIC Educational Resources Information Center

    McClelland, Robert A.; Hirata, Glenn T.

    The document presents the final report of the Assessment and Improvement of Related Services (AIRS) Project, an effort to assess the impact and effectiveness of special education related services in Hawaii. Each of the four project objectives focused on accomplishment of one of the evaluation types specified in the Context-Input-Process-Product…

  9. Improving Child Health Services: Lessons Learned from Nine Community Efforts.

    ERIC Educational Resources Information Center

    Hobson, William D.

    One of the major reasons many children do not receive efficient, effective health care is that much of public spending for child health services has been funneled through categorical funding programs. The Child Health Initiative provided an opportunity to learn how different communities would approach improving child health services through…

  10. Using mobile technology to improve healthcare service quality.

    PubMed

    Chao, Chia Chen; Jen, Wen Yuan; Li, Yu-Chuan; Chi, Y P; Chen, Chang-I; Feng, Chen Chjeh

    2005-01-01

    Improving healthcare service quality for illness of treatment, illness prevention and patient service is difficult for most hospitals because the hospitals are lack adequate resources and labor. In order to provide better healthcare service quality for patients, mobile technology can be used to manage healthcare in a way that provides the optimal healthcare service for patients. Pursuing utilization of mobile technology for better patient service, Taipei Medical University Municipal W. F. Teaching Hospital has implemented a mobile healthcare service (m-HS) system to increase healthcare service quality. The m-HS system improves the quality of medical care as well as healthcare service. The m-HS is a multi-functional healthcare management agent, meets the mobile tendency of the present society. This study seeks to discuss the m-HS architecture and workflow processes. We believe the m-HS does have the potential to improve healthcare service quality. Finally, the conclusions and suggestions for the m-HS are given. PMID:16160283

  11. Nanosized ethosomes bearing ketoprofen for improved transdermal delivery.

    PubMed

    Chourasia, Manish K; Kang, Lifeng; Chan, Sui Yung

    2011-05-01

    The potential of ethosomes for delivering ketoprofen via skin was evaluated. The ethosomes were prepared, optimized and characterized. Vesicular shape, size and entrapment efficiency were determined by transmission electron microscopy, dynamic light scattering and minicolumn centrifugation technique, respectively. Vesicle sizes varied from 120.3±6.1 to 410.2±21.8 nm depending on the concentrations of soya phosphatidyl choline (SPC) and ethanol. Entrapment efficiency increased with concentrations of SPC and ethanol. The formulations exhibited entrapment efficiencies of 42-78%. In vitro release through cellophane membrane showed sustained release of drug from ethosomal formulations in contrast to hydroalcoholic drug solution (HA), which released most of the drug within 2-3 h. In vitro drug permeation across human skin revealed improved drug permeation and higher transdermal flux with ethosomal formulations compared to hydroethanolic drug solution. Kinetics of in vitro skin permeation showed zero order drug release from formulations. Based on in vitro transdermal flux, the estimated steady state in vivo plasma concentration from ethosomes attained therapeutic drug levels whereas hydroalcoholic drug solution exhibited sub therapeutic drug concentration with a patch size of 50 cm(2). Skin permeation of ethosomal formulations assessed by confocal microscopy revealed enhanced permeation of Rhodamine 123 loaded formulation in comparison to the hydroalcoholic solution. PMID:25755983

  12. Emulsion design to improve the delivery of functional lipophilic components.

    PubMed

    McClements, David Julian

    2010-01-01

    The food industry has used emulsion science and technology for many years to create a diverse range of food products, such as milk, cream, soft drinks, nutritional beverages, dressings, mayonnaise, sauces, dips, deserts, ice cream, margarine, and butter. The majority of these food products are conventional oil-in-water (O/W) or water-in-oil (W/O) type emulsions. Recently, there has been increasing interest within the food industry in either improving or extending the functional performance of foods using novel structured emulsions. This article reviews recent developments in the creation of structured emulsions that could be used by the food and other industries, including nanoemulsions, multiple emulsions, multilayer emulsions, solid lipid particles, and filled hydrogel particles. These structured emulsions can be produced from food-grade [generally recognized as safe (GRAS)] ingredients (e.g., lipids, proteins, polysaccharides, surfactants, and minerals), using simple processing operations (e.g., mixing, homogenizing, and thermal processing). The structure, production, performance, and potential applications of each type of structured emulsion system are discussed. PMID:22129337

  13. Nanosized ethosomes bearing ketoprofen for improved transdermal delivery

    PubMed Central

    Chourasia, Manish K.; Kang, Lifeng; Chan, Sui Yung

    2011-01-01

    The potential of ethosomes for delivering ketoprofen via skin was evaluated. The ethosomes were prepared, optimized and characterized. Vesicular shape, size and entrapment efficiency were determined by transmission electron microscopy, dynamic light scattering and minicolumn centrifugation technique, respectively. Vesicle sizes varied from 120.3±6.1 to 410.2±21.8 nm depending on the concentrations of soya phosphatidyl choline (SPC) and ethanol. Entrapment efficiency increased with concentrations of SPC and ethanol. The formulations exhibited entrapment efficiencies of 42–78%. In vitro release through cellophane membrane showed sustained release of drug from ethosomal formulations in contrast to hydroalcoholic drug solution (HA), which released most of the drug within 2–3 h. In vitro drug permeation across human skin revealed improved drug permeation and higher transdermal flux with ethosomal formulations compared to hydroethanolic drug solution. Kinetics of in vitro skin permeation showed zero order drug release from formulations. Based on in vitro transdermal flux, the estimated steady state in vivo plasma concentration from ethosomes attained therapeutic drug levels whereas hydroalcoholic drug solution exhibited sub therapeutic drug concentration with a patch size of 50 cm2. Skin permeation of ethosomal formulations assessed by confocal microscopy revealed enhanced permeation of Rhodamine 123 loaded formulation in comparison to the hydroalcoholic solution. PMID:25755983

  14. Consumer-Directed Goal Planning in the Delivery of Assistive Technology Services for People Who Are Ageing with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Mirza, Mansha; Hammel, Joy

    2009-01-01

    Background: A consumer-directed service-delivery approach to assistive technology and environmental modification intervention was examined with people who were ageing with intellectual disabilities. Material and Methods: The intervention was based on a collaborative approach involving consumers, their social supports and service deliverers. Thirty…

  15. 26 CFR 31.3306(c)(15)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... newspapers, shopping news, or magazines. 31.3306(c)(15)-1 Section 31.3306(c)(15)-1 Internal Revenue INTERNAL..., shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping news, not...

  16. 26 CFR 31.3121(b)(14)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... newspapers, shopping news, or magazines. 31.3121(b)(14)-1 Section 31.3121(b)(14)-1 Internal Revenue INTERNAL... distribution of newspapers, shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping...

  17. 26 CFR 31.3306(c)(15)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... newspapers, shopping news, or magazines. 31.3306(c)(15)-1 Section 31.3306(c)(15)-1 Internal Revenue INTERNAL..., shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping news, not...

  18. 26 CFR 31.3121(b)(14)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... newspapers, shopping news, or magazines. 31.3121(b)(14)-1 Section 31.3121(b)(14)-1 Internal Revenue INTERNAL... distribution of newspapers, shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping...

  19. 26 CFR 31.3306(c)(15)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... newspapers, shopping news, or magazines. 31.3306(c)(15)-1 Section 31.3306(c)(15)-1 Internal Revenue INTERNAL..., shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping news, not...

  20. 26 CFR 31.3121(b)(14)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... newspapers, shopping news, or magazines. 31.3121(b)(14)-1 Section 31.3121(b)(14)-1 Internal Revenue INTERNAL... distribution of newspapers, shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping...

  1. Students' Satisfaction with Service Delivery in Federal Universities in South-South Geo-Political Zone, Nigeria

    ERIC Educational Resources Information Center

    Akpoiroro, Roseline M.; Okon, James E.

    2015-01-01

    The study was designed to investigate the level of students' satisfaction with service delivery in federal universities in South-south geopolitical zone of Nigeria in terms of educational, library, security, medical, transport, hostel, and ICT services. Survey design was used to carry out the study, the hypothesis was formulated and literature…

  2. 45 CFR 61.9 - Reporting civil judgments related to the delivery of a health care item or service.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting civil judgments related to the delivery of a health care item or service. 61.9 Section 61.9 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE...

  3. Preventing Elder Abuse: The Texas Plan for a Coordinated Service Delivery System. Collaborative Elder Abuse Prevention Project.

    ERIC Educational Resources Information Center

    McDaniel, Garry L.

    The Texas Department of Human Services, in collaboration with 13 other public and private organizations, co-sponsored a statewide Collaborative Elder Abuse Prevention project. The goal of this project is to develop a comprehensive, long-range plan for the prevention of elder abuse, a method for achieving a coordinated service delivery system for…

  4. 26 CFR 31.3306(c)(15)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... newspapers, shopping news, or magazines. 31.3306(c)(15)-1 Section 31.3306(c)(15)-1 Internal Revenue INTERNAL..., shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping news, not...

  5. 26 CFR 31.3306(c)(15)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... newspapers, shopping news, or magazines. 31.3306(c)(15)-1 Section 31.3306(c)(15)-1 Internal Revenue INTERNAL..., shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping news, not...

  6. 26 CFR 31.3121(b)(14)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... newspapers, shopping news, or magazines. 31.3121(b)(14)-1 Section 31.3121(b)(14)-1 Internal Revenue INTERNAL... distribution of newspapers, shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping...

  7. 26 CFR 31.3121(b)(14)-1 - Services in delivery or distribution of newspapers, shopping news, or magazines.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... newspapers, shopping news, or magazines. 31.3121(b)(14)-1 Section 31.3121(b)(14)-1 Internal Revenue INTERNAL... distribution of newspapers, shopping news, or magazines. (a) Services of individuals under age 18. Services performed by an employee under the age of 18 in the delivery or distribution of newspapers or shopping...

  8. Quasi-Experimental Study of the Effectiveness of an Integrated Service Delivery Network for the Frail Elderly

    ERIC Educational Resources Information Center

    Tourigny, Andre; Durand, Pierre J.; Bonin, Lucie; Hebert, Rejean; Rochette, Louis

    2004-01-01

    The aim of this study was to examine the effectiveness of a new, integrated service delivery (ISD) network of health and social services for frail elderly living in a semi-urban community. A quasi-experimental study was conducted from 1997 to 2000, with measures taken before implementation (T0) and every 12 months after implementation for a 3-year…

  9. 49 CFR 1242.76 - Administration; pickup and delivery, marine line haul, and rail substitute service; loading...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 9 2011-10-01 2011-10-01 false Administration; pickup and delivery, marine line haul, and rail substitute service; loading, unloading and local marine; protective services; freight lost or damaged-solely related; fringe benefits; casualties and insurance; joint facility, and other (accounts XX-34-01, XX-34-73, XX-34-74,...

  10. 49 CFR 1242.76 - Administration; pickup and delivery, marine line haul, and rail substitute service; loading...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 9 2010-10-01 2010-10-01 false Administration; pickup and delivery, marine line haul, and rail substitute service; loading, unloading and local marine; protective services; freight lost or damaged-solely related; fringe benefits; casualties and insurance; joint facility, and other (accounts XX-34-01, XX-34-73, XX-34-74,...

  11. 49 CFR 1242.76 - Administration; pickup and delivery, marine line haul, and rail substitute service; loading...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 9 2013-10-01 2013-10-01 false Administration; pickup and delivery, marine line haul, and rail substitute service; loading, unloading and local marine; protective services; freight lost or damaged-solely related; fringe benefits; casualties and insurance; joint facility, and other (accounts XX-34-01, XX-34-73, XX-34-74,...

  12. 49 CFR 1242.76 - Administration; pickup and delivery, marine line haul, and rail substitute service; loading...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 9 2014-10-01 2014-10-01 false Administration; pickup and delivery, marine line haul, and rail substitute service; loading, unloading and local marine; protective services; freight lost or damaged-solely related; fringe benefits; casualties and insurance; joint facility, and other (accounts XX-34-01, XX-34-73, XX-34-74,...

  13. 49 CFR 1242.76 - Administration; pickup and delivery, marine line haul, and rail substitute service; loading...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 9 2012-10-01 2012-10-01 false Administration; pickup and delivery, marine line haul, and rail substitute service; loading, unloading and local marine; protective services; freight lost or damaged-solely related; fringe benefits; casualties and insurance; joint facility, and other (accounts XX-34-01, XX-34-73, XX-34-74,...

  14. Research on the Caretaking of Children of Incarcerated Parents: Findings and Their Service Delivery Implications

    PubMed Central

    Hanlon, Thomas E.; Carswell, Steven B.; Rose, Marc

    2007-01-01

    This paper reviews research findings on caretaking-related problems associated with the absence of parents from the home following incarceration. It focuses on the impact of incarceration on the welfare and adjustment of urban African American children and on the assumption of caretaking responsibilities by other caretakers, principally maternal grandmothers. Noting the complex situational difficulties involved and the potential burdens associated with surrogate parenting in general, and with this population in particular, the service-provider implications of this parenting arrangement are considered in this review. Findings indicate that problems associated with incarceration of parents tend to be intergenerational and vary considerably in complexity and severity. To the extent that they impact the children involved, these issues should be addressed in coordinated service delivery focusing on prevention. PMID:18311320

  15. Improving workplace behaviour in maternity services.

    PubMed

    Gerrard, Jacque; Smith, Gillian

    2016-02-01

    Within the midwifery and medical profession it is tragic that we are still witnessing bullying and poor workplace behaviours in the NHS. The Royal College of Midwives (RCM) and Royal College of Obstetricians and Gynaecologists (RCOG) have been discussing this since the early 2000s as midwifery and obstetrics feature at the top of General Medical Council (GMC) reporting and NHS surveys. It has come to the point that, as royal colleges, we need to take responsibility, show leadership and do something about this, before waiting for the next set of survey results. Through a joint project, both royal colleges are optimistic that the juggernaut of poor workplace behaviour can be turned around and improved in a generation, if we all work together. PMID:27008756

  16. Improving IT Service Management Processes: A Case Study on IT Service Support

    NASA Astrophysics Data System (ADS)

    Lahtela, Antti; Jäntti, Marko

    IT services and IT service management play a very important role in the today's IT industry. Software as service approach enables IT customers to focus on using the software while IT service providers take care of the installation, configuration, support and maintenance activities. Various process frameworks can be used to improve IT service management processes. The most widely used IT service management framework is the IT Infrastructure Library (ITIL) that provides best practices for IT service providers on how to design, manage and support IT services. Despite the IT service management process frameworks, implementing an effective service support interface between an IT service provider and an IT customer is a big challenge. The research problem in this study is: what types of challenges are related to the service support interface between an IT service provider and IT customers. The main contribution of this paper is present challenges in a service support interface identified during a case study with a large IT service provider company in Finland.

  17. Delivery

    PubMed Central

    Miller, Thomas A

    2013-01-01

    Enthusiasm greeted the development of synthetic organic insecticides in the mid-twentieth century, only to see this give way to dismay and eventually scepticism and outright opposition by some. Regardless of how anyone feels about this issue, insecticides and other pesticides have become indispensable, which creates something of a dilemma. Possibly as a result of the shift in public attitude towards insecticides, genetic engineering of microbes was first met with scepticism and caution among scientists. Later, the development of genetically modified crop plants was met with an attitude that hardened into both acceptance and hard-core resistance. Transgenic insects, which came along at the dawn of the twenty-first century, encountered an entrenched opposition. Those of us responsible for studying the protection of crops have been affected more or less by these protagonist and antagonistic positions, and the experiences have often left one thoughtfully mystified as decisions are made by non-participants. Most of the issues boil down to concerns over delivery mechanisms. © 2013 Society of Chemical Industry PMID:23852646

  18. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

    PubMed Central

    Chersich, Matthew F; Luchters, Stanley; Ntaganira, Innocent; Gerbase, Antonio; Lo, Ying-Ru; Scorgie, Fiona; Steen, Richard

    2013-01-01

    Introduction Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. Results We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are

  19. Improving Pharmaceutical Aerosol Delivery During Noninvasive Ventilation: Effects of Streamlined Components

    PubMed Central

    Longest, P. Worth; Golshahi, Laleh; Hindle, Michael

    2013-01-01

    Aerosol delivery efficiency during noninvasive ventilation (NIV) is known to be low (~10%) and is associated with poor outcomes of aerosol therapy. The objective of this study was to demonstrate the benefit of redesigning ventilation circuit components using a streamlining approach to improve aerosol delivery during nasal high flow therapy in adults with a conventional-sized aerosol from a mesh nebulizer. The ventilation circuit consisted of a humidifier, mesh nebulizer, mixing T-connector (with 90° angle), 10 mm tubing, and nasal cannula interface. In vitro experiments and computational fluid dynamics analyses were used to evaluate depositional losses in a system of existing components and a newly proposed streamlined T-connector and cannula at flow rates of 30 and 45 LPM. Streamlined designs reduced deposition in the T-connector by a factor of 4. In the nasal cannula, the streamlined designs reduced depositional losses by factors of 1.25–2.0. With the streamlined designs, the highest emitted dose achieved was >40% for a conventional-sized aerosol at 30 LPM. Streamlined geometries offer an effective method to significantly improve the delivery of aerosols through components of NIV systems. This increase in delivery efficiency is important for new inhaled medications with narrow therapeutic windows, increased costs, or long delivery times. PMID:23423706

  20. Online Learning Communities and Teacher Professional Development: Methods for Improved Education Delivery

    ERIC Educational Resources Information Center

    Lindberg, J. Ola, Ed.; Olofsson, Anders D., Ed.

    2009-01-01

    In today's society, the professional development of teachers is urgent due to the constant change in working conditions and the impact that information and communication technologies have in teaching practices. "Online Learning Communities and Teacher Professional Development: Methods for Improved Education Delivery" features innovative…

  1. Use of integrated care delivery to improve the quality of diabetes management among African Americans.

    PubMed

    Bray, Paul; Cummings, Doyle M; Thompson, Debra K

    2011-01-01

    The prevalence of type 2 diabetes is increasing, and racial disparities in that prevalence persist. Reimbursement policies do not match the innovative care delivery systems that have been developed. One key policy goal involves reimbursement for diabetes care delivered by physician and nonphysician health care professionals on the same day. Our evidence suggests that this integrated care improves outcomes among patients. PMID:22416520

  2. Action Research to Improve Methods of Delivery and Feedback in an Access Grid Room Environment

    ERIC Educational Resources Information Center

    McArthur, Lynne C.; Klass, Lara; Eberhard, Andrew; Stacey, Andrew

    2011-01-01

    This article describes a qualitative study which was undertaken to improve the delivery methods and feedback opportunity in honours mathematics lectures which are delivered through Access Grid Rooms. Access Grid Rooms are facilities that provide two-way video and audio interactivity across multiple sites, with the inclusion of smart boards. The…

  3. Sport Psychology Service Provision: Preferences for Consultant Characteristics and Mode of Delivery among Elite Malaysian Athletes

    PubMed Central

    Ponnusamy, Vellapandian; Grove, J. Robert

    2014-01-01

    Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217). The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regularly attend training sessions and competitions, and have prior experience as an athlete or coach. General preferences were also expressed for program content to be determined by the coach or consultant, and for regular, small doses of mental skills training to be delivered in a face-to-face context throughout the year. At a sub-group level, team sport athletes had stronger preferences than individual sport athletes for program delivery on a group/team basis, while individual sport athletes had stronger preferences than team sport athletes for having a role in determining program content. Findings are discussed in relation to dominant value themes within Malaysian society and the reinforcement of these themes within specific sport subcultures. Key points Consultant characteristics and program delivery methods have an impact on the effectiveness of sport psychology services. Preferred consultant characteristics and preferred methods of delivery may be affected by cultural and subcultural values. Elite Malaysian athletes prefer consultants to lead a physically active lifestyle; to regularly attend training/competition; and to have prior experience as an athlete or coach. Elite Malaysian athletes also prefer that the coach or consultant determine program content, and that mental skills training take place in a face-to-face context throughout the year. PMID:25177193

  4. Impact of Affirmative Action on Quality of Service Delivery in the Public Service Sector of Kenya: A Comparative Case Study of the Ministry of State in the Office of the President and Ministry of Higher Education

    ERIC Educational Resources Information Center

    Kilonzo, Evans Mbuthi; Ikamari, Lawrence

    2015-01-01

    This study was carried out to determine the impact of affirmative action policy on the quality service delivery in the public service sector of Kenya. The study was carried out on the premise that there is a relationship between affirmative Action implementation and the quality of service delivery in the public service sector of Kenya. A lot of…

  5. Personalizing Knowledge Delivery Services for Emerging Knowledge Processes (EKPs): A Conceptual Framework

    NASA Technical Reports Server (NTRS)

    Majchrzak, Ann; Chellappa, Ramnath K.; Cooper, Lynne P.; Hars, Alexander

    2003-01-01

    The contents include: 1) What do most KMS in use today assume?; 2) Assumptions are violated when KMS is used by EKP workers - Why?; 3) Current State of KMS for EKPs are inadequate; 4) What would an "adequate" KMS for EKPs look like?; 5) "User-as-Consumer" Analogue: Ecommerce/Eem ployee Services; 6) Why is an ideal KMS for EKPs hard to achieve?; 7) So, what type of KMS design would work?; 8) Human-Based KMS for EKP - Proposal Call Managers at R&DLAB; 9) Proposal Call Managers (PCMs); 10) Specific PCM tasks; 11) Why is a R&DLAB PCM a human metaphor for a KMS for EKP?; 12) Data Collection; 13) Finding #1; 14) Finding #2; 15) Finding #3; 16) Factors affecting How/when; 17) Finding #4; 18) Finding #5; 19) Implication#l for a KMS for EKP: From System to Service; 20) Implication #2: From technology or human-centric to Mixed Mode; 21) Implication #3: From Simple User Profiles to Dynamic Delivery Profiles; 22) Implication #4: Maintaining a trustworthy environment; 23) Implication #5: Constructing a dynamic delivery profile; 24) Implications for Research: Model; and 25) Example Research Qs on KMS Support for EKPs.

  6. The African Field Epidemiology Network-Networking for effective field epidemiology capacity building and service delivery

    PubMed Central

    Gitta, Sheba Nakacubo; Mukanga, David; Babirye, Rebecca; Dahlke, Melissa; Tshimanga, Mufuta; Nsubuga, Peter

    2011-01-01

    Networks are a catalyst for promoting common goals and objectives of their membership. Public Health networks in Africa are crucial, because of the severe resource limitations that nations face in dealing with priority public health problems. For a long time, networks have existed on the continent and globally, but many of these are disease-specific with a narrow scope. The African Field Epidemiology Network (AFENET) is a public health network established in 2005 as a non-profit networking alliance of Field Epidemiology and Laboratory Training Programs (FELTPs) and Field Epidemiology Training Programs (FETPs) in Africa. AFENET is dedicated to helping ministries of health in Africa build strong, effective and sustainable programs and capacity to improve public health systems by partnering with global public health experts. The Network's goal is to strengthen field epidemiology and public health laboratory capacity to contribute effectively to addressing epidemics and other major public health problems in Africa. AFENET currently networks 12 FELTPs and FETPs in sub-Saharan Africa with operations in 20 countries. AFENET has a unique tripartite working relationship with government technocrats from human health and animal sectors, academicians from partner universities, and development partners, presenting the Network with a distinct vantage point. Through the Network, African nations are making strides in strengthening their health systems. Members are able to: leverage resources to support field epidemiology and public health laboratory training and service delivery notably in the area of outbreak investigation and response as well as disease surveillance; by-pass government bureaucracies that often hinder and frustrate development partners; and consolidate efforts of different partners channelled through the FELTPs by networking graduates through alumni associations and calling on them to offer technical support in various public health capacities as the need arises

  7. Improving Reference Service: The Case for Using a Continuous Quality Improvement Method.

    ERIC Educational Resources Information Center

    Aluri, Rao

    1993-01-01

    Discusses the evaluation of library reference service; examines problems with past evaluations, including the lack of long-term planning and a systems perspective; and suggests a method for continuously monitoring and improving reference service using quality improvement tools such as checklists, cause and effect diagrams, Pareto charts, and…

  8. The potential impact of climate change and ultraviolet radiation on vaccine-preventable infectious diseases and immunization service delivery system.

    PubMed

    Guo, Biao; Naish, Suchithra; Hu, Wenbiao; Tong, Shilu

    2015-04-01

    Climate change and solar ultraviolet radiation may affect vaccine-preventable infectious diseases (VPID), the human immune response process and the immunization service delivery system. We systematically reviewed the scientific literature and identified 37 relevant publications. Our study shows that climate variability and ultraviolet radiation may potentially affect VPID and the immunization delivery system through modulating vector reproduction and vaccination effectiveness, possibly influencing human immune response systems to the vaccination, and disturbing immunization service delivery. Further research is needed to determine these affects on climate-sensitive VPID and on human immune response to common vaccines. Such research will facilitate the development and delivery of optimal vaccination programs for target populations, to meet the goal of disease control and elimination. PMID:25493706

  9. Estimating the costs of the vaccine supply chain and service delivery for selected districts in Kenya and Tanzania.

    PubMed

    Mvundura, Mercy; Lorenson, Kristina; Chweya, Amos; Kigadye, Rosemary; Bartholomew, Kathryn; Makame, Mohammed; Lennon, T Patrick; Mwangi, Steven; Kirika, Lydia; Kamau, Peter; Otieno, Abner; Murunga, Peninah; Omurwa, Tom; Dafrossa, Lyimo; Kristensen, Debra

    2015-05-28

    Having data on the costs of the immunization system can provide decision-makers with information to benchmark the costs when evaluating the impact of new technologies or programmatic innovations. This paper estimated the supply chain and immunization service delivery costs and cost per dose in selected districts in Kenya and Tanzania. We also present operational data describing the supply chain and service delivery points (SDPs). To estimate the supply chain costs, we collected resource-use data for the cold chain, distribution system, and health worker time and per diems paid. We also estimated the service delivery costs, which included the time cost of health workers to provide immunization services, and per diems and transport costs for outreach sessions. Data on the annual quantities of vaccines distributed to each facility, and the occurrence and duration of stockouts were collected from stock registers. These data were collected from the national store, 2 regional and 4 district stores, and 12 SDPs in each country for 2012. Cost per dose for the supply chain and immunization service delivery were estimated. The average annual costs per dose at the SDPs were $0.34 (standard deviation (s.d.) $0.18) for Kenya when including only the vaccine supply chain costs, and $1.33 (s.d. $0.82) when including immunization service delivery costs. In Tanzania, these costs were $0.67 (s.d. $0.35) and $2.82 (s.d. $1.64), respectively. Both countries experienced vaccine stockouts in 2012, bacillus Calmette-Guérin vaccine being more likely to be stocked out in Kenya, and oral poliovirus vaccine in Tanzania. When stockouts happened, they usually lasted for at least one month. Tanzania made investments in 2011 in preparation for planned vaccine introductions, and their supply chain cost per dose is expected to decline with the new vaccine introductions. Immunization service delivery costs are a significant portion of the total costs at the SDPs. PMID:25865467

  10. Applying Quality Function Deployment Model in Burn Unit Service Improvement.

    PubMed

    Keshtkaran, Ali; Hashemi, Neda; Kharazmi, Erfan; Abbasi, Mehdi

    2014-10-13

    Quality function deployment (QFD) is one of the most effective quality design tools. This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients' expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients' expectations and service specifications and also the relationships between service specifications were determined through an expert group's opinion. Last, the final importance scores of service specifications were calculated through simple additive weighting method. The findings show that burn unit patients have 40 expectations in six different areas. These expectations are in 16 priority levels. Burn units also have 45 service specifications in six different areas. There are four-level relationships between the patients' expectations and service specifications and four-level relationships between service specifications. The most important burn unit service specifications have been identified in this study. The QFD model developed in the study can be a general guideline for QFD planners and executives. PMID:23884047

  11. Effective Interventions on Service Quality Improvement in a Physiotherapy Clinic

    PubMed Central

    Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

    2014-01-01

    Background: Service quality is considered as a main domain of quality associ­ated with non-clinical aspect of healthcare. This study aimed to survey and im­proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. Methods: A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli­able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. Results: In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Conclusion: Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers. PMID:25097838

  12. Evaluation and delivery of domestic animal health services in remote communities in the Northwest Territories: A case study of status and needs.

    PubMed

    Brook, Ryan K; Kutz, Susan J; Millins, Caroline; Veitch, Alasdair M; Elkin, Brett T; Leighton, Ted

    2010-10-01

    Domestic animal health services are supplied to communities in Canada's Northwest Territories (NT) in diverse ways, including private veterinary practices in 2 of 33 communities, and by mail-order, fly-in, free clinics, and a government-coordinated lay vaccinator program in some of the other 31 communities. We evaluated delivery, needs, and potential uptake of domestic animal health services in the Sahtu Settlement Area, NT by offering free clinics for 225 dogs in 2008 and 2009; and administered questionnaires to 42 dog owners and 67 students in 2008. Owners indicated that 20% of dogs were neutered, 37% had had rabies vaccinations, and 29% had been dewormed. Physical examination of dogs demonstrated that 54% were "thin" and 4% were "emaciated." Owners and youth showed a range of attitudes toward dogs and supported improved domestic animal health services. Future services need to build on existing programs and collaborate with communities to ensure relevance, ownership, and sustainability. PMID:21197203

  13. HIV multidisciplinary teams work: support services improve access to and retention in HIV primary care.

    PubMed

    Sherer, R; Stieglitz, K; Narra, J; Jasek, J; Green, L; Moore, B; Shott, S; Cohen, M

    2002-08-01

    The multidisciplinary team model of HIV care evolved out of necessity due to the diverse characteristics and needs of people living with HIV disease. Though it is now accepted as the international standard of care, it represents a significant departure from methods of care for other infectious diseases, and debate continues regarding the effectiveness of its interventions. The debate has been largely uninformed by data; for example, little is known about the relationship between ancillary support services and primary care outcomes. We hypothesized that support services increase access to and retention in HIV primary care in an inner city public hospital clinic. We conducted a retrospective analysis of clinical data sets on 2,647 patients at the CORE Center, Chicago from 1997-1998 to investigate the relationship between four support services-case management (CM), transportation (TRANS), mental health (MH) and chemical dependency (CD)-and access to and retention in HIV primary care. We found that patients who received each of these services were significantly more likely to receive any care, regular care and had more visits than patients with no service, and retention increased by 15-18%. Female gender, younger age, self-pay status and IDU predicted less regular care. Need for all services was substantial and significantly greater in women. Outcomes improved to the greatest extent among patients who needed and received each service. We conclude that support services significantly increased access to and retention in HIV primary care. Our findings validate the multidisciplinary team model of HIV care, and suggest that health services that are tailored to the express needs of patients lead to better care and improved health outcomes. Further testing of changes in health care delivery to meet the rapidly changing needs of people living with HIV disease and respond to the constantly changing practice of HIV medicine is urgently needed to maintain and extend the advances

  14. Annual cost of antiretroviral therapy among three service delivery models in Uganda

    PubMed Central

    Vu, Lung; Waliggo, Samuel; Zieman, Brady; Jani, Nrupa; Buzaalirwa, Lydia; Okoboi, Stephen; Okal, Jerry; Borse, Nagesh N; Kalibala, Samuel

    2016-01-01

    Introduction In response to the increasing burden of HIV, the Ugandan government has employed different service delivery models since 2004 that aim to reduce costs and remove barriers to accessing HIV care. These models include community-based approaches to delivering antiretroviral therapy (ART) and delegating tasks to lower-level health workers. This study aimed to provide data on annual ART cost per client among three different service delivery models in Uganda. Methods Costing data for the entire year 2012 were retrospectively collected as part of a larger task-shifting study conducted in three organizations in Uganda: Kitovu Mobile (KM), the AIDS Support Organisation (TASO) and Uganda Cares (UC). A standard cost data capture tool was developed and used to retrospectively collect cost information regarding antiretroviral (ARV) drugs and non-ARV drugs, ART-related lab tests, personnel and administrative costs. A random sample of four TASO centres (out of 11), four UC clinics (out of 29) and all KM outreach units were selected for the study. Results Cost varied across sites within each organization as well as across the three organizations. In addition, the number of annual ART visits was more frequent in rural areas and through KM (the community distribution model), which played a major part in the overall annual ART cost. The annual cost per client (in USD) was $404 for KM, $332 for TASO and $257 for UC. These estimates were lower than previous analyses in Uganda or the region compared to data from 2001 to 2009, but comparable with recent estimates using data from 2010 to 2013. ARVs accounted for the majority of the total cost, followed by personnel and operational costs. Conclusions The study provides updated data on annual cost per ART visit for three service delivery models in Uganda. These data will be vital for in-country budgetary efforts to ensure that universal access to ART, as called for in the 2015 World Health Organization (WHO) guidelines, is

  15. The Climate Services Partnership (CSP): Working Together to Improve Climate Services Worldwide

    NASA Astrophysics Data System (ADS)

    Zebiak, S.; Brasseur, G.; Members of the CSP Coordinating Group

    2012-04-01

    Throughout the world, climate services are required to address urgent needs for climate-informed decision-making, policy and planning. These needs were explored in detail at the first International Conference on Climate Services (ICCS), held in New York in October 2011. After lengthy discussions of needs and capabilities, the conference culminated in the creation of the Climate Services Partnership (CSP). The CSP is an informal interdisciplinary network of climate information users, providers, donors and researchers interested in improving the provision and development of climate services worldwide. Members of the Climate Services Partnership work together to share knowledge, accelerate learning, develop new capacities, and establish good practices. These collaborative efforts will inform and support the evolution and implementation of the Global Framework for Climate Services. The Climate Services Partnership focuses its efforts on three levels. These include: 1. encouraging and sustaining connections between climate information providers, users, donors, and researchers 2. gathering, synthesizing and disseminating current knowledge on climate services by way of an online knowledge management platform 3. generating new knowledge on critical topics in climate service development and provision, through the creation of focused working groups on specific topics To date, the Climate Services Partnership has made progress on all three fronts. Connections have been fostered through outreach at major international conferences and professional societies. The CSP also maintains a website and a monthly newsletter, which serves as a resource for those interested in climate services. The second International Conference on Climate Services (ICCS2) will be held in Berlin in September. The CSP has also created a knowledge capture system that gathers and disseminates a wide range of information related to the development and provision of climate services. This includes an online

  16. The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

    PubMed Central

    Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

    2014-01-01

    Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national

  17. Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries.

    PubMed

    White, Julia N; Corker, Jamaica

    2016-08-11

    Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013-2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. PMID:27540122

  18. Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries

    PubMed Central

    White, Julia N; Corker, Jamaica

    2016-01-01

    ABSTRACT Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013–2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. PMID:27540122

  19. Correlates of and barriers to the utilization of health services for delivery in South Asia and Sub-Saharan Africa.

    PubMed

    Tey, Nai-Peng; Lai, Siow-li

    2013-01-01

    The high maternal and neonatal mortality rates in South Asia and Sub-Saharan Africa can be attributed to the lack of access and utilization of health services for delivery. Data from the Demographic and Health Surveys conducted in Bangladesh, India, Pakistan, Kenya, Nigeria, and Tanzania show that more than half of the births in these countries were delivered outside a health facility. Institutional delivery was closely associated with educational level, family wealth, place of residence, and women's media exposure status, but it was not influenced by women's work status and their roles in decision-making (with the exception of Nigeria). Controlling for other variables, higher parity and younger women were less likely to use a health facility for delivery. Within each country, the poorer, less educated and rural women had higher unmet need for maternal care services. Service related factors (accessibility in terms of cost and distance) and sociocultural factors (e.g., did not perceive the need for the services and objections from husband and family) also posed as barriers to institutional delivery. The paper concludes with some suggestions to increase institutional delivery. PMID:24288482

  20. Improved delivery of polymer therapeutics to prostate tumors using plasmonic photothermal therapy

    NASA Astrophysics Data System (ADS)

    Gormley, Adam Joseph

    When a patient is presented with locally advanced prostate cancer, it is possible to provide treatment with curative intent. However, once the disease has formed distant metastases, the chances of survival drops precipitously. For this reason, proper management of the disease while it remains localized is of critical importance. Treating these malignant cells with cytotoxic agents is effective at cell killing; however, the nonspecific toxicity profiles of these drugs often limit their use until the disease has progressed and symptom palliation is required. Incorporation of these drugs in nanocarriers such as polymers help target them to tumors with a degree of specificity, though major vascular barriers limit their effective delivery. In this dissertation, it is shown that plasmonic photothermal therapy (PPTT) can be used to help overcome some of these barriers and improve delivery to prostate tumors. First, the concept of using PPTT to improve the delivery of macromolecules to solid tumors was validated. This was done by measuring the tumor uptake of albumin. Next, the concept of targeting gold nanorods (GNRs) directly to the tumor's vasculature to better modulate vascular response to heating was tested. Surface conjugation of cyclic RGD (Arg-Gly-Asp) to GNRs improved their binding and uptake to endothelial cells in vitro, but not in vivo. Nontargeted GNRs and PPTT were then utilized to guide the location of polymer therapeutic delivery to prostate tumors. N-(2-hydroxypropyl)methacrylamide (HPMA) copolymers, which were designed to be targeted to cells previously exposed to heat shock, were used in this study. Treatment of tumors with PPTT facilitated a burst accumulation of the copolymers over 4 hours, and heat shock targeting to cells allowed them to be retained for an extended period of time. Finally, the tumor localization of the HPMA copolymers following PPTT was evaluated by magnetic resonance imaging (MRI). These results show that PPTT may be a useful tool

  1. Improved intracellular delivery of peptide- and lipid-nanoplexes by natural glycosides.

    PubMed

    Weng, Alexander; Manunta, Maria D I; Thakur, Mayank; Gilabert-Oriol, Roger; Tagalakis, Aristides D; Eddaoudi, Ayad; Munye, Mustafa M; Vink, Conrad A; Wiesner, Burkhard; Eichhorst, Jenny; Melzig, Matthias F; Hart, Stephen L

    2015-05-28

    Targeted nanocarriers undergo endocytosis upon binding to their membrane receptors and are transported into cellular compartments such as late endosomes and lysosomes. In gene delivery the genetic material has to escape from the cellular compartments into the cytosol. The process of endosomal escape is one of the most critical steps for successful gene delivery. For this reason synthetic lipids with fusogenic properties such as 2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE) are integrated into the nanocarriers. In this study we show that a natural, plant derived glycoside (SO1861) from Saponaria officinalis L. greatly improves the efficacy of lipid based as well as non-lipid based targeted nanoplexes consisting of a targeted K16 peptide with a nucleic acid binding domain and plasmid-DNA, minicircle-DNA or small interfering RNA (siRNA). By confocal live cell imaging and single cell analyses, we demonstrate that SO1861 augments the escape of the genetic cargo out of the intracellular compartments into the cytosol. Co-localisation experiments with fluorescence labelled dextran and transferrin indicate that SO1861 induces the release of the genetic cargo out of endosomes and lysosomes. However, the transduction efficacy of a lentivirus based gene delivery system was not augmented. In order to design receptor-targeted nanoplexes (LPD) with improved functional properties, SO1861 was integrated into the lipid matrix of the LPD. The SO1861 sensitized LPD (LPDS) were characterized by dynamic light scattering and transmission electron microscopy. Compared to their LPD counterparts the LPDS-nanoplexes showed a greatly improved gene delivery. As shown by differential scanning calorimetry SO1861 can be easily integrated into the lipid bilayer of glycerophospholipid model membranes. This underlines the great potential of SO1861 as a new transfection multiplier for non-viral gene delivery systems. PMID:25758332

  2. Methods for Improving the Quality of Palliative Care Delivery: A Systematic Review

    PubMed Central

    Lau, Brandyn D.; Aslakson, Rebecca A.; Wilson, Renee F.; Fawole, Oluwakemi A.; Apostol, Colleen C.; Martinez, Kathryn A.; Vollenweider, Daniela; Bass, Eric B.; Dy, Sydney E. Morss

    2015-01-01

    Background The effectiveness for improving the outcomes across palliative care domains remains unclear. We conducted a systematic review of different types of quality improvement interventions relevant to palliative care. Methods We searched PubMed, CINAHL, PsycINFO, and Cochrane for relevant articles published between 2000 and 2011. Results A total of 10 randomized controlled trials and 7 nonrandomized controlled trials were included. Of the 5 studies using relay of clinical information, 1 reported significant improvement in patient quality of life. Of the 5 studies targeting education and self-management, 4 found significant improvements in quality of life or patient symptoms. Conclusion A minority of quality improvement interventions have succeeded in improving the quality of palliative care delivery. More studies are needed on specific quality improvement types, including organizational change and multiple types of interventions. PMID:23532404

  3. The determinations of remote sensing satellite data delivery service quality: A positivistic case study in Chinese context

    NASA Astrophysics Data System (ADS)

    Jin, Jiahua; Yan, Xiangbin; Tan, Qiaoqiao; Li, Yijun

    2014-03-01

    With the development of remote sensing technology, remote-sensing satellite has been widely used in many aspects of national construction. Big data with different standards and massive users with different needs, make the satellite data delivery service to be a complex giant system. How to deliver remote-sensing satellite data efficiently and effectively is a big challenge. Based on customer service theory, this paper proposes a hierarchy conceptual model for examining the determinations of remote-sensing satellite data delivery service quality in the Chinese context. Three main dimensions: service expectation, service perception and service environment, and 8 sub-dimensions are included in the model. Large amount of first-hand data on the remote-sensing satellite data delivery service have been obtained through field research, semi-structured questionnaire and focused interview. A positivist case study is conducted to validate and develop the proposed model, as well as to investigate the service status and related influence mechanisms. Findings from the analysis demonstrate the explanatory validity of the model, and provide potentially helpful insights for future practice.

  4. Improving continence services for older people from the service-providers’ perspective: a qualitative interview study

    PubMed Central

    Orrell, Alison; McKee, Kevin; Dahlberg, Lena; Gilhooly, Mary; Parker, Stuart

    2013-01-01

    Objective To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting 3 acute and 13 primary care National Health Service Trusts in England. Participants 16 continence service leads in England actively treating and managing older people with UI. Results In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service

  5. 'Trust and teamwork matter': community health workers' experiences in integrated service delivery in India.

    PubMed

    Mishra, Arima

    2014-01-01

    A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011-2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive 'teamwork' and 'building trust with the community' (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology - which the health workers espouse - is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration. PMID:25025872

  6. Perceived constraints to privatization of delivery of veterinary services in Ghana.

    PubMed

    Turkson, P K; Brownie, C F

    1999-04-01

    Ghana is on the verge of privatizing selected activities in the delivery of animal health services. However, various constraints are being encountered. The aim of this paper is to identify these constraints so as to help find and solutions to them. Questionnaires were administered to veterinarians in Ghana to elicit their responses on various issues concerning privatization. A significant proportion (61%) of government veterinarians, who formed 94% of the respondents, were unwilling to go into private practice. Among the reasons given were that private practice was too risky, that farmers were unwilling or unable to pay for services, that capital to start practices was lacking and that the societal value for animals was low. Also, low livestock densities in many areas and the absence of commercial livestock farming were perceived as deterrents to the sustainability of private practice. Furthermore, the poor macroeconomic environment of high inflation, high interest rates and unstable currency discouraged investment. If privatization of veterinary services is to succeed in Ghana, these perceptions have to be addressed and solutions found, since veterinarians are the targets of the privatization process. PMID:10371009

  7. ‘Trust and teamwork matter’: Community health workers' experiences in integrated service delivery in India

    PubMed Central

    Mishra, Arima

    2014-01-01

    A comprehensive and integrated approach to strengthen primary health care has been the major thrust of the National Rural Health Mission (NRHM) that was launched in 2005 to revamp India's rural public health system. Though the logic of horizontal and integrated health care to strengthen health systems has long been acknowledged at policy level, empirical evidence on how such integration operates is rare. Based on recent (2011–2012) ethnographic fieldwork in Odisha, India, this article discusses community health workers' experiences in integrated service delivery through village-level outreach sessions within the NRHM. It shows that for health workers, the notion of integration goes well beyond a technical lens of mixing different health services. Crucially, they perceive ‘teamwork’ and ‘building trust with the community’ (beyond trust in health services) to be critical components of their practice. However, the comprehensive NRHM primary health care ideology – which the health workers espouse – is in constant tension with the exigencies of narrow indicators of health system performance. Our ethnography shows how monitoring mechanisms, the institutionalised privileging of statistical evidence over field-based knowledge and the highly hierarchical health bureaucratic structure that rests on top-down communications mitigate efforts towards sustainable health system integration. PMID:25025872

  8. Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care.

    PubMed

    Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys

    2015-01-01

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services. PMID:26686267

  9. Patients’ experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care

    PubMed Central

    Chung, Vincent CH; Yip, Benjamin HK; Griffiths, Sian M; Yu, Ellen LM; Liu, Siya; Ho, Robin ST; Wu, Xinyin; Leung, Albert WN; Sit, Regina WS; Wu, Justin CY; Wong, Samuel YS

    2015-01-01

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services. PMID:26686267

  10. Initiation of quality improvement activities in mental health services.

    PubMed

    Tobin, M; Chen, L

    1999-06-01

    In the public sector mental health service setting, accountability for quality has often been considered the responsibility of the individual clinician. This presents a particular challenge for introducing an organization-wide quality improvement culture in this setting. The introduction of a systemic view of quality may encounter resistance from individual clinicians reluctant to accept that some clinical autonomy must be subsumed within more standardized patterns of intervention and evaluation. Services must firstly tackle the issue of clinicians' readiness to embrace such a culture, which requires strong direction from the executive level. The area of recently diagnosed psychosis was selected in one public sector mental health service as a starting point for initiating the quality improvement culture. The eventual outcome for the organization has been a positive commitment to improvement, but the journey was long and hard. This paper describes the beginning of this ultimately rewarding journey. PMID:10408753

  11. Improvements in Correctional HIV Services: A Case Study in Delaware

    PubMed Central

    Swan, Holly; O’Connell, Daniel J.; Visher, Christy A.; Martin, Steven S.; Swanson, Karen R.; Hernandez, Kristin

    2015-01-01

    This article describes the experience and outcomes of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies HIV Services and Treatment Implementation in Corrections protocol in the state of Delaware. The protocol was designed to test the effectiveness of a change team model in improving HIV services in correctional settings. In Delaware, a team was created with representatives from correctional and community agencies to work on improving linkage to HIV care for individuals released from incarceration. The team made improvements in the entire HIV service continuum: linkage to HIV care, HIV education, and HIV testing. The experiences in Delaware and the findings from this study suggest that the use of a change team model is a viable method for making organizational change in correctional settings. PMID:25788611

  12. How to Estimate the Value of Service Reliability Improvements

    SciTech Connect

    Sullivan, Michael J.; Mercurio, Matthew G.; Schellenberg, Josh A.; Eto, Joseph H.

    2010-06-08

    A robust methodology for estimating the value of service reliability improvements is presented. Although econometric models for estimating value of service (interruption costs) have been established and widely accepted, analysts often resort to applying relatively crude interruption cost estimation techniques in assessing the economic impacts of transmission and distribution investments. This paper first shows how the use of these techniques can substantially impact the estimated value of service improvements. A simple yet robust methodology that does not rely heavily on simplifying assumptions is presented. When a smart grid investment is proposed, reliability improvement is one of the most frequently cited benefits. Using the best methodology for estimating the value of this benefit is imperative. By providing directions on how to implement this methodology, this paper sends a practical, usable message to the industry.

  13. Improvements in Correctional HIV Services: A Case Study in Delaware.

    PubMed

    Swan, Holly; O'Connell, Daniel J; Visher, Christy A; Martin, Steven S; Swanson, Karen R; Hernandez, Kristin

    2015-04-01

    This article describes the experience and outcomes of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies HIV Services and Treatment Implementation in Corrections protocol in the state of Delaware. The protocol was designed to test the effectiveness of a change team model in improving HIV services in correctional settings. In Delaware, a team was created with representatives from correctional and community agencies to work on improving linkage to HIV care for individuals released from incarceration. The team made improvements in the entire HIV service continuum: linkage to HIV care, HIV education, and HIV testing. The experiences in Delaware and the findings from this study suggest that the use of a change team model is a viable method for making organizational change in correctional settings. PMID:25788611

  14. Delivery of video-on-demand services using local storages within passive optical networks.

    PubMed

    Abeywickrama, Sandu; Wong, Elaine

    2013-01-28

    At present, distributed storage systems have been widely studied to alleviate Internet traffic build-up caused by high-bandwidth, on-demand applications. Distributed storage arrays located locally within the passive optical network were previously proposed to deliver Video-on-Demand services. As an added feature, a popularity-aware caching algorithm was also proposed to dynamically maintain the most popular videos in the storage arrays of such local storages. In this paper, we present a new dynamic bandwidth allocation algorithm to improve Video-on-Demand services over passive optical networks using local storages. The algorithm exploits the use of standard control packets to reduce the time taken for the initial request communication between the customer and the central office, and to maintain the set of popular movies in the local storage. We conduct packet level simulations to perform a comparative analysis of the Quality-of-Service attributes between two passive optical networks, namely the conventional passive optical network and one that is equipped with a local storage. Results from our analysis highlight that strategic placement of a local storage inside the network enables the services to be delivered with improved Quality-of-Service to the customer. We further formulate power consumption models of both architectures to examine the trade-off between enhanced Quality-of-Service performance versus the increased power requirement from implementing a local storage within the network. PMID:23389189

  15. Improvements in ecosystem services from investments in natural capital.

    PubMed

    Ouyang, Zhiyun; Zheng, Hua; Xiao, Yi; Polasky, Stephen; Liu, Jianguo; Xu, Weihua; Wang, Qiao; Zhang, Lu; Xiao, Yang; Rao, Enming; Jiang, Ling; Lu, Fei; Wang, Xiaoke; Yang, Guangbin; Gong, Shihan; Wu, Bingfang; Zeng, Yuan; Yang, Wu; Daily, Gretchen C

    2016-06-17

    In response to ecosystem degradation from rapid economic development, China began investing heavily in protecting and restoring natural capital starting in 2000. We report on China's first national ecosystem assessment (2000-2010), designed to quantify and help manage change in ecosystem services, including food production, carbon sequestration, soil retention, sandstorm prevention, water retention, flood mitigation, and provision of habitat for biodiversity. Overall, ecosystem services improved from 2000 to 2010, apart from habitat provision. China's national conservation policies contributed significantly to the increases in those ecosystem services. PMID:27313045

  16. The Answer to Diabetes Prevention: Science, Surgery, Service Delivery, or Social Policy?

    PubMed Central

    Colagiuri, Ruth; Colagiuri, Stephen; Yach, Derek; Pramming, Stig

    2006-01-01

    The diabetes and obesity epidemics are closely intertwined. International randomized controlled trials demonstrate that, in high-risk individuals, type 2 diabetes can be prevented or at least delayed through lifestyle modification and, to a lesser degree, medication. We explored the relative roles of science, surgery, service delivery, and social policy in preventing diabetes. Although it is clear that there is a role for all, diabetes is a complex problem that demands commitment across a range of government and nongovernment agencies to be effectively controlled. Accordingly, we argue that social policy is the key to achieving and sustaining social and physical environments required to achieve widespread reductions in both the incidence and prevalence of diabetes. PMID:16873751

  17. Lipid nanoparticle delivery of a microRNA-145 inhibitor improves experimental pulmonary hypertension.

    PubMed

    McLendon, Jared M; Joshi, Sachindra R; Sparks, Jeff; Matar, Majed; Fewell, Jason G; Abe, Kohtaro; Oka, Masahiko; McMurtry, Ivan F; Gerthoffer, William T

    2015-07-28

    Therapies that exploit RNA interference (RNAi) hold great potential for improving disease outcomes. However, there are several challenges that limit the application of RNAi therapeutics. One of the most important challenges is effective delivery of oligonucleotides to target cells and reduced delivery to non-target cells. We have previously developed a functionalized cationic lipopolyamine (Star:Star-mPEG-550) for in vivo delivery of siRNA to pulmonary vascular cells. This optimized lipid formulation enhances the retention of siRNA in mouse lungs and achieves significant knockdown of target gene expression for at least 10days following a single intravenous injection. Although this suggests great potential for developing lung-directed RNAi-based therapies, the application of Star:Star-mPEG mediated delivery of RNAi based therapies for pulmonary vascular diseases such as pulmonary arterial hypertension (PAH) remains unknown. We identified differential expression of several microRNAs known to regulate cell proliferation, cell survival and cell fate that are associated with development of PAH, including increased expression of microRNA-145 (miR-145). Here we test the hypothesis that Star:Star-mPEG mediated delivery of an antisense oligonucleotide against miR-145 (antimiR-145) will improve established PAH in rats. We performed a series of experiments testing the in vivo distribution, toxicity, and efficacy of Star:Star-mPEG mediated delivery of antimiR-145 in rats with Sugen-5416/hypoxia induced PAH. We showed that after subchronic therapy of three intravenous injections over 5weeks at 2mg/kg, antimiR-145 accumulated in rat lung tissue and reduced expression of endogenous miR-145. Using a novel in situ hybridization approach, we demonstrated substantial distribution of antimiR-145 in the lungs as well as the liver, kidney, and spleen. We assessed toxic effects of Star:Star-mPEG/antimiR-145 with serial complete blood counts of leukocytes and serum metabolic panels, gross

  18. Improving intranasal delivery of neurological nanomedicine to the olfactory region using magnetophoretic guidance of microsphere carriers

    PubMed Central

    Xi, Jinxiang; Zhang, Ze; Si, Xiuhua A

    2015-01-01

    Background Although direct nose-to-brain drug delivery has multiple advantages, its application is limited by the extremely low delivery efficiency (<1%) to the olfactory region where drugs can enter the brain. It is crucial to developing new methods that can deliver drug particles more effectively to the olfactory region. Materials and methods We introduced a delivery method that used magnetophoresis to improve olfactory delivery efficiency. The performance of the proposed method was assessed numerically in an image-based human nose model. Influences of the magnet layout, magnet strength, drug-release position, and particle diameter on the olfactory dosage were examined. Results and discussion Results showed that particle diameter was a critical factor in controlling the motion of nasally inhaled ferromagnetic drug particles. The optimal particle size was found to be approximately 15 μm for effective magnetophoretic guidance while avoiding loss of particles to the walls in the anterior nose. Olfactory delivery efficiency was shown to be sensitive to the position and strength of magnets and the release position of drug particles. The results of this study showed that clinically significant olfactory doses (up to 45%) were feasible using the optimal combination of magnet layout, selective drug release, and microsphere-carrier diameter. A 64-fold-higher delivery of dosage was predicted in the magnetized nose compared to the control case, which did not have a magnetic field. However, the sensitivity of olfactory dosage to operating conditions and the unstable nature of magnetophoresis make controlled guidance of nasally inhaled aerosols still highly challenging. PMID:25709443

  19. Kenya’s emergency-hire nursing programme: a pilot evaluation of health service delivery in two districts

    PubMed Central

    2014-01-01

    Objective To assess the feasibility of utilizing a small-scale, low-cost, pilot evaluation in assessing the short-term impact of Kenya’s emergency-hire nursing programme (EHP) on the delivery of health services (outpatient visits and maternal-child health indicators) in two underserved health districts with high HIV/AIDS prevalence. Methods Six primary outcomes were assessed through the collection of data from facility-level health management forms—total general outpatient visits, vaginal deliveries, caesarean sections, antenatal care (ANC) attendance, ANC clients tested for HIV, and deliveries to HIV-positive women. Data on outcome measures were assessed both pre-and post-emergency-hire nurse placement. Informal discussions were also conducted to obtain supporting qualitative data. Findings The majority of EHP nurses were placed in Suba (15.5%) and Siaya (13%) districts. At the time of the intervention, we describe an increase in total general outpatient visits, vaginal deliveries and caesarean sections within both districts. Similar significant increases were seen with ANC attendance and deliveries to HIV-positive women. Despite increases in the quantity of health services immediately following nurse placement, these levels were often not sustained. We identify several factors that challenge the long-term sustainability of these staffing enhancements. Conclusions There are multiple factors beyond increasing the supply of nurses that affect the delivery of health services. We believe this pilot evaluation sets the foundation for future, larger and more comprehensive studies further elaborating on the interface between interventions to alleviate nursing shortages and promote enhanced health service delivery. We also stress the importance of strong national and local relationships in conducting future studies. PMID:24636052

  20. Current and Projected Modes of Delivery of Veterinary Medical Services to Animal Agriculture: The Private Practitioner.

    ERIC Educational Resources Information Center

    Jarrett, James A.

    1980-01-01

    The trend in agriculture is to fewer and larger farms--a trend that is evident in the food animal industry as well. The economic value of services delivered, and the need for veterinarians to improve relationships with people in all fields of animal science are discussed. (MLW)

  1. Improving IMRT delivery efficiency with reweighted L1-minimization for inverse planning

    SciTech Connect

    Kim, Hojin; Becker, Stephen; Lee, Rena; Lee, Soonhyouk; Shin, Sukyoung; Candes, Emmanuel; Xing Lei; Li Ruijiang

    2013-07-15

    Purpose: This study presents an improved technique to further simplify the fluence-map in intensity modulated radiation therapy (IMRT) inverse planning, thereby reducing plan complexity and improving delivery efficiency, while maintaining the plan quality.Methods: First-order total-variation (TV) minimization (min.) based on L1-norm has been proposed to reduce the complexity of fluence-map in IMRT by generating sparse fluence-map variations. However, with stronger dose sparing to the critical structures, the inevitable increase in the fluence-map complexity can lead to inefficient dose delivery. Theoretically, L0-min. is the ideal solution for the sparse signal recovery problem, yet practically intractable due to its nonconvexity of the objective function. As an alternative, the authors use the iteratively reweighted L1-min. technique to incorporate the benefits of the L0-norm into the tractability of L1-min. The weight multiplied to each element is inversely related to the magnitude of the corresponding element, which is iteratively updated by the reweighting process. The proposed penalizing process combined with TV min. further improves sparsity in the fluence-map variations, hence ultimately enhancing the delivery efficiency. To validate the proposed method, this work compares three treatment plans obtained from quadratic min. (generally used in clinic IMRT), conventional TV min., and our proposed reweighted TV min. techniques, implemented by a large-scale L1-solver (template for first-order conic solver), for five patient clinical data. Criteria such as conformation number (CN), modulation index (MI), and estimated treatment time are employed to assess the relationship between the plan quality and delivery efficiency.Results: The proposed method yields simpler fluence-maps than the quadratic and conventional TV based techniques. To attain a given CN and dose sparing to the critical organs for 5 clinical cases, the proposed method reduces the number of segments

  2. Associations between Perceptions of Drinking Water Service Delivery and Measured Drinking Water Quality in Rural Alabama

    PubMed Central

    Wedgworth, Jessica C.; Brown, Joe; Johnson, Pauline; Olson, Julie B.; Elliott, Mark; Forehand, Rick; Stauber, Christine E.

    2014-01-01

    Although small, rural water supplies may present elevated microbial risks to consumers in some settings, characterizing exposures through representative point-of-consumption sampling is logistically challenging. In order to evaluate the usefulness of consumer self-reported data in predicting measured water quality and risk factors for contamination, we compared matched consumer interview data with point-of-survey, household water quality and pressure data for 910 households served by 14 small water systems in rural Alabama. Participating households completed one survey that included detailed feedback on two key areas of water service conditions: delivery conditions (intermittent service and low water pressure) and general aesthetic characteristics (taste, odor and color), providing five condition values. Microbial water samples were taken at the point-of-use (from kitchen faucets) and as-delivered from the distribution network (from outside flame-sterilized taps, if available), where pressure was also measured. Water samples were analyzed for free and total chlorine, pH, turbidity, and presence of total coliforms and Escherichia coli. Of the 910 households surveyed, 35% of participants reported experiencing low water pressure, 15% reported intermittent service, and almost 20% reported aesthetic problems (taste, odor or color). Consumer-reported low pressure was associated with lower gauge-measured pressure at taps. While total coliforms (TC) were detected in 17% of outside tap samples and 12% of samples from kitchen faucets, no reported water service conditions or aesthetic characteristics were associated with presence of TC. We conclude that consumer-reported data were of limited utility in predicting potential microbial risks associated with small water supplies in this setting, although consumer feedback on low pressure—a risk factor for contamination—may be relatively reliable and therefore useful in future monitoring efforts. PMID:25046635

  3. PEGylation as a strategy for improving nanoparticle-based drug and gene delivery.

    PubMed

    Suk, Jung Soo; Xu, Qingguo; Kim, Namho; Hanes, Justin; Ensign, Laura M

    2016-04-01

    Coating the surface of nanoparticles with polyethylene glycol (PEG), or "PEGylation", is a commonly used approach for improving the efficiency of drug and gene delivery to target cells and tissues. Building from the success of PEGylating proteins to improve systemic circulation time and decrease immunogenicity, the impact of PEG coatings on the fate of systemically administered nanoparticle formulations has, and continues to be, widely studied. PEG coatings on nanoparticles shield the surface from aggregation, opsonization, and phagocytosis, prolonging systemic circulation time. Here, we briefly describe the history of the development of PEGylated nanoparticle formulations for systemic administration, including how factors such as PEG molecular weight, PEG surface density, nanoparticle core properties, and repeated administration impact circulation time. A less frequently discussed topic, we then describe how PEG coatings on nanoparticles have also been utilized for overcoming various biological barriers to efficient drug and gene delivery associated with other modes of administration, ranging from gastrointestinal to ocular. Finally, we describe both methods for PEGylating nanoparticles and methods for characterizing PEG surface density, a key factor in the effectiveness of the PEG surface coating for improving drug and gene delivery. PMID:26456916

  4. Sequential delivery of angiogenic growth factors improves revascularization and heart function after myocardial infarction

    PubMed Central

    Awada, Hassan K.; Johnson, Noah R.; Wang, Yadong

    2015-01-01

    Treatment of ischemia through therapeutic angiogenesis faces significant challenges. Growth factor (GF)-based therapies can be more effective when concerns such as GF spatiotemporal presentation, bioactivity, bioavailability, and localization are addressed. During angiogenesis, vascular endothelial GF (VEGF) is required early to initiate neovessel formation while platelet-derived GF (PDGF-BB) is needed later to stabilize the neovessels. The spatiotemporal delivery of multiple bioactive GFs involved in angiogenesis, in a close mimic to physiological cues, holds great potential to treat ischemic diseases. To achieve sequential release of VEGF and PDGF, we embed VEGF in fibrin gel and PDGF in a heparin-based coacervate that is distributed in the same fibrin gel. In vitro, we show the benefits of this controlled delivery approach on cell proliferation, chemotaxis, and capillary formation. A rat myocardial infarction (MI) model demonstrated the effectiveness of this delivery system in improving cardiac function, ventricular wall thickness, angiogenesis, cardiac muscle survival, and reducing fibrosis and inflammation in the infarct zone compared to saline, empty vehicle, and free GFs. Collectively, our results show that this delivery approach mitigated the injury caused by MI and may serve as a new therapy to treat ischemic hearts pending further examination. PMID:25836592

  5. Oral delivery of shRNA based on amino acid modified chitosan for improved antitumor efficacy.

    PubMed

    Zheng, Hao; Tang, Cui; Yin, Chunhua

    2015-11-01

    In this investigation, chitosan-histidine-cysteine (CHC) was engineered for oral delivery of Survivin short hairpin RNA (shRNA)-expressing plasmid DNA (shSur-pDNA) to promote hepatoma regression through integrating the advantages of histidine and cysteine to conquer serial cellular and systemic barriers. CHC could effectively encapsulate shSur-pDNA to form compact nanocomplexes (NC) at adequate weight ratios. Sequential modification with histidine and cysteine conferred CHC NC with the beneficial attributes for shRNA delivery including improved stability, facilitated internalization, promoted endosomal escape, increased nuclear localization, and GSH-responsive release, which contributed to their superior performance in terms of apoptosis promotion, proliferation inhibition, and Survivin down-regulation of tumor cells. More importantly, in hepatoma-bearing mice, orally delivered CHC NC overweighed chitosan counterparts with respect to suppressed Survivin expression, retarded tumor growth, and prolonged surviving time, owing to their above-mentioned merits in combination with enhanced intestinal permeation. Especially, rapid intracellular release of CHC NC with lower molecular weight of 30 kDa (CHC30 NC) might be responsible for the most satisfactory antitumor efficacy with tumor inhibition ratio (TIR) of 92.5%, which rendered CHC30 NC a promising vehicle for oral delivery of shRNA. This investigation would shed light on the deliberate design of oral shRNA delivery vehicles to mediate effective antitumor efficacy. PMID:26310108

  6. Cultural sensitivity: a practical approach to improving services.

    PubMed

    Daddy, J; Clegg, A

    Reports commissioned by the Department of Health (Acheson 1998, Alexander 1999) have highlighted the failure of the NHS to provide culturally sensitive services for black and Asian patients. Cultural sensitivity in nursing is the provision of care that is sensitive to the needs of clients from all cultures. The authors outline the action taken to improve cultural sensitivity in a community hospital. PMID:12216266

  7. 76 FR 18759 - Improving Communications Services for Native Nations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-05

    ... recognized American Indian Tribes and Alaska Native Villages--as well as Hawaiian Home Lands. The first five... COMMISSION Improving Communications Services for Native Nations AGENCY: Federal Communications Commission..., communication adoption opportunities, and incentives for Native Nations. The Commission also seeks...

  8. Geropsychology Post-Doctoral Training in Public Sector Service Delivery: The USF/Tampa VA Fellowship Model

    ERIC Educational Resources Information Center

    Molinari, Victor; Chiriboga, David A.; Schonfeld, Lawrence; Haley, William E.; Schinka, John A.; Hyer, Kathy; Dupree, Larry W.

    2005-01-01

    There is a growing need for geropsychologists who are specialists in practice, research, education, and advocacy for older adults. The combined USF/Tampa VA geropsychology fellowship program focuses on the training of three post-doctoral Fellows each year in public sector service delivery across diverse long term care (LTC) and primary care…

  9. Internet-Based Intervention Training for Parents of Young Children with Disabilities: A Promising Service-Delivery Model

    ERIC Educational Resources Information Center

    Meadan, Hedda; Daczewitz, Marcus E.

    2015-01-01

    Efficient early intervention (EI) services are required to serve the needs of young children with disabilities and the needs of their families. Effective EI includes family-centred practices, evidence-based interventions, parent involvement/training, and delivery in children's natural environments. Due to the challenges of providing…

  10. Comparing Different Short-Term Service Delivery Methods of Visual-Motor Treatment for First Grade Students in Mainstream Schools

    ERIC Educational Resources Information Center

    Ratzon, Navah Z.; Lahav, Orit; Cohen-Hamsi, Shifra; Metzger, Yehiela; Efraim, Daniela; Bart, Orit

    2009-01-01

    To compare the efficacy of three different short-term service delivery methods on first grade children with soft neurological signs who suffer from visual-motor difficulties. One hundred and forty seven first grade students who scored below the 21st percentile on the Visual-Motor Integration Test (VMI) were recruited from schools and randomly…

  11. Supporting Non-State Providers in Basic Education Service Delivery. Create Pathways to Access. Research Monograph No. 4

    ERIC Educational Resources Information Center

    Rose, Pauline

    2007-01-01

    Basic education is commonly regarded as a state responsibility. However, in reality, non-state providers (NSPs) have always been involved in basic education service delivery, and there is often a blurring of boundaries between state and non-state roles with respect to financing, ownership, management, and regulation. In recent years, the focus on…

  12. Multi-Disciplinary Approaches to Pupil Behaviour in School--The Role of Evaluation in Service Delivery

    ERIC Educational Resources Information Center

    Hartnell, Naomi

    2010-01-01

    This study evaluates the work of a multi-disciplinary Behaviour Support Team developed to support schools in managing problematic behaviour. An evidence base to inform future service delivery is developed, using a model of evaluation which incorporates both quantitative, outcome data and more explanatory qualitative data, incorporating the views…

  13. Mechanistic models as a transferable framework for projecting effects of habitat change on production and delivery of ecosystem services

    EPA Science Inventory

    Drawing a link between habitat change and the production and delivery of ecosystem services is a priority in coastal estuarine ecosystems. Mechanistic modeling tools are highly functional for exploring this link because they allow for the synthesis of multiple ecological and beh...

  14. Evidence-Based Systematic Review: Effects of Different Service Delivery Models on Communication Outcomes for Elementary School-Age Children

    ERIC Educational Resources Information Center

    Cirrin, Frank M.; Schooling, Tracy L.; Nelson, Nickola W.; Diehl, Sylvia F.; Flynn, Perry F.; Staskowski, Maureen; Torrey, T. Zoann; Adamczyk, Deborah F.

    2010-01-01

    Purpose: The purpose of this investigation was to conduct an evidence-based systematic review (EBSR) of peer-reviewed articles from the last 30 years about the effect of different service delivery models on speech-language intervention outcomes for elementary school-age students. Method: A computer search of electronic databases was conducted to…

  15. The Student Profile, Service Delivery Model, and Support Practices of Four Early Childhood Intervention Environments in Singapore

    ERIC Educational Resources Information Center

    Poon, Kenneth K.; Yang, Xueyan

    2016-01-01

    The student profile, model of service delivery, and support practices for young children with disabilities receiving early childhood intervention (ECI) in Singapore is reported and contrasted in this study. The supervisors/managers/principals of eight Early Intervention Programme for Infants and Children (EIPIC) centres, eight Integrated Child…

  16. The Role of Counseling Faculty and Delivery of Counseling Services in the California Community Colleges. Adopted Spring 2012

    ERIC Educational Resources Information Center

    Academic Senate for California Community Colleges, 2012

    2012-01-01

    The original paper, "The Role of Counseling Faculty in the California Community Colleges" (1994), provided principled positions of the Academic Senate regarding the essential functions of counselors and the delivery of counseling services in helping students achieve success. The paper concluded with specific guidance on appropriate roles…

  17. Comparison between Synchronous and Asynchronous Instructional Delivery Method of Training Programme on In-Service Physical Educators' Knowledge

    ERIC Educational Resources Information Center

    Emmanouilidou, Kyriaki; Derri, Vassiliki; Antoniou, Panagiotis; Kyrgiridis, Pavlos

    2012-01-01

    The purpose of the study was to compare the influences of a training programme's instructional delivery method (synchronous and asynchronous) on Greek in-service physical educators' cognitive understanding on student assessment. Forty nine participants were randomly divided into synchronous, asynchronous, and control group. The experimental groups…

  18. 34 CFR 206.31 - How does the Secretary evaluate points for prior experience for HEP and CAMP service delivery?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 1 2012-07-01 2012-07-01 false How does the Secretary evaluate points for prior experience for HEP and CAMP service delivery? 206.31 Section 206.31 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION SPECIAL EDUCATIONAL PROGRAMS FOR STUDENTS...

  19. Roles of Social Movement Organizations for Securing Workers' Safety in Korea: A Case Study of Abolition of the 30-Minute Delivery Guarantee Program in Pizza Delivery Service.

    PubMed

    Park, Ji-Eun; Kim, Myoung-Hee

    2016-07-01

    Many restaurants in Korea maintain quick-delivery service programs to satisfy customers. This service allows delivery workers limited time to deliver, which frequently put them in danger. Most of the workers are young, work part-time, and are rarely organized into trade unions. In this article, through a case study of the social movement to abolish the 30-minute delivery guarantee program of pizza companies in Korea, we argue that social movements involving social movement organizations (SMOs) and individual citizens could serve as a means to rectify this problem. We show how the SMOs developed and expanded the movement using a framing perspective and how the general public became involved through social media. Data was collected via online searching. Interview scripts from key players of SMOs and unofficial documents they provided were also reviewed. Three SMOs primarily led the movement, successfully forming a frame that emphasized social responsibility. SMOs also utilized social media to link their standing frame with unmobilized citizens and to expand the movement. We identified contributing factors and limitations of the movement and drew lessons that could be applied to other sectors where workers are in vulnerable positions. PMID:27179063

  20. Fortifier and cream improve fat delivery in continuous enteral infant feeding of breast milk.

    PubMed

    Tabata, Mika; Abdelrahman, Khaled; Hair, Amy B; Hawthorne, Keli M; Chen, Zhensheng; Abrams, Steven A

    2015-01-01

    Premature and high-risk infants require accurate delivery of nutrients to promote appropriate growth. Continuous enteral feeding methods may result in significant fat and micronutrient loss. This study evaluated fat loss in enteral nutrition using current strategies for providing high-risk infants fortified human milk (HM). The fat content of HM was measured by IR analyzer in a simulated feeding system using the Kangaroo epumpTM and the MedFusionTM 2010 pump. Comparisons in fat loss were made between HM, HM supplemented with donor HM-derived fortifier Prolacta+H2MFTM (H2MF), and HM supplemented with H2MF and donor HM-derived cream ProlactCRTM (cream). When using the Kangaroo epumpTM, the addition of H2MF and cream to HM increased fat delivery efficiency from 75.0%±1.2% to 83.7%±1.0% (p<0.0001). When using the MedFusionTM 2010 pump, the addition of H2MF to HM increased fat delivery efficiency from 83.2%±2.8% to 88.8%±0.8% (p<0.05), and the addition of H2MF and cream increased fat delivery efficiency to 92.0%±0.3% (p<0.01). The addition of H2MF and cream to HM provides both the benefits of bioactive elements from mother's milk and increased fat delivery, making the addition of H2MF and cream an appropriate method to improve infant weight gain. PMID:25679230

  1. Fortifier and Cream Improve Fat Delivery in Continuous Enteral Infant Feeding of Breast Milk

    PubMed Central

    Tabata, Mika; Abdelrahman, Khaled; Hair, Amy B.; Hawthorne, Keli M.; Chen, Zhensheng; Abrams, Steven A.

    2015-01-01

    Premature and high-risk infants require accurate delivery of nutrients to promote appropriate growth. Continuous enteral feeding methods may result in significant fat and micronutrient loss. This study evaluated fat loss in enteral nutrition using current strategies for providing high-risk infants fortified human milk (HM). The fat content of HM was measured by IR analyzer in a simulated feeding system using the Kangaroo ePump™ and the MedFusion™ 2010 pump. Comparisons in fat loss were made between HM, HM supplemented with donor HM-derived fortifier Prolacta + H2MF™ (H2MF), and HM supplemented with H2MF and donor HM-derived cream ProlactCR™ (cream). When using the Kangaroo ePump™, the addition of H2MF and cream to HM increased fat delivery efficiency from 75.0% ± 1.2% to 83.7% ± 1.0% (p < 0.0001). When using the MedFusion™ 2010 pump, the addition of H2MF to HM increased fat delivery efficiency from 83.2% ± 2.8% to 88.8% ± 0.8% (p < 0.05), and the addition of H2MF and cream increased fat delivery efficiency to 92.0% ± 0.3% (p < 0.01). The addition of H2MF and cream to HM provides both the benefits of bioactive elements from mother’s milk and increased fat delivery, making the addition of H2MF and cream an appropriate method to improve infant weight gain. PMID:25679230

  2. Integrating the life course into MCH service delivery: from theory to practice.

    PubMed

    Brady, Carol; Johnson, Faye

    2014-02-01

    To describe the efforts of a community-based maternal and child health coalition to integrate the life course into its planning and programs, as well as implementation challenges and results of these activities. Jacksonville-Duval County has historically had infant mortality rates that are significantly higher than state and national rates, particularly among its African American population. In an effort to address this disparity, the Northeast Florida Healthy Start Coalition embraced the life course approach as a model. This model was adopted as a framework for (1) community needs assessment and planning; (2) delivery of direct services, including case management, education and support in the Magnolia Project, its federal Healthy Start program; (3) development of community collaborations, education and awareness; and, (4) advocacy and grass roots leadership development. Implementation experience as well as challenges in transforming traditional approaches to delivering maternal and child health services are described. Operationalizing the life course approach required the Coalition to think differently about risks, levels of intervention and the way services are organized and delivered. The organization set the stage by using the life course as a framework for its required local planning and needs assessments. Based on these assessments, the content of case management and other key services provided by our federal Healthy Start program was modified to address not only health behaviors but also underlying social determinants and community factors. Individual interventions were augmented with group activities to build interdependence among participants, increasing social capital. More meaningful inter-agency collaboration that moved beyond the usual referral relationships were developed to better address participants' needs. And finally, strategies to cultivate participant advocacy and community leadership skills, were implemented to promote social change at the

  3. How to Improve the Design and Delivery of High-Quality Technical Assistance. Newsletter

    ERIC Educational Resources Information Center

    Center for Comprehensive School Reform and Improvement, 2005

    2005-01-01

    Educators often use the term technical assistance to define services delivered or received in the pursuit of school- and district-improvement initiatives. More specifically, technical assistance can be defined as any assistance that identifies, selects, or designs research-based solutions and practices to support school improvement (Mattson &…

  4. Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

    PubMed Central

    Powers, Richard J.; Bennett, Mihoko V.; Finer, Neil N.; Halamek, Louis P.; Nisbet, Courtney; Crockett, Margaret; Chance, Kathy; Blackney, David; von Köhler, Connie; Kurtin, Paul; Sharek, Paul J.

    2014-01-01

    BACKGROUND: There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects. METHODS: This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support. RESULTS: There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12 528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%). CONCLUSIONS: Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices. PMID:25332503

  5. Formulation of 20(S)-protopanaxadiol nanocrystals to improve oral bioavailability and brain delivery.

    PubMed

    Chen, Chen; Wang, Lisha; Cao, Fangrui; Miao, Xiaoqing; Chen, Tongkai; Chang, Qi; Zheng, Ying

    2016-01-30

    The aim of this study was to fabricate 20(S)-protopanaxadiol (PPD) nanocrystals to improve PPD's oral bioavailability and brain delivery. PPD nanocrystals were fabricated using an anti-solvent precipitation approach where d-α-tocopheryl polyethylene glycol 1000 succinate (TPGS) was optimized as the stabilizer. The fabricated nanocrystals were nearly spherical with a particle size and drug loading of 90.44 ± 1.45 nm and 76.92%, respectively. They are in the crystalline state and stable at 4°C for at least 1 month. More than 90% of the PPD could be rapidly released from the nanocrystals, which was much faster than the physical mixture and PPD powder. PPD nanocrystals demonstrated comparable permeability to solution at 2.52 ± 0.44×10(-5)cm/s on MDCK monolayers. After oral administration of PPD nanocrystals to rats, PPD was absorbed quickly into the plasma and brain with significantly higher Cmax and AUC0-t compared to those of the physical mixture. However, no brain targeting was observed, as the ratios of the plasma AUC0-t to brain AUC0-t for the two groups were similar. In summary, PPD nanocrystals are a potential oral delivery system to improve PPD's poor bioavailability and its delivery into the brain for neurodegenerative disease and intracranial tumor therapies in the future. PMID:26680316

  6. Nanoparticle delivery of an AKT/PDK1 inhibitor improves the therapeutic effect in pancreatic cancer

    PubMed Central

    Lucero-Acuña, Armando; Jeffery, Justin J; Abril, Edward R; Nagle, Raymond B; Guzman, Roberto; Pagel, Mark D; Meuillet, Emmanuelle J

    2014-01-01

    The K-ras mutation in pancreatic cancer can inhibit drug delivery and increase drug resistance. This is exemplified by the therapeutic effect of PH-427, a small molecule inhibitor of AKT/PDK1, which has shown a good therapeutic effect against a BxPC3 pancreatic cancer model that has K-ras, but has a poor therapeutic effect against a MiaPaCa-2 pancreatic cancer model with mutant K-ras. To increase the therapeutic effect of PH-427 against the MiaPaCa-2 pancreatic cancer model with mutant K-ras, we encapsulated PH-427 into poly(lactic-co-glycolic acid) nanoparticles (PNP) to form drug-loaded PH-427-PNP. PH-427 showed a biphasic release from PH-427-PNP over 30 days during studies in sodium phosphate buffer, and in vitro studies revealed that the PNP was rapidly internalized into MiaPaCa-2 tumor cells, suggesting that PNP can improve PH-427 delivery into cells harboring mutant K-ras. In vivo studies of an orthotopic MiaPaCa-2 pancreatic cancer model showed reduced tumor load with PH-427-PNP as compared with treatment using PH-427 alone or with no treatment. Ex vivo studies confirmed the in vivo results, suggesting that PNP can improve drug delivery to pancreatic cancer harboring mutant K-ras. PMID:25516710

  7. Efficient Service Delivery for High-speed Railway Communications Using MIMO and Access Control Technique

    NASA Astrophysics Data System (ADS)

    Zhou, Yuzhe; Ai, Bo

    2014-07-01

    In order to realize the notion of "anytime, anywhere" communication for high-speed train passengers, the Long Term Evolution for Railway is designed to provide broadband accesses and reliable communications for high-speed train passengers. However, with the increase of train speed, the system is subject to high bit error rate, Doppler frequency shift, and call drops. This paper is trying to solve these problems by employing the Multiple-Input Multiple-Output technique and access control schemes. The goal is to provide higher quality of services such as data rate, reliability, and delay for train passengers. Physical layer performance analysis and access control schemes are proposed in a two-hop model. Handovers and service types are also considered. Simulation results show that proposed models and schemes perform better in improving the quality of services.

  8. Outcomes for Youth with Severe Emotional Disturbance: A Repeated Measures Longitudinal Study of a Wraparound Approach of Service Delivery in Systems of Care

    ERIC Educational Resources Information Center

    Painter, Kirstin

    2012-01-01

    Background: Systems of care is a family centered, strengths-based service delivery model for treating youth experiencing a serious emotional disturbance. Wraparound is the most common method of service delivery adopted by states and communities as a way to adhere to systems of care philosophy. Objective: The purpose of this study was to evaluate…

  9. Action research to improve methods of delivery and feedback in an Access Grid Room environment

    NASA Astrophysics Data System (ADS)

    McArthur, Lynne C.; Klass, Lara; Eberhard, Andrew; Stacey, Andrew

    2011-12-01

    This article describes a qualitative study which was undertaken to improve the delivery methods and feedback opportunity in honours mathematics lectures which are delivered through Access Grid Rooms. Access Grid Rooms are facilities that provide two-way video and audio interactivity across multiple sites, with the inclusion of smart boards. The principal aim was to improve the student learning experience, given the new environment. The specific aspects of the course delivery that the study focused on included presentation of materials and provision of opportunities for interaction between the students and between students and lecturers. The practical considerations in the delivery of distance learning are well documented in the literature, and similar problems arise in the Access Grid Room environment; in particular, those of limited access to face-to-face interaction and the reduction in peer support. The nature of the Access Grid Room classes implies that students studying the same course can be physically situated in different cities, and possibly in different countries. When studying, it is important that students have opportunity to discuss new concepts with others; particularly their peers and their lecturer. The Access Grid Room environment also presents new challenges for the lecturer, who must learn new skills in the delivery of materials. The unique nature of Access Grid Room technology offers unprecedented opportunity for effective course delivery and positive outcomes for students, and was developed in response to a need to be able to interact with complex data, other students and the instructor, in real-time, at a distance and from multiple sites. This is a relatively new technology and as yet there has been little or no studies specifically addressing the use and misuse of the technology. The study found that the correct placement of cameras and the use of printed material and smart boards were all crucial to the student experience. In addition, the

  10. Sustained delivery of proangiogenic microRNA-132 by nanoparticle transfection improves endothelial cell transplantation

    PubMed Central

    Devalliere, Julie; Chang, William G.; Andrejecsk, Jillian W.; Abrahimi, Parwiz; Cheng, Christopher J.; Jane-wit, Dan; Saltzman, W. Mark; Pober, Jordan S.

    2014-01-01

    Transplantation of endothelial cells (ECs) for therapeutic vascularization or tissue engineering is a promising method for increasing tissue perfusion. Here, we report on a new approach for enhanced EC transplantation using targeted nanoparticle transfection to deliver proangiogenic microRNA-132 (miR-132) to cultured ECs before their transplantation, thereby sensitizing cells to the effects of endogenous growth factors. We synthesized biodegradable PLGA polymer nanoparticles (NPs) that were loaded with miR-132 and coated with cyclic RGD (cRGD) peptides that target integrin αvβ3 expressed on cultured human umbilical vein ECs (HUVECs), increasing NP uptake through clathrin-coated pits. Unlike previously reported NPs for miR delivery, these NPs slowly release RNA for several weeks. The endocytosed NPs remain in clathrin-coated vesicles from which they mediate intracellular delivery of siRNA or miRNA. Transfection of HUVECs with miR-132 enhances growth factor-induced proliferation and migration in 2D culture, producing a 1.8- and 5-fold increase, respectively. However, while the effects of conventional transfection were short-lived, NP transfection produced protein knockdown and biological effects that were significantly longer in duration (≥6 d). Transfection of HUVECs with miR-132 NP resulted in a 2-fold increase in the number of microvessels per square millimeter compared to lipid after transplantation into immunodeficient mice and led to a higher number of mural cell-invested vessels than control transfection. These data suggest that sustained delivery of miR-132 encapsulated in a targeted biodegradable polymer NP is a safe and efficient strategy to improve EC transplantation and vascularization.—Devalliere, J., Chang, W. G., Andrejecsk, J. W., Abrahimi, P., Cheng, C. J., Jane-wit, D., Saltzman, W. M., Pober, J. S. Sustained delivery of proangiogenic microRNA-132 by nanoparticle transfection improves endothelial cell transplantation. PMID:24221087

  11. Adult male circumcision in Nyanza, Kenya at scale: the cost and efficiency of alternative service delivery modes

    PubMed Central

    2014-01-01

    Background Adult male circumcision (MC) services in Kenya are provided through both horizontal and vertical programs, and via facility-based, mobile and outreach service delivery. This study assesses the costs and composition of unit costs for each program approach and service delivery mode and assess the cost-effectiveness of each. Methods This study was conducted on the unit costs of adult MC delivery in 222 purposively-selected MC delivery sites in Nyanza Province, Kenya from November 2008 through April 2010 using program data from the AIDS, Population, and Health Integrated Assistance Project II (APHIA II) and from the Nyanza Reproductive Health Society (NRHS). The former program can be characterized as horizontal or integrated; the latter as ‘diagonal’; containing both horizontal and vertical elements. Expenditure and services data were collected from project financial and monitoring documents and via discussions with program officials. In addition, per-case, direct service delivery costs were calculated using time and motion observations of 246 adult MC procedures performed during May and June, 2010. We calculated the cost per HIV infections averted for each of the service delivery modalities. Results Unit cost per adult MC was $38.62 and $44.24 for APHIA II and NRHS respectively, ranging from $29.32 (APHIA II mobile) to $46.20 (NRHS outreach/mobile). Unit costs at base facilities was similar for the two approaches. Time and motion data revealed that the opportunity cost of the elapsed time between the arrival of the surgical team and the time the first MC procedure begins varies between $2.08 and $6.27 per case. The cost per HIV infection (HIA) averted ranged from $117.29 for mobile service via the horizontal APHIA-II program to $184.84 per HIA for the diagonal NRHS program. Conclusions This study provides evidence for the similar efficiency of a horizontal approach (APHIA II) and a combination of horizontal and vertical approaches (NRHS) to support

  12. The potential for nanotechnology to improve delivery of therapy to the acute ischemic heart.

    PubMed

    Evans, Cameron W; Iyer, K Swaminathan; Hool, Livia C

    2016-04-01

    Treatment of acute cardiac ischemia remains an area in which there are opportunities for therapeutic improvement. Despite significant advances, many patients still progress to cardiac hypertrophy and heart failure. Timely reperfusion is critical in rescuing vulnerable ischemic tissue and is directly related to patient outcome, but reperfusion of the ischemic myocardium also contributes to damage. Overproduction of reactive oxygen species, initiation of an inflammatory response and deregulation of calcium homeostasis all contribute to injury, and difficulties in delivering a sufficient quantity of drug to the affected tissue in a controlled manner is a limitation of current therapies. Nanotechnology may offer significant improvements in this respect. Here, we review recent examples of how nanoparticles can be used to improve delivery to the ischemic myocardium, and suggest some approaches that may lead to improved therapies for acute cardiac ischemia. PMID:26980180

  13. UK Parkinson's Excellence Network: empowering service improvement across the UK.

    PubMed

    Burn, David

    2015-01-01

    Parkinson's UK, together with leading Parkinson's professionals, has set up the UK Parkinson's Excellence Network to bring together the passion and expertise of leading clinicians with the strategic leadership and resources of Parkinson's UK underpinned by the voice of people affected by Parkinson's. Launched in London in February 2015, the Excellence Network aims to drive sustainable improvements in health and social care services. It will provide a more strategic approach to clinical development so that Parkinson's services across health and social care can be transformed to provide the best quality care across the UK. PMID:26107314

  14. Domestic Water Service Delivery Indicators and Frameworks for Monitoring, Evaluation, Policy and Planning: A Review

    PubMed Central

    Kayser, Georgia L.; Moriarty, Patrick; Fonseca, Catarina; Bartram, Jamie

    2013-01-01

    Monitoring of water services informs policy and planning for national governments and the international community. Currently, the international monitoring system measures the type of drinking water source that households use. There have been calls for improved monitoring systems over several decades, some advocating use of multiple indicators. We review the literature on water service indicators and frameworks with a view to informing debate on their relevance to national and international monitoring. We describe the evidence concerning the relevance of each identified indicator to public health, economic development and human rights. We analyze the benefits and challenges of using these indicators separately and combined in an index as tools for planning, monitoring, and evaluating water services. We find substantial evidence on the importance of each commonly recommended indicator—service type, safety, quantity, accessibility, reliability or continuity of service, equity, and affordability. Several frameworks have been proposed that give structure to the relationships among individual indicators and some combine multiple indicator scores into a single index but few have been rigorously tested. More research is needed to understand if employing a composite metric of indicators is advantageous and how each indicator might be scored and scaled. PMID:24157507

  15. Strategies for improving chemotherapeutic delivery to solid tumors mediated by vascular permeability modulation

    NASA Astrophysics Data System (ADS)

    Roy Chaudhuri, Tista

    An essential mode of distribution of blood-borne chemotherapeutic agents within a solid tumor is via the micro-circulation. Poor tumor perfusion, because of a lack of functional vasculature or a lack of microvessels, as well as low tumor vascular permeability, can prevent adequate deposition of even low molecular-weight agents into the tumor. The modulation of tumor vascular function and density can provides numerous strategies for improving intratumor deposition of chemotherapeutic agents. Here we investigated strategies to improve drug delivery to two tumor types that share in common poor drug delivery, but differ in the underlying cause. First, in an angiogenesis-driven brain tumor model of Glioblastoma, the vascular permeability barrier, along with poorly-functional vasculature, hinders drug delivery. A strategy of nanoparticle-based tumor 'priming' to attack the vascular permeability barrier, employing sterically stabilized liposomal doxorubicin (SSL-DXR), was investigated. Functional and histological evaluation of tumor vasculature revealed that after an initial period of depressed vascular permeability and vascular pruning 3--4 days after SSL-DXR administration, vascular permeability and perfusion were restored and then elevated after 5--7 days. As a result of tumor priming, deposition of subsequently-administered nanoparticles was enhanced, and the efficacy of temozolomide (TMZ), if administered during the window of elevated permeability, was increased. The sequenced regimen resulted in a persistent reduction of the tumor proliferative index and a 40% suppression of tumor volume, compared to animals that received both agents simultaneously. Second, in a hypovascular, pancreatic ductal adenocarcinoma model, disruption of tumor-stromal communication via sonic hedgehog (sHH) signaling pathway inhibition mediated an indirect vascular proliferation and a more than 2-fold increase in intratumor nanoparticle deposition. Enhanced delivery of SSL-DXR in tumors pre

  16. The Climate Services Partnership: Linking Efforts to Improve Climate Services Worldwide

    NASA Astrophysics Data System (ADS)

    Zebiak, S. E.

    2012-12-01

    Throughout the world, climate services are required to address urgent needs for climate-informed decision-making, policy and planning. These needs were explored in detail at the first International Conference on Climate Services (ICCS-1), held in New York in October 2011. After deliberating on needs, capabilities, and opportunities, the conference culminated in the creation of the Climate Services Partnership (CSP). The CSP is an informal interdisciplinary network of climate information users, providers, donors and researchers interested in improving the provision and development of climate services worldwide. Members of the Climate Services Partnership work together to share knowledge, accelerate learning, develop new capacities, and establish good practices. These collaborative efforts also inform and support the evolution and implementation of the UN-led Global Framework for Climate Services. To date, the work of the CSP has focused on three areas: - encouraging and sustaining connections between climate information providers, users, donors, and researchers - gathering, synthesizing and disseminating current knowledge on climate services by way of an online knowledge management platform - generating new knowledge on critical topics in climate service development and provision, through the creation of focused working groups on specific topics Connections are being fostered through outreach at major international conferences and professional societies. CSP maintains a website and a monthly newsletter, which serve as a resource for those interested in climate services. CSP also sponsored the second International Conference on Climate Services (Brussels, Sept. 2012), which focused especially on public-private partnerships to support climate services. Over the past year, CSP has focused knowledge capture efforts around an initial set of more than 40 case studies, and several in-depth evaluations of climate services activities. CSP additionally has created an online

  17. Comparison of biomaterial delivery vehicles for improving acute retention of stem cells in the infarcted heart.

    PubMed

    Roche, Ellen T; Hastings, Conn L; Lewin, Sarah A; Shvartsman, Dmitry E; Brudno, Yevgeny; Vasilyev, Nikolay V; O'Brien, Fergal J; Walsh, Conor J; Duffy, Garry P; Mooney, David J

    2014-08-01

    Cell delivery to the infarcted heart has emerged as a promising therapy, but is limited by very low acute retention and engraftment of cells. The objective of this study was to compare a panel of biomaterials to evaluate if acute retention can be improved with a biomaterial carrier. Cells were quantified post-implantation in a rat myocardial infarct model in five groups (n = 7-8); saline injection (current clinical standard), two injectable hydrogels (alginate, chitosan/β-glycerophosphate (chitosan/ß-GP)) and two epicardial patches (alginate, collagen). Human mesenchymal stem cells (hMSCs) were delivered to the infarct border zone with each biomaterial. At 24 h, retained cells were quantified by fluorescence. All biomaterials produced superior fluorescence to saline control, with approximately 8- and 14-fold increases with alginate and chitosan/β-GP injectables, and 47 and 59-fold increases achieved with collagen and alginate patches, respectively. Immunohistochemical analysis qualitatively confirmed these findings. All four biomaterials retained 50-60% of cells that were present immediately following transplantation, compared to 10% for the saline control. In conclusion, all four biomaterials were demonstrated to more efficiently deliver and retain cells when compared to a saline control. Biomaterial-based delivery approaches show promise for future development of efficient in vivo delivery techniques. PMID:24862441

  18. Comparison of biomaterial delivery vehicles for improving acute retention of stem cells in the infarcted heart

    PubMed Central

    Lewin, Sarah A.; Shvartsman, Dmitry; Brudno, Yevgeny; Vasilyev, Nikolay V.; O'Brien, Fergal J.; Walsh, Conor J.; Duffy, Garry P.; Mooney, David J.

    2014-01-01

    Cell delivery to the infarcted heart has emerged as a promising therapy, but is limited by very low acute retention and engraftment of cells. The objective of the study was to compare a panel of biomaterials to evaluate if acute retention can be improved with a biomaterial carrier. Cells were quantified post-implantation in a rat myocardial infarct model in five groups (n=7–8); saline injection (current clinical standard), two injectable hydrogels (alginate, chitosan/β-glycerophosphate) and two epicardial patches (alginate, collagen). Human mesenchymal stem cells (hMSCs) were delivered to the infarct border zone with each biomaterial. At 24 hours, retained cells were quantified by fluorescence. All biomaterials had superior fluorescence to saline control, with 8 and 14-fold increases with alginate and chitosan/β-GP injectables, and 47 and 59-fold increases achieved with collagen and alginate patches, respectively. Immunohistochemical analysis qualitatively confirmed these findings. All four biomaterials retained 50–60% of cells that were present immediately following transplantation, compared to 10% for the saline control. In conclusion, all four injectable hydrogels and epicardial patches were demonstrated to more efficiently deliver and retain cells when compared to a saline control. Biomaterial-based delivery approaches show promise for future development of efficient in vivo delivery techniques. PMID:24862441

  19. Local delivery of FTY720 in PCL membrane improves SCI functional recovery by reducing reactive astrogliosis.

    PubMed

    Wang, Junjuan; Wang, Jiaqiu; Lu, Ping; Cai, Youzhi; Wang, Yafei; Hong, Lan; Ren, Hao; Heng, Boon Chin; Liu, Hua; Zhou, Jing; Ouyang, Hongwei

    2015-09-01

    FTY720 has recently been approved as an oral drug for treating relapsing forms of multiple sclerosis, and exerts its therapeutic effect by acting as an immunological inhibitor targeting the sphingosine-1-phosphate (S1P) receptor subtype (S1P1) of T cells. Recently studies demonstrated positive efficacy of this drug on spinal cord injury (SCI) in animal models after systemic administration, albeit with significant adverse side effects. We hereby hypothesize that localized delivery of FTY720 can promote SCI recovery by reducing pathological astrogliosis. The mechanistic functions of FTY720 were investigated in vitro and in vivo utilizing immunofluorescence, histology, MRI and behavioral analysis. The in vitro study showed that FTY720 can reduce astrocyte migration and proliferation activated by S1P. FTY720 can prolong internalization of S1P1 and exert antagonistic effects on S1P1. In vivo study of SCI animal models demonstrated that local delivery of FTY720 with polycaprolactone (PCL) membrane significantly decreased S1P1 expression and glial scarring compared with the control group. Furthermore, FTY720-treated groups exhibited less cavitation volume and neuron loss, which significantly improved recovery of motor function. These findings demonstrated that localized delivery of FTY720 can promote SCI recovery by targeting the S1P1 receptor of astrocytes, provide a new therapeutic strategy for SCI treatment. PMID:26036174

  20. Working appreciatively to improve services for children and families.

    PubMed

    Onyett, Steve

    2009-10-01

    Service improvement approaches are described that specifically focus on appreciating the positive that individuals bring to contexts related to children and family services. This includes application of Solution-Focused approaches, Appreciative Inquiry and other approaches that promote a positive emotional climate and focus on what works. Their conceptual foundations are explored and particularly their value in supporting working well with complex adaptive systems. Specific applications described include leadership and management practice, work in school settings, engaging clinicians in healthcare improvement, establishing clinical networks, work with homeless youth, child protection and approaches to drawing out best practice and community development. The theme that unites is a focus on developing effective relationships at all levels and a pragmatic focus on what works so that we can find opportunities to do more of it. PMID:19759068

  1. Modeling Sustained Delivery of Agroecosystem Services at a Watershed Scale under Climate Change

    NASA Astrophysics Data System (ADS)

    Jaradat, A. A.; Starr, J.

    2015-12-01

    The intensive land use and agricultural production systems in the Chippewa River Watershed (CRW) in Minnesota, USA, contribute to inherent environmental problems and have major direct impact on soil conservation, and on several competing agro-ecosystem services (AESs); and may have indirect impact on AESs in the Upper Mississippi River Basin (UMRB). Field-scale indicators of AESs are largely absent in the highly diverse soils of the CRW. Therefore, proxy indicators were developed to assess these services under current (A0) and predicted (A2; 100 years) global climate change (GCC) scenarios. Individual indices were developed for biomass, grain yield, NO3- and NH4-N, soil carbon, runoff, and soil erosion for 132 soil series classified into three land capability classes (LCCs). The indices and a weighted index (Iw) were subjected to multivariate analyses procedures, including distance-weighted least squares, and variance components estimation. Three-D maps delineated contiguous areas of increasing or decreasing AESs in response to projected GCC. Largest significant variance portions in Iw were attributed to GCC scenarios; followed by the interaction of crop rotations and LCCs within conventional and organic cropping systems. The AES were predicted with larger certainty under A2 in organically-managed LCC-1 compared to conventional management. Significantly more runoff and soil erosion are predicted in conventionally-managed LCC-2 and LCC-3 under the same GCC scenario, regardless of soil heterogeneity. The modeling framework and the mapped AES indicators are designed to achieve multiple goals and will be used to support farmers in designing specific crop rotations that are suitable for each of the three LCCs and for major and vulnerable soil series in the watershed. Also, the modeling framework will address sustained delivery of multiple AESs, while enhancing soil conservation, water quality, and environmental protection aspects of farming in the CRW and the UMRB.

  2. Future Directions in the Design, Development, and Investigation of Technology as a Service Delivery Vehicle

    PubMed Central

    Jones, Deborah J.

    2013-01-01

    Treatment outcome research with children and adolescents has progressed to such an extent that numerous handbooks have been devoted to reviewing and summarizing the evidence base. Ensuring that consumers of these advancements in state-of-the-field interventions have the opportunity to access, engage in, and benefit from this evidence-base, however, has been wrought with challenge. As such, much discussion exists about innovative strategies for overcoming the gap between research and practice; yet, no other potential solution that has received more attention in both the popular and academic press than technology. The promise of technology is not surprising given the fast-paced evolution in development and, in turn, a seemingly endless range of possibilities for novel service delivery platforms. Yet, this is precisely the most formidable challenge threatening to upset the very promise of this potential solution: The rate of emerging technologies is far outpacing the field’s capacity to demonstrate the conceptual or empirical benefits of such an approach. Accordingly, this paper aims to provide a series of recommendations that better situate empirical enquiry at the core of a collaborative development, testing, and deployment process that must define this line of work if the promise of mental health technologies is going to be a reality for front-line clinicians and the clients they serve. PMID:24400723

  3. Future directions in the design, development, and investigation of technology as a service delivery vehicle.

    PubMed

    Jones, Deborah J

    2014-01-01

    Treatment outcome research with children and adolescents has progressed to such an extent that numerous handbooks have been devoted to reviewing and summarizing the evidence base. Ensuring that consumers of these advancements in state-of-the-field interventions have the opportunity to access, engage in, and benefit from this evidence base, however, has been wrought with challenge. As such, much discussion exists about innovative strategies for overcoming the gap between research and practice; yet no other potential solution that has received more attention in both the popular and academic press than technology. The promise of technology is not surprising given the fast-paced evolution in development and, in turn, a seemingly endless range of possibilities for novel service delivery platforms. Yet this is precisely the most formidable challenge threatening to upset the very promise of this potential solution: The rate of emerging technologies is far outpacing the field's capacity to demonstrate the conceptual or empirical benefits of such an approach. Accordingly, this article aims to provide a series of recommendations that better situate empirical enquiry at the core of a collaborative development, testing, and deployment process that must define this line of work if the promise of mental health technologies is going to be a reality for front-line clinicians and the clients they serve. PMID:24400723

  4. Improvement of Service Searching Algorithm in the JVO Portal Site

    NASA Astrophysics Data System (ADS)

    Eguchi, S.; Shirasak, Y.; Komiya, Y.; Ohishi, M.; Mizumoto, Y.; Ishihara, Y.; Tsutsumi, J.; Hiyama, T.; Nakamoto, H.; Sakamoto, M.

    2012-09-01

    The Virtual Observatory (VO) consists of a huge amount of astronomical databases which contain both of theoretical and observational data obtained with various methods, telescopes, and instruments. Since VO provides raw and processed observational data, astronomers can concentrate themselves on their scientific interests without awareness of instruments; all they have to know is which service provides their interested data. On the other hand, services on the VO system will be better used if queries can be made by means of telescopes, wavelengths, and object types; currently it is difficult for newcomers to find desired ones. We have recently started a project towards improving the data service functionality and usability on the Japanese VO (JVO) portal site. We are now working on implementation of a function to automatically classify all services on VO in terms of telescopes and instruments without referring to the facility and instrument keywords, which are not always filled in most cases. In the paper, we report a new algorithm towards constructing the facility and instrument keywords from other information of a service, and discuss its effectiveness. We also propose a new user interface of the portal site with this algorithm.

  5. Production of Inhalable Submicrometer Aerosols from Conventional Mesh Nebulizers for Improved Respiratory Drug Delivery

    PubMed Central

    Longest, P. Worth; Spence, Benjamin M.; Holbrook, Landon T.; Mossi, Karla M.; Son, Yoen-Ju; Hindle, Michael

    2012-01-01

    Submicrometer and nanoparticle aerosols may significantly improve the delivery efficiency, dissolution characteristics, and bioavailability of inhaled pharmaceuticals. The objective of this study was to explore the formation of submicrometer and nanometer aerosols from mesh nebulizers suitable for respiratory drug delivery using experiments and computational fluid dynamics (CFD) modeling. Mesh nebulizers were coupled with add-on devices to promote aerosol drying and the formation of submicrometer particles, as well as to control the inhaled aerosol temperature and relative humidity. Cascade impaction experiments were used to determine the initial mass median aerodynamic diameters of 0.1% albuterol aerosols produced by the AeroNeb commercial (4.69 μm) and lab (3.90 μm) nebulizers and to validate the CFD model in terms of droplet evaporation. Through an appropriate selection of flow rates, nebulizers, and model drug concentrations, submicrometer and nanometer aerosols could be formed with the three devices considered. Based on CFD simulations, a wire heated design was shown to overheat the airstream producing unsafe conditions for inhalation if the aerosol was not uniformly distributed in the tube cross-section or if the nebulizer stopped producing droplets. In comparison, a counter-flow heated design provided sufficient thermal energy to produce submicrometer particles, but also automatically limited the maximum aerosol outlet temperature based on the physics of heat transfer. With the counter-flow design, submicrometer aerosols were produced at flow rates of 5, 15, and 30 LPM, which may be suitable for various forms of oral and nasal aerosol delivery. Thermodynamic conditions of the aerosol stream exiting the counter-flow design were found be in a range of 21-45 °C with relative humidity greater than 40% in some cases, which was considered safe for direct inhalation and advantageous for condensational growth delivery. PMID:22707794

  6. Essential medicines in Tanzania: does the new delivery system improve supply and accountability?

    PubMed

    Mikkelsen-Lopez, Inez; Cowley, Peter; Kasale, Harun; Mbuya, Conrad; Reid, Graham; de Savigny, Don

    2014-02-01

    Objective: Assess whether reform in the Tanzanian medicines delivery system from a central 'push' kit system to a decentralized 'pull' Integrated Logistics System (ILS) has improved medicines accountability. Methods: Rufiji District in Tanzania was used as a case study. Data on medicines ordered and patients seen were compiled from routine information at six public health facilities in 1999 under the kit system and in 2009 under the ILS. Three medicines were included for comparison: an antimalarial, anthelmintic and oral rehydration salts (ORS). Results: The quality of the 2009 data was hampered by incorrect quantification calculations for orders, especially for antimalarials. Between the periods 1999 and 2009, the percent of unaccounted antimalarials fell from 60 to 18%, while the percent of unaccounted anthelmintic medicines went from 82 to 71%. Accounting for ORS, on the other hand, did not improve as the unaccounted amounts increased from 64 to 81% during the same period. Conclusions: The ILS has not adequately addressed accountability concerns seen under the kit system due to a combination of governance and system-design challenges. These quantification weaknesses are likely to have contributed to the frequent periods of antimalarial stock-out experienced in Tanzania since 2009. We propose regular reconciliation between the health information system and the medicines delivery system, thereby improving visibility and guiding interventions to increase the availability of essential medicines. PMID:25013720

  7. Essential medicines in Tanzania: does the new delivery system improve supply and accountability?

    PubMed Central

    Mikkelsen-Lopez, Inez; Cowley, Peter; Kasale, Harun; Mbuya, Conrad; Reid, Graham; de Savigny, Don

    2014-01-01

    Objective: Assess whether reform in the Tanzanian medicines delivery system from a central ‘push' kit system to a decentralized ‘pull' Integrated Logistics System (ILS) has improved medicines accountability. Methods: Rufiji District in Tanzania was used as a case study. Data on medicines ordered and patients seen were compiled from routine information at six public health facilities in 1999 under the kit system and in 2009 under the ILS. Three medicines were included for comparison: an antimalarial, anthelmintic and oral rehydration salts (ORS). Results: The quality of the 2009 data was hampered by incorrect quantification calculations for orders, especially for antimalarials. Between the periods 1999 and 2009, the percent of unaccounted antimalarials fell from 60 to 18%, while the percent of unaccounted anthelmintic medicines went from 82 to 71%. Accounting for ORS, on the other hand, did not improve as the unaccounted amounts increased from 64 to 81% during the same period. Conclusions: The ILS has not adequately addressed accountability concerns seen under the kit system due to a combination of governance and system-design challenges. These quantification weaknesses are likely to have contributed to the frequent periods of antimalarial stock-out experienced in Tanzania since 2009. We propose regular reconciliation between the health information system and the medicines delivery system, thereby improving visibility and guiding interventions to increase the availability of essential medicines. PMID:25013720

  8. Improving outpatient phlebotomy service efficiency and patient experience using discrete-event simulation.

    PubMed

    Yip, Kenneth; Pang, Suk-King; Chan, Kui-Tim; Chan, Chi-Kuen; Lee, Tsz-Leung

    2016-08-01

    Purpose - The purpose of this paper is to present a simulation modeling application to reconfigure the outpatient phlebotomy service of an acute regional and teaching hospital in Hong Kong, with an aim to improve service efficiency, shorten patient queuing time and enhance workforce utilization. Design/methodology/approach - The system was modeled as an inhomogeneous Poisson process and a discrete-event simulation model was developed to simulate the current setting, and to evaluate how various performance metrics would change if switched from a decentralized to a centralized model. Variations were then made to the model to test different workforce arrangements for the centralized service, so that managers could decide on the service's final configuration via an evidence-based and data-driven approach. Findings - This paper provides empirical insights about the relationship between staffing arrangement and system performance via a detailed scenario analysis. One particular staffing scenario was chosen by manages as it was considered to strike the best balance between performance and workforce scheduled. The resulting centralized phlebotomy service was successfully commissioned. Practical implications - This paper demonstrates how analytics could be used for operational planning at the hospital level. The authors show that a transparent and evidence-based scenario analysis, made available through analytics and simulation, greatly facilitates management and clinical stakeholders to arrive at the ideal service configuration. Originality/value - The authors provide a robust method in evaluating the relationship between workforce investment, queuing reduction and workforce utilization, which is crucial for managers when deciding the delivery model for any outpatient-related service. PMID:27477930

  9. 77 FR 54783 - Improving Access to Mental Health Services for Veterans, Service Members, and Military Families

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-05

    ..., employees, or agents, or any other person. (Presidential Sig.) THE WHITE HOUSE, August 31, 2012. [FR Doc... Documents#0;#0; ] Executive Order 13625 of August 31, 2012 Improving Access to Mental Health Services for... deployments and intense combat conditions require optimal support for the emotional and mental health needs...

  10. Do health care delivery system reforms improve value? The jury is still out

    PubMed Central

    Korenstein, Deborah; Duan, Kevin; Diaz, Manuel Jose; Ahn, Rosa; Keyhani, Salomeh

    2016-01-01

    Background Widespread restructuring of health delivery systems is underway in the US to reduce costs and improve the quality of healthcare. Objective To describe studies evaluating the impact of system-level interventions (incentives and delivery structures) on the value of US healthcare, defined as the balance between quality and cost. Research Design We identified articles in PubMed (2003 to July 2014) using keywords identified through an iterative process, with reference and author tracking. We searched tables of contents of relevant journals from August 2014 through 11 August 2015 to update our sample. Subjects We included prospective or retrospective studies of system-level changes, with a control, reporting both quality and either cost or utilization of resources. Measures Data about study design, study quality, and outcomes was extracted by one reviewer and checked by a second. Results Thirty reports of 28 interventions were included. Interventions included patient-centered medical home (PCMH) implementations (n=12), pay-for-performance programs (n=10), and mixed interventions (n=6); no other intervention types were identified. Most reports (n=19) described both cost and utilization outcomes. Quality, cost, and utilization outcomes varied widely; many improvements were small and process outcomes predominated. Improved value (improved quality with stable or lower cost/utilization or stable quality with lower cost/utilization) was seen in 23 reports; 1 showed decreased value, and 6 showed unchanged, unclear or mixed results. Study limitations included variability among specific endpoints reported, inconsistent methodologies, and lack of full adjustment in some observational trials. Lack of standardized MeSH terms was also a challenge in the search. Conclusions On balance the literature suggests that health system reforms can improve value. However, this finding is tempered by the varying outcomes evaluated across studies with little documented improvement in

  11. A community pain service solution-focused pain management programme: delivery and preliminary outcome data

    PubMed Central

    Iddon, Joanne; Barker, Chris

    2014-01-01

    Summary points 1. This article introduces a rationale for a solution-focused approach to a community-based pain management programme (PMP), describing delivery and preliminary outcome data. 2. It suggests PMPs can be feasibly run in the community without necessity for hospital care setting. 3. A community setting is also advantageous in that it allows maintenance of social networks and close third-sector links to support long-term, sustained mental well-being. 4. Solution-focused psychological approaches help the clinician tap into patient expertise and develop rich descriptions of the patient’s preferred future, enhancing self-efficacy and empowerment. 5. Evaluation found significant statistical and clinical improvements in pre–post pain self-efficacy, mental well-being and function (but findings were limited by internal and external validity and no significant effect was found on pain levels). 6. Statistically significant change was maintained at 10 weeks for self-efficacy and function (and for the latter, clinically significant change was also maintained); improvements in mental well-being showed maintenance at all measured time points (up to 12 months) in terms of both statistical and clinical significant changes. PMID:26516534

  12. Effectiveness of a Telehealth Service Delivery Model for Treating Attention-Deficit/Hyperactivity Disorder: A Community-Based Randomized Controlled Trial

    PubMed Central

    Myers, Kathleen; Stoep, Ann Vander; Zhou, Chuan; McCarty, Carolyn A.; Katon, Wayne

    2015-01-01

    Objective To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training. Method The Children’s ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks. Results Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ2[4]=19.47, p<.001), hyperactivity (χ2[4]=11.91, p=0.02), combined ADHD (χ2[4]=14.90, p=0.005), ODD (χ2[4]=10.05, p=0.04), and VADRS-Caregiver role performance (χ2 [4]=12.40, p=0.01) and CIS-P impairment (χ2[4]=20.52, p<.001). For the VADRS-Teacher diagnostic criteria, children in the telehealth service model had significantly more improvement in hyperactivity (χ2[4]=11.28, p=0.02) and combined ADHD (χ2[4]=9.72, p=0.045). Conclusion The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to

  13. Free-standing cancer centers: rationale for improving cancer care delivery.

    PubMed

    Lokich, J J; Silvers, S; Brereton, H; Byfield, J; Bick, R

    1989-10-01

    Free-standing cancer centers (FSCC) represent a growing trend in cancer care delivery within community practice. The critical components to FSCC are multidisciplinary cancer care, a complete menu of direct care and support services, a commitment to clinical trials and clinical investigation, and a comprehensive program for quality assurance. The advantages of FSCC to the community, to hospital programs, to the practicing surgical, medical, and radiation oncologists, and to the third-party carriers, including health maintenance organizations, are detailed. The development of an FSCC depends on the resolution of issues of (a) competition (between hospitals, hospitals and physicians, therapeutic disciplines, regional comprehensive cancer centers and FSCCs) and (b) concerns about conflict of interest. The ideal model of FSCC may well be represented by the joint venture of community hospital(s) and the community oncologists. PMID:2801600

  14. Toward Effective Science Delivery among Recreation Personnel

    ERIC Educational Resources Information Center

    Courtney, Arielle; Schneider, Ingrid E.

    2016-01-01

    Effective science delivery to practitioners can improve recreation experiences and environmental educational outcomes. This project explored U.S. Department of Agriculture-Forest Service recreation personnel's research-based information sources, constraints to access and use of research, and opinions about how to improve science delivery to…

  15. Innovative health service delivery models in low and middle income countries - what can we learn from the private sector?

    PubMed Central

    2010-01-01

    Background The poor in low and middle income countries have limited access to health services due to limited purchasing power, residence in underserved areas, and inadequate health literacy. This produces significant gaps in health care delivery among a population that has a disproportionately large burden of disease. They frequently use the private health sector, due to perceived or actual gaps in public services. A subset of private health organizations, some called social enterprises, have developed novel approaches to increase the availability, affordability and quality of health care services to the poor through innovative health service delivery models. This study aims to characterize these models and identify areas of innovation that have led to effective provision of care for the poor. Methods An environmental scan of peer-reviewed and grey literature was conducted to select exemplars of innovation. A case series of organizations was then purposively sampled to maximize variation. These cases were examined using content analysis and constant comparison to characterize their strategies, focusing on business processes. Results After an initial sample of 46 studies, 10 case studies of exemplars were developed spanning different geography, disease areas and health service delivery models. These ten organizations had innovations in their marketing, financing, and operating strategies. These included approaches such a social marketing, cross-subsidy, high-volume, low cost models, and process reengineering. They tended to have a narrow clinical focus, which facilitates standardizing processes of care, and experimentation with novel delivery models. Despite being well-known, information on the social impact of these organizations was variable, with more data on availability and affordability and less on quality of care. Conclusions These private sector organizations demonstrate a range of innovations in health service delivery that have the potential to better

  16. Insect GDNF:TTC fusion protein improves delivery of GDNF to mouse CNS

    SciTech Connect

    Li, Jianhong; Chian, Ru-Ju; Ay, Ilknur; Kashi, Brenda B.; Celia, Samuel A.; Tamrazian, Eric; Pepinsky, R. Blake; Fishman, Paul S.; Brown, Robert H.; Francis, Jonathan W.

    2009-12-18

    With a view toward improving delivery of exogenous glial cell line-derived neurotrophic factor (GDNF) to CNS motor neurons in vivo, we evaluated the bioavailability and pharmacological activity of a recombinant GDNF:tetanus toxin C-fragment fusion protein in mouse CNS. Following intramuscular injection, GDNF:TTC but not recombinant GDNF (rGDNF) produced strong GDNF immunostaining within ventral horn cells of the spinal cord. Intrathecal infusion of GDNF:TTC resulted in tissue concentrations of GDNF in lumbar spinal cord that were at least 150-fold higher than those in mice treated with rGDNF. While levels of immunoreactive choline acetyltransferase and GFR{alpha}-1 in lumbar cord were not altered significantly by intrathecal infusion of rGNDF, GDNF:TTC, or TTC, only rGDNF and GDNF:TTC caused significant weight loss following intracerebroventricular infusion. These studies indicate that insect cell-derived GDNF:TTC retains its bi-functional activity in mammalian CNS in vivo and improves delivery of GDNF to spinal cord following intramuscular- or intrathecal administration.

  17. Liposomal buccal mucoadhesive film for improved delivery and permeation of water-soluble vitamins.

    PubMed

    Abd El Azim, Heba; Nafee, Noha; Ramadan, Alyaa; Khalafallah, Nawal

    2015-07-01

    This study aims at improving the buccal delivery of vitamin B6 (VB6) as a model highly water-soluble, low permeable vitamin. Two main strategies were combined; first VB6 was entrapped in liposomes, which were then formulated as mucoadhesive film. Both plain and VB6-loaded liposomes (LPs) containing Lipoid S100 and propylene glycol (∼ 200 nm) were then incorporated into mucoadhesive film composed of SCMC and HPMC. Results showed prolonged release of VB6 (72.65%, T50% diss 105 min) after 6h from LP-film compared to control film containing free VB6 (96.37%, T50% diss 30 min). Mucoadhesion was assessed both ex vivo on chicken pouch and in vivo in human. Mucoadhesive force of 0.2N and residence time of 4.4h were recorded. Ex vivo permeation of VB6, across chicken pouch mucosa indicated increased permeation from LP-systems compared to corresponding controls. Interestingly, incorporation of the vesicles in mucoadhesive film reduced the flux by 36.89% relative to LP-dispersion. Meanwhile, both films provided faster initial permeation than the liquid forms. Correlating the cumulative percent permeated ex vivo with the cumulative percent released in vitro indicated that LPs retarded VB6 release but improved permeation. These promising results represent a step forward in the field of buccal delivery of water-soluble vitamins. PMID:25899288

  18. Point-of-care technology: integration for improved delivery of care.

    PubMed

    Gregory, Debbie; Buckner, Martha

    2014-01-01

    The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"? PMID:24896558

  19. Cancer Nanotheranostics: Improving Imaging and Therapy by Targeted Delivery across Biological Barriers

    PubMed Central

    Kievit, Forrest M.; Zhang, Miqin

    2012-01-01

    Cancer nanotheranostics aims to combine imaging and therapy of cancer through use of nanotechnology. The ability to engineer nanomaterials to interact with cancer cells at the molecular level can significantly improve the effectiveness and specificity of therapy to cancers that are currently difficult to treat. In particular, metastatic cancers, drug-resistant cancers, and cancer stem cells impose the greatest therapeutic challenge that requires targeted therapy to treat effectively. Targeted therapy can be achieved with appropriate designed drug delivery vehicles such as nanoparticles, adult stem cells, or T cells in immunotherapy. In this article, we first review the different types of materials commonly used to synthesize nanotheranostic particles and their use in imaging. We then discuss biological barriers that these nanoparticles encounter and must bypass to reach the target cancer cells, including the blood, liver, kidneys, spleen, and particularly the blood-brain barrier. We then review how nanotheranostics can be used to improve targeted delivery and treatment of cancer cells using nanoparticles, adult stem cells, and T cells in immunotherapy. Finally, we discuss development of nanoparticles to overcome current limitations in cancer therapy. PMID:21842473

  20. Nanoparticle tumor localization, disruption of autophagosomal trafficking, and prolonged drug delivery improve survival in peritoneal mesothelioma.

    PubMed

    Liu, Rong; Colby, Aaron H; Gilmore, Denis; Schulz, Morgan; Zeng, Jialiu; Padera, Robert F; Shirihai, Orian; Grinstaff, Mark W; Colson, Yolonda L

    2016-09-01

    The treatment outcomes for malignant peritoneal mesothelioma are poor and associated with high co-morbidities due to suboptimal drug delivery. Thus, there is an unmet need for new approaches that concentrate drug at the tumor for a prolonged period of time yielding enhanced antitumor efficacy and improved metrics of treatment success. A paclitaxel-loaded pH-responsive expansile nanoparticle (PTX-eNP) system is described that addresses two unique challenges to improve the outcomes for peritoneal mesothelioma. First, following intraperitoneal administration, eNPs rapidly and specifically localize to tumors. The rate of eNP uptake by tumors is an order of magnitude faster than the rate of uptake in non-malignant cells; and, subsequent accumulation in autophagosomes and disruption of autophagosomal trafficking leads to prolonged intracellular retention of eNPs. The net effect of these combined mechanisms manifests as rapid localization to intraperitoneal tumors within 4 h of injection and persistent intratumoral retention for >14 days. Second, the high tumor-specificity of PTX-eNPs leads to delivery of greater than 100 times higher concentrations of drug in tumors compared to PTX alone and this is maintained for at least seven days following administration. As a result, overall survival of animals with established mesothelioma more than doubled when animals were treated with multiple doses of PTX-eNPs compared to equivalent dosing with PTX or non-responsive PTX-loaded nanoparticles. PMID:27343465